Euthanasia in the Netherlands is Helping People Who Want to Die, Dr. Rob Jonquière Ep. 13

A Life & Death Conversation with Dr. Bob Uslander

Dr. Rob Jonquière is the Executive Director of the International Federation for Right to Die Societies. He shares how euthanasia is helping people who want to die in the Netherlands. Now, assisted suicide is also legal. Hear how this is impacting the country. Contact World Federation of Right To Die Societies website San Diego Hemlock Society website Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text. We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print. Transcript Dr. Bob: Welcome to another episode of Life and Death Conversation. I'm Dr. Bob Uslander, and I'm here today with a guest who I'm anxious to hear from. He's got a rich experience in caring for people at the end of life, and he's really on the forefront of the movement to assist people in having a more peaceful and dignified end of life worldwide. So, welcome Dr. Rob. Jonquière. Thank you for joining me today. Dr. Rob Jonquière: Good evening, yes. Dr. Bob: Yes. It is evening. For me, it's morning, for you it's evening. Dr. Rob Jonquiere: Sorry. Dr. Bob: Can you tell us where you're calling, where we're talking from? DrRob Jonquière: Amsterdam, in the Netherlands. It's evening here at this moment. Dr. Bob: Very nice, and you were just mentioning to me that you're in the midst of winter, but you're having some- Dr. Rob Jonquière: It's not a real winter, unfortunately. It's too hot. They are expecting a little bit colder next week, of course, in my youth, I used to go skating outside, and it is a long time since we have been able to do that, so probably the climate change, I'm afraid. Dr. Bob: Well, as you know, I'm in sunny San Diego right now, having grown up in the Midwest in Chicago, I had my fair share of snowy, cold winters, so I'm feeling fairly blessed knowing what's happening in the Midwest and the East Coast right now. Well, again, thanks for taking time. We met not long ago, a month or two ago, when you were here in San Diego at a conference, and I got to a chance to hear a bit about your background and what you're involved with, and I think we are kind of birds of a feather. We seem to share a belief system and philosophy about how people should be cared for and supported at the end of life. You live in a very progressive country, with respect to this, and you've been a pioneer for many years, so I'd love for you to share a bit about what you're doing and kind of give us a sense of how you came to be in this position. What was the path that brought you here? Dr. Rob Jonquière: Yeah. Well, actually, at this moment, I'm involved in the international movement as it is called, the Federation for Right to Die Societies, which is an international federation of 52 societies, like the Hemlock Society of San Diego is one of the members, and I am the executive director of that federation, which implies actually looking after the website of the federation and assisting the committee or the board of the Board of Directors of the federation, and I came there after I was retired. I had been retired from my work at the Dutch Right to Die Society, NVVE as the name is, and in my retirement, I'm not used to sitting still, doing nothing, and I'm very interested in the whole movement, not only in the Netherlands but also worldwide. When I was working at the NVVE, I was started work there about five days after the health minister brought her bill, an euthanasia bill in the Parliament, so I have been involved in all the debates actually right from the beginning in the parliamentary debates, and as Chief Executive Officer of the NVVE, I've been for eight, nine years involved in the practical situation after the bill was approved in the Parliament, and now we have our official euthanasia law since 2002, and having a law is not the end of ... Well, it is the end of a process, but it's the beginning of a new process, to get people to accustomed to the fact that we have a law where it is legal for a doctor to assist in euthanasia, and aid in dying as it is called today, and we have to see the patients get what they want and that the law is used as it should be. And, of course, it's interesting how I became to be the executive officer because my original profession is a family medicine, so I have been working as a family doctor in the eastern part of the country, and I know from the beginning, I always have been very interested in ... Well, let's say, not the patient with colds, or a little complaints or things like that, but especially the situations in which patients needed guidance, whatever they need guidance in, so I have been delivering babies on the one side of the life, and I also became involved in the end of life guidance, where automatically, in that period, first careful questions came from patients especially patients working in the healthcare field, about my position regarding euthanasia as it was known, but as it was illegal at that moment. And, of course, I had never got training on what euthanasia was, how you do it, or what kind of medication you use, so it's using your experience and trying to sort of help people die in a peaceful and dignified way, and of course having been given this kind of help, I have never reported it, because if I had reported it, I would have been persecuted and probably get before the courts, and I didn't want to do that- Dr. Bob: Of course not. Dr. Rob Jonquière: No, and my patients didn't want to have me in front of courts. They asked me to help. They said not if you're getting trouble, and of course, in the situations I'm talking about, it has been patients with terminal cancer situations, who actually were really at the