Huffpost Politics

Rick Santorum Claims About Euthanasia In The Netherlands Are Way Off Base: Fact Check

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The Following post first appeared on FactCheck.org.

Rick Santorum grossly mischaracterized euthanasia practices in the Netherlands during an appearance at a faith conference. He overstated the rate of euthanasia and falsely claimed that the elderly are being killed against their will and wear "do not euthanize me" bracelets:

  • Santorum claimed legal euthanasia is responsible for "10 percent of all deaths for the Netherlands." Government statistics show euthanasia is climbing, but represented only 2.3 percent in 2010, according to the most recent data.
  • Santorum added that half of the people euthanized were killed "involuntarily." A representative of the Royal Dutch Medical Association said "there are no forced cases of euthanasia." Dutch euthanasia review boards found nine cases in 2010 where doctors "had not acted in accordance with the due care criteria," mostly for how the procedure was performed -- not because it was against anyone's will.
  • Santorum claimed the Dutch elderly wear bracelets that say "do not euthanize me," but the Dutch government and medical association say no such bracelets exists. Santorum "might be confused with a 'do not resuscitate' bracelet or necklace" worn by some patients, a medical association representative said.

Santorum discussed euthanasia in the Netherlands during a Feb. 3 forum at the Grace Bible Church in Columbia, Mo. Dr. James C. Dobson, who has endorsed Santorum, moderated the discussion. Dobson is the founder of Focus on the Family, a Christian organization.


The former Pennsylvania senator described the current situation in the Netherlands with alarm:

Santorum, Feb. 3: In the Netherlands people wear a different bracelet if you're elderly and the bracelet is 'do not euthanize me.' Because they have voluntary euthanasia in the Netherlands, but half the people who are euthanized every year, and it's 10 percent of all deaths for the Netherlands, half of those people are euthanized involuntarily at hospitals because they are older and sick. And so elderly people in the Netherlands don't go to the hospital, they go to another country, because they are afraid, because of budget purposes, that they will not come out of that hospital if they go in with sickness.

These comments "prompted a furious backlash" in the Netherlands, the International Business Times reported. And for good reason.

First, let's review the law. The 2001 Termination of Life on Request and Assisted Suicide (Review Procedures) Act allows Dutch citizens to end their lives if they are suffering from a medical condition that causes "unbearable suffering with no prospect of improvement." There are two end-of-life procedures: euthanasia, where a doctor administers a fatal drug, or assisted suicide, where the doctor prescribes the fatal drug and the patient administers it. The law took effect on April 1, 2002.

According to a publication distributed by the Netherlands Ministry of Foreign Affairs, doctors must be satisfied that the patient's request is "voluntary and well-considered," and that there is "unbearable suffering with no prospect for improvement." The patient's doctor must consult at least one other independent doctor, who is responsible for ensuring the "due care criteria" is met.

After the termination of a patient's life, the death must be reported to the government and reviewed by regional committees composed of, at a minimum, a doctor, ethicist and legal expert.

Now, let's look at Santorum's three claims. We'll begin with a stunning claim that the elderly are so afraid of being euthanized for "budget purposes" that they wear "do not euthanize me" bracelets. We were told by a government official and a representative of a Dutch physicians' association that this is simply not true.

When we contacted the Ministry of Health, Welfare and Sport, public health spokeswoman Inge Freriksen told us that "a bracelet asking not to be euthanized doesn't exist." Patients would only be euthanized after they followed the set of guidelines as outlined above.

Gert van Dijk of the Royal Dutch Medical Association told us the same thing.

"There are no bracelets for people who don't want to be euthanized. Mr. Santorum might be confused with a 'do not resuscitate' bracelet or necklace," van Dijk told us in an email. (That may be, but we don't know. The Santorum campaign did not get back to us.)

The government recognizes a DNR medallion, which includes the name, date of birth, signature and photograph of the bearer, as fulfilling "all the statutory requirements for a written directive," a government website says.

"These are sometimes worn by people who do not want to be resuscitated when they for instance have a heart attack in the street. Surely you must have these in the U.S. as well?" van Dijk said. "Recently, there is one hospital which is experimenting with this type of DNR bracelet for patients who do not want to be resuscitated whilst they are in the hospital. So people are not afraid of euthanasia, they are sometimes afraid of being resuscitated against their will."

Santorum's statistics aren't close to being true, either.

His claim that euthanasia accounts for 10 percent of all deaths in the Netherlands brought an audible gasp from some in the audience. But that's more than four times the actual rate.

In 2010, there were 3,136 cases of euthanasia, assisted suicide or a combination of both, according to the 2010 annual report by the Regional Euthanasia Review Committees. That's 2.3 percent of the 136,058 total deaths in the Netherlands in 2010, government statistics show.

The 3,136 euthanasia cases represented a 19 percent jump from the previous year and the first time that the rate has exceeded 2 percent since the law took effect. "The cause of this continuing increase in the number of [right-to-death] notifications from year to year is not known," the report said.

Van Dijk, of the medical association, emailed us a chart that showed the rate had been below 2 percent for the first eight years that the law had been in place. It was 1.32 percent in 2002. But by 2009, 2,636 people, or 1.96 percent of all deaths, chose to terminate their lives, the medical association's data show. That was a record high -- until 2010.

Still, Santorum was way off base in claiming it was 10 percent of all deaths.

Even further off the mark is Santorum's claim that "half the people who are euthanized every year ... are euthanized involuntarily." According to the regional review board's 2010 annual report, only nine doctors "were found not to have acted in accordance with the criteria." In five of those cases, it was the way in which euthanasia or assisted suicide was performed that caused concern -- not whether the patient had properly consented. The report also says that 81 percent of the Dutch who decided to end their lives in 2010 were suffering from cancer.

"There are no forced cases of euthanasia," van Dijk said. "Euthanasia can only be performed when there is a voluntary request from the patient and the patient is suffering unbearably. An independent physician has to check this beforehand, and an independent commission checks afterwards. There are very stringent criteria in place."

As in other countries, doctors who kill patients against their will are criminally prosecuted.

We take no position on euthanasia in the Netherlands or anywhere else. But the facts are clear: Santorum grossly misrepresented the practice of euthanasia in the Netherlands when making his case against it."

- Michael Morse and Eugene Kiely

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