Dr. Louise Campbell:

The Oregon Health Authority argues that the process of legalised assisted dying operates entirely within the intended framework in an exemplary fashion. Its most recent report, from 2016, summarises the data from 1997 to 2016, which is 19 years of data. It maintains that there is no greater threat to vulnerable persons than there is to any other member of society from the legalisation of this regime. However, the US jurisdictions do not allow anybody diagnosed with a psychiatric illness to avail of this service.

I believe we should look not at the North American situation but, rather, at the European situation. There is a long tradition in Luxembourg of allowing patients who are suffering unbearably, both for physical and psychological reasons, to avail of this practice. We can look at the documents published, in English, by the regional euthanasia committees in the Netherlands. The Belgian data is much harder to access. Much of the Dutch data is accessible, but not all of it is translated. A report is published every year which looks at examples of several cases. The cases are discussed in some detail, and if the cases are read carefully it is obvious that due diligence has been done in those situations where they claim that the due care criteria, under the law, have been met. The description of these cases is actually ethical rather than medico-legal in nature. Issues such as competence and the patient's values, wishes and prior expressed wishes are discussed, all of which have a fundamental bearing on an ethical discussion of what is right or wrong in these circumstances. Other cases are described as not meeting the due care criteria. There are only a few such cases; I believe there were ten in 2016 altogether. They did not meet the due care criteria largely because procedural requirements were not met, rather than the substantive requirements.

If one scrutinises this data and looks at the code of practice for practitioners providing this service, one gets a sense that it is well thought out and that every attempt is made to carry out due diligence. I am considering the increase in provision of this service to persons with psychiatric illnesses in both Belgium and the Netherlands. That is a very serious concern. On the whole, however, the published reports - certainly in the Netherlands - seem to indicate that due diligence is being carried out. Any system is open to abuse but there seems to be quite a lot of oversight in this system. The cases are looked at in detail and the five regional euthanasia committees are asked to report back on any concerns. It is said that 80% of the cases are straightforward; the mandatory notification procedure is met and the documentation is adequate. However, in 20% of cases the physician is called and questioned to confirm that the due care criteria was met and the code of practice was complied with. I do not think it is perfect but due diligence is being done. I would be satisfied that, with continuous tweaks and small improvements, abuse of vulnerable persons could be reduced to a minimum. I do not think it will ever be eliminated. There will always be unscrupulous doctors, as there are unscrupulous members of every profession.