2004 ORDINARY SESSION(Second part)
REPORT
Eleventh sittingTuesday 27 April 2004 at 3 p.m.
ADDENDUM II
Euthanasia
In this report:
1. Speeches in English are reported in full.
2. Speeches in other languages are summarised.
3. Speeches in German and Italian are reproduced in full in a separate document.
4. Corrections should be handed in at Room 1059A not later than 24 hours after the report has been circulated.
The following texts were submitted for inclusion in the official report by members who were present in the Chamber but were prevented by lack of time from delivering them.
Ms BEMELMANS-VIDEC (Netherlands). – I would like to support the opinion report by Mr McNamara, Document 9923, its views on the Marty report, its request to reaffirm Parliamentary Assembly Recommendation 1418 (1999) (Gatterer Report) on “Protection of the human rights and diginity of the terminally-ill and the dying”.
I would like to underline the point made in the opinion report where it refers to the serious mistake in the Marty report equating withdrawal of life supporting treatment with euthanasia. As the McNamara report states, “knowledge that a certain course of conduct may bring about death does not automatically constitute euthanasia. Intention or purpose is the key”.
When the advantages of treatment are not proportionate to the disadvantages - the chance of side effects and complications - the withdrawal or non-appliance of such treatment does not have the intention of ending life. In this case, it simply concerns giving up the primary goal of medicine: saving lives or curing diseases.
I would like strongly to support the view that what we need first of all is a professional and well-established system of palliative care. Recent research in the Netherlands in 1999 and 2001 shows the impressive effects of palliative care: only a very small number of people actually persist in their request for euthanasia when receiving palliative care.
The Marty report should take account of the potential and the limitations of legislation as an instrument to control euthanasia practice. Where as the aim of Dutch legislation is to create greater transparency of this practice as well as a more careful practice, there is cause for serious concern in terms of actual effects.
Inquiries into euthanasia practice in the Netherlands in 2001 and 2002 indicate that this practice has become – juridically speaking – less careful. The percentage of euthanasia cases that are officially notified has increased from 41% to 54% between the periods of 1995-96 and 2001-02. This would indicate that the practice of euthanasia has become more careful. However, apart from the fact that in 2001-02, nearly half the cases were still not notified, some important developments have to be mentioned: since 1998, the number of notified cases has decreased, whereas the total number of cases of euthanasia and medically assisted suicide have increased. This indicates that the percentage of notified cases is actually decreasing.
The actual number of cases of euthanasia without request has not decreased further since 1995, but has remained steady at about 900.
There is growing concern about the relatively high number of cases that go under the guide of “terminal sedation”. This has lead to the conclusion by the president of the College of Procurators-General that terminal sedation also be legally regulated and subject to the obligation of notification which applies to cases of euthanasia.
The Marty report failed to take note of the grave concerns expressed by the UN Human Rights Committee at its meetings in July 2001 regarding the new Act on euthanasia. The committee is well aware that the new Act does not as such decriminalise euthanasia and assisted suicide. However, where a state party seeks to relax legal protection with respect to an act deliberately intended to put an end to human life, the committee believes that the convenant obliges it to apply the most rigorous scrutiny to determine whether the state party’s obligations to ensure the right to life are being complied with - articles 2 and 6 of the covenant.
The new Act contains, however, a number of conditions under which the physician is not punishable when he or she terminates the life of a person, inter alia at the “voluntary and well-considered request” of the patient in a situation of “unbearable suffering” offering “no prospect of improvement” and “no reasonable solution”.
The committee is concerned lest such a system may fail to detect and prevent situations where undue pressure could lead to these criteria being circumvented.
The committee is also concerned that, with the passage of time, such a practice may lead to a routine and insensitive approach to the strict application of the requirements in a way not anticipated.
The committee learnt with unease that under the present legal system more than 2 000 cases of euthanasia and assisted suicide - or a combination of both - were reported to the review committee in the year 2000 and that the review committee came to a negative assessment in only three cases. The large numbers involved raise doubt whether the present system is indeed only being used in extreme cases in which all the substantive conditions are scrupulously maintained. It expressed grave concerns that the law is also applicable to minors who have reached the age of twelve years – consent of parents or guardian being needed only up to sixteen years.
