Chapter XIX: Crypthanasia

By Fenigsen, Richard; Fenigsen, Ryszard | Issues in Law & Medicine, Fall 2012 | Go to article overview

Chapter XIX: Crypthanasia

Fenigsen, Richard, Fenigsen, Ryszard, Issues in Law & Medicine

I use the term crypthanasia (from Greek kryptos, secret, hidden, and Thanatos, The Death) to denote covert medical killings of unsuspecting patients. (164)

Excerpts From Dutch Publications on Crypthanasia. The reality of crypthanasia is illustrated by the following.

* "'Mother is bedridden, has to be helped with everything, she is unclean, does not recognize people any more.' ... The small group enters the patient's room. The physician administers the lethal injection." Jan Hendrik van den Berg, Medical Power and Medical Ethics, 1969. (165)

* "I think that when a human being ... gets into such condition that he no more can live in real social communication with others, (his) remaining life ... can no more claim a right to be protected ... In this respect there is no reason to make a distinction between the demented elderly, ... the victims of road accidents, ... and children with Thalidomide-induced limb malformations." J. Ekelmans, The Mature Mortal, 1971. (166)

* "Involuntary active euthanasia.... It is a public secret that this form of euthanasia does occur.... [W]e should summon up enough courage to look closely at (it), and try to show understanding." Sometimes Death Comes Too Late: A Pamphlet of the Foundation for Voluntary Euthanasia, 1975. (167)

* "[In] those smarting cases in which one can suppose that were the patient able to express his will he would choose euthanasia, ... rights of decisions must be adjudged to other persons." The Board of the Royal Dutch Society of Medicine, Answer to the Questions of the State Committee on Euthanasia, 1984. (167)

* "This patient ... never said 'put an end to it,' only 'relieve my pain.' ... We tried everything .... And he simply did not die, whatever we did. Finally a huge dose of potassium was injected, he lapsed into a cardiac arrest and that was the end of him." Internist interviewed by Henri W. H. Hilhorst, Euthanasia in the Hospital, 1983. (169)

* "I had a young patient who terribly clung to life.... He didn't even want to discuss his own bad situation. He had the kind of lung cancer that is inoperable, when it is diagnosed it already had spread. Chemotherapy gives fair results, so it also was with this patient.... And then suddenly I said: now it becomes too crazy, I cannot go on like that.... Now give me active euthanasia! I gave him an I.V. with such drugs that he died." Chest physician interviewed by Hilhorst, 1983. (170)

* "How euthanasia used to be carried out? Stealthily, in deep secret, but always out of love to mankind." Physician interviewed by Hilhorst, 1983. (171)

* "I do recognize the difference between termination of life upon request and without request of the patient. But from the point of view of a doctor, from moral point of view, these are two actions of almost the same kind." Dutch Secretary of Health, Mr. H. J. Simons, 1993. (172)

The Public Awareness of Crypthanasia. For years crypthanasia remained a public secret, just as the pamphlet Euthanasia asserted. Almost everybody knew this was happening, but there was no proof, no established facts, very little in writing.

In 1972, Holland's largest illustrated weekly published the statement of Dr. Karel E Gunning who had returned from North Africa and was indignant about practices he had encountered in some Dutch hospitals: when the general practitioners phoned specialists in the evening, asking them to admit seriously ill older patients, sometimes they were advised not to send the patients in, but to kill them with an intravenous injection. (173)

Then in 1983, the sociologist Henri W. H. Hilhorst published the book Euthanasia in the Hospital, (174) based on his study, sponsored by the Royal Dutch Academy of Science and the University of Utrecht, and conducted in eight hospitals. He found not only voluntary euthanasia, but also secret involuntary euthanasia of children and adults practiced in these situations. (175) The book contained interviews with doctors who had performed active euthanasia without the patients' request, consent, or knowledge.

Alarmed by Hilhorst's findings, the Dutch Patients' Association (N.P.V.), warned patients and their families that "in many hospitals" people were put to death against their will, without their knowledge, and without the knowledge of their families. (176) The N.P.V. advised patients and their families to monitor the doctor's actions as closely as possible. Unfortunately, the real possibilities of doing so are negligible.

