By / Sep 6

Over the past week, internal conflicts over Brexit has pushed the British government to the brink of a constitutional crisis. Here is what you should know to make sense of the issue, and to understand why it matters for Christians across the globe.

What is Brexit?

Brexit is merely the shorthand abbreviation for “British exit,” which refers to the UK leaving the European Union (EU).

British, Irish, and Commonwealth citizens voted in June 2016 on the question “Should the United Kingdom remain a member of the European Union or leave the European Union?” The referendum resulted in 51.9% of votes being in favor of leaving the EU. Although the referendum wasn’t legally binding, the government at the time agreed to abide by the desire of the people. Two subsequent elections have also given the government a mandate to proceed with the disentanglement from the EU.

What is the European Union?

After two World Wars devastated the continent, Europe realized that increasing ties between nations through trade might increase stability and lead to peace.

In 1958, this led to the creation of the European Economic Community (EEC), an arrangement that increased economic cooperation between six countries: Belgium, Germany, France, Italy, Luxembourg, and the Netherlands.

Over the next few decades, more countries joined (there are now 28 member state) and it morphed into a federalist-style economic-political union. The UK joined in 1973, and in 1993, the name was changed to the European Union.

The EU institutions are: the European Council, the Council of the European Union, the European Parliament, the European Commission, the Court of Justice of the European Union, the European Central Bank, and the European Court of Auditors.

Why is there a push for the UK to leave?

One of the main principles of EU membership is “free movement“, which means any citizens living in an EU country can live and work in another member nation without needing a visa (it’s similar to how in the United States you don’t need a work visa to move from California to Texas or live in Missouri and work in Kansas). This prevents a country from having much say into who can enter, and some people in the UK prefer to have more control over their borders.

The EU also imposes numerous restrictions on businesses, requires full regulatory compliance, and acceptance of the supremacy of EU law. Critics of the EU also say that the UK could get many of the same benefits of trade without having to pay billions of pounds (the UK currency) to be a member state. (Denmark and the UK are two member states that have opted out of using the euro, the official currency of the eurozone, which consists of 19 of the 28 member states.)

What is “Soft,” “Hard,” and “No-Deal” Brexit”?

This exit from the EU can take many forms, from “soft” to “hard.” When people refer to Soft Brexit they are referring to a situation in which the UK stays  either within the EU’s Single Market by becoming a member of the European Economic Area (like Norway), or in the EU Customs Union, or both. When people refer to Hard Brexit they are referring to a situation where the UK would leave not only the EU but also the EU’s Single Market and the EU Customs Union.

Under Soft Brexit the economic impact of leaving the EU would likely be minimal. However, if it remained in the Single Market, the UK would have to maintain free movement of EU citizens, would have to contribute to the EU budget, and would remain subject to judgments of the European Court of Justice and it. Under Hard Brexit the UK would not have to sign up to free movement of EU nationals, would not be subject to the European Court of Justice, and would likely not have to contribute to the EU budget. However, the economic impact of leaving the EU would likely be substantial since the UK would have to negotiate new trade agreements with the EU and many other countries.

No-Deal is the most extreme of the Hard Brexit options, and is predicted to have a significant impact on the UK economy.

What is the current crisis about?

Britain's Prime Minister Boris Johnson is pushing for the no-deal Brexit to take effect on October 19. But within his own Conservative Party (known as Tories) 21 members of parliament (MPs) in the House of Commons have joined with other parties in voting for an extension to UK's membership in the EU—essentially a vote against a no-deal Brexit. (The MPs who voted against Johnson have been kicked out of the Conservative Party.) That bill is now pending a vote in the other chamber of the UK parliament, the House of Lords, where it is expected to pass.

In response to the bill, Johnson is pushing for a general election—known as a “snap election”—in the hopes of replacing the members of his own party with ones that will support his Brexit strategy. Under the British system, a snap election can be approved by a two-thirds supermajority of MPs in the House of Commons.

If the Conservative Party wins 35 percent of the national vote in the snap election, Johnson would remain prime minister and his party would have a mandate for no-deal Brexit. If the Conservative Party was not able to retain control after the snap election, Johnson would be replaced and the future of Brexit would once again be unclear.

