In places where it’s legal, how many people are ending their lives using euthanasia?

 

Image 20170303 24331 15wkfi.jpg?ixlib=rb 1.1
One paper reported that between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal.
Flickr/Alberto Biscalchin, CC BY-NC-ND

Andrew McGee, Queensland University of Technology

The Victorian Parliament will consider a bill to legalise euthanasia in the second half of 2017. That follows the South Australian Parliament’s decision to knock back a voluntary euthanasia bill late last year, and the issue has also cropped up in the run-up to the March 11 Western Australian election.

With the issue back in the headlines, federal Labor’s justice spokesperson, Clare O’Neil, told Q&A that in countries where the practice is legal, “very, very small” numbers of people use the laws.

Whether or not you agree with O’Neil’s statement depends largely on your interpretation of the subjective term “very, very small”, but there is a growing body of data available on how many people are using euthanasia or assisted dying laws in places such as the Netherlands, Belgium, Luxembourg, Colombia, Canada and some US states.

Assisted dying, assisted suicide and euthanasia

Many people use the terms “assisted dying”, “assisted suicide” and “euthanasia” interchangeably. But, technically, these phrases can have different meanings.

Assisted dying (sometimes also assisted death) is where the patient himself or herself ultimately takes the medication. Euthanasia, by contrast, is usually where the doctor administers the medication to the patient.

Assisted suicide includes people who are not terminally ill, but who are being helped to commit suicide, whereas assisted dying refers to people who are already dying. Some reports do not, however, distinguish between assisted dying and assisted suicide, and I will not distinguish them here.

In some jurisdictions, the word “euthanasia” is used to refer to both assisted dying/suicide (where the patient himself or herself takes the medication) and to euthanasia (where the doctor administers the medication to the patient). So “euthanasia” can sometimes be used as a broad term to cover a range of actions.

Euthanasia and assisted suicide rates around the world

According to a peer-reviewed paper published last year in the respected journal JAMA:

Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization … Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices.

The authors of that paper said that 35,598 people died in Oregon in 2015. Of these deaths, 132, or 0.39%, were reported as physician-assisted suicides. The same paper said that in Washington in 2015 there were 166 reported cases of physician-assisted suicide (equating to 0.32% of all deaths in Washington in that year).

Interestingly, the same paper noted that US data show that:

pain is not the main motivation for PAS (physician-assisted suicide)… The dominant motives are loss of autonomy and dignity and being less able to enjoy life’s activities.

The authors said that in officially reported Belgian cases, pain was the reason for euthanasia in about half of cases. Loss of dignity is mentioned as a reason for 61% of cases in the Netherlands and 52% in Belgium.

A 2016 Victorian parliamentary report has quoted from the UK Commission on Assisted Dying, which in turn referenced the work of John Griffiths, Heleen Weyers and Maurice Adams in their book Euthanasia and Law in Europe. The commission said:

There are no official data in Switzerland on the numbers of assisted suicides that take place each year, as the rate of assisted suicide is not collected centrally. Griffiths et al observe that there are approximately 62,000 deaths in Switzerland each year and academic studies suggest that between 0.3% and 0.4% of these are assisted suicides. This figure increases to 0.5% of all deaths if suicide tourism is included (assisted suicides that involve non‑Swiss nationals).

Around 3.7% of deaths in the Netherlands in 2015 were due to euthanasia. The Netherlands’ regional euthanasia review committees reported that there were 5,516 deaths due to euthanasia in 2015. That is out of a total of around 147,000 – 148,000 deaths in the Netherlands that year.

This figure represents an increase of 4% of deaths due to euthanasia compared to 2014.

A 2012 paper published in The Lancet reported on the results of nationwide surveys on euthanasia in the Netherlands in 1995, 2001, 2005 and 2010. The researchers said:

In 2002, the euthanasia act came into effect in the Netherlands, which was followed by a slight decrease in the euthanasia frequency … In 2010, of all deaths in the Netherlands, 2.8% were the result of euthanasia. This rate is higher than the 1.7% in 2005, but comparable with those in 2001 and 1995.