To protect patients from involuntary euthanasia in case of admission to hospital, the N.V.P, together with the Sanctuary Foundation (Stichting Schuilplaats), printed a Declaration of the Will to Live. "This card, which anyone can carry on his person, states that the signer does not wish euthanasia performed on him." (177)

In the spring of 1985 it came to people's attention that in the De Terp nursing home in The Hague twenty residents had died entirely unexpectedly in a short period of time. (178) An inquiry was launched, and doctor B. who worked at De Terp was apprehended. He admitted having put an end to the lives of five people without their consent or knowledge. (179)

In 1987 it was discovered that three nurses working at the intensive car unit of the Free University Hospital in Amsterdam secretly killed several unconscious patients. (180) They said they could no longer endure the sight of those unfortunate human beings.

These reports were followed by the estimates of Dessaur, (181) Gunning, (182) Dessaur and Rutenfrans, (183) and Van der Sluis (184) that more people in the Netherlands were dying by involuntary than by voluntary euthanasia. There was also a series of six cases reported by Innemee (185) and my report (186) on involuntary active euthanasia in one of the hospitals in Rotterdam.

The VARA/Interview study published in 1990 revealed that--according to patients' families--the decisions to terminate patients' lives were often taken without their consent or knowledge. (187) The Royal Dutch Society of Medicine expressed concern in connection with these findings but the Dutch Society for Voluntary Euthanasia dismissed the problem by declaring that euthanasia was by definition voluntary. Whatever was done without the patients' request could not be euthanasia; such acts were, therefore, beyond the scope of debate. (188)

It would be an easy way to make the world a better place if all evil could be eliminated by adopting definitions. The real question is whether patients are killed without their request. They are. In a study done by the Medico-Legal Group of the Limburg University in Maastricht, the questionnaire circulated among 299 doctors contained, among others, the question whether they had performed euthanasia without the patient's request. One hundred twenty-three doctors answered this question in the affirmative; seven doctors performed involuntary euthanasia on more than fifteen patients each. (189)

Public Opinion on Crypthanasia. Whenever cases of crypthanasia were revealed, attempts were made to dismiss them as "abuses" that had nothing in common with the regular practice of voluntary euthanasia--as exceptional, sporadic, and criminal acts. (190) However, the problem could not be discarded in this way. Neither could it be claimed that the covert medical killings were perpetrated by some outcasts whose actions were contrary to the public mood. The reverse was true. Two consecutive polls conducted by NIPO Institute showed that while 76 percent of the Dutch public approved voluntary euthanasia, 77 percent supported active involuntary euthanasia: 33 percent of the respondents showed "considerable sympathy" and another 44 percent "some sympathy" for those who out of mercy kill their own father or mother without his or her consent. Forty-three percent approved of involuntary active euthanasia for unconscious persons 'with little chance of recovery," while 27 percent were certain or thought that they probably would request involuntary active euthanasia for a demented relative. (191) Ninety percent of the polled undergraduate students of economics supported compulsory euthanasia of unspecified groups of people to streamline the economy. (192)

The perpetrators of covert medical killings enjoyed broad public and institutional support, and total judicial leniency. The doctor who admitted having killed a number of inhabitants of the De Terp nursing home in The Hague, and was convicted of several murders, received public declarations of support from, among others, the president of the Dutch Society for Voluntary Euthanasia, the vice-president of the Royal Dutch Society of Medicine, and from a former attorney general at the Supreme Court. (193) A Citizens' Committee of Support for the De Terp doctor was founded in Amsterdam.194 In an official statement, the Board of Royal Society of Medicine declared itself alarmed, however, not by the killings, but by the conviction of the doctor, which could cause feelings of insecurity among physicians who helped their patients to die. (195) Finally, a court of appeals dismissed the accused doctor's guilty plea and declared him "not guilty" on a technicality, (196) while a civil court awarded him 300,000 guilders ($150,000 U.S.) in damages. (197)

The four nurses at the neurosurgical intensive care unit of the Free University Hospital in Amsterdam, who admitted having secretly killed several unconscious patients, received support from the hospital's Employees' Council which demanded their immediate release and reinstatement.19s While releasing the nurses from custody, the Amsterdam court held that their actions had been prompted by humane considerations. The victims' parents who only after the arrests of the nurses learned how their sons and daughters had died, thanked the nurses at an emotionally charged, televised ceremony. Thus, crypthanasia is not an "abuse" of the practice of the voluntary euthanasia; it is widely accepted, openly supported, and praised as a charitable deed.

Among repeated warnings by critics of euthanasia, and loud denials from the pro-euthanasia establishment, the country and the international community waited for a definitive statement.

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Chapter XIX: Crypthanasia


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