So far, MPs who oppose Johnson have not yet agreed to hold a new election. But Johnson is attempting to “prorogue Parliament” (i.e., forcing a five-week hiatus) which could begin as early as Monday. This measure, which is being challenged in the courts, would push a resolution of the issue close to the October 19 deadline. MPs will vote on the issue of a snap election on Monday.

What are the potential ramifications?

Opponents of a no-deal Brexit claim it could lead to a self-imposed humanitarian crisis on citizens in the UK. For example, because almost one-third of Britain’s food comes from the EU, the change could result in higher food prices and shortages. Similarly, some medications—including common painkillers and anti-depressants—will be more expensive and less available Both of these will have a harmful effect on the poor in the UK.

The Bank of England (the equivalent to the U.S. Federal Reserve) has also predicted that it would lead to an immediate economic crash that would be worse than the Great Recession of 2008 (the UK economy shrunk 6% between the first quarter of 2008 and the second quarter of 2009 and is estimated to shrink 8% after a no-deal Brexit). Unemployment may also nearly double from the current rate of 3.9% to 7.5%, while inflation could triple from 2% to 6.5%. All of these economic forces would have a devastating effect on the poor.

No-deal Brexit would also mean the border between Northern Ireland and the Republic of Ireland would immediately become an external EU border, requiring customs checks. As the Council on Foreign Relations notes, many worry that a hard border could undermine the 1998 Good Friday Agreement and even revive conflict between Catholics and Protestants in Northern Ireland.

However, supporters of no-deal Brexit claim the concern are overblown and that the economy can handle the breakup. They also believe that politicians have stalled for too long and are failing to represent the will of the people to reinstitute national sovereignty. For them, the restoration of political autonomy and liberty outweigh the possible dangers of a no-deal Brexit.

By / Jun 24

Every Friday, we bring to you the top five international stories of the week, with a particular emphasis on religious liberty, justice issues, and geopolitical issues that impact liberty and justice.  

1. The United Kingdom votes to leave the European Union. The move plunges the UK into the unknown, as Britain will be the first country ever to leave the 23-year-old EU. British Prime Minister David Cameron resigned today, saying the the UK needs “fresh leadership.” World stock markets are in turmoil, as financial analysts grapple with the short- and long-term implications of “Brexit.” One of the key arguments made by Leave advocates was that the UK needs to to “take back its country” from the EU’s control, primarily over matters of immigration. As a result, what role, if any, the UK will play in Europe’s migrant crisis moving forward remains to be seen.

Last week, British Parliamentarian, Jo Cox, was shot and stabbed to death on Thursday in an English village near the city of Leeds. Cox had recently been very outspoken regarding her pro-immigration position for refugees and her support of Britain’s continued membership in the EU. No motives have yet to be confirmed, but police suspect that the assailant shouted “Britain first!” during and after the attack. Though Great Britain is known for strict regulations limiting gun ownership, this tragedy is a reminder that no degree of gun control can remove the human impulse toward violence in a society.   For more on Brexit, see Joe Carter’s helpful explainer.  

2. UN: There are now a 65 million refugees in the world, more than at any point in recorded history. This number is an increase of 5.8 million from last year, surpassing for the first time the number of displaced people after World War II. owing to continued conflict in Syria, Iraq, Yemen, Afghanistan, South Sudan, and elsewhere. To put this figure in perspective, one out of every 113 people in the world is a refugee. In other refugee-related news, the Iraqi military’s assault on Fallujah has caused 85,000 people to flee their homes, overwhelming Iraqi refugee camps. Lise Grande, U.N. Humanitarian Coordinator for Iraq: “People have run and walked for days. They left Falluja with nothing. They have nothing and they need everything.”

3. Deepening food shortages in Venezuela spark riots, looting at grocery stores. Venezuela has the largest oil reserves in the world, yet much of the country’s population is without food. CBC: “What started as persistent food shortages under President Hugo Chavez has turned into a food crisis under the Nicolas Maduro government, elected in 2013. A tour of Maracaibo last month showed the crisis is especially dire.” The NY Times has an unbelievable photo essay of the situation.

4. Political turmoil grows in Egypt over the transfer of two Red Sea islands to Saudi Arabia. The conflict centers on two small islands, Tiran and Sanafir, which Egyptian President Fattah al-Sisi ceded to Saudi Arabia on a presidential trip that coincided with an oil deal and an aid package from the Kingdom. The island transfer has been unpopular in Egypt, sparking protests and in turn, a government backlash against those protests. The Sisi Administration has appealed the decision, and the future of the islands remains unclear.

