While surfing cellphone news headlines, my attention was caught by one from the New York Post that blared: “Dutch are Euthanizing Autistic People.” The Post aims for sensationalism, and the headline implied mass slaughter, akin to the Nazi gassing of individuals with mental disabilities. As euthanasia is of academic interest to me, I felt compelled to read the story.
The article’s basis was a study conducted at Kingston University, London. However, the study’s title was never provided, and there was no indication of peer review, journal publication, or conference presentation. The New York Post is known for inferring more than is warranted by the evidence.
The researchers analyzed the files of 900 people euthanized between 2012 and 2021. Out of these, thirty-nine (approximately 4 percent) were considered autistic or mentally disabled, with neither condition being further detailed. Importantly, none were euthanized because of their condition, rendering the Post’s implication meaningless. Instead, all of them applied for assisted death, undergoing a rigorous determination process based on their belief that their future lives were not worth living.
Courts in the Netherlands began establishing criteria for aid-in-dying in the 1980s, but national regulation did not occur until 2002 and was initially limited to those with acute terminal illnesses (e.g., cancer). Over time, the standards were expanded to include non-acute terminal conditions (e.g., amyotrophic lateral sclerosis) and, most recently, to permit applications from those who perceived no further advantage to living.
An applicant must provide a detailed explanation of their current suffering, a statement that their future life would be unbearable given their condition, and that no present options to improve the condition exist. This information, along with all pertinent medical records, and possible interviews with the patient and family, is considered by the applicant’s primary care physician (PCP). The regulations also take into account the patient’s competence and the possibility of family coercion. If the physician approves, a second PCP, unfamiliar with the patient and family, performs a similar review, and both physicians must concur for euthanasia to be permitted. Either may recommend further treatment, with reconsideration of euthanasia if this treatment fails. If they cannot agree, a regional committee reviews the application and makes the decision. An additional assessment of the patient’s desire to continue living is made by a non-physician just prior to drug administration.
Euthanasia typically occurs at a patient’s home, often with family and friends in attendance. After final farewells, the patient retires to a bedroom, likely with close individuals, where the physician administers a lethal dose of a sedative. The physician remains in case this injection is insufficient and/or to pronounce the patient’s demise.
In addition to the pre-approval procedures, each euthanasia death is reported to a provincial committee that ensures all statutory criteria were followed. If not, the case is referred to the Public Prosecution Service for additional investigation and possible criminal charges. If a physician is found guilty, a prison term of up to 12 years could be imposed.
Dutch medical ethics consider the provision of euthanasia an ethical act as it relieves or prevents suffering. A physician can decline but must provide a substitute who will perform the service. In the U.S., only the provision of a lethal prescription is permitted in states that allow for death with dignity, yet nationally even this is perceived as unethical. Even in states that allow death with dignity, a declining physician is required, at most, to provide only names and contact information of physicians who might assist a patient, and finding a receptive doctor is the patient’s responsibility. However, when asked anonymously, the majority of U.S. doctors support at least some euthanasia options. In a 2020 poll, 55 percent of physicians were supportive of legalized euthanasia, and an additional 17 percent were undecided, while in a 2021 poll, 69 percent of gynecologic oncologists supported some form of legalized euthanasia.
Some “experts” quoted in the Post article, which was negatively skewed, claimed that autistic and mentally disabled individuals are incompetent to decide on euthanasia, but how they lacked competence was not elaborated upon. The terms autistic and mentally disabled, by themselves, are insufficient for determining competence, as they encompass a broad range of conditions. It would be inhumane and unethical for these labels alone to be determinative. The U.S. has a dark history of using labels (e.g., gender, race, nationality, property ownership) in an exclusionary manner, and I would be loath for us to return to this form of segregation.
Several of the requesting individuals complained that they did not fit into society, and one commentator, vacuously in my opinion, claimed that these people were likely dissatisfied with the services provided by social welfare agencies and were requesting to die out of pique. Did they assume that physicians would consider displeasure alone a valid justification for euthanasia, or that the applicants were so emotionally compromised as to use and maintain childish petulance throughout the lengthy consideration process?
I would, however, be curious to know whether these applicants availed themselves of voluntary specialty organizations or even general interest ones (e.g., Rotary Club) before determining that they did not fit socially. What employment options were tried, and what adaptations were attempted within these environments? Did these individuals seek therapy to determine if they might have contributed to their lack of fit? Such specifics were not provided.
The regulations governing euthanasia are a governmental decision. The Netherlands, along with some other countries, has more liberal regulations. Additional countries are more cautious, and in a third group, like the U.K., euthanasia is illegal. Regardless of a nation’s stance on euthanasia or similar weighty issues, the position should arise through a national plebiscite, rather than from politicians, whose perspectives often diverge from those of their constituents.
M. Bennet Broner is a medical ethicist.