Two-year-old euthanised in Netherlands in first assisted dying case of its kind

[IwantToRetire]

I'm not going to select any part of the article but just post the link for those who want to read
https://www.mirror.co.uk/news/world-news/netherlands-infant-2-euthanised-assisted-37709218

Pharmaceutical companies, including major European manufacturers and firms like Pfizer, refuse to sell their drugs for use in executions. The European Union heavily restricts the export of execution drugs.

States resort to using alternative, untested drug combinations or experimental methods like nitrogen hypoxia, which have a high rate of botched procedures and severe complications.

Of course it’s not families who’d in practice do the caring, it would be women.

Having worked harder in school on average, had demanding jobs while bringing up families and doing by far and away the lion’s share of the domestic and childcare responsibilities, just when the children are off hand you want them to look after their elderly relatives as well! Marvellous.

Because people are living longer and we’re artificially keeping them alive as you wish well past the point where there is quality of life - go to any ward in a hospital and listen to the screaming, terrified Alzheimer’s patients - you want women to look after them when many are violent and have extremely complex needs. Whereas years ago they would probably be allowed to drift away with pneumonia once quality of life was so poor.

It’s people like you who are selfish. Trying to kid themselves that life can be extended indefinitely and forcing people to live in unbearable pain. While thinking that exhausted women would pick up the caring responsibilities. It’s not just nice little old ladies being taken to the park, it’s often extremely gruelling looking after someone with complex needs. If you want to look after people with challenging medical needs then become a carer yourself. Don’t try and guilt us into doing it.

I don’t want my children to look after me, absolutely no way.

Would you like assisted dying for yourself if you get dementia, or an illness which is not in itself going to kill you soon? Or earlier stages of cancer with still many months to go?

I too would hate my family to give up everything to look after me if I were ill to the point of being difficult, but what the other pp was meaning I think is how there could be a slip into offering death rather than care by anyone. This has happened in other countries. Or terrible hospital care as outlined in the discussion of the dreadful misuse of the Liverpool Pathway.

There can be many years of being old though where simply living with your family can be care in itself which can prevent some illnesses. Hence, for my part, I was speaking of better, more adaptable housing stock.

@ScrollingLeaves “I was speaking of better, more adaptable housing stock.”

New builds are generally getting smaller in the UK.

“There can be many years of being old though where simply living with your family can be care in itself which can prevent some illnesses.”

Plenty of families won’t be willing or unable to have an elderly parent live with them.

Thank you for acknowledging I have been replying in good faith, as have you. I agree we are in a position where we have to agree to disagree. It’s really nice to have this kind of conversation where we are listening to each other even if we don’t agree.

I’m assuming by “why are we so selfish” you are referring to women now being unwilling to take on the grunt work of caring for relatives as has always been expected.

Well in my case, my mum is 82 and suffers from Parkinson’s disease. She is relatively capable of looking after herself at the moment but that will change. I’m 59 and will need to work full time until I’m 67 in order to pay my mortgage.

I can’t live with her as she doesn’t have space in her small rented bungalow, she can’t live with me as I’m in a first floor flat that she won’t be able to access.

Both of my siblings work full time and one lives 20 miles away and doesn’t drive. They both have to pay mortgages and don’t have suitable accommodation for mum.

Incidentally, mum has expressed a wish to end her own life when she gets to the point whereby she can no longer cope on her own. She absolutely will not go into a care home. I fully support her decision and it breaks my heart that I won’t be able to be with her when she takes that step without risking being arrested.

There are different methods and drug protocols for assisted dying by country and for execution by state and country.

This paper gives a good overview of the different drugs combinations, but the take away is that all the drugs used for either assisted dying or execution can or have been used for both and can or have complications(suffering, pains or fail to work.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9270985/

Tough situation all around.

It sounds like a lot of thought went into the decision and that thorough assessments were completed. I am satisfied that the decision was not taken lightly and that the results those reports contained were a lose-lose situation.

In my opinion, keeping a person alive in such suffering and agony is inhumane.

I will be watching because tight controls will be needed to ensure this isn't usurped by poorly informed actors.

My heart goes out to the child, family and medical team who were involved.

It’s the same with assisted dying. Here is an excerpt from the paper I linked above of an experience from Oregon, which is the process and laws that Leadbetter modelled the UK Assisted Dying bill after:

Evidence from jurisdictions where assisted suicide is legal reveals that some patients who ingest the prescribed lethal drugs experience distressing complications. The Canadian Association of MAiD Assessors and Providers acknowledges that patients who ingest assisted suicide drugs can experience burning, nausea, vomiting and regurgitation, especially if the patient is experiencing difficulty swallowing large volumes of liquid. Nausea, oesophagitis, gastritis, severe dehydration or pathology of the gastrointestinal tract likely interfere with drug absorption.3 This is reflected in the data published by US states such as Oregon, where annual complication rates have been as high as 14.8% and patients are reported to have experienced difficulty swallowing or drug regurgitation, seizures and have even regained consciousness after ingesting the ‘lethal’ drugs.9