5. 51 US State Department officials sign document dissenting from Obama Administration’s Syria policy. Eight of the officers met with Secretary of State John Kerry to discuss their concerns in a meeting that was described as “surprisingly cordial.” The dissent cable, which has not yet been made public, urges military intervention in Syria. The document does not represent the prevailing view within the State Department but does demonstrate fractures among the American foreign policy establishment on how the US should respond to the Syrian Civil War.

Matt Mihelic contributed to this post. Have suggestions for a top five article this week or think there’s an issue we should be covering? Email me at [email protected].  

By / Jun 10

Every Friday, we bring to you the top five international stories of the week, with a particular emphasis on religious liberty, justice issues and geopolitical issues that impact liberty and justice.

1. Two Palestinians carry out shooting in Tel Aviv, killing four and wounding 16. The two shooters were cousins from the West Bank town of Yatta. The attack took place in the middle of a large outdoor market and shopping center popular among locals. In response, the Israeli military has restricted Palestinian access to Jerusalem, a significant issue as Muslims are now celebrating Ramadan across the world.

2. Yemeni government releases 54 children captured during conflict against Houthis. The Saudi government facilitated the release and accused the Houthi rebels of using child soldiers in the conflict. Reuters: “It was not clear how many child prisoners are being held in all, but Yemeni political sources say that the Houthis and the government submitted in late May a list of nearly 7,000 names of prisoners they say are being held by the other side.”

3. The migrant crisis in Europe continues; this week 300 migrants are rescued from capsized boat in Mediterranean. With summer months bringing warmer temperatures, the flow of migrants from the Middle East and North Africa to Europe has been increasing. This is despite the EU’s efforts to reduce the flow of migrants through a shift in policy and a controversial deal with Turkey. BBC: “In a separate incident, ‘more than 100 bodies’ were recovered off the coast of Libya, the AP news agency said.”

4. German parliament approves resolution labelling Ottoman massacre of Armenians in 1915-16 a “genocide,” sparking tensions with Turkey. In retaliation, Turkey has withdrawn its diplomatic envoy to Germany. Yahoo: “The use of the word ‘genocide’ goes to the heart of a long-running battle for world opinion between Armenia and Turkey over the massacres committed a century ago. Armenia has led a decades-long campaign to have the bloodshed characterised as genocide, which Turkey rejects as a gross injustice. Ankara argues the killings were a collective tragedy in which equal numbers of Turks and Armenians died.”

5. German authorities arrested three Syrian men who had entered the country with a wave of migrants due to suspicion that the men were planning an ISIS attack on the city of Düsseldorf. According to the arresting authorities, the plot involved suicide bombers, firearms and explosives—reminiscent of the attacks in Paris and Brussels. Only a minute fraction of migrants coming have been arrested or killed while attempting to carry out terror plots. But this arrest draws attention to the threat that ISIS poses to Europeans while posing as migrants and the need for European governments to screen as best as possible those who they think they are providing asylum.

Have suggestions for a top five article this week or think there’s an issue we should be covering? Email me at [email protected].

*Matt Mihelic contributed to this post

By / Mar 21

Here’s a headline you won’t read in American newspapers today as we continue with what has become a true political circus.

What happened in Europe last week? The Social Affairs Committee of the Parliamentary Assembly of the Council of Europe voted against the practice of all forms of surrogacy—commercial or altruistic, gestational or “traditional,” rejecting a draft report on human rights and ethical issues related to surrogacy that called for regulation of the practice. The European Parliament has already condemned the practice of surrogacy, so last week’s majority vote by the Council of Europe, which represents 47 Member States, is additional, welcome news.

This is the correct position to take on the matter of surrogacy: not to regulate, which tacitly condones the practice, but to prohibit it altogether.

But what about here in the U.S., known throughout the world as the Wild Wild West of reproduction? My state of California is a leader in the global reproductive trade of eggs, sperm, wombs for hire, and babies. For example, Elton John and his partner David Furnish came to California twice to partake of our reproductive “services.” They bought eggs from women, and they hired surrogate mothers who gestated babies for them to take back to the United Kingdom.

