Autism and Intellectual Disabilities as Reasons for Euthanasia Raise Concerns in the Netherlands, Researchers Say

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According to recent research, a number of individuals in the Netherlands with autism and intellectual disabilities have undergone legal euthanasia in the past few years, claiming an inability to lead a normal life as their primary reason. However, these cases have sparked unease among some experts, who argue that they push the boundaries of the original intentions of the law.

In 2002, the Netherlands became the first country to permit doctors to fulfill patient requests for euthanasia under strict conditions, such as having an incurable illness that causes “unbearable” physical or mental suffering.

From 2012 to 2021, nearly 60,000 people were euthanized in the Netherlands at their own request, as reported by the Dutch government’s euthanasia review committee. To shed light on the application and interpretation of the rules, the committee released documents related to over 900 of these cases, primarily involving older individuals with conditions like cancer, Parkinson’s disease, and ALS.

In a study published in the journal BJPsych Open in May, Irene Tuffrey-Wijne, a palliative care specialist at Kingston University in Britain, and her colleagues examined these documents to understand how Dutch doctors handled euthanasia requests from individuals with autism or lifelong mental impairments.

Among the publicly available case files of the 900 individuals, 39 were identified as having autism and/or intellectual disabilities. While some were elderly, 18 were under 50 years old.

The patients cited various combinations of mental health issues, physical ailments, diseases, and challenges associated with aging as reasons for seeking euthanasia. Thirty of them mentioned loneliness as one of the causes of their unbearable suffering. Eight individuals attributed their suffering solely to factors related to their intellectual disability or autism, such as social isolation, a lack of coping strategies, or an inability to adapt their thinking.

“There is no doubt that these people were experiencing suffering,” said Tuffrey-Wijne. “However, we must question whether society is truly comfortable with the message being conveyed — that there is no other way to assist these individuals and that it is preferable for them to be dead.”

While other countries like Belgium, Canada, and Colombia also permit euthanasia, the Netherlands is the only one that openly shares detailed information about potentially controversial cases, offering valuable insights into emerging trends in assisted dying. However, the records are limited to what doctors disclose, potentially omitting other factors or cases where the patient’s autism or intellectual disabilities were not documented.

Given the selectiveness of the committee’s released records, the actual number of people with autism or intellectual disabilities who died by euthanasia at their own request remains unknown.

The researchers highlighted eight patients, including a man in his 20s with autism. According to his record, he had been unhappy since childhood, faced regular bullying, and longed for social connections but was unable to establish them. The man, who remained unnamed, chose euthanasia after concluding that living in his current state for several more years would be unbearable.

The case files also documented the story of an autistic woman in her 30s who also had borderline personality disorder. Although she was offered a place in a supported living center, her doctors determined that she was unable to maintain relationships and found interacting with others too challenging.

The researchers noted that in one-third of the cases, Dutch doctors considered autism and intellectual disabilities as untreatable, with no prospects for improvement.

Simon Baron-Cohen, director of Cambridge University’s Autism Research Centre, expressed his concern about autistic individuals being euthanized without being offered additional support. He pointed out that many autistic people battle depression, which could impair their ability to make a lawful request to die. He also emphasized that an autistic person asking for euthanasia might not fully grasp the complexity of the situation.

Dutch psychiatrist Dr. Bram Sizoo expressed his unease regarding young people with autism perceiving euthanasia as a viable solution. He shared that some of them even appeared excited about the prospect of death, believing it would put an end to their problems and their family’s difficulties.

The Royal Dutch Medical Association stated that it is the responsibility of doctors to determine if someone meets the criteria for euthanasia. They acknowledged that many cases involving patients with autism are highly complex and that age alone is not the decisive factor in determining whether a person is experiencing unbearable suffering.

Kasper Raus, an ethicist and public health professor at Ghent University in Belgium, observed a shift in the kinds of people seeking euthanasia in both the Netherlands and Belgium over the past two decades. Initially, when euthanasia was legalized, the focus was on individuals with cancer, not those with autism.

Tim Stainton, director of the Canadian Institute for Inclusion and Citizenship at the University of British Columbia, raised concerns about whether a similar trend could be happening in Canada, which has arguably the world’s most permissive euthanasia laws but lacks comprehensive records like those in the Netherlands.

Stainton remarked, “Helping people with autism and intellectual disabilities to die is essentially eugenics.”

Note: This text has been rewritten to ensure clarity and coherence while conveying the information accurately.

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More about euthanasia controversy

• The Guardian: Dutch doctors euthanised patients with autism, intellectual disabilities
• BBC News: Euthanasia and autism: ‘I am not a disease to be cured’
• ScienceDaily: People with autism, intellectual disabilities at risk for euthanasia in Netherlands