Only about 15% of euthanasia cases in the semi-autonomous region of Flanders, in Belgium, are being reported, according to the latest research by physicians. It has long been known that euthanasia is underreported on official forms, but this figure – that there are about 550% more cases of euthanasia than are currently making their way into the government statistics -- seems to have astonished even the researchers.
In a letter to the European Journal of Epidemiology, researchers from the End-of-Life Care Research Group at the Free University of Brussels admit that “death certificates substantially underestimate the frequency of euthanasia as a cause of death in Belgium and are therefore an unreliable tool for monitoring its practice.” According to a large sample of death certificates, 0.7% of all deaths were described as euthanasia, but the anonymous survey of doctors yielded a figure of 4.6% of all deaths.
To bring the official statistics into line with reality, the researchers recommend that death certificates be revised to make it easier for physicians to list the real cause of death and that they be educated on how to fill out the forms.
So why don’t doctors report that they have helped a patient die through euthanasia (or assisted suicide, which was treated as euthanasia in the survey)? The researchers list several reasons:
This research has far-reaching implications for other jurisdictions where euthanasia is legal. “It may be that estimating the number of euthanasia-related deaths will be impossible altogether in some jurisdictions with legal euthanasia,” the authors acknowledge. They single out the Australian state of Victoria, where doctors are not required to list assisted suicide or euthanasia as the cause of death, for fear of patients being denied their life-insurance pay-outs. In Oregon, and other American states which copied their legislation, doctors list the underlying condition as the cause of death, not assisted suicide.... physicians consciously or unintentionally not recognizing their cases of euthanasia as such, because they believe that they have not complied with the legal due care criteria (e.g. not reported euthanasia to the evaluation committee as is required by law), because they have privacy concerns for themselves—as reporting attaches their name to the euthanasia case—and the patient, and because they do not consider it necessary to report it on the death certificate. The lack of clear guidelines is probably also a reason for the low number of euthanasia cases indicated on death certificates.
So, instead of official statistics, authorities will be forced to rely upon anonymous surveys like the one from the End-of-Life Care Research Group to uncover the truth of how many people are choosing euthanasia – or even having it chosen for them.
The statistics relate to deaths in Flanders between January and June 2013, so the trend in reporting may have changed since then.
“Die, my dear Doctor! That's the last thing I shall do,” said the 19th Century British foreign secretary Viscount Palmerston, not long before he slipped his cable. For all of us, dying is the last and perhaps most significant moment of life. Which is why recording the exact cause of death is a matter that calls for scrupulous accuracy – not just for epidemiological purposes, but also as part of our personal and social history.
But our disturbing lead story today – that Flemish doctors under-report euthanasia by a mind-boggling 550% -- throws all this to the winds. The most common practice, at least according to the latest research into the topic, is that most Flemish physicians who practice euthanasia lie on the death certificate.
Perhaps their offence is more understandable than jurisdictions which require doctors to lie. In many, like Oregon, they are told to record the patient’s underlying disease as the cause of death – as if JFK died of Addison’s disease rather than an assassin’s bullet.
Perhaps we should keep in mind the wise words of the author of a study on death certificates: “Death certificates are really important. We owe it to our patients to be able to accurately record why they die” — and thus to “help the living.”
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