The committee, having taken full note of the monitoring task of the review committee, is also concerned about the fact that this committee, as the main instrument of control, only exercises an ex post control mechanism, not being able to prevent the termination when statutory conditions are not fulfilled. The ex ante control mechanism should be strengthened.
The legal instrument as practised presently has serious shortcomings; we are held to practise the most rigorous scrutiny to ensure the right of life, which is as we believe the most precious God-given right of all.
We are therefore held also to discuss the limitations of legislation as an instrument of control of euthanasia. I would therefore like to see these limitations, as they are presenting themselves in practice, discussed in a new report on euthanasia. Again, to me this new report would need to reaffirm the excellent and well-balanced 1999 Gatterer report.
Mr FALZON (Malta) – I would like to thank the assembly for finally giving us the opportunity to discuss this sensitive issue, euthanasia.
A terminally ill patient may ask for death because he is in extreme pain and suffering. The two concepts are different. Pain can be relieved by drugs and treatment regimens; suffering sometimes cannot. A patient suffers when he feels that his integrity or life is threatened, or if he has psychological or emotional distress. He suffers when he does not understand the cause or meaning of his distress, or when others who should understand do not, and when it is ignored by others, especially those who should be interested.
The developments in the medical field are there to relieve and not to increase suffering.
Can suffering be measured or assessed? When a patient demands death, can anyone assess whether his suffering is greater or smaller than that of another person who would utter the same cry in different circumstances?
These underlying feelings could indicate a psychological pain which can be tackled with adequate understanding and care from the family and with help from the community. If this is the basic reason why a person asks to die, better supporting services could make him not want to die. So it follows that, if we concentrate more on our support services, euthanasia may not be necessary and neither would its legalisation. Euthanasia is becoming increasingly unnecessary because of progress in palliative care.
First, we should attempt to prevent the occurrence of those situations for which euthanasia has been suggested by anticipating their onset and forestalling their development. Secondly, we should offer our patients all the methods of relief and control of distressing symptoms that are currently available. Thirdly, we should encourage and promote research to improve the means of relief of suffering, whether by discovering new methods or by increasing the effectiveness of existing ones.
We must recognise that the care of the suffering patient and the relief of his suffering are never purely medical concerns. We must also provide for the patient’s physical, mental and spiritual welfare by involving all the caring professions in an effective and sensitive approach to the patient and his family in order to support them in their moment of need.
Mr President, the legalisation of euthanasia would have grave medical consequences. It would fundamentally alter our concept of what constitutes medical practice at the end of life. Letting a person die is different from making a person die – one risks death, the other seeks it. The legalisation of euthanasia raises fundamental ethical questions and we should not shy away from asking them.
Would it provide an answer to the ongoing debate on the rising cost of health services, welfare services and care of the dying by helping the strong and killing the fail and sick, or would it hinder the development of those services each country requires to help its own people, whatever their age, colour, creed or health?
Can anyone really say that his country’s medical services, including palliative care and community support services, are so advanced that the time has come to legalise euthanasia? Is everyone happy with the state of affairs in his own country as regards the help available to dying patients, including the existence of quick and efficient institutions providing immediate care, multidisciplinary trained teams and immediate response palliative care?
The basic discussion today should be on how we can help each other increase the community care we provide our patients, to formulate strategies and to exchange information and resources to help our patients.
Let us exchange views on how to tackle these issues. Once a patient is dead there is no turning back, but while a patient is alive, whatever his or her condition, there is always something that can be done whether by the family or by the community.
Victory is achieved when one has done everything for one’s family or patient to relieve pain and suffering without resorting to killing. It is a psychological defeat, which one has to bear for one’s whole life, when one has to perform euthanasia because services by trained individuals or by family and community are inadequate. This important fact has to be borne in mind by everybody, because studies show that where palliative care is efficient euthanasia is neither needed nor requested.
In view of this, Mr President, I would like to propose that, since Mr Marty’s report offers no conclusion except more ongoing discussion, we should vote against the report.
We here members of the Parliamentary Assembly of the Council of Europe should look forward not backwards. We have to face these “end of life” difficult situations as our challenges for life improvement and not of “giving up”.