“In the Netherlands, people wear different bracelets if they are elderly. And the bracelet is: ‘Do not euthanize me.’ Because they have voluntary euthanasia in the Netherlands but half of the people who are euthanized — ten percent of all deaths in the Netherlands — half of those people are enthanized 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, they will not come out of that hospital if they go in there with sickness.”

— Former senator Rick Santorum, at the American Heartland Forum in Columbia, Missouri, Feb. 3, 2012

These were interesting remarks by one of the leading candidates for the GOP nomination. Though Santorum made this observation earlier in the month, a video of his comments only circulated on the web over the weekend and a number of readers asked whether he is correct. (His comments also spawned headlines in Holland, such as one that proclaimed: “Rick Santorum Thinks He Knows the Netherlands: Murder of the Elderly on a Grand Scale.”)

So we will check his statistics — 10 percent of all deaths in the Netherlands are from euthanasia and 50 percent of those die involuntarily — and also his claim that the elderly wear bracelets requesting that they not be euthanized.

(Full disclosure: The Fact Checker’s parents emigrated from Holland and I have direct, personal experience with the practice of euthanasia there. My father’s brother requested euthanasia when he was diagnosed with a terminal disease and after various remedies were ineffective. In the United States, he might have lived another two or three months, in great pain, and likely would have lapsed into a coma before death. But, after a conclusion by the Dutch medical establishment that he had no chance of survival, he arranged for his death at home with his family at his side. He even called me an hour before his death to say good-bye.)

We realize this is an emotional issue in the United States. But the simple facts, as Santorum described them, should be clear.

The Facts

In 2001, The Netherlands became the first country to legalize euthanasia, setting forth a complex process. The law, which went into effect a year later, codified a practice that has been unofficially tolerated for many years.

Under the Dutch law, a doctor must diagnose the illness as incurable and the patient must have full control of his or her mental faculties. The patient must voluntarily and repeatedly request the procedure, and another doctor must provide a written opinion agreeing with the diagnosis. After the death, a commission made up of a doctor, a jurist and an ethical expert also are required to verify that the requirements for euthanasia have been met.

Late last year, in the first such case, a 64-year-old woman with advanced Alzheimer’s disease was euthanized, on the strength of her insisting for years that she wanted the procedure to be done.

Nevertheless, the statistics show it is still a relatively uncommon form of death. In 2010, the number of euthanasia cases reported to one of five special commissions was 3,136, according to their annual report. This was a 19 percent increase over 2009, but “this amounts to 2.3 percent of all 136,058 deaths in the Netherlands in 2010,” said Carla Bundy, spokeswoman for the Dutch embassy in Washington.

At the time of the annual report, the commissions had been able to reach conclusions in 2,667 euthanasia notifications reported to the agency and found only nine in which “the physician had not acted in accordance with the due care criteria,” the annual report said. More than 80 percent of the patients were suffering from cancer; almost 80 percent died at home.

A 2005 study by the New England Journal of Medicine found only a minimal number of the cases — 0.4 percent — in which there was an ending of life without explicit request by the patient. The study concluded the rate had actually been cut in half since the euthanasia law was passed.

These statistics were so at odds with Santorum’s claims that we wondered how he could have thought that 50 percent of the elderly were put to death involuntarily (or that 10 percent of all deaths in Holland were from euthanasia.) Spokesmen for Santorum did not respond to a query, but the best we can tell, he is grossly misinterpreting the results of a 1991 survey known as the Remmelink Report, which was influential in crafting the 2001 law.

The Remmelink Report found that 0.8 percent of the deaths at the time were done without the explicit request of the patient; in 59 percent of the cases, the physician had some information about the patient’s wish. “Life was shortened by between some hours and a week at most in 86 percent,” a summary of the report said. “In 83 percent the decision has been discussed with relatives and in 70 percent with a colleague. In nearly all cases, according to the physician, the patient was suffering unbearably, there was no chance of improvement, and palliative possibilities were exhausted.”

And what about those “Do Not Euthanize me” bracelets?

This also appears to be a strange misinterpretation of life in the Netherlands. We did find that a Web site known as Right Wing News last year published an article which asserted that “over 10,000 [Dutch] citizens carry ‘Do Not Euthanize Me’ cards in case they are ever admitted to a hospital unexpectedly.” The source was the Louisiana Right To Life Federation, which in turn cited no specific source except possibly the Nightingale Alliance, which opposes euthanasia. But this group does not appear to have published any actual figures.

In a letter to the British Medical Journal last year, a Dutch euthanasia specialist wrote that such cards do not exist. “What does exist is a living will (the levenswensverklaring), which is distributed by the Christian Dutch Patient Association,” in which people can “state that active life termination is not an acceptable option.” He wrote that it is unclear how many people completed such a living will.

“According to the Ministry of Health, ‘Do not euthanize me’ bracelets do not exist in the Netherlands,” said Bundy of the Dutch embassy. “In the Netherlands, there are indeed living wills, which are documents in which members can state their wishes regarding euthanasia.”

The Pinocchio Test

There appears to be not a shred of evidence to back up Santorum’s claims about euthanasia in the Netherlands. It is telling that his campaign did not even bother to defend his comments.

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