end of their lives, suffering from their cancer situations, although we have been treating with all kinds of care and medication and help we could. Dr. Bob: So, I want to touch on that, I want to clarify a bit for anybody who would like that, this was occurring when you were a practicing family doctor. Dr. Rob Jonquière: Yes, the '70s, '80s. Dr. Bob: Okay, and you were doing the whole full spectrum of caring for people from birth to death, and you recognized that there were people who were suffering, and you obviously philosophically felt comfortable with providing that support, even though it was not legal. So, first of all, the statute of limitations, I'm assuming the statute of limitations, for that type of activity, is past so that you can speak freely about it- Dr. Rob Jonquière: Yes. Dr. Bob: About your experiences back then. Dr. Rob Jonquière: Well, I can, and I mean, even you can say that is kind of a Dutch culture. I mean, at that moment, I could not go to the authorities and say, listen, I've terminated a life of a patient because she was suffering terribly, so I just said, in my records, that she died because of her cancer, which was actually the case. I only speed up the dying process a little bit. Dr. Bob: Which is the same as the aid of dying laws here in the United States, where the patients are dying. Anyone who is eligible for physician aid in dying is dying. Dr. Rob Jonquière: Certainly. That is now, and of course, in the Netherlands, it is now absolutely normal practice in terminal cancer situations. People are in such a situation, and don't want to go to the real end of the suffering can ask for it, and will get euthanasia without any problem. Dr. Bob: Okay, so let's go back. So you ended your clinical practice. What drove you at that point to stop practicing in the way that you were in that practice? Dr. Rob Jonquière: Well, you know, the main reason is I have always been interested to not only do my work as a family doctor, but I always liked to work in organization, to support, to develop things, to do on education, or research, or whatever, so I did many things besides my practice, and actually that became a little bit too much for a work situation, and then I got the opportunity to become the head of the vocational training program for family doctors, which actually meant that I could go to work on a university. I had the opportunity to be involved in research, in education, in organization, and it was still inside the field of the job and the kind of work I liked, which is family medicine. So, not specifically my work in the field of end of life, just a change of work from being a, let's say a medical practitioner into a person on university working on a higher level. Dr. Bob: Got it, and through that period, were you still working in the end of life arena, helping patients at end of life? Dr. Rob Jonquière: Not intentionally. Not as a kind of idea. There were other things that I was focusing on. You can say that I developed, in that period, the vocational training scheme for nursing home physicians, which is a little bit that way, and whenever in the curriculum of the vocational training, the topic was end of life or palliative care, although they didn't give it that name at that moment, but end of life care, guiding dying people, yes, of course, I was interested in that because it touched a part of my practical work. Dr. Bob: Wonderful. And, then additional sort of responsibilities and opportunities, and then eventually found yourself really diving fully into the Right to Die organization, is that right? Dr. Rob Jonquière: That was also, actually, accidentally. I was looking for ... I don't know whether you know the issue of middle management. Working at a university, I was all the time in a middle management position, and I wanted to take one step further at being, having the end responsibility of something, and then I was invited, actually, to applicate for the job of the chief executive officer of the Dutch Right to Die Society, and of course, the main question they asked me, what is your opinion on end of life and euthanasia, because they were, at that moment, advocating. It's a large advocacy group for euthanasia in the Netherlands, and I could say, I'm in favor of it. I did practice the issue, and I thought it, indeed, should be legalized because I practiced when it was not legal, and I knew what difficult situation that was, doing something, which is very emotional but being allowed to officially talk about it. So that was is where I applicated for a job of the Dutch Right to Die Society, and from that moment I was indeed more than 100% into end of life, euthanasia, medical aid to dying, and all of the developments. Dr. Bob: And, you were there, you mentioned, that euthanasia has been legal since 2002. Dr. Rob Jonquière: Since 2002, yes. Dr. Bob: This was all happening right at the beginning of your tenure there. Dr. Rob Jonquière: Yeah. Dr. Bob: Well, fantastic. Can you describe for people who are listening what the different terms refer to? Dr. Rob Jonquière: The official translation of euthanasia is a good death, but in the Netherlands, we have since the middle '80s, the commission has looked into, and we have, in the Netherlands, defined euthanasia as the intentional termination of life on request of the person who is going to die. So it means that you do something, and the only aim of your action is that the patient is going die, and you only do that if the patient asks for it. So, if there is no request, you cannot practice euthanasia. You cannot practice euthanasia by giving medication, which, as a side effect, will terminate life of someone. Next, to euthanasia, which is an action by giving an injection, we have what we call