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Theo Boer: “Killing a human being is, and should be, an exception.” Photo/Supplied

The Dutch ethics professor who changed his mind on euthanasia

As the End of Life Choice Bill enters its final stages in Parliament, visiting professor Theo Boer warns that if euthanasia is legalised, the ramifications will be more far-reaching than most of us realise.

Theo Boer chooses his words carefully when explaining his views on euthanasia, wary of being labelled a scaremonger. For several years, the quietly spoken professor of healthcare ethics has played a key part in the Netherlands’ euthanasia system, but he is now opposed to the law he once condoned. Doctors in the Netherlands can carry out euthanasia if a patient is enduring “unbearable and endless suffering” and has requested “earnestly and with full conviction” that they be put to death.

Act leader David Seymour is championing New Zealand’s legislation. Labour and National MPs have a conscience vote on the bill, whereas Green and NZ First MPs will support it en bloc, subject to amendments – the Greens want assisted dying for terminal patients only and NZ First wants a referendum on the issue.

Nearly 39,000 submissions, from groups and individuals, were received during the select committee process.

The Care Alliance, which funded Boer’s visit to New Zealand, is an umbrella group of organisations opposed to the End of Life Choice Bill. Its members include Hospice New Zealand, the Salvation Army, Family First and Palliative Care Nurses New Zealand.

To ensure the support of the Greens, Seymour has narrowed the focus of the bill, and euthanasia would now be available only to people suffering from a terminal illness and with a prognosis of less than six months to live.

A pro-euthanasia video campaign enlists the support and testimonies of a range of New Zealanders, including Matt Vickers, the widower of Lecretia Seales who died from brain cancer in 2015 after unsuccessfully petitioning the High Court to allow her doctor to assist her in dying without fear of prosecution. Former New Zealander of the Year Dr Lance O’Sullivan is also a supporter of the bill.

Related article: Lecretia Seales' widower makes his case for death with dignity 

Lecretia Seales, who died from cancer in 2015. Photo/Hagen Hopkins/Listener

Asking for it

Between 2005 and 2014, Boer was a member of one of the Netherlands’ five oversight committees, reporting annually on whether the euthanasia law was working as intended. Initially, Boer was satisfied euthanasia was of benefit, albeit rarely, to some people. He now contends that the introduction of the Dutch law was a naive mistake and New Zealand should learn from it before the final vote comes before Parliament later this year, or the issue goes to a referendum.

Assisted suicide has been legal in Switzerland since the 1940s and the US state of Oregon introduced a similar law in 1997. Both regimes require the patient seeking to end their life to self-administer lethal drugs provided by a doctor. Other regimes, including the Netherlands’, allow a doctor to administer the euthanising drug. The Netherlands model was Seymour’s starting point for his bill.

Boer says there was overwhelming support for euthanasia when it was introduced in the Netherlands and, as a democrat, he supported the majority decision. He was also in favour of bringing assisted death into the open, to prevent the unofficial and illegal practice of doctors helping end the lives of terminally ill patients, preferring it to happen with controls in place.

Seventeen years after the Netherlands’ introduction of euthanasia, Boer says the number of his fellow countrymen and women asking for it has increased dramatically and it has become normalised as part of the human life cycle.

Boer and Seymour offer slightly different figures on what percentage of all deaths in the Netherlands are the result of euthanasia – 5% and 4% respectively. The difference is small, but Boer says that taking regional variances into account gives a better picture and that, in some regions, euthanasia accounts for nearly 15% of all deaths.

David Seymour. Photo/Getty Images

Expanding euthanasia

Boer, who teaches at the Protestant Theological University in Groningen, is concerned that the choices people are making are changing the way they view the process of dying.

“There is a societal move to equate dignified dying and orchestrated dying. They think that the only dignified death is one that you have caused yourself or that your doctor has caused. That concerns me because killing a human being is, and should be, an exception.

“We shouldn’t pretend that killing a human being whose natural life is not ended is normal. That is certainly not the view of Dutch doctors – they continue to stress that it is emotionally very burdensome to do euthanasia.”

Two recent court rulings are offered by Boer as evidence that euthanasia laws, no matter how tightly crafted, will inevitably be loosened. In a landmark court case in the Netherlands, a doctor was charged with murder for her role in euthanising a woman with dementia who had requested to be euthanised if she needed to go into care. Despite a sedative being slipped into her coffee, the woman roused as the lethal drug was about to be administered and she was held down by her family as the doctor completed the procedure. Judges said the doctor acted lawfully as not carrying out the process would have undermined the patient’s wish.

Boer says the implications are far reaching. “The court has said that if a patient has made an advance directive and the patient has severe dementia that her advance directive trumps her present expression [of what she wants to happen].

“The patient fought back; the court has ruled it was okay to put a sedative in her coffee in order to try to prevent her realising what is going on. It brings a lot of trouble to doctor-patient relationships because we expect there will be pressure now, from relatives, on gerontologists and nursing-home physicians to euthanise people who are incompetent. It is likely to be appealed and it should go to the High Court.”

Seymour’s bill is narrower than Dutch law and would allow euthanasia only for terminally ill people with less than six months to live. Although Boer says that is superior to Dutch law, he cautions it is hard to accurately predict life expectancy for the terminally ill.

More importantly, Boer contends the six-months-to-live criterion is arbitrary. “Limiting assisted suicide and euthanasia to patients with half a year to live or less – isn’t that a grave injustice to patients with similar suffering, who say their lives are unbearable, but who have longer to live?

“In Canada [where there has been euthanasia for three years], a Quebec court deemed the criterion of terminal illness to be unconstitutional. Two patients with chronic illnesses challenged the law and the court ruled it is unconstitutional to limit the law to the terminally ill.

“Both the Dutch and Canadian verdicts illustrate that if you have a euthanasia law, it will expand. It is an absolute certainty that, if New Zealand accepts Mr Seymour’s bill, it is not a matter of if but when the first court cases will start in which chronically ill patients fight against the limiting [of the law] to the terminally ill.”

Completed life

Boer also points to a bill drafted by the D66,  a coalition partner in the Netherlands Government. The party’s Completed Life Act, if introduced and passed, would allow people over the age of 75 to access euthanasia regardless of their physical health. “The reason why this is being brought forward is that this is a group of people who might suffer from ‘meaninglessness, detachment and loneliness’.

“This law would send two signals: one would be positive – we respect your autonomy – but the second signal frightens me, that there are groups of people in society we can do without. And this comes as we in the Netherlands, and in your country, campaign to prevent suicide.”

What does Boer hope to achieve by visiting New Zealand in the latter stages of debate on the End of Life Choice Bill? Is his message primarily that New Zealand is on a slippery slope, as he contends has happened in his homeland?

“I’m not so fond of the ‘slippery slope’, but you can see from the different countries that have legalised euthanasia that there is a systemic injustice in limiting it to terminal patients. People are bound to challenge this, but I don’t call it a ‘slippery slope’ because you end up being called a scaremonger, and I’m not. I just want to be realistic and I think New Zealanders should make informed decisions.

“Even if they end up in favour of euthanasia, it should not be because of a naive romanticism about how well it goes in the Netherlands.”

This article was first published in the September 28, 2019 issue of the New Zealand Listener.