Here in America, our lawmakers, our media, and our public citizens seem woefully unaware of the billions of dollars a year industry that has cropped up with almost no regulation. It literally is a business profiting from the buying and selling of reproductive bodies and the manufacturing of children who through contracts are sold to “intended parents.”

But what is so wrong with surrogacy, and why is this vote by the Council of Europe such welcome news?

Surrogacy undermines the dignity of women, the children born via this method, our bodies and their procreative capacities. Treating women as paid or unpaid breeders robs women of their inherent dignity and treats children as commodities to be bought, sold, and paid for. As one child conceived through the practice says in our film Breeders and in a separate interview I conducted with her last year, she is a product.

Surrogacy carries risks to women and children that are not present in an otherwise natural pregnancy. These high-tech assisted reproductive technologies (ART) are not only risky to the women but also the children born through ART/surrogacy. Surrogate mothers suffer higher rates of preeclampsia, maternal hypertension, and gestational diabetes, and the children suffer with higher rates of preterm birth. Often there are also all the complications of a multiple pregnancy as surrogate mothers frequently carry twins, triplets, or more—because these technologies are very expensive and have a high failure rate.

I recently attended a “Families Through Surrogacy” conference in London where one same-sex couple from Paris told me they had to use three egg donors and two surrogate mothers to finally have success with twins who will be born this year in Canada. They explained that they were already well “over our budget,” but happily awaiting the birth of the babies in Canada to take back to France, where all surrogacy is prohibited.

Surrogacy intentionally and without concern, breaks important maternal-child bonds. As a pediatric nurse, I know how important and good bonding is to both mother and child. Our wombs are not arbitrary locations. Connections between mother and child begin in utero. One surrogate mother I spoke with in London said, “I just think of myself as the pre-birth babysitter.” The psalmist reminds us that we were “ knit together in our mother’s womb.” Surrogacy intentionally breaks this bond and the lifelong connection that begins well before birth.

Surrogacy is exploitative and class based. Who buys and who sells? The wealthy buy and the low income and poor sell. Female college students are targeted and marketed to, in order to sell their eggs. Low-income military wives are heavily marketed to and recruited to serve as paid surrogate mothers.

This broad social justice movement across the European continent is spreading to other places. India, Mexico, and Thailand have closed their borders to the international exploitation of their poor women and the trafficking of babies back to countries like France, Italy, and Germany.

But as these borders close and Europe positions themselves to prohibit and abolish surrogacy, it will become open season on women in the U.S., Canada, and other countries with permissive, relaxed surrogacy policies. America will increasingly be a destination for paying women to carry babies.

The Council of Europe should be widely commended for its action. I remain hopeful that political and religious leaders, the media, and even individual citizens in America will soon get their heads out of the sand on this issue. Far too much is at stake for us not to.

By / Sep 11

Note: This is the second in a series on euthanasia. Click here to read Part I.

Over the past few decades the Dutch have expanded the scope of protected physician killing to include children. With their parent’s permission, a child between the ages of 12 to 16 years old may request and receive assisted suicide. Initially, minors could obtain an assisted death even if their parents objected, but after domestic and international criticism, the law was changed to require parental consent. Even before the Parliament made it legal to euthanize young children, doctors in the Netherlands took it upon themselves to end the life of infants and others who do not have the free will to agree to end their own lives, but whose existence doctors or parents deemed them “unfit.”

In October 2004, the Groningen Academic Hospital officially proposed a government policy—dubbed the Groningen Protocol—which would allow doctors to legally euthanize children under the age of twelve for conditions in which suffering was “so severe that the newborn has no hope of a future.” The hospital even admitted to administering a lethal dose of sedatives to four newborns in 2003. In the previous three-year period, fourteen other cases had also been reported by various hospitals to the Justice Ministry. No legal proceedings were ever taken against either the hospitals that condoned the practice or the doctors who carried out the killings.  

The lack of prosecutions is hardly surprising considering the Dutch people’s attitude toward killing those deemed unworthy of life. A survey by the NIPO Institute in 1998 found that 77 percent of the populace favored non-voluntary euthanasia while only 76 percent favored voluntary euthanasia. Although the one percent difference falls within the margin of error, it may also be attributable to the false belief that non-voluntary killing is considered only as a last resort while voluntary euthanasia can be administered for almost any reason. As reported in one Dutch documentary, a young woman in remission from anorexia was concerned that her eating disorder would return. To prevent a relapse, she asked her doctor to kill her. He willingly complied with her request.  

