Until now I haven’t been able to grab clips from the CTV W5 programme with Victor Malarek which would allow me to go through my argument step by step. However, I just managed it, so this will take a number of clips from the programme and comment, briefly, upon them.

This is simply false. The Dutch euthanasia law does not require written consent. According to the “due care” criteria (Chapter II: Due Care Criteria), written consent is not required. The criteria for “due care” are as follows:

Section 2

1. In order to comply with the due care criteria referred to in article 293, paragraph 2, of the Criminal Code, the attending physician must:

a. be satisfied that the patient has made a voluntary and carefully considered request;

b. be satisfied that the patient’s suffering was unbearable, and that there was no prospect of improvement;

c. have informed the patient about his situation and his prospects;

d. have come to the conclusion, together with the patient, that there is no reasonable alternative in the light of the patient’s situation;

e. have consulted at least one other, independent physician, who must have seen the patient and given a written opinion on the due care criteria referred to in a. to d. above; and

f. have terminated the patient’s life or provided assistance with suicide with due medical care and attention.

 Furthermore, the Dutch law explicitly recognises the validity of advanced care directives:

2. If a patient aged sixteen or over who is no longer capable of expressing his will, but before reaching this state was deemed capable of making a reasonable appraisal of his own interests, has made a written declaration requesting that his life be terminated, the attending physician may comply with this request. The due care  criteria referred to in subsection 1 shall apply mutatis mutandis.

The Beligian euthanasia law, on the other hand, does require written request (Chapter 2: Conditions and Procedure, Subsection 4):

The patient’s request must be in writing. The document is drawn up, dated and signed by the patient himself/herself. If the patient is not capable of doing this, the document is drawn up by a person designated by the patient. This person must have attained the age of majority and must not have any material interest in the death of the patient.

The person indicates that the patient is incapable of formulating his/her request in writing and the reasons why. In such a case the request is drafted in the presence of the physician whose name is mentioned on the document. This document must be annexed to the medical record.

The patient may revoke his/her request at any time, in which case the document is removed from the medical record and returned to the patient.

While there is some truth to the claim that not all patients in Belgium who receive assistance in dying have given their written consent, studies show that, in general, this occurs when the patient’s disease takes a sudden and unexpected trajectory leading to death, and, as doctors do everywhere, even in Canada, patient’s suffering is relieved by merciful doctors helping to hasten their deaths, whether as a secondary effect of pain relief, or as the result of a medical decision deliberately to terminate life. The point that Dr. José Pereira makes, however, is simply wrong. Written consent is not required in the Netherlands, and so there has been no erosion of accountability in this respect.

Also, there is no significant evidence that increased numbers of people are being involuntarily killed. The definition of terms with respect to euthanasia is still in flux, and no definitions have yet been generally accepted, so every discussion of euthanasia or assisted dying must begin with a definition of terms. Pereira’s understanding of ‘involuntary euthanasia’ is unusual. He defines it as follows:

“Involuntary euthanasia” refers to a situation in which a person possesses the capacity but has not provided consent …

He also defines ‘non-voluntary euthanasia’ in an unusual way:

“non-voluntary euthanasia,” [occurs] in a situation in which a person is unable to provide consent for reasons such as severe dementia or coma.

Contrast this with the definitions provided by the Royal Society of Canada report on euthanasia:

‘Non-voluntary‘ means without the knowledge of the wishes expressed by a competent person or through a valid advance directive. [7]

‘Involuntary‘means against the wishes expressed by a competent person or through avalid advance directive. [8]

This is the more usual acceptation of these words when used in the context of assisted dying. What Pareira’s definition allows him to do is to categorise all those cases where explicit request has not been given as cases of murder — precisely what he wants to be able to do. In this light it becomes very alarming when we hear that there are around 500 cases of ”involuntary euthanasia” a year in the Netherlands. But Pareira accomplishes this by redefining words to suit himself. And, while the definition of these words is by no means fixed in the literature, it is incumbent upon Pareira to have warned his readers that he was using terms in an extended sense.

One point of great importance here is that we simply do not know how many cases of non-voluntary euthanasia occur in Canada every year. Since doctors must now do this sub rosa, since to do so is to against the law, though it is well known that it is done by many compassionate doctors, there are no statistics for Canada. Thus, Pareira can make it seem as though there is a serious problem in the Netherlands, but none in Canada. But this is far from being the truth. This leads him to suggest that there is a slippery slope in the Netherlands, where records are kept, and surveys are regularly made, but no problem at all in Canada:

There is simply no sign that there is a slippery slope in the Netherlands. It is the case that the reach of assisted dying has been extended as people with what were to them intolerable life-conditions began to demand acceptance of assisted dying for them. But this does not mean that Netherlands society has got to a place where they did not want to be. Indeed, assisted dying is still supported by a majority of Dutch citizens. The claim often made that the person who spear-headed the drive for the legalisation of assisted dying (who almost always remains nameless) in the Netherlands now has second thoughts is completely untrue, though still repeated by the religious press.

This leads to another comment about José Pereira. Not only is he a palliative care physician and not an expert on assisted dying. He is also a Roman Catholic and speaks at Roman Catholic gatherings about ways to oppose the legalisation of assisted dying. He knows, as do most Catholics, that the sanctity of life argument is no longer one that is persuasive in a secular society, so they use every means at their disposal to show that assisted dying puts people at risk. There is simply no evidence that this is the case, even though they will comb the statistics of various studies in order to make their case.