assisted suicide. I know there is a lot of problems with the term suicide in the world, but we call it assisted suicide. There, as a doctor, you prescribe the medication, which causes death of the patient, but the patient takes the medication him or herself and legally- Dr. Bob: And, is that happening? Is that happening in the Netherlands as well, or has that pretty much gone by the wayside because of euthanasia being legal? Dr. Rob Jonquière: Well, the funny thing is that I've been speaking with my doctors of course, after the legalization, and all those doctors I spoke to said, well, I always want the patient to take the medication himself, so practice physician assisted suicide, still if we look at the figures in the Netherlands, we are lucky in the Netherlands that there is a very quality research and surveys going on what is happening, and there you see that between 85% and 90% or even more of the actions at the end of life is euthanasia, and only 5% is assisted suicide. So, officially, euthanasia is the main, so that's the reason why when we discuss the issue, we always talk only about euthanasia, but assisted suicide is the same, and you see that now some of the patients rather want to do it themselves. Some of the doctors, indeed, say if you want to die, you have to do something about it yourself, and I'm only prepared to give you the medication as you do in California. Dr. Bob: Okay. Is the medication being administered in the euthanasia cases, is that regulated? Is there a specific medication that everyone has access to? Dr. Rob Jonquière: Well, yes, it is officially one of an anesthesiologist, Pieter Admiraal, who you could call the inventor of the euthanasia medication, which is actually you bring the patient in a real deep coma, mostly by injecting barbiturates, an overdose of barbiturates, and after you have checked that patient really is in coma, and doesn't feel anything at all, you give again an overdose of a muscle relaxant, the medication anesthesiologist use when the patient is operated on. Dr. Bob: Okay. Dr. Rob Jonquière: Yeah, and that is now more or less a kind of protocol, and even if you look at our laws at this moment, it says, if you do it, you have to do it the proper way, which is you have to do it according to the medical standard, which is using that protocol, and the assisted suicide is just barbiturate, nine grams or 10 grams or so in a cloud of water. Dr. Bob: That's the same medication being used here, for the most part, the Seconal. Are there specific physicians who are trained in this, or what's that process like? How does a physician get certified or be allowed to do this? Dr. Rob Jonquière: Yeah, in the Netherlands and the Dutch law doesn't say that it has to be a certification. You have to be a doctor. That's the only thing you have to be. You have to follow the criteria of the law. The only certificate doctors are a group of second opinion doctors. Their obligation is, one of the criteria is that you have to consult a second independent doctor about case before you can perform the euthanasia, and these doctors are trained. Yes, of course, about the practicalities, about legal issues, but mainly about what kind of problems there are, and how to give a consultation to a colleague, if they are asked for it, but every doctor can actually practice euthanasia. Dr. Bob: Okay, like in California with the aid in dying, and the end of life option, it just requires a medical license, and the hope then is the physicians who are participating are becoming familiar, are becoming experts on their own. That's what we would hope. Dr. Rob Jonquière: I think that's what's happening. I mean, if you see in the Netherlands, we have of course what is it, 13, 14,000 family doctors, 85% of euthanasia is performed by family doctors, and you see of those family doctors, some 30%, 40% do it more regularly, which is still not more than two or three times a year in the average. So, they get used to how to do it, and there are manuals. We have papers or documents they can consult, and of course, that is where the second independent doctor can help. That doctor is trained. When that doctor comes, they can say, well, everything is okay, but, these and these things are not yet okay, and then the doctor can change that. We see more or less now, that sometimes, especially younger doctors don't go alone if they have to do it, but take an older colleague with them, so train themselves. Dr. Bob: Sure, we have mentors to help guide them. Is there opposition? Dr. Rob Jonquière: And, of course, that is also important of having a law. They are legally allowed to discuss their case. They can openly talk about, instead of having the fear that someone is listening and saying, hey, you have done something illegal and go to the police. Dr. Bob: Is there opposition in the Netherlands that is of significance? DrRob Jonquiere: There is. I don't think it is of significance. The main opposition is from the Orthodox-Protestant churches, and of course, we have the official opposition from the Catholic Church, the higher institutions. We see lower ... What do you call it? Clergy. Dr. Bob: Clergy, mm-hmm (affirmative). Dr. Rob Jonquière: Clergy working with family doctors, and then guiding their dying patients as well, but officially, the Church is against it, and practically we see 10% to 12% of doctors, mostly on religious situations, are not doing it principally, and then you have some 30%, 40% of doctors who are afraid, well, you know, don't know what to do, how to do, and don't want to go into that field. Dr. Bob: They just don't want to stretch themselves in that way. They don't feel comfortable for whatever reason. Dr. Rob Jonquière: Yeah. Dr. Bob: Well, that's fascinating. I