El futuro NOM: si eres pobre, al hoyo. Canadá recomienda cuneta a quién no tenga dinero para tratarse sus dolencias

Este es el futuro. Cuando seamos mayores y no tengamos pensión, jubilación a los 80 y cuneta al año siguiente.



Por cierto, en Holanda llevan tiempo con estos temas. Aquí un artículo en un periódico nada sospechoso de ser de izquierdas (The Guardian) crítico con la eutanasia. Muy interesante. Es de 2019, y ya se planteaba el recurso a la eutanasia para aquellos casos complicados de tratar (es decir, pobres)


Artículo:

Last year a Dutch doctor called Bert Keizer was summoned to the house of a man dying of lung cancer, in order to end his life. When Keizer and the nurse who was to assist him arrived, they found around 35 people gathered around the dying man’s bed. “They were drinking and guffawing and crying,” Keizer told me when I met him in Amsterdam recently. “It was boisterous. And I thought: ‘How am I going to cleave the waters?’ But the man knew exactly what to do. Suddenly he said, ‘OK, guys!’ and everyone understood. Everyone fell silent. The very small children were taken out of the room and I gave him his injection. I could have kissed him, because I wouldn’t have known how to break up the party.”



Keizer is one of around 60 physicians on the books of the Levenseindekliniek, or End of Life Clinic, which matches doctors willing to perform euthanasia with patients seeking an end to their lives, and which was responsible for the euthanasia of some 750 people in 2017. For Keizer, who was a philosopher before studying medicine, the advent of widespread access to euthanasia represents a new era. “For the first time in history,” he told me, “we have developed a space where people move towards death while we are touching them and they are in our midst. That’s completely different from killing yourself when your wife’s out shopping and the kids are at school and you hang yourself in the library – which is the most horrible way of doing it, because the wound never heals. The fact that you are a person means that you are linked to other people. And we have found a bearable way of severing that link, not by a natural death, but by a self-willed ending. It’s a very special thing.”

This “special thing” has in fact become normal. Everyone in the Netherlands seems to have known someone who has been euthanised, and the kind of choreographed farewell that Keizer describes is far from unusual. Certainly, the idea that we humans have a variety of deaths to choose from is more familiar in the Netherlands than anywhere else. But the long-term consequences of this idea are only just becoming discernible. Euthanasia has been legal in the Netherlands for long enough to show what can happen after the practice beds in. And as an end-of-life specialist in a nation that has for decades been the standard bearer of libertarian reform, Keizer may be a witness to the future that awaits us all.


In 2002, the parliament in the Hague legalised euthanasia for patients experiencing “unbearable suffering with no prospect of improvement”. Since then, euthanasia and its close relation, assisted dying, in which one person facilitates the suicide of another, have been embraced by Belgium and Canada, while public opinion in many countries where it isn’t on the national statute, such as Britain, the US and New Zealand, has swung heavily in favour.

The momentum of euthanasia appears unstoppable; after Colombia, in 2015, and the Australian state of Victoria, in 2017, Spain may be the next big jurisdiction to legalise physician-assisted death, while one in six Americans (the majority of them in California) live in states where it is legal. In Switzerland, which has the world’s oldest assisted dying laws, foreigners are also able to obtain euthanasia.

If western society continues to ***ow the Dutch, Belgian and Canadian examples, there is every chance that in a few decades’ time euthanasia will be one widely available option from a menu of possible deaths, including an “end of life” poison pill available on demand to anyone who finds life unbearable. For many greying baby boomers – veterans of earlier struggles to legalise abortion and contraception – a civilised death at a time of their choosing is a right that the state should provide and regulate. As this generation enters its final years, the precept that life is precious irrespective of one’s medical condition is being called into question as never before.


As the world’s pioneer, the Netherlands has also discovered that although legalising euthanasia might resolve one ethical conundrum, it opens a can of others – most importantly, where the limits of the practice should be drawn. In the past few years a small but influential group of academics and jurists have raised the alarm over what is generally referred to, a little archly, as the “slippery slope” – the idea that a measure introduced to provide relief to late-stage cancer patients has expanded to include people who might otherwise live for many years, from sufferers of diseases such as muscular dystrophy to sexagenarians with dementia and even mentally ill young people.

Perhaps the most prominent of these sceptics is Theo Boer, who teaches ethics at the Theological University of Kampen. Between 2005 and 2014, Boer was a member of one of the five regional boards that were set up to review every act of euthanasia and hand cases over to prosecutors if irregularities are detected. (Each review board is composed of a lawyer, a doctor and an ethicist.) Recent government figures suggest that doubts over the direction of Dutch euthanasia are having an effect on the willingness of doctors to perform the procedure. In November, the health ministry revealed that in the first nine months of 2018 the number of cases was down 9% compared to the same period in 2017, the first drop since 2006. In a related sign of a more hostile legal environment, shortly afterwards the judiciary announced the first prosecution of a doctor for malpractice while administering euthanasia.

