The Danish Council on Ethics published in 2023 a report about euthanasia. The conclusion was that 16 out of the 17 members found that it is not possible to establish a proper regulation of euthanasia and consequently it is not recommendable to introduce euthanasia in Denmark.
Marianne Kastrup: Was it difficult to reach an agreement in the Council on this rather delicate issue?
Merete Nordentoft: Surprisingly not. We have in the Council discussed other topics where we ended up having a larger minority giving dissent. It is not decisive for the Council to reach unanimous decisions; we do not vote as such but explore the given possibilities outlined. In the case of euthanasia, we were by and large expressing the same concerns.
The report focuses on two models: That of Oregon and that of the Netherlands. Why did you choose those?
Our focus was less on a specific state or country than on describing two models: One model– the Oregon model – allows only assisted suicide and only for people who expected to die soon. The other model– the Netherland model – allows euthanasia for people who are judged to be in an unbearable condition irrespective of whether they are expected to die soon or not. In the assisted suicide model, the person is provided with the means to commit suicide, but health professionals are not carrying out the act itself. The euthanasia model involves health professionals carrying out the act of ending the patient’s life. In the case of the Netherlands, they have over time become more and more liberal by allowing euthanasia to a broader range of conditions. It is not just in case of imminent death it is legal, but it is also allowed when a person is expressing that life is no longer worth living. Two doctors should agree on the decision.
There is a concern among people that oppose euthanasia that it may become a slippery slope allowing more and more to get a permission, so the criteria gradually loosen. In the Netherlands we now see that euthanasia comprises 5% of all deaths to which comes 1% due to suicide.
Are there particular concerns related to giving permissions to mentally ill persons?
In the Netherlands, permission is also given to persons with mental illness. The question is whether there may still be therapeutic possibilities before permission is given. There is evidence that people with a prolonged grief reaction (more than a year) have been given permission, and the question remains whether all possibilities to find a way forward have been explored.
Furthermore, I have for many years been involved in research related to suicide and it is documented that most regret having attempted suicide. There is always ambivalence and follow-up studies find that only 10% of a population of suicide attempters end up committing suicide. And yet, young persons with repeated suicide attempts may in the Netherlands be allowed euthanasia.
The Council on Ethics discussed in the report potential changes in the existing criminal law.
Yes, some members brought forward that the size of the penalty for persons who help – typically a close relative - in assisting suicide may be reduced in the light of the circumstances or penalty may even be cancelled. This is not legalizing euthanasia, but de-criminalizing it. The Council did not suggest this change in legislation, but it was mentioned as a possible solution by some members.
Other concerns?
Many raises economic considerations with a concern that frail, old or handicapped persons may feel pressed to apply for euthanasia even if they may not want it sincerely or they do it not to be a burden to family or society. We have to take it seriously that disabled individuals do fear that society do not consider their life as valuable as that of non-disabled persons.
We have to focus on adequate palliative care providing pain coverage to severely ill persons and ensure that the knowledge available on palliative possibilities becomes widespread. There are misunderstandings about the legislation in this area. Many people are not aware that doctors are allowed to prescribe life-shortening medication for terminally ill patients. In Danish legislation it is permitted for a doctor to prescribe medication to alleviate pain, anxiety or other kinds of suffering, even if this medication is life shortening. The doctor is not allowed to prescribe medication in order to shorten the patient’s life, but it can be an acceptable adverse event, if high doses of medication is needed to end the patients suffering. Another misunderstanding is that doctors are forced by law to continue treatment in spite of the patient’s will. That is not the case.
Palliative care should be more widely accessible for people in terminal phases of their lives.
Another aspect is “the right to be a nuisance”. This right to be different, to live with different challenges is part of a modern, diverse society where we have to accept this diversity. All have a right to live.
I think that a very important aspect of the euthanasia debate is the recognition and acceptance that we do not know what lies ahead for each of us, what destiny. We may all become completely dependent on help in order to survive. And living with this dependency does not imply that life is less dignified and less worth living. That to me is essential to debate – there is no single form of life that is more dignified and more worth living. □