Another Netherlands-based study published in the journal JAMA Internal Medicine reported in 2015 that:

Certainly, not all requests are granted; studies conducted between 1990 and 2011 report rates of granting requests between 32% and 45%.

A 2015 paper in the New England Journal of Medicine about euthanasia rates in the Flanders region of Belgium (the northern half of the country) noted:

The rate of euthanasia increased significantly between 2007 and 2013, from 1.9% to 4.6% of deaths.

Filling in the bigger picture

It can be hard to put these rates in context, but what is clear is that euthanasia is by no means a leading cause of death in countries where it is legal. For example, Statistics Belgium said that for the year 2012, cardiovascular disease was the most common cause of death (28.8%), and cancer was the second most common cause of death (26%).

And in the Netherlands – where 5,516 of deaths were due to euthanasia in 2015 – more than 12,000 Dutch people died from the effects of dementia in 2014, approximately 10,000 Dutch people died from lung cancer and nearly 9,000 died from a heart attack. In 2013, 30% (about 42,000) of Dutch deaths were from cancer and 27% (about 38,000) of Dutch deaths were from cardiovascular disease.


The ConversationIf this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 44.

Andrew McGee, Senior Lecturer, Faculty of Law, Queensland University of Technology

This article was originally published on The Conversation. Read the original article.

Why is it so hard for the wrongfully jailed to get justice?

Linda Asquith, Leeds Beckett University

Imagine for a moment you are wrongfully convicted of a crime. You get sent to prison, where you start to serve out your sentence – every minute of every day knowing you are innocent. Then the unthinkable happens and you are released. You are elated – this is the moment you’ve been waiting for.

But those feelings of elation and happiness quickly turn to fear and despair as you realise you have nowhere to go. Your old life as you knew it is gone, you have no way of supporting yourself, your relationships have broken down and you have nowhere to turn to for support.

Sadly, this is the reality many exonerees face when they are trying to put their lives back together. Many of these people – who have in some cases spent years behind bars – find upon release that their problems are only exacerbated. Wrongfully wrenched from their families, homes and communities, they struggle to reintegrate into society when they return.

And things seem to be made worse because unlike prisoners who have access to support to help them resettle when they are released from prison, those who suffer a miscarriage of justice do not get this.

“Rightfully convicted” individuals are provided with a plan for release from prison – often starting months in advance. This involves a range of activities, all of which are aimed at helping the person to resettle back into the community. But exonerees have none of these preparations – and often receive very little notice of their release.

Victor Nealon, for example, served 16 years in prison after he was falsely charged with rape. He received three hours’ notice of his release, and ended up in a bed and breakfast on his first night as a free man – he had nowhere else to go.

An unfamiliar world

The wrongfully convicted don’t receive any preparation for their release because of the way the prison system works. Prisoners have to show they are “tackling their offending behaviour” to gain parole. But if you haven’t committed the crime in the first place, this is not possible. The end result is that a person may spend longer in prison than if they had committed the offence and admitted it.

Upon release, the wrongfully convicted are thrust into a world they are unfamiliar with – and they have zero support or guidance. It’s common for exonerees to develop PTSD as a result of their wrongful conviction, alongside other mental and physical health problems requiring significant support.

This in part happens because as soon as the conviction is quashed, these people are no one’s responsibility. They are no longer a prisoner, or an ex-offender. There is no standard programme of support which is triggered at the point of release. And while probation would be well placed to support the wrongfully convicted, they cannot as they are not ex-offenders – ex-prisoners, yes, but not ex-offenders.

Say I’m innocent

There are only two specific organisations that provide support to exonerees. They are the Citizens Advice Bureau (CAB) based at the Royal Courts of Justice, and the Miscarriages of Justice Organisation (MOJO). This was founded by Paddy Hill – one of the six men wrongly convicted of the 1974 Birmingham pub bombings. He set it up in an attempt to provide the support to others that he was not given when released in 1991.