It is too early to say if euthanasia in the Netherlands has reached a high-water mark – and too early to say if the other countries that are currently making it easier to have an assisted death will also hesitate if the practice comes to be seen as too widespread. But it is significant that in addition to the passionate advocacy of Bert Keizer – who positively welcomes the “slippery slope” – Boer’s more critical views are being solicited by foreign parliamentarians and ethicists who are considering legal changes in their own countries. As Boer explained to me, “when I’m showing the statistics to people in Portugal or Iceland or wherever, I say: ‘Look closely at the Netherlands because this is where your country may be 20 years from now.’”

“The process of bringing in euthanasia legislation began with a desire to deal with the most heartbreaking cases – really terrible forms of death,” Boer said. “But there have been important changes in the way the law is applied. We have put in motion something that we have now discovered has more consequences than we ever imagined.”

Bert Keizer carried out his first euthanasia in 1984. Back then, when he was working as a doctor in a care home, ending the life of a desperately ill person at their request was illegal, even if prosecutions were rare. When a retired shoemaker called Antonius Albertus, who was dying of lung cancer, asked to be put out of his misery, Keizer found that two sides of himself – the law-abiding doctor and the altruist – were at odds.


“Antonius wasn’t in pain,” Keizer told me, “but he had that particular exhaustion that every oncologist knows, a harrowing exhaustion, and I saw him dwindle before me.” In the event, Keizer, who as an 11-year-old watched his mother suffer an excruciating death from liver disease, went with the altruist. He injected 40mg of Valium into Antonius – enough to put him in a coma – then gave him the anti-respiratory drug that ended his life.

Keizer was not investigated after reporting an unnatural death at his own hand, and his career did not suffer as he antiestéticared it might. But what, I asked him, had prompted him to break the law, and violate a principle – the preservation of life – that has defined medical ethics since Hippocrates? Keizer paused to brush away a spider that had crawled uninvited on to my shoulder. “It was something very selfish,” he replied. “If ever I was in his situation, asking for death, I would want people to listen to me, and not say, ‘It cannot be done because of the law or the Bible.’”

Over the past few decades the Bible has been increasingly sidelined, and the law has vindicated the young doctor who put Antonius to sleep. As people got used to the new law, the number of Dutch people being euthanised began to rise sharply, from under 2,000 in 2007 to almost 6,600 in 2017. (Around the same number are estimated to have had their euthanasia request turned down as not conforming with the legal requirements.) Also in 2017, some 1,900 Dutch people killed themselves, while the number of people who died under palliative sedation – in theory, succumbing to their illness while cocooned from physical discomfort, but in practice often dying of dehydration while unconscious – hit an astonishing 32,000. Altogether, well over a quarter of all deaths in 2017 in the Netherlands were induced.


MPs in Victoria, Australia, embrace after the passing of the Voluntary Assisted Dying bill in 2017. Photograph: David Crosling/EPA

One of the reasons why euthanasia became more common after 2007 is that the range of conditions considered eligible expanded, while the definition of “unbearable suffering” that is central to the law was also loosened. At the same time, murmurs of apprehension began to be heard, which, even in the marvellously decorous chamber of Dutch public debate, have risen in volume. Concerns centre on two issues with strong relevance to euthanasia: dementia and autonomy.

Many Dutch people write advance directives that stipulate that if their mental state later deteriorates beyond a certain point – if, say, they are unable to recognise family members – they are to be euthanised regardless of whether they dissent from their original wishes. But Last January a medical ethicist called Berna Van Baarsen caused a stir when she resigned from one of the review boards in protest at the growing frequency with which dementia sufferers are being euthanised on the basis of a written directive that they are unable to confirm after losing their faculties. “It is fundamentally impossible,” she told the newspaper Trouw, “to establish that the patient is suffering unbearably, because he can no longer explain it.”

Van Baarsen’s scruples have crystallised in the country’s first euthanasia malpractice case, which prosecutors are now preparing. (Three further cases are currently under investigation.) It involves a dementia sufferer who had asked to be killed when the “time” was “right”, but when her doctor judged this to be the case, she resisted. The patient had to be drugged and restrained by her family before she finally submitted to the doctor’s fatal injection. The doctor who administered the dose – who has not been identified – has defended her actions by saying that she was fulfilling her patient’s request and that, since the patient was incompetent, her protests before her death were irrelevant. Whatever the legal merits of her argument, it hardly changes what must have been a scene of unutterable grimness.

