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Santorum and Dutch Euthanasia: Fact-Checking the ‘Fact Checkers’



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Rick Santorum’s critical claims about Dutch euthanasia have been attacked by self-styled “fact checkers”: Glenn Kessler in the Washington Post (“Euthanasia in the Netherlands: Rick Santorum’s Bogus Statistics”) and Michael Morse and Eugene Kiely on FactCheck.org (“Santorum’s Bogus Euthanasia Claims”). Their attack should not pass unchallenged: Santorum’s claims are not so easily dismissed.  

The attack targets three claims allegedly made by Santorum about Dutch euthanasia: that euthanasia accounts for 10 percent of all deaths in the Netherlands each year; that half of these cases are “involuntary”; and that elderly people wear “do not euthanize me” bracelets.

Morse and Kiely claim that Santorum’s figure of 10 percent is more than four times the actual rate and is “way off base”; Kessler suggests that Santorum is “grossly misinterpreting” a 1991 Dutch survey. However, all three beg an important question: What counts as “euthanasia”? There is, in fact, no agreed definition, and the total one arrives at depends on the definition one uses. If, in interpreting the data generated by the 1991 survey, one counts as “euthanasia” only cases where it was the doctor’s primary intention to end a patient’s life by an act, at the patient’s request, then the figure is closer to 2 percent of all deaths. But if one counts as “euthanasia” cases where it was the doctor’s primary or secondary intention to end a patient’s life, by act or omission, and whether or not at the patient’s request, the figure is over 10 percent. The former, (unusually) narrow definition is the one used by the Dutch. The wider definition is, however, no less valid. (Indeed, it has more to commend it for it includes all intentional life-shortening.)

What of Santorum’s statement that half of Dutch euthanasia cases are “involuntary.” Kessler again speculates that Santorum is “grossly misinterpreting” the 1991 survey because that survey showed that 0.8 percent of all deaths involved no explicit request by the patient. However, that figure again relates only to cases in which doctors admitted that it was their primary intention to end life by an act. If one includes cases where doctors admitted a primary or secondary intention to end life, by act or omission, then over half of all euthanasia deaths, so defined, involved no explicit request by the patient.

In any event, 0.8 percent of all deaths amounted to over 1,000 cases in the year surveyed in which Dutch doctors admitted that they had administered a lethal injection with a primary intent to terminate a patient’s life without an explicit request from the patient. In Dutch law this was, and remains, the crime of murder. (In its landmark report against euthanasia in 1994, the New York State Task Force noted that 0.8 percent would translate in the U.S. to 16,000 cases per year.) Kessler mentions a more recent survey indicating that the percentage has fallen to 0.4 percent. But this still amounts to some 500 medical murders per year. Despite this serious and continuing violation of Dutch law, prosecution has been a rarity.

In short, since lethal injections became lawful in certain circumstances in the Netherlands in 1984 (not 2001 as Kessler writes), Dutch doctors have violated a cardinal legal requirement — an explicit request from the patient — in thousands of cases, and with virtual impunity.

Turning to Santorum’s claim that some elderly Dutch wear “do not euthanize me” bracelets, Kessler describes this as a “strange misrepresentation.” However, Kessler himself quotes a Dutch euthanasia specialist that the Christian Dutch Patients Association issues a “living will” in which people can state that active life termination is not an acceptable option. What, then, is the “strange misrepresentation?” That opposition is written on a card rather than on a bracelet? It would not be remotely surprising if some elderly Dutch, fearing a lethal injection without request, were to express their opposition in advance. Indeed, it would be prudent for them to do so. The majority of Dutch doctors told the survey authors that they either had given or would give a lethal injection without request. And the survey authors have written, in the light of the persistent practice of euthanasia without request, that it is now the responsibility of patients to make it clear in advance what their wishes are.

Kessler comments that each euthanasia case is verified by “a commission” (which in fact comprises three part-timers). But this “commission” decides on the basis of a written report filed, after the event, by the very doctor in question. As a leading supporter of Dutch euthanasia once put it, this is like enforcing the speed limit by asking drivers to report when they have exceeded it. Moreover, the Dutch surveys have disclosed that since 1984 doctors have, again in clear violation of the law, failed to file a report in thousands of cases.

Hardly less remarkable than the “fact checkers’” uncritical portrayal of Dutch euthanasia is their key source: the Dutch establishment. For example, Morse and Kiely cite the Dutch Ministry of Health that patients will only be euthanized after the guidelines have been followed. However, as we have seen, the Dutch surveys show that the guidelines have frequently been breached. A far more reliable source than the self-serving Dutch establishment would have been the U.N. Human Rights Committee. The Committee has repeatedly voiced serious criticisms of the Dutch euthanasia regime, not least its approval of lethal injections for disabled babies.

Kessler concludes that there is “not a shred of evidence” to support Santorum’s claims. On the contrary, Morse and Kiely conclude that in relation to Dutch euthanasia “the facts are clear.” Indeed they are, but not in the way they think.

— John Keown is a professor at the Kennedy Institute of Ethics at Georgetown University and editor of Euthanasia Examined; he is also author of Euthanasia, Ethics and Public Policy and co-author of Debating Euthanasia.



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