But both services are restricted by funding and staffing limitations, and while both organisations do superb work against a backdrop of austerity measures and extremely limited resources, both are at best a piecemeal response to what is, in reality, a government responsibility.

A recent BBC documentary called Fallout highlights these issues. The the director of the documentary Mark Mcloughlin has launched the “Say I’m Innocent” campaign, and is now fighting for all the services that are available to guilty prisoners on release to be made available to exonerees. The campaign is also calling for a public announcement of a person’s innocence upon their release. As well as other measure including a transition centre in both the UK and Ireland to allow them time and help to reintegrate into society.

The ConversationThis is important because the key issue here is responsibility. The state assumed responsibility for these individuals when they were wrongfully convicted. It is therefore only right that the state continues to take responsibility for them once exonerated.

Linda Asquith, Senior Lecturer in Criminology, Leeds Beckett University

This article was originally published on The Conversation. Read the original article.

Are energy efficiency programmes all they seem?

Ross Gillard, University of York and Carolyn Snell, University of York

The cost of energy in the UK is once again a hot topic. During the party conference season, Nicola Sturgeon, the first minister of Scotland, announced that the Scottish government will set up a publicly owned, not for profit energy company. Labour’s Jeremy Corbyn restated his wish to nationalise utility companies to “stop the public being ripped off”. And the Conservative prime minister Theresa May promised to fix the “broken” energy market, in part by imposing a cap on some domestic energy prices.

The UK government swiftly followed this season of rhetoric with two supporting policy announcements. It has drawn up draft legislation to set an energy price cap, although this may take until the winter of 2018/19 to be enacted. Second, it has published a clean growth strategy, which promises “cleaner air, lower energy bills, greater economic security and a natural environment protected and enhanced for the future”.

It’s not easy to address the social, environmental and economic dimensions of domestic energy in one go, as these different goals interact with each other. For example, a price cap clearly makes energy more affordable, but it doesn’t reduce the amount of energy needed or used. While the sheer price of energy is problematic for many people, so too is inefficient housing which increases bills and associated greenhouse gas emissions.

The clean growth strategy addresses this by reconfirming a commitment to require large energy companies to install efficiency measures such as insulation and heating systems. This scheme, the energy company obligation (ECO), now has £3.6 billion in funding through to 2028. It aims to help 2.5m fuel-poor households. Alongside stricter regulations within the private rented sector, the ECO is intended to upgrade all fuel-poor homes to a decent standard by 2030.

But it’s worth putting the rhetoric and promises of these policy announcements into context. Help for people in fuel poverty has decreased since 2010, largely due to the coalition government abandoning publicly funded schemes in England in favour of privately funded energy supplier obligations like ECO. Though social and environmental policies do add to fuel bills, policymakers assume that this increase is more than offset by people using less energy thanks to efficiency savings.

How much heat is escaping out of your windows?
Ivan Smuk / shutterstock

In our research we are currently looking at whether ECO is an effective way to address affordability and energy efficiency in vulnerable people’s homes. England is the only one of the four UK nations that relies solely on this market-driven scheme, so it’s important to evaluate its impact. We recently highlighted a number of potential problems, and solutions. To begin with, only certain people are eligible. Proxies such as welfare benefits, demographics and postcodes are used, but they can arbitrarily exclude households on the margins of these measures who may indeed be vulnerable.

People also struggle to upgrade their homes if the work does not enable a certain amount of carbon savings at a certain price. In other words, private companies are likely to prioritise meeting their statutory obligations rather than findings and helping the most vulnerable households. Even for those that do secure funding, it’s at best a long and complicated process. Some upgrades are never completed because installers are not equipped to manage the needs of people with, for example, disabilities or mental health conditions.

What is clear from our comparative research of the UK nations is that state funded schemes, such as nest in Wales and home energy efficiency programmes in Scotland, are better able to target, and respond to the needs of, vulnerable households. Market driven schemes are different as they will, by definition, seek out the most cost effective work. But this ceases to be an asset once the low-hanging fruit has all been picked, and those with the greatest need (and potentially higher costs) are left subsidising other people’s housing upgrades.

