Professor Theo Boer:

I thank the committee for inviting me. It is a pleasure to be part of its deliberations. My opening statement, which members may have received, is as follows.

It is an honour to share some observations from the Netherlands, a country with half a century of debating and regulating assisted dying. As for myself, I switched from being moderately supportive of the Dutch euthanasia law to being increasingly critical. From 2005 through 2014 I was a member of a Dutch euthanasia review committee and on behalf of the Dutch Government I reviewed a total of 4,000 cases. The numbers I refer to in this contribution are not contested. All parties accept them as being empirically right.

As for the terminology, in this introduction I use the term “assisted dying” as an umbrella term for two rather different things that reside under one law in the Netherlands, namely, the so-called euthanasia law. The first is euthanasia, which means that a physician uses an infusion or injection to end a patient’s life at their request, and second is physician-assisted suicide, in which a physician hands a patient a deadly poison to end their own life. It may take place differently in Switzerland but the essence is that the patient is taking his own destiny in his own hands. Interestingly, and very importantly, 97 out of 100 assisted deaths in my country, up from 90 out of 100 in 2002, are the consequence of euthanasia. The number of people preferring euthanasia over assisted suicide is strongly rising. Obviously, most patients shy away from performing the act themselves. This is substantiated by the fact that in countries that have legalised only assisted suicide, such as 11 US states, the deaths are about seven times lower than in countries that have legalised euthanasia as well. The biggest example is Oregon, where 0.7% of all deaths are the consequence of assisted suicide. In the Netherlands it is 5.2%, with about the same number of years since they have legalised it.

Before proceeding to some of the developments in my country, let me address three misunderstandings. One is that I am categorically opposed to assisted dying. I am not. I can still imagine that killing a patient or hastening their death at their request can be a reasonable exception to the prohibition to actively and intentionally kill a patient. Second, I do not criticise any individual physician, patient, or family member. We are all part of an increasingly permissive, cynical, and sometimes desperate system of end-of-life decisions, for which individuals bear very little personal responsibility. That is what a society such as Dutch samenlevenor living together will bring about. It is a shared responsibility in which I also have my part. A third misunderstanding is that my scepticism stems from my Protestant background. Interestingly, it does not. My church, the Dutch Reformed Church, is a liberal church and it was the first worldwide to support assisted dying back in the 1970s. In the 1980s, about 80% of all its vocal supporters were Reformed ethics professors, politicians and physicians. My critique arises from what I have seen happen in practice.

First, after years of relative stability and increasing transparency in the early 2000s, which made us all very happy, the numbers are now rising significantly year after year.

In the past 20 years, the numbers have quadrupled and, as members can see in chart 1, which they probably have on their desks, the increase seems to accelerate rather than slow down. In some neighbourhoods assisted deaths account for between 15% and 20% of all deaths. The reason the average is still at a relatively low 5.2% nationally is that in some predominantly rural areas the percentage is well under 2%, but here too we see it catching up.

The second development we have seen is an expansion of the pathologies - the reasons underlying a request to die - as can be seen in chart 2. From patients who dread spending the last days or weeks of their lives in pain and agony and afraid of choking, the category of patients that once was the most important reason for assisted dying advocacy in my country in the first place, and which I think still is in Ireland and Great Britain, we see a shift to patients who fear years or decades of loneliness, alienation and care dependency. In the Netherlands, as in other countries that have legalised assisted dying, this expansion is motivated - this is important for the committee, as Members of Parliament, to take into account - by a logic of justice, the question as to why euthanasia is provided only for terminal patients, for example? That is the question that was asked in Canada, which expanded euthanasia to patients with chronic illnesses too. Why only permit assisted dying for those suffering from a physical illness or people suffering from an illness rather than anyone in unbearable and irremediable suffering? After all, a person can suffer very much for non-medical reasons as well. That is why we have now a law in parliament that legalises euthanasia for all people over 74 years, with or without an illness. Their age is the only reason they can have assisted dying. That in turn is why we now have a regulation that allows parents to request euthanasia for their young children aged from zero to 11 years old. I am convinced it is only a matter of time before we take the next hurdle, namely, allowing children of dementia patients to request euthanasia for their demented parents.

I have other concerns but my time is short and members may have questions. I will conclude by drawing a parallel. The legalisation of euthanasia has done much more than just providing some citizens the liberty of taking a way out. It has turned the whole landscape of dying, including our view of illness, suffering, ageing and care dependence, upside down. Ageing and dying increasingly become a life project, a task to be managed. As members can see, in the slipstream of legal euthanasia the percentage of people dying through terminal sedation has skyrocketed in the past 20 years. It was up to 25% of all deaths last year, whereas in most other developed countries that proportion is well below 2%. The committee's considerations and upcoming decisions are among the most consequential a parliament can ever make. I sincerely hope the Irish Parliament seriously weighs all these experiences. I look forward to our conversation and thank the committee once again for the invitation.