The anorexia example is horrifying, but at least in that instance an actual physical illness was involved. As the most recent legislative proposal shows, some advocates of the practice consider the presence of a debilitating illness or physical suffering as too stringent a prerequisite for permitting euthanasia. The Dutch Voluntary Euthanasia Society (DVES), for example, was generally pleased with the relaxation of euthanasia laws, but it was disappointed that the law continued to forbid the killing of people who are simply tired of living. “We think that if you are old, you have no family near, and you are really suffering from life,” said DVES spokesperson Walburg de Jong, “then [euthanasia] should be possible.” Days after the change in the law, Dutch health minister Els Borst admitted in an interview that she had no problems with providing “suicide pills” for elderly citizens who were simply “bored sick” with living. (The public now seem to agree: A study in 2013 found that more than one in five Dutch people believe that euthanasia should be allowed for elderly people who are “tired of living.”)

Perhaps the most significant shift in the public acceptability of voluntary euthanasia occurred in the summer of 1991, crystallizing around another important legal case. Psychiatrist Boudewijn Chabot treated a woman whom he gave the fictional name of “Netty Boomsma.” The woman was suffering from grief over the loss of her youngest son to cancer at the age of twenty. Her eldest son was also dead, having killed himself two years earlier after being rejected by his girlfriend. Boomsma, who had a long history of depression, approached Chabot with the understanding that he would assist her suicide if she did not change her mind about wanting to die.  

Although the crushing grief over losing a child can last for years, Chabot treated Boomsma for only two months before fulfilling his promise. Four months after the loss of her youngest son to cancer, Chabot gave Boomsma the lethal agent she needed to kill herself. While listening to the sounds of the same Bach flute sonata that had played at her son’s funeral, the grieving mother took the medication and asked the psychiatrist: “Why do young kids want suicide?” Thirty minutes later she was dead. With the aid of the psychiatrist, the mother was able to end her life and fulfill her desire to be buried between the graves of her two sons. In his defense, Chabot insisted that Boomsma was not depressed, nor even a real patient. She was, he claimed, simply a grieving woman who wanted to die. Many Dutch therapists insist that there is an obligation to assist in the suicide of a patient with suicidal ideation if treatment has not succeeded. 

But Chabot provided only minimal treatment: The despairing patient became her own diagnostician, and the doctor simply acted as the deadly pharmacist. After reporting the case to the coroner, Chabot was prosecuted for violating Dutch law, but the case was appealed to the country’s supreme court, which upheld the precedent set by the Leeuwarden criminal court in 1973”that pain relief that runs the risk of shortening life is acceptable when helping a patient suffering from a terminal condition. The court found that Chabot was guilty of not having provided an adequate psychiatric review of the patient’s case before assisting with the suicide. However, the court imposed no penalty on Chabot, and the legal ruling established the precedent that physical illness was not a requirement for providing “pain relief” that ends a life when the request is voluntary, well-considered, and reviewed by a second physician. Suicidal depression became a terminal disease; psychic distress became a legitimate ground for doctor-assisted death.

While the Supreme Court’s decision was hailed as a victory by euthanasia supporters, it took more than ten years before the medical community openly agreed that neither a terminal illness nor physical suffering should be necessary for ending a patient’s life. After a three-year investigation, the KNMG concluded in January 2005 that doctors should be able to kill patients who are not ill but who are judged to be “suffering through living.” 

Jos Dijkhuis, the emeritus professor of clinical psychology who led the inquiry, said that it was “evident to us that Dutch doctors would not consider euthanasia from a patient who is simply ‘tired of, or through with, life.’” Instead, the committee agreed on the term “suffering through living,” because a patient may present a variety of physical and mental complaints that can lead them to conclude that life is unbearable. “In more than half of cases we considered, doctors were not confronted with a classifiable disease,” said Dijkhuis. “In practice the medical domain of doctors is far broader . . . . We believe a doctor’s task is to reduce suffering, therefore we can’t exclude these cases in advance. We must now look further to see if we can draw a line and if so where.” 

