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Rick Santorum comments on euthanasia in the Netherlands cause stir in Dutch media

Comments that Rick Santorum made about euthanasia in the Netherlands have caused a stir in the Dutch media – largely because the figures Santorum used appear to be either exaggerated or outdated and other allegations he makes about the practice are not backed by evidence.

Earlier this month, Santorum brought up the subject at the American Heartland Forum with conservative leader James Dobson. “They have voluntary euthanasia in the Netherlands, but half the people who are euthanized every year, and it’s 10 percent of all deaths, half of those people are euthanized involuntarily in hospitals, because they are older and sick,” Santorum said. “So elderly people in the Netherlands don’t go to the hospital. They go to another country. Because they’re afraid because of budget purposes they will not come out of that hospital if they go in with sickness.” He said the Dutch wear bracelets saying “Don’t euthanize me.”

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Since then, Dutch news sources have picked up the story – and reacted with outrage. “Rick Santorum Thinks He Knows the Netherlands: Murder of the Elderly on a Grand Scale,” read a headline in the daily newspaper NRC Handelsblad.

A story in Buzz Feed reported that the Dutch media has described Santorum’s claims as “fact-free” and “imaginative” with a “surreal view” of the Netherlands.

The Santorum campaign did not respond to a request for documentation of Santorum’s claims. But independent sources show the number of euthanasia cases appear to be much lower than Santorum suggested.

Euthanasia and physician-assisted suicide became legal in the Netherlands in 2002, in cases of “unbearable suffering.” (Euthanasia means a doctor gives a patient a life-ending medicine; physician-assisted suicide means a patient takes the medication himself.)

The New England Journal of Medicine published an article in 2007 studying the impact of the new law. It found that in 2005, 1.7 percent of all deaths in the Netherlands were by euthanasia, and 0.1 percent were by physician-assisted suicide. Of all deaths, 0.4 percent were the result of the ending of a life without an explicit request by the patient. (In most of those cases, the decision was made after talking to family members and/or medical colleagues.)

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The study found that the new law actually led to a slight decrease in the number of euthanasia deaths – which had accounted for 2.6 percent of all deaths in 2001. In 2001, 0.7 percent of all deaths were from euthanasia done without an explicit request from the patient.

One Dutch news site cited statistics showing that around 2.3 percent of deaths in 2010 were by euthanasia. By law, doctors must report all euthanasia deaths to a review committee.

The patients who die by euthanasia are not all elderly. A report by the national doctors association, the KNMG, found in 2005 that 38 percent of those euthanized were under age 65. (The vast majority of patients requesting euthanasia were cancer patients.)

Most likely, Santorum’s data came from a summary of a 1991 government report referred to as the Remmelink report. That report found that in 1990, 9.1 percent of deaths in Holland were caused intentionally by doctors, according to a widely-distributed summary by the Patients Rights Council, an Ohio-based organization that opposes euthanasia. (That figure includes voluntary and involuntary euthanasia, physician-assisted suicide, and intentional overdoses of pain medication.) Of those, the majority were involuntary, meaning they were done without the patient’s knowledge or consent. But other medical studies from 1990 found that euthanasia accounted for around 2 percent of deaths in Holland.

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Rita Marker, attorney and executive director of the Patients Rights Council, said it is impossible to know the exact number of euthanasia deaths in the Netherlands, since a “significant number” of deaths are not reported. Particularly if a doctor does not follow the guidelines laid out by Dutch law, they are less likely to report the death. Additionally, some studies quantifying euthanasia include only voluntary euthanasia in their numbers. Despite that, Marker said, “I think [Santorum’s] figures are not accurate.”

Marker said there have been reports of patients – particularly those with dementia – who have been euthanized without requesting it. “There’s reason for patients and their families to be concerned,” Marker said. But Marker said she was not aware of patients going to hospitals outside the Netherlands out of fear of euthanasia. (Two nearby countries, Belgium and Luxembourg, have similar laws.)

There is no evidence that the bracelets Santorum cited actually exist.

Now that Santorum is rising in the polls, his current and past statements are receiving more scrutiny. The Drudge report dug up a Santorum speech that he gave in 2008 at the Ave Maria University in Florida when he declared that “Satan has his sights on the United States of America” and Satan is “attacking” American institutions “using those great vices of pride, vanity, and sensuality.” He also said mainline Protestantism in America “is gone from the world of Christianity as I see it.”

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Shira Schoenberg can be reached at sschoenberg@globe.com. Follow her on Twitter @shiraschoenberg.