One reason for such difficulties may be that ingesting sufficiently toxic dosages of the prescribed drugs can prove a significant, and often distressing, challenge. In order to achieve an ‘assisted’ death, patients in the USA have been required to ingest 90 to 100 barbiturate pills by crushing them and mixing them into a sweet solvent. The emetogenic potency and bitterness requires antiemetics prior to ingestion to prevent vomiting. Such an experience of her aunt’s assisted suicide was described by a relative in 20164:
The full ‘cocktail’ included two anti-nausea pills, an anti-seizure pill and 100 capsules of Secobarbital. It all had to be ingested within an hour... My attention turned to the kitchen table, where my husband and sister, wearing latex gloves, frantically scraped the powder from 100 capsules with toothpicks, trying to beat the clock... The mountain of powder we poured into more sugar syrup created a half-cup of sludge so bitter it literally burned my tongue. And my aunt, who could barely swallow water, had to drink all of it in <5 min to ‘ensure success.’... When we sat back down at the kitchen table, white powder everywhere, we all had to wonder, ‘Who the hell wrote this law?’ We had been forced to assist in the most bizarre fashion, jumping through seemingly random legal hoops and meeting arbitrary deadlines while my aunt suffered, and finally emptying capsules, making an elixir so vile I cried when I knew she had to drink it. This was death with dignity?

@ScrollingLeaves

That is good but stairs end up needing a stair lift so there also needs to be an extra room downstairs so an elderly/ill person can use that for sleeping in, and the rest of the family still has a sitting room, kitchen and place to eat

Yes, but try getting the house building associations to go with that.

When the new standards were coming in the disability movement fought hard against a number of measures that would have meant this sort of thing but the Housebuilding lobby is big, powerful and didn't want to do it. A lot of watering down Part M of the building regs went on (the accessibility part).

The difficulty with assisted suicide meant that Canada added a provision that you consent to euthanasia if the lethal cocktail of orally ingested drugs fail…50% of assisted suicides then required the physician to step in and euthanise when after 60mins of suffering the person was still alive. More from the paper linked upthread:

In 2017, The Denver Post published an article about a man in Colorado who sought assisted suicide after being diagnosed with cancer. Although his wife thought he would die quickly and peacefully, after ingesting the lethal drugs he experienced distressing complications and took over 9 h to die5:
On the day of Kurt’s death, Susan mixed the liquids prescribed as directed and Kurt began drinking the compound. ‘But with every sip,’ Susan says, ‘he’s choking and coughing, choking and coughing.’ It went on for nearly 20 min... Although he never regained consciousness, the gasping, uneven breathing continued. Two hours passed. Then 4 h. ‘At 4:15,’ Susan says, ‘I started to majorly panic.’ As she tried without success to reach a doctor, a couple more disturbing thoughts crossed her mind: She feared that Kurt, despite his unconsciousness, could hear everything—the calls, the desperation in her voice. And she wondered if his choking when he first took the medication meant that he had aspirated enough to delay its effect. Around 7 p.m., she asked hospice to send a nurse. Shortly after the nurse arrived, a doctor called and suggested some additional measures. Soon after, Susan saw her husband sit up slightly and appear to retch three times. She ran to his bedside. Then he slid back into his pillows and stopped breathing.

The unpredictable efficacy of assisted suicide drugs is acknowledged by the Royal Dutch Medical and Pharmaceutical Societies and the Canadian Association of MAiD Assessors and Providers, who both recommend that clinicians obtain consent from patients to convert to euthanasia prior to ingestion of the lethal drugs in case the patient takes too long to die.8,25 In 2018, of the MAiD cases in Canada with available data, 50% were unsuccessful by 60 min and the clinician transitioned to euthanasia to complete the ‘assisted’ death.25

The Leadbetter UK Assisted Dying bill as written excludes physician assisted euthanasia as it only allows self administered oral ingestion, but it is a sure thing that it will need to be added after the first dozen or so people die horribly without it. A suggested amendment from the HoL to add it was rejected by her committee as well.

This bit directly compares lethal injection in some US states to the euthanasia injection used in the Netherlands, what this 2 yr old child would have experienced.