Over a period of forty years, the Dutch have continued the search for where to draw the line with euthanasia, shifting from acceptance of voluntary euthanasia for the terminally ill, to voluntary euthanasia for the chronically ill, to non-voluntary euthanasia for the sick and disabled, to euthanasia for those who are not sick at all but are merely “suffering through living.” While the initial impetus may have been spurred by a desire to give expanded rights to the person who faces extreme suffering or imminent death, the effect has been to concentrate power into the hands of state-sponsored medical professionals. And while the justification for assisted death is usually the supposed well-being of the suffering patient, the Dutch have redefined natural dependency into an unacceptable or unwanted social burden. 

By conflating the duty to reduce suffering with the perceived necessity to eliminate all suffering, Dutch physicians have increasingly resorted to euthanasia as a novel form of sympathectomy. A sympathectomy is a medical procedure that is sometimes required after a localized trauma or peripheral nerve injury, when a person may feel a syndrome of pain and tenderness that can only be relieved by the excision of a sympathetic nerve. In a similar manner, when faced with the many pains, heartaches, and disabilities that eventually afflict most of us in one form or another, the Dutch are resorting to the excision provided by euthanasia. 

In doing so, they are severing more than the cords of life, they are cutting the sympathetic nerves that tie us to our fellow human beings. By perverting the traditional role of the physician, the Dutch are making a mockery of true human compassion, and providing a stark warning to those aging societies, like our own, which might one day be tempted to allow this sympathectomy of the soul. 

By / Sep 4

“I will give no deadly medicine to any one if asked, nor suggest any such counsel.”

For centuries, the Hippocratic Oath, which included this admonition against assisted suicide and euthanasia formed the core of Western medical ethics. Over the past few decades, though, the Hippocratic ideal has been eroding. Euthanasia—both voluntary and involuntary—is becoming increasingly common in Europe and is beginning to be viewed as more acceptable in North America.

The story of how euthanasia, once condemned by all doctors, began to be acceptable begins in the Netherlands. Since the end of World War II the most direct challenges to life and human dignity came from the Netherlands and the nation’s cultural and legal acceptance of the “right to die.” The medical community and broader citizenry have so embraced the right to choose death that parents of gravely ill children can now have doctors speed up their death.

In almost any other country on earth such a policy might be considered radical and shocking. But in the Netherlands—the country that first legalized euthanasia—the legalized killing of children merely decriminalized a practice that has been occurring for decades. An examination of how this formerly conservative, tradition-bound culture could adopt what the modern Hippocratic Oath refers to as “therapeutic nihilism” is useful for understanding how other nations will likely begin to accept euthanasia in the near future. 

As occurred in many Western countries during the 1960s, the people of the Netherlands began to reject traditional authority structures in favor of increased individual freedom. While the change led most visibly to a liberalization of attitudes toward sex and drugs, it also carried over into the role of doctors and patients, particularly in the expansion of patient’s rights and patient autonomy. 

In 1969 the influential physician J. H. Van den Berg published Medische macht en medische ethiek (“Medical power and medical ethics”), which argued that medical technology was making doctors more powerful. According to Van den Berg, doctors, when bound by Hippocratic ethics, are morally required to keep patients alive as long as possible (a dubious interpretation of the oath and its meaning). But in the age of advanced medical technology, he argued, the ancient creed posed new ethical problems. On the basis of this revised ethical code, Berg argued not only for voluntary euthanasia but also for the involuntary killing of individuals who suffer from reduced quality of life, such as elderly patients suffering from dementia.  

After the release of Van den Berg’s book, end-of-life issues began to be included in the debates on patient’s rights. But while public sentiment was evolving rapidly—becoming much more tolerant of assisted suicide and euthanasia—the law was slower to conform. Despite legal prohibitions against euthanasia and assisted suicide, which had been part of Dutch law since the Dutch Penal Code replaced the French Code Penal in 1886, euthanasia become increasingly common. 

A turning point occurred in 1973 when Dr. Geertruida Postma was convicted of killing her elderly mother, but on such grounds and with such limited punishment that the conviction had the practical effect of giving public protection to physicians engaging in certain forms of euthanasia. In this landmark case, the criminal court ruled that it was possible to administer pain-relieving drugs leading to the death of the patient provided the purpose of treatment was the relief of physical or psychological pain arising from an incurable terminal illness. Because Postma’s primary goal was to cause the death of her patient, she was found guilty and received a one week suspended sentence and one year’s probation. 