Notable in the last clip is the “scary” music that is being played in the background as Pereira and Malarek are speaking about the dangers of the legalisation of assisted dying. Switzerland, for example, has had legalised assisted suicide since 1941, and no one has suggested that this law has put anyone at risk. And, notice, completely left out of account by Pereira is any sense of the risk of suffering that is imposed on those who are dying or are suffering from long term degenerative conditions.

Not only would palliative care not have helped Elizabeth, she might have lived for many years completely paralysed, in pain, and unable to communicate, before she died. The idea that assisted dying should be restricted to those who are dying neglects the fact that there are many other conditions that are intolerable to those trapped in them. People like Wesley J. Smith say — see here — a bit cynically, when considering cases like Elizabeth’s that we should “can the smoke and mirrors arguments about assisted suicide being limited to the terminally ill in irremediable suffering, and have an honest debate.” No, it’s not about terminal illness. That’s the mistake that Oregon and Washington State made. It’s about intolerable suffering, continuing, unending suffering that makes death seem better than continuing to live. But Wesley J. Smith should can the smoke and mirrors too, and stop pretending that those, like Elizabeth, who choose to die, are depresses. Elizabeth was not, and Smith’s claim that she was is without foundation, and, to my mind, slanderous. I have tried to get him to retract his statement, but he will not.

Again, notice how Malarek makes the proposal of legalised assisted dying seem very scary. We know that Pereira will say this. He’s a Roman Catholic. He only stands to gain from the claim that there are scary scenarios out there. But there is no evidence for this. And if there were evidence for it, there would be reason to change the laws (in those jurisdictions where assisted dying is legal), not to revoke them. As for Pareira’s claim that hundreds and thousands of palliative care physicians know how to relieve suffering — well, he knows that this is just false. There is some pain that they cannot touch, and even palliative sedation has been shown very often just to render a person unable to complain about the pain and distress while experiencing it all the same. As for terminal sedation: where a patient is put into a drug-induced coma, and then left to die without nutrition and hydration: what is this but an undignified form of assisted dying?

So when we get to the end of the programme, Malarek simply gets it wrong. He simply wasn’t listening. Did he not hear what people were saying? Lloyd Robertson thinks, falsely, that the programme offered two arguments, for and against. It did not. It offered one argument, against, and an emotional appeal by those who were either anticipating the time when they would like to have assisted dying available, or by those who had experienced the assisted death of a loved one, for the legalisation of assisted dying. But there was very little argument offered for this option, when there are many and good ones, some of them pertaining to human rights, which Malarek never mentions. However he does manage to remember, at the end of the programme, the scary thought of assisted dying advocates  “going after people,” like those with chronic degenerative conditions. And no one seems to notice, when talking about risk to the elderly and the disabled, that these are people too who might want, at some point, assistance in dying. This part of the “argument” is simply left unsaid, because the producers of the programme had no one to say it.

It is simply untrue that other countries are “stretching the boundaries.” It has been widely recognised, for a long time, that assisted dying is not sought only by the terminally ill. Indeed, assisted dying and the reasons for it are almost universally misunderstood. Malarek accepts Pareira’s point of view without argument, and Pareira’s point of view is heavily indebted to his Roman Catholic convictions. For him, assisted dying should not be legalised for any reason whatever. That is so cruel and inhuman that it is contemptible, but Malarek lets that point of view stand at the end.

He even accepts, without criticism, Pareira’s view of the new research by the Royal Dutch Medical Association, which would accept, as a sufficient reason for assisted dying, something that they call “suffering through living.” This is not, as Malarek alleges, a matter of casually saying, “I’ve lived a good long life, I think I’ll check out now.” That is a parody of what is meant. What “suffering through living” would mean — if accepted — is that a person at an advanced age, with poor health due to a multitude of medical complaints, perhaps failing eyesight, severe arthritis, increasing deafness, inability to walk, etc. — all of which might add up to a condition that could be termed “suffering through living” – which might lead a person to say, reasonably, “I have nothing left to live for.” (A good example of that might be Sir Edward Downes, who, together with his wife Joan, died at the Dignitas clinic in Switzerland. His wife was terminally ill, but he was not. However, with failing health, poor eyesight, and increasing deafness, he felt that he should depart this life with his wife of many years.)  Malarek, unfortunately, is a journalist with a sledgehammer. He doesn’t make nice distinctions. He seems unable to pick up nuance. All he seems able to do is to parrot the clearest words that he heard — those from the doctrinaire Dr. Pereira. Everyone else is an amateur, we are led to suppose, but here is the voice of the expert. The documentary is a lie.

Perhaps you can tell that I am angry. Well, I am. I have said before, and I will say again, that Malarek and his crew used me, and in my view defiled the memory of my beloved Elizabeth. This programme served no one’s interests but those of the Roman Catholic Church and its idiotically constricted notion of what human dignity is all about (which amounts, really, to an equation of dignity and sanctity). But I know, because I was there, that Elizabeth died with great courage and dignity, and avoided the tragedy, as it would have been, of being entrapped alive in her own body, where she would have been forced by ancient religious prejudices and unjust law to remain until she died “naturally” (as they call it), but really in great misery and suffering, and in a way completely at odds with the deliberate and thoughtful way in which she had lived her life. Of Malarek and his W5 crew I have, on further consideration, very little good to say. No doubt the cameraman and the soundman are blameless, but those who shaped the programme bear full responsibility. They abused a trust, and for that I find forgiveness hard to find.