that there's a lot of people around the world, and a lot of people in the United States that are clearly in favor of laws that are more favorable towards helping people having a peaceful end of life, you know, I hear so often when I'm taking care of people who are struggling with end of life challenges that we take better care of our animals than we do of our people here in this country, and of course, they are referring to the ease of which we can have animals euthanized but not allowing humans to have their suffering end that way. Dr. Rob Jonquière: What I have heard from one of my opponents once, as well, that's why there is a difference between a dog and a man, a human. Dr. Bob: Easy to throw that out, but just sort of deflect the conversation. So I appreciate ... I know that a lot of people will be very interested in just hearing more of the specifics of what is happening in the Netherlands. Dr. Rob Jonquière: Well, you know, the funny thing is, Bob, if you look at the attitudes in the population, yes, of course, maybe in the Netherlands it is a little bit higher than in other countries, but what I see in my function as executive officer of the World Federation now is that in practically all countries, even in what is seen as Catholic countries, you see a population of over 60% to 70% who are in favor of it. So, it is not the population which is a problem, it is the politician, and the politicians who many times have, of course, have broader responsibilities. You see in some countries, and I think in the United States certainly, you see more influence from the churches on politicians because they are dependent on that kind of situations, and that is the situation we don't know in the Netherlands, and in some other countries in Europe as well. Dr. Bob: The ability to influence politicians that way? Dr. Rob Jonquière: Yeah. Dr. Bob: With financial incentives and other types of influence. That is a problem ... and I know it is not unique to the United States, but it is especially problematic those influences, and in many cases, it comes down to fear and greed and how do you feel that the pharmaceutical industry or the insurance industry, the financial industry, how do you feel that they factor into this conversation? Dr. Rob Jonquière: As far as I know in the Netherlands, it's practically has no influence at all. That's of course because our system is based that if, as a doctor, you prescribe your medication, and the medication is known and accepted, it's being paid out of the insurance money, so what I hear from the States, where you pay, what is it, $3.5 thousand for a shot of Seconal, I don't know what it costs here, but maybe not more than 80, 90, or 100 euro which is paid by the insurance. So, there is no reason for patients not to have euthanasia because it is too expensive. Dr. Bob: Yeah, and that's in the Netherlands. I'm kind of trying to get the sense of the impact in the countries that don't have, you know, a national health service that covers the cost of care, and I'm sure there is some- Dr. Rob Jonquière: Then, it's what you see in the States, where actually, again, it is something which can only be done by patients who have the money for the medication. Dr. Bob: Well, can you give a sense of where you think things are heading worldwide? What's your prediction? Dr. Rob Jonquière: Well, I see the last years, there are changes going on. You see gradual changes, if you look at the United States, of course, you see more and more states getting over to laws, and unfortunately, there are impediments of financial reasons, but we see a change happening. I don't hope, actually, your new president will change something in the federal situation, because your Supreme Court is now more conservative, so if it comes to federal Supreme Court things, then you'll have some problems, but I see changing in the States, of course, changing Canada has an important push into America, I think. I see changes in Australia since Victoria has now a bill which will be in effect in 2019, I think, in June, and think that Victoria having passed a bill will mean the other states will also pass bills. They have been trying to do that, so there you see a gradual change and the only thing is I have no idea about Africa, which is, of course, a large continent, except South Africa, but that is practically not what I would call an African continental nation, but there is no movement at all in those countries as far as I know. And, in South America, we see Columbia having a law, and I know that countries like Ecuador or Chile who have even, in these kinds of laws, are more progressive than the Netherlands sometimes. So, I could imagine that maybe if they want that they would be able to change laws in this direction sooner. Dr. Bob: Well, it does seem like we're in general moving in that direction- Dr. Rob Jonquière: Yes, I think so. Dr. Bob: Many states have bills that are being discussed, and when you refer to Australia, I'm interested in that. I just read a book called Dying, which was a fascinating account of a woman dying of metastatic melanoma, who was living in Australia, and had actually obtained medication through an online source, but was very reluctant to utilize it or let anyone know she had it because without there being a law in Australia, anybody who had knowledge of this, or who supported her, would potentially be susceptible to being prosecuted for aiding in a suicide. The law in Victoria that you were referring to is that euthanasia or- Dr. Rob Jonquière: Yes, it is euthanasia. Dr. Bob: It is euthanasia. Dr. Rob Jonquière: And, the law is called Medical Aid In Dying, so euthanasia is a possibility, so where doctors actively apply medication and also assisted or giving