The underlying problem with the advance directives is that they imply the subordination of an irrational human being to their rational former self, essentially splitting a single person into two mutually opposed ones. Many doctors, having watched patients adapt to circumstances they had once expected to find intolerable, doubt whether anyone can accurately predict what they will want after their condition worsens.

The second conflict that has crept in as euthanasia has been normalised is a societal one. It comes up when there is an opposition between the right of the individual and society’s obligation to protect lives. “The euthanasia requests that are the most problematic,” explains Agnes van der Heide, professor of medical care and end-of-life decision-making at the Erasmus Medical Centre in Rotterdam, “are those that are based on the patient’s autonomy, which leads them to tell the doctor: ‘You aren’t the one to judge whether I am to die.’” She doesn’t expect this impulse, already strong among baby boomers, to diminish among coming generations. “For our young people, the autonomy principle is at the forefront of their thinking.”


The growing divisions over euthanasia are being reflected in the deliberations of the review boards. Consensus is rarer than it was when the only cases that came before them involved patients with late-stage terminal illnesses, who were of sound mind. Since her resignation, Berna Van Baarsen has complained that “legal arguments weigh more and more heavily” on the committees, “while the jovenlandesal question of whether in certain cases good is done by killing, threatens to get snowed under”.

In this new, more ambiguous environment, the recent dip in euthanasia numbers doesn’t seem surprising. Besides their antiestéticar of attracting prosecutors’ attention, some doctors have been irked by the growing public perception that they are no-questions-asked purveyors of dignified death, and are pushing back. For Dutch GPs, fielding demands for euthanasia from assertive patients who resent the slightest reluctance on the part of their physician has become one of the more disagreeable aspects of their job.

“In the coldest weeks of last winter,” Theo Boer told me, “a doctor friend of mine was told by an elderly patient: ‘I demand to have euthanasia this week – you promised.’ The doctor replied: ‘It’s -15C outside. Take a bottle of whisky and sit in your garden and we will find you tomorrow, because I cannot accept that you make me responsible for your own suicide.’ The doctor in question, Boer said, used to perform euthanasia on around three people a year. He has now stopped altogether.

Although he supported the 2002 euthanasia law at the time, Boer now regrets that it didn’t stipulate that the patient must be competent at the time of termination, and that if possible the patient should administer the fatal dose themselves. Boer is also concerned about the psychological effect on doctors of killing someone with a substantial life expectancy: “When you euthanise a final-stage cancer patient, you know that even if your decision is problematic, that person would have died anyway. But when that person might have lived decades, what is always in your mind is that they might have found a new balance in their life.”

In November 2016, Monique and Bert de Gooijer, a couple from Tilburg, became minor celebrities when a regional paper, the Brabants Dagblad, devoted an entire issue to the euthanasia of their son, an obese, darkly humorous, profoundly disturbed 38-year-old called Eelco. His euthanasia was one of the first high-profile cases involving a young person suffering from mental illness. Of the hundreds of reactions the newspaper received, most of them supportive, the one that made the biggest impression on the de Gooijers came from a woman whose daughter had gone out one day, taking the empty bottles to the store, and walked in front of a train. “She envied us,” Monique told me as I sat with her and Bert in their front room, “because she didn’t know why her daughter had done it. She said: ‘You were able to ask Eelco every question you had. I have only questions.’”

Privately, even surreptitiously undertaken, suicide leaves behind shattered lives. Even when it goes according to plan, someone finds a body. That openly discussed euthanasia can cushion or even obviate much of this hurt is something I hadn’t really considered before meeting the de Gooijers. Nor had I fully savoured the irony that suicide, with its high risk of failure and collateral damage, was illegal across Europe until a few decades ago, while euthanasia, with its apparently more benign – at least, more manageable – consequences, remains illegal in most countries.

Whatever the act of killing a physically healthy young man tells us about Dutch views of human wellbeing, the demise of Eelco de Gooijer didn’t traumatise a train driver or a weekender fishing in a canal. Eelco was euthanised only after long thought and discussions with his family. He enjoyed a good laugh with the undertaker who had come to take his measurements for a super-size coffin. He was able to say farewell to everyone who loved him, and he died, as Monique and Bert assured me, at peace. There might be a word for this kind of suicide, the kind that is acceptable to all parties. Call it consensual.

“You try to make your child happy,” Monique said in her matter-of-fact way, “but Eelco wasn’t happy in life. He wanted to stop suffering, and death was the only way.” Eelco came of age just as euthanasia was being legalised. After years of being examined by psychiatrists who made multiple diagnoses and prescribed a variety of ineffective remedies, he began pestering the doctors of Tilburg to end his life.

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