However, euthanasia seems to confront a different kind of challenge, as some clinicians question whether death by lethal injection is as peaceful and painless as it may seem. In 2019, a group of clinicians reviewed methods commonly used for euthanasia and contrasted these with an analysis of capital punishment in the USA. Although some of the specific dugs, doses and monitoring techniques employed vary, they found that methods of US capital punishment closely resemble the Dutch injection technique. Their concern lies in the challenge posed by achieving and ensuring unconsciousness during euthanasia, as evidenced from studies of penal death as well as the medical phenomena known as ‘accidental awareness during general anesthesia’.26
While caution is needed in extrapolating findings from a generally physically healthy population to those with pathology, based on toxicology reports, up to 88% of executed prisoners studied had postmortem blood concentrations of anesthetic in the blood lower than that required for surgery and 43% had concentrations consistent with awareness.27 This means that some prisoners who are subjected to lethal injection do not received a sufficient amount of anesthetic to be fully unaware of the dying process. However, because neuromuscular blocking agents are administered, these prisoners cannot move any muscle even if they remain cognizant and therefore appear to be unconscious.
Sinmyee et al.26 express concern that monitoring consciousness in patients who are undergoing euthanasia and have received paralytic agents is difficult and, unless properly monitored, ‘there is a risk that vulnerable citizens may be killed by suboptimal, or even cruel, means’. This is of particular concern as opponents of lethal injection argue that a majority of executed prisoners show postmortem signs of flash pulmonary oedema, i.e. their lungs are filled with fluid and weigh several times the weight of normal lungs.28 This may be due to toxic drug effects on alveolar basement membrane, allowing rapid fluid ingress. If the person were aware, it has been suggested that the experience of death by lethal injection could be akin to suffocation or drowning.

@NullaEffugium · Today 10:53

I have to say that the problem with posting the disasters of euthanasia - and there are a few - is that you are not acknowledging the disasters of not allowing assisted suicide / euthanasia. Of which there are, unfortunately, many. Where people have died, or lived and carried on living, in extreme distress.

There is, frankly, a great deal more dignity in the excerpt you posted than in the unscreaming agony that some people have to endure for far longer than half an hour or even four hours.

Very easy research allows some heartrending stories of people who have been desperate to die and not given the support.

One of the men I knew who went for assisted suicide was in the end stages of leukemia, was a dignified, fiercely intelligent man who had given a great deal to society and enjoyed his life. His wife told me of his last days and I don't want to write them down because he was a friend. But euthanasia gave him the means to step out of life without a terribly distressing (for him, as well as his family) last passage of time.

There is a Spanish film, 'The Sea Inside', which is based on the real life story of a man who chose to end his life after being a quadriplegic for 25 years. It gives a whole new perspective on the matter, he fought for the right to die for many years.

Just because we can extend life through advanced medical techniques does not mean we should.

Apparently he was so good at pleading his cause and so good a communicator that he became rather celebrated and people didn't want to lose him.

Bit rich to be fighting for the right to die for roughly thirty years only for people to say 'you're so good at this we don't want to lose you'.

Another chilling post.

Nobody goes to Switzerland because they can't afford care.

Do you think we should just give up on all public services then?

What about prisons? Nobody likes their taxes being spent on criminals. Do you think people should be offered AS instead of a prison sentence?

@kxeil you didn't answer my questions -

If there is no money and no care available then how is such an offer a 'choice' exactly?

If you got your way, how long before not taking up an offer of AS, preferring to live out your natural lifespan with all its attendant costs, came to be seen as a selfish thing to do?

How long before the state stopped funding care altogether so a natural lifespan became a luxury only the wealthy could afford?

@PencilsInSpace “Nobody goes to Switzerland because they can't afford care.”

I never said they do. I said there was a need for assisted dying and euthanasia, which is why people go to countries where it’s legal.

@PencilsInSpace” If there is no money and no care available then how is such an offer a 'choice' exactly?”

It would be a choice of dying naturally (which could involve immense suffering) with no care, or having the option to end your life by assisted dying or euthanasia.

You have repeatedly argued for AS for people who can't afford care. That's what we were discussing.

as a note, you have to be a resident of the NL and have a dutch healthcare insurance before you can use the 'endoflifeclinic' services here, although you don't have to be Dutch. It's not like Dignitas where if you can pay and travel to Switzerland and self-administer the drugs, anyone can go.

@PencilsInSpace “to live out your natural lifespan”

Modern medicine often prolongs life way past ‘your natural lifespan’.

No I haven’t! I do want it as an option if I’m suffering and I’m unable to kill myself. I also want it as an option if there’s no care available if I end up needing it.

If I became a quadriplegic (with no use of hands and arms) and there was no care available I would want it as an option.

@PencilsInSpace The problem is that while services ought to be well funded and good levels of care ought to be available for everyone, they aren't. And they aren't, realistically, going to be.

@kxeil 's position is a step too far for me, but they are at least being practical. Nice ethical considerations tend to fade into unimportance when you're cold, hungry and in pain with no realistic chance of improvement.

It's easy to say that we shouldn't allow people in that position the option to die easily, but we are not in that position ourself and we are, by our inaction, allowing this suffering to go on from our position of privilige.

I think it is a valid pov to say that we are arrogantly refusing people in that situation the way to die when they don't want to go on, while we are content enough with our own lives to want to live. We are taking a great deal on ourselves to remove that possibility from others, when it exists.

(again, I personally cannot go as far as @kxeil here too).