The ConversationAn energy price cap will certainly provide some initial relief. But unless it is continually ratcheted down or extended to more customers it will not provide long-term savings or wider benefits. Increasing investment in energy efficiency ticks more social and environmental boxes, but the regressive approach to funding such a scheme in England means it will continue prioritising cost-effective carbon savings over helping those most in need.

Ross Gillard, Research associate, University of York and Carolyn Snell, Senior Lecturer in Social Policy, University of York

This article was originally published on The Conversation. Read the original article.

Ivory is out in the UK, as government moves to shutter legal trade

Five books about Britain

I haven’t read the fifth one yet, but take for granted that it’s highly informative. The first one is pretty heavy reading, more suitable to browse and read when anything catches your eye about how the tea tradition came about for instance or that alcohol used to be seen as good sustenance for hard-working people. Do that often and you’ll learn a few things you didn’t know yet.

The other four are much easier reads.

The Making of the English Working Class (Penguin Modern Classics)

Rich Britain

The Making of Modern Britain

SHOPPED: The Shocking Power of British Supermarkets

A History of Modern Britain

Food bank row

This morning, the first news today’s papers informed me of was a row over food banks.

fruitApparently, someone – an aide to the current Secretary of State for Work and Pensions – threatened to have food banks shut down if they continued to raise awareness about their activities and about food poverty in the UK. This aide has the wrong idea.

Only a few years ago, in 2011, I noticed a major discrepancy in this area. The Trussell Trust – which runs the food banks in the UK – wasn’t accomplishing even 10% of what Dutch food banks were doing.

  • UK food banks handed out 40,000 parcels per year.
  • 900,000 per year were handed out by Dutch food banks.
  • The population of England & Wales on 27 March 2011 was 56,075,912. The population of Scotland on that day was 5,295,000.
  • On 1 January 2011, the population of the Netherlands was around 16,700,000 persons. That’s almost 45 million people less!

So, while British food banks were handing out 0.00065 parcel per person per year, Dutch food banks handed out 0.054 parcel per person per year. Or did my calculator trip me up badly?

cheeseAround 83 times more food parcels were being handed out in a tiny country with much greater equality and almost none of the appallingly deep poverty of the UK!

That is not the Trussell Trust’s fault.

While the number of food parcels handed out in the UK has gone up substantially since then, it still is nowhere near enough. The Trussell Trust gave emergency food to 913,138 people in the UK in 2013-2014. Presumably, that means ‘once’.

According to the Trussell Trust, 13,000,000 people in the UK live below the poverty threshold. (That’s what it also said three years ago.)

Addressing the UK’s persistent poverty problems would improve the lives of everyone here, not just the lives of the poor. When UK scientists Richard Wilkinson and Kate Pickett investigated the impact of inequality on society, they had to conclude that a higher degree of equality would lead to overall improvements for everyone, not just for the so-called vulnerable.

Conquering poverty would also benefit the nation’s budget, as the estimated cost of child poverty alone in the UK is £25 billion per year in terms of costs to business, the police, courts and health and education services.

Inhabitants of the Netherlands rank among the happiest people on the planet, year after year after year. Dutch children consider themselves very happy children, regardless of their socioeconomic background. The same cannot be said for British children.

At the end of 2010, UNICEF research into child inequality in 24 developed countries showed that income poverty has the greatest impact on child inequality in the UK. The UK ranks alongside countries such as Hungary, Slovakia and the Czech Republic. There is little inequality in the Netherlands, however, and the lives of children from the richest families differ little from the lives of the poorest Dutch children.

UNICEF UK commented that addressing income poverty is the crucial factor. ‘David Bull, Executive Director UNICEF UK said:

‘We must not lose sight of the importance of family income to eradicating child poverty in this country. We must ensure that no family with children has to live on an income which cannot provide the warmth, shelter and food they need.’

We need to hand out many more food parcels. There is no shame in handing out food, and none in accepting it either. The embarrassment is in not handing it out.