What Covid-19 has revealed about euthanasia

Amid this crisis, using death as a medical treatment feels more wrong than ever.

Kevin Yuill and Theo Boer

There has not been, in living memory, more focus on healthcare, the vital role of doctors, the sacrifices made by nurses, and the wonderful efforts of everyone involved in the sector. Amid the coronavirus crisis, daily heroism, the scale of human loss, and the awful scenes in hospitals underline what is important – and what is not.

It will surprise some that in the Netherlands, the only dedicated clinic providing euthanasia and assisted suicide has closed. Euthanasia Expertise Centre (formerly known as End of Life Clinic) has suspended all euthanasia procedures. The clinic’s website says that existing procedures have been put on hold and new patients are no longer admitted. The centre – which in 2019 alone ended the lives of 898 patients suffering from cancers, psychiatric problems, early on-set dementia, and accumulated age-related complaints – is willing to make an exception only for those expected to die soon and those who may soon lose their capacity for decision-making.

Similarly, in Belgium, Jacqueline Herremans, a member of the federal commission reviewing euthanasia, has noted that there are few resources and even fewer doctors available for euthanasia at the moment: ‘The most important thing right now is that we fight the coronavirus.’

In Canada, authorities are also shutting down services. For a process that requires two different medical assessments and witnesses, the lives involved are not worth the risk. According to the Globe and Mail, two places in Ontario, where euthanasia and assisted suicide have been legal since 2016, have stopped providing medical assistance in dying (MAID) because of the coronavirus pandemic (one has since resumed for existing patients and those whose deaths are imminent).

The Euthanasia Expertise Centre explains its decision on its website, noting that in ‘the interest of public health, our patients, their loved ones and employees of the expertise centre, it is no longer responsible to continue our current care provision’. As it admits, ‘euthanasia care cannot be identified as a top priority in healthcare’. In Canada, health authorities said that MAID is being cut back along with other ‘elective services’.

This is an extraordinary admission. Those carrying out euthanasia in the Netherlands, where euthanasia and assisted suicide are legal, and those campaigning to change the law in places like the UK, have long insisted that assisted dying is necessary to alleviate ‘unbearable suffering’. To shut down euthanasia clinics and services because of the danger of infection from Covid-19 means that those who perform euthanasia no longer believe their services are necessary; otherwise, many of them would brave the risk and despatch suffering patients.

Stephen Pleiter, director of the Euthanasia Expertise Centre, stated last year that, ‘If the situation is unbearable and there is no prospect of improvement, and euthanasia is an option, it would be almost unethical [of a doctor] not to help that person’. In Canada, MAID is a constitutional right. In Britain, Nick Boles MP introduced a gruesome description of suffering at the end of life in the UK by saying that the lack of provision of assisted dying forces people to ‘undergo unbearable physical and psychological trauma’, which, he said, was ‘a moral outrage’. But suddenly, where it is legal, it doesn’t seem so necessary.

This is in stark contrast to hospice services, who continue their vital service to the dying despite all of the risks involved. According to the Dutch Association of Hospice Care there are no reports of hospice closures in the Netherlands. Hospices in Ontario, where MAID services have shut, continue to operate, rapidly organising themselves to accommodate palliative care for terminally ill Covid-19 cases. In the UK, hospices are reported to be extraordinarily busy; in Scotland, at least one has joined forces to provide care for Covid-19 cases requiring palliative care. Most are full and senior staff are ‘managing lots of clinical queries and huge fear and anxiety’, one hospice doctor reported. They are included in Covid-19 planning groups, as this NHS document indicates. Their staff have continued working despite the crisis.

What the Covid-19 crisis has demonstrated is that the need for euthanasia and assisted suicide is abstract rather than practical. In the Netherlands in the 1980s, assisted dying started out as the ultimate solution to impending horrible deaths. In present times, with a high level of care for the dying available in most countries with good healthcare, assisted dying is not about actual deaths, but about deaths that people fear. The reality is that most people die peaceful deaths. But many fear loss of control and find the prospect of others caring for them terrifying.

Covid-19 brings the reality of death, the necessity of caring for others and being cared for by others, into our living rooms, making the preciousness of all lives and the tragedy of all deaths real. We see the humanity of the elderly and frail; no longer are they burdens to be despatched from this world, but victims of horrifying disease that all are invested in fighting.

Those who work in euthanasia clinics are caring, dedicated people who usually feel that they are doing good. They are not cowards – many are being deployed to fight the virus. But their stock in trade – the existential angst about death that seems to make euthanasia a necessary human right – has disappeared in this time of crisis. Death, in this time of war against a disease, no longer appears a comforting friend or a useful medical treatment.

In a few months we may return to normal, in which case euthanasia clinics will return to granting people’s wishes to no longer be, to escape this life, or to be in control of their deaths. Perhaps, though, we can remember this time when we made huge sacrifices to preserve every life, no matter how frail and vulnerable. We can remember this time when euthanasia no longer seemed necessary.

