How attitudes to mercy killings differ around Europe

TWO European countries, Britain and Belgium, have had cause in recent weeks to ponder the same ethical question: what happens when doctors decide a patient has no chance of a bearable life? In Britain headlines reported the grief of parents whose wishes were overruled by the courts, allowing doctors to turn off the ventilators keeping their son alive. Shortly afterwards a new study reported that active euthanasia—in which not only is medical care withdrawn, but drugs are used to shorten life—is opposed by two-thirds of British doctors.
A similar debate has broken out in Belgium, another European country that has moved in a broadly secular, permissive direction over the past few decades. But this one was very different. Buried on inside pages, small newspaper stories reported a survey of paediatric intensive-care nurses. It emerged that they had witnessed two dozen infants and children being given lethal drugs to speed their deaths. That amounts to involuntary euthanasia, which is illegal (though Belgium, like the Netherlands, has legalised euthanasia for consenting adults). Asked if the law should be changed to allow the ending of minors’ lives, 89% of nurses in the Belgian study said yes.
This was not a rogue result. In 2005 academics investigated all 292 children who died before their first birthday in a given year in Flanders, the Dutch-speaking bit of Belgium. In half the cases, doctors had taken an “end-of-life decision”, a term that takes in three distinct practices. Most often, doctors withdrew or withheld treatment keeping infants alive, which is quite a common practice. In 40 cases, painkillers such as morphine were used to alleviate suffering, but at high doses likely to hasten death: a legal grey area. In 17 cases lethal drugs or doses were illegally given to end life. Similar practices were revealed by a study in the Netherlands; that led to the appointment of a committee to review cases where a baby’s suffering seems impossible to relieve, suggesting that a swift death might be merciful.


Even to set up such a committee would be controversial in most of Europe, especially where church leaders retain political clout. In Britain debate on euthanasia revolves around gravely ill adults who consciously want to die. Even in such secular, permissive countries as Sweden, doctors tell surveys they oppose euthanasia by large margins. What explains these differences?
Religious faith is important, but can be trumped. A 2006 study found that in Italy and Poland, practising Catholics were more hostile to euthanasia than their less devout compatriots. But in France, the Netherlands, Belgium and Scandinavia, believers and their secular neighbours hold similar views. Memories of Nazi programmes to murder unwanted citizens under the label of “euthanasia” make Germans cautious, regardless of religion. The author of the recent British studies, Clive Seale of London University, notes another wrinkle: British doctors are more religious than the population at large, with half calling themselves somewhat, very or extremely religious, as opposed to a third of ordinary Britons. (Not all those devout doctors are Christians: the National Health Service employs many Asians and British Asians).
National character matters too. In the Netherlands, euthanasia is mostly carried out by family doctors, who know their patients well. The Dutch are an outspoken, demanding bunch, who expect straight answers, says Luc Deliens, a Belgian academic. Things are different in southern Europe, where doctor-patient relationships are more hierarchical. The Dutch, a seafaring nation of traders, have also long imported new and foreign opinions. They are used to resolving conflicting principles, says Dick Willems, a Dutch doctor and ethicist. There has never been “one very strong common idea about what is allowed”.
Economics plays a role, he adds. In America a long terminal illness can leave people deep in debt: that makes ethicists fear that euthanasia might be requested for financial reasons. In Dutch hospitals, compulsory insurance covers even the most expensive treatments, lessening such fears.

When to pull the plug

Arguably, some countries are in denial. In only a few countries have there been serious attempts to measure the incidence of euthanasia. Academics found it existed in every country studied. London University studies estimate that one in 500 deaths in Britain involve voluntary euthanasia, and one in 300 involuntary euthanasia. That amounts to 3,000 deaths a year, outside any legal framework. British numbers are “disturbing” and cry out for regulation, says Mr Deliens. Britain also has a higher than average incidence of “terminal sedation”, where patients are kept unconscious until they die. Critics call this “slow euthanasia”.
Some worry that legal euthanasia creates a slippery slope towards state-sponsored killing. Legalisation has not made euthanasia more common, Dutch experts insist: the main effect is to improve communication between doctors, patients and families. Yet not all legal grey areas can be resolved. Take the recent cases in Belgium, mostly of newborns whose lives were ended with lethal drugs. A typical case might involve an irreversibly brain-damaged newborn taken off artificial respiration who, instead of dying as expected, lingers on, suffering terribly. In such cases, some doctors feel obliged to hasten death. A law formalising rules for such cases would be a mistake, suggests Mr Willems. Some decisions should remain morally and personally difficult.
The honesty of the Belgian and Dutch debate can feel pretty brutal. But whatever one’s views of euthanasia, openness is surely to be applauded. The phenomenon is only now being studied properly. And when Europeans know, they will need to decide what they really think.