The ruling marked a notable shift in the law, allowing the formulation of conditions under which life could be deliberately shortened by physicians. The light sentence also sent a clear signal that cases of euthanasia would be treated mildly by the judicial system. The result was that the publicly popular practice, while not yet decriminalized, began to be carried out more regularly and routinely, but without a studied understanding of its prevalence or the circumstances under which it was administered.

In 1990, the Dutch government set up a Commission, chaired by Attorney General Jan Remmelink, to investigate and quantify what was happening in the shadows of the law. Using the narrow definition of euthanasia as “active termination of life upon the patient’s request,” the Remmelink report concluded that 2,300 instances of euthanasia were carried out during 1990. And while the Royal Dutch Medical Association (KNMG) had established in its Guidelines for Euthanasia that terminating a life without a patient’s request is “juridically a matter of murder or killing and not of euthanasia,” the Remmelink Commission found, through interviews with randomly selected physicians and mailed questionnaires, that over 20,000 life-ending actions had been taken in 1990 without the patient’s express consent.

These “matters of murder” do not include, as the report notes, the unknown numbers of disabled newborns, children with life-threatening conditions, or psychiatric patients who may have been killed involuntarily but were not included in the survey. 

Rather than being disturbed by the findings, the Commission glossed over these instances of involuntary killing by claiming that “active intervention” was usually “inevitable” because of the patients’ “death agony.” In 1993, the Dutch Parliament responded not by tightening controls on doctors but by implementing the Commission’s recommendation to establish in statutory form the report physicians who practice euthanasia should file with the local medical examiner. Euthanasia shifted from being a punishable criminal offense to being a matter of bureaucratic form-filing. 

According to the Dutch Ministry of Justice, of the 135,675 deaths recorded in 1995, 3,600 (2.4 percent) were the result of a doctor-assisted termination of life while another 238 (0.3 percent) were cases of assisted suicide. The most disturbing statistic, however, is that 913 (0.7 percent) were terminations of life without the express request of the patient. For every three lives ended at the request of the patient, one person was killed without consent. While it is assumed that these cases consisted of terminally ill patients with no chance of survival, no one in the Netherlands knows for certain. Because the numbers are based on self-reporting by physicians, no accurate data exists to determine exactly how many Dutch citizens have been killed against their will.

Another comprehensive survey by Dr. Paul J. van der Maas in 1996 showed that the situation had indeed worsened since 1990. The total number of cases of euthanasia and assisted suicide had risen by a third from 2,700 to 3,600, with an estimated 60 percent not being officially reported. The number of cases of euthanasia without request by the patient also remained high, with 900 cases being reported.

Although the government passively accepted the practice, doctors were still legally susceptible to prosecution if a disgruntled family member disagreed with the killing of their relative. Legislation to decriminalize euthanasia, which had been repeatedly proposed since 1984, was finally passed on April 10, 2001. A criminal liability exclusion was added for doctors who willingly reported their actions and demonstrated that they have satisfied the criteria of “due care.” 

A survey of 405 Dutch doctors published in the Journal of Medical Ethics in 1999 revealed that safeguards established by the Royal Dutch Medical Association to control how and when euthanasia is performed were often ignored. Dr. Henk Jochemsen of the Lindeboom Institute for Medical Ethics and Dr. John Keown of the University of Cambridge found that almost two-thirds of cases of euthanasia and assisted suicide in 1995 were not reported. According to the findings, in 20 percent of cases the patients did not explicitly request to die and in 17 percent of cases other treatments were available. The doctors surveyed claimed that 56 percent of patients wanted to “prevent loss of dignity” while 47 percent wanted to “prevent further suffering.” “The reality is that a clear majority of cases of euthanasia, both with and without request, go unreported and unchecked,” said Drs. Jochemsen and Keown. “Dutch claims of effective regulation ring hollow.”