Kevin Yuill teaches American studies at the University of Sunderland. His book, Assisted Suicide: The Liberal, Humanist Case Against Legalisation, is published by Palgrave Macmillan. (Buy this book from Amazon (UK).)

Theo Boer is a professor of healthcare ethics at the Protestant Theological University. He is also a member of the Dutch Health Council, and was from 2005-14 a member of a Regional Euthanasia Review Committee. His views expressed here do not represent any institution’s view.

Picture by: Getty.

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Comments

Dave Jones

15th April 2020 at 8:02 am

Sorry but I just cannot get behind these decisions that reach out to everyone else, and take away what are totally legitimate decisions/freedoms from them – just because some scenarios exist where it should not be done/contemplated. If there is some burden felt by some people upon making this choice available to them, it is no moral solution to then allow them to take this choice away from everyone. We all have the right to die, by suicide as the only method currently. And it can be horrendous/messy/botched. Reaching into other people’s lives to say you can *never* have someone help you have a peaceful/dignified death, people about to undertake this act anyway through suicide, is overbearing and asserting that your morals must be what others have to comply with. This should be decided democratically, and currently most people agree with having carefully regulated euthanasia available.
Yes, there are very serious pitfalls to allowing euthanasia, like potentially causing some to become pressured into making that choice. Given the choice to die is currently available to everyone, just with no assistance, how often does unwanted pressure to die even occur? I haven’t heard of it once – though I don’t doubt that it’s possible. If we did carefully begin to allow euthanasia for some we could allow lifelong unbreakable opt-outs for anyone, etc, none of these pitfalls are not able to be mitigated, almost in their entirely. And the benefits to those desperately seeking to go out of this world, given none of us were asked, at any point if we gave permission to be brought, or kept here, are immeasurable. While suicides happen any age group/sex, for men under 45 in the UK it is the single highest cause of death, from all causes. Suicide is how young men die. The 1st thing we can do is to honestly address the reasons why – but given we’re so terribly bad at that, or even giving men’s issues any recognition/listening to what they’re actually saying, we could at least do OK by the 2nd thing we should do, and give them a dignified and painless death. We have no right whatsoever to demand they stay around for our needs, or very likely face more pain in death than they were suffering in life – to be done by an amateur on their 1st attempt.

And no, this isn’t “identity politics”, it’s observing the facts on the ground. It’s maybe civil rights/human rights, where we should consider acknowledging/supporting men’s issues, and anyone can have reason to not want to be alive any more.

Sue McKeown

16th April 2020 at 3:31 am

Is there pressure to die prematurely? In the US, there sure is. My husband has been a private-pay long-term care resident for 4.5 years. He is only 64 years old and has a form of dementia (frontotemporal degeneration) that accounts for about 15% all forms of dementia. He is in very good physical health. Things are not bad now with the new Director of Nursing and Nursing Home Administrator, but the previous higher ups put subtle pressure on me to sign a DNR order. The Director of Nursing also discouraged me to even use a noninvasive colon cancer screening test (Cologuard) for him. She out and out lied to me. She said that if he had colon cancer and if it was treated he *would* require a permanent colonoscopy and why would I put him through that. I knew that was pure BS.

Are those two things examples out and out examples of encouragement to death? Well, not precisely. But neither are they encouragement to give someone physically healthy the same medical treatment that everyone deserves. They are discrimination against someone solely on the basis of cognitive functioning in the *absence* of an advance directive that states that he wishes less aggressive medical treatment than the norm. That is a clear violation of his civil rights, just the same as it would be on the basis of gender, sexual orientation, age, ethnicity, religion, or any other variable.

Chris Nolan

14th April 2020 at 12:40 pm

That I cannot choose euthansia, especially during Corona, I find very distressing. I am UK based so there is no official euthanisa, though a sympathetic doctor will ‘push people over the edge’ if you want and are lucky to get such a sympathetic doctor. I am a terminal cancer patient and the prospect of either my cancer or Corona forcing me into a hospital where I die alone from my family, and in pain fills me with horror and fear. There is a line trotted out by the medical establishment that people in my situation do not die in pain is not true – lots of people die in pain (experience from friends, relatives, etc).
Euthanisa is a major step for society I agree, and should not be taken lightly – but a law requiring review each case be reviewed by two high court judges and two doctors, as I believe was proposed in the UK last time around) would seem sufficient safeguard. There will be, as with any procedure or law, occasions where there are mistakes, or it is abused. In a UK population of 70MM any process (including the current) has errors.
As a counter point many more ‘lives’ are ended through abortion with minimal safeguards. Viable foetuses, that if they made adulthood would presumably quite like to carry on living are aborted each year, on some occasion, unfortunately, but no doubt, for trivial reasons. I am not advocating restrictions on abortions but I find it difficult to see how a society will allow viable ‘children’ (I am trying not to over emote through use of language), who are healthy and not asked are terminated. While sick, suffering, adults who can clearly express their rational choice are forced to live in pain makes no sense to me at all. I am getting through so much pain relief, cant sleep, pain all the time – and have been for about 6 weeks, I have probably 1-2 months more of this to go.

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