LONDON – Several people with autism and intellectual disabilities have been legally euthanized in the Netherlands in recent years because they said they could not live a normal life, researchers have found.
The cases included five people under the age of 30 who cited autism as either the sole reason or a major factor in euthanasia. This set a worrying precedent that some experts say goes beyond what the law originally intended.
In 2002, the Netherlands became the first country to allow doctors to kill patients if they met strict conditions, including having an incurable disease causing “intolerable” physical or mental suffering.
According to the Dutch government’s Euthanasia Review Board, nearly 60,000 people were killed of their own accord between 2012 and 2021. To show how the rules are applied and interpreted, the committee released documents on more than 900 of these people, most of whom were elderly and had diseases such as cancer, Parkinson’s and ALS.
Irene Tuffrey-Wijne, a palliative care specialist at Britain’s Kingston University, and her colleagues reviewed the documents to find out how Dutch doctors dealt with euthanasia requests from people with autism or lifelong intellectual disabilities. She published their findings in the BJPsych Open magazine in May.
Of the 900 people with publicly released case files, 39 were autistic and/or mentally disabled. A handful were elderly, but 18 of them were younger than 50.
Many of the patients cited different combinations of mental health problems, physical ailments, illnesses, or age-related difficulties as reasons for seeking euthanasia. For 30 of them, loneliness was one of the causes of their unbearable pain. Eight said the only causes of their condition were factors related to their intellectual disability or autism—social isolation, lack of coping skills, or an inability to adjust their thinking.
“I have no doubt that these people suffered,” said Tuffrey-Wijne. “But is society really okay with sending the message that there’s no other way to help them and that it’s just better to be dead?”
Other countries including BelgiumLegal euthanasia exists in Canada and Colombia, but the Netherlands is the only one that shares detailed information about it potentially controversial deaths, Provides the best insight into emerging trends in euthanasia. Nevertheless, the records are limited to what doctors disclose. So there could be other factors that were not disclosed, or cases where the patient’s autism or intellectual disability was not noted.
Also, because the committee publishes only select records, it is impossible to determine the true number of people with autism or intellectual disabilities who have been killed of their own volition.
Among the eight patients named by the researchers was an autistic man in his 20s. His file states: “The patient had felt unhappy since childhood, was regularly bullied and craved social contact, but was unable to socialize.” The man, whose name was not given, made up his mind for euthanasia after deciding that “it was an abomination to have to live like this for years”.
The records also included an autistic woman in her 30s who also had borderline personality disorder. She was offered a place in an assisted living center but her doctors said she couldn’t maintain relationships and felt it was “too difficult” to connect with others.
In a third of the cases, Dutch doctors concluded that autism and intellectual disability were untreatable and that “there was no prospect of improvement,” the researchers wrote.
Simon Baron-Cohen, director of the University of Cambridge’s Autism Research Centre, said it was “abhorrent” that people with autism were being euthanized without being offered further support.
He noted that many autistic people struggle with depression, which may affect their ability to legitimately submit a death request. He also said that an autistic person who begs for death may not grasp the complexity of the situation.
dr Bram Sizoo, a Dutch psychiatrist, was concerned that young people with autism were seeing euthanasia as a viable solution.
“Some of them are almost excited at the prospect of death,” Sizoo said. “They believe this will be the end of their problems and the problems of their family.”
A representative of the Royal Dutch Medical Association said it is up to doctors to decide whether someone meets the criteria for euthanasia. The group said that many cases of patients with autism are “very complex” and that “age itself is not a determining factor in whether a person is suffering unbearably.”
Kasper Raus, an ethicist and professor of public health at Belgium’s Ghent University, said the nature of people seeking euthanasia has changed over the past two decades in both the Netherlands and Belgium. When euthanasia was legalized, he said the debate was about people with cancer, not people with autism.
Tim Stainton, director of the Canadian Institute for Inclusion and Citizenship at the University of British Columbia, wonders if the same is happening in Canada, where it may be The most permissive euthanasia laws in the world and that doesn’t keep the kind of records that the Netherlands keep.
“Helping people with autism and intellectual disability to die is essentially eugenics,” Stainton said.
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