In 2003, the regional testing committee reported that the total number of euthanasia cases had slowly fallen from 2,123 in 2000 to 1,882 in 2002. What was not clear was whether the change was due to a reduction in euthanasia requests or because fewer doctors were reporting when they terminated a patient’s life. While only 18 percent of euthanasia cases were being reported in 1990, the decriminalization in 2001 only increased the reporting frequency to 54 percent. Since prosecutions only occur if the regional review committee is aware of the case and finds that the due care procedures were not adequately followed, doctors have little incentive to report when they assist in killing a patient. Unless the family of the deceased has an objection, the incident will never receive public scrutiny. While prosecutions may be rare, doctors are leery of taking the unnecessary risk of reporting their actions.

The Royal Dutch Medical Association has since called for increased reporting to bolster public trust in euthanasia laws. But enthusiasm for following these procedures and standards remains muted, since doctors know that no penalties will be incurred by simply ignoring the law. Prosecutions for guideline violations are exceedingly rare and no doctor has ever been imprisoned or substantially penalized for noncompliance. Even when the government is made aware of cases of non-voluntary euthanasia, no legal action is likely to be taken.  

Click here to read Part II.

By / Feb 20

In Belgium, a country with a majority of Catholic citizens, the parliament is set to pass a low allowing for euthanasia for minors. Here is what you should know about that legislation and other facts about the practice of euthanasia in Europe.

1. Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering. Euthanasia is generally categorized as voluntary, non-voluntary, or involuntary. Voluntary euthanasia is only legal in the Netherlands, Belgium, and Luxembourg, although non-voluntary euthanasia is also carried out in those countries. (Euthanasia is technically distinct from physician-assisted suicide, which entails making lethal means available to the patient to be used at a time of the patient’s own choosing.)

2. In the Netherlands, euthanasia is common (responsible for about 2 percent of all deaths annually) and popular. Polls show that 86.5% of Dutch doctors would cooperate in principle with a request for euthanasia, while only 7.9% said they would not cooperate and that one in five Dutch citizens believe euthanasia should be allowed for elderly people who are "tired of living." In 1990, prior to euthanasia being legalized in the Netherlands, the Dutch government investigated what was happening in the shadows of the law. Using the narrow definition of euthanasia as “active termination of life upon the patient’s request,” they found 2,300 instances of euthanasia were carried out during 1990. And while the Royal Dutch Medical Association had established in its Guidelines for Euthanasia that terminating a life without a patient’s request is “juridically a matter of murder or killing and not of euthanasia,” the government found, through interviews with randomly selected physicians and mailed questionnaires, that over 20,000 life-ending actions had been taken in 1990 without the patient’s express consent. These “matters of murder” did not include, as the report notes, the unknown numbers of disabled newborns, children with life-threatening conditions, or psychiatric patients who may have been killed involuntarily but were not included in the survey. 

3. A survey of 405 Dutch doctors published in the Journal of Medical Ethics in 1999 revealed that safeguards established by the Royal Dutch Medical Association to control how and when euthanasia is performed were often ignored. Dr. Henk Jochemsen of the Lindeboom Institute for Medical Ethics and Dr. John Keown of the University of Cambridge found that almost two-thirds of cases of euthanasia and assisted suicide in 1995 were not reported. According to the findings, in 20 percent of cases the patients did not explicitly request to die and in 17 percent of cases other treatments were available. The doctors surveyed claimed that 56 percent of patients wanted to “prevent loss of dignity” while 47 percent wanted to “prevent further suffering.” “The reality is that a clear majority of cases of euthanasia, both with and without request, go unreported and unchecked,” said Drs. Jochemsen and Keown. “Dutch claims of effective regulation ring hollow.”

4. Last week, Belgian lawmakers gave final approval to a measure that would allow euthanasia for incurably ill children enduring insufferable pain. The law would make Belgium the first country to lift all age restrictions on legal, medically induced deaths. Under the measure, euthanasia would be permissible for terminally ill children who are close to death, experiencing “constant and unbearable suffering” and can show a “capacity of discernment,” meaning they can demonstrate they understand the consequences of such a choice.

5. Although technically illegal, a study conducted by the Canadian Medical Association found that non-voluntary euthanasia in Belgium is common. The study discovered that about half of the nearly 500 euthanasia deaths the authors investigated were non-voluntary. Some of the patients were even killed by nurses. Both killing without request and euthanasia by nurse violate Belgian law, but as in the Netherlands, the law is rarely enforced.