medication which they take themselves, so they really have a law in the direction of euthanasia. The only thing there is, and that is what you see, is that because they wanted to take the wind out of the sails of the opposition, they brought in a huge number of criteria and safeguards. So, even I have seen somewhere they said this law is the most safeguarded law in the world. You have to comply, what is it, about 68 or 72 safeguards, so it is very complicated, and fortunately, what I see for example is that more and more, just because they are in their fight against opponents, people say you must be ill. It must be a terminal illness. We see in the Netherlands, many people are maybe not terminal because we have what's terminal, I mean, everybody is going to die, so in a way, we are all terminal. So, terminal illness is involved. There's expectation that you have to die within a certain amount of months, so it takes away the whole idea that it is, and that's what I think is important. It has to go about the suffering of the patient. Dr. Bob: And, that's similar to our law here in California. There is that requirement that there is a six months prognosis, which is sometimes difficult to ascertain. Dr. Rob Jonquière: You know, probably like me that the worst issue for the doctor is to say how long you're going to live. Dr. Bob: We're not good at it. Dr. Rob Jonquière: And, you also know patients who you say, you won't live a month, and they're still alive after 10 years, and the other way around. Dr. Bob: So, in the Netherlands, with the euthanasia law, there is not a requirement for the person to have a terminal illness, is that correct? Dr. Rob Jonquière: No. The requirement is that you ask for it, and you have welcomed the request, and you have a well-considered request, and the request must be voluntary. You must be suffering, and the suffering must be unbearable and hopeless, and I always say that is a major issue in our law, the unbearability of suffering is only the patient can say, this is for me unbearable, and the hopelessness is reason for the doctor to say, I cannot make your suffering bearable, so in that way, it is hopeless. And, if you together say, you're suffering is unbearable and hopeless, then you have fulfilled the criteria in that field, and then you have your second independent doctor. You must have no real alternatives et cetera, et cetera. Dr. Bob: And, that really just gives the ... it gives the responsibility back to the patient. It allows them to determine what is bearable or unbearable for them. Dr. Rob Jonquière: For that issue, of course, in the Netherlands, our population, our members of the Right to Die Society are not very happy about the law, because as they say, it is a doctor's law. The law protects doctors against prosecution if they comply with the request for euthanasia, and the patients say, okay, I have to ask for it. That's my responsibility. Okay, I have to tell the doctor it is unbearable, but I'm dependent of a doctor who says, yes, I will do it. And, many people, and certainly, I think that is a kind of why you can't call it progress in our culture, say, if I say have ... my life finished. I'm suffering too much. I want to end my life. I have the right to have my life ended. There the problem always is that if you want to end your life well, and dignified, and humanely, you have the possibility of having the right medication, or pharmaceuticals, and the only way to have the right one is to go to your doctor and ask a prescription. Dr. Bob: So, it's still not perfect, at least according to the eyes of the people, but it's- Dr. Rob Jonquière: It's not perfect if you look at autonomy, things like that, and that is the kind of development I see at this moment in the Netherlands going on, where organizations are trying to find out, and maybe you know Phillip Nitschke from Australia. They're trying to find stuff, well you can't call it medication, but organics, or bills, or substances which can end your life in a humane, quick way, which you get outside the help of a doctor. You can do it yourself. I don't know whether that's good. That's my personal ... I hesitate. Dr. Bob: That opens an entirely different can of worms, and that could be another conversation. Do you have a sense of how many people in the Netherlands make a request, but are not found to qualify according to the physicians who are they are requesting it of? Dr. Rob Jonquière: It is more or less, already for years, we see that about 10 to 12,000 requests every year, a third of them are refused for all sorts of reasons because the request is not well-considered because doctor sees there is no real suffering, or there are alternatives. A third is honored the requests, so between three and four and it's getting a little bit more thousand cases every year died by euthanasia, and then the other third, there the patient dies sometimes before the actually the whole process is started, because the nature of thing is, which we didn't speak about, I think one of the things when I talked to my patients, and I told them, if they really thought their suffering was unbearable, and I could do something more, and they asked, then, in the end, I would really help them. Then I saw, that actually they lived much longer in a rather good quality of life, and died in a natural way, just because they knew they were going be helped if it got really bad. Dr. Bob: Yeah, I had that experience where just the knowledge that the patients have this option available improves their quality of life from the moment I had that first conversation. Dr. Rob Jonquière: Yeah, that maybe is a major positive effect of having a law. Dr. Bob: Yeah. It's one of them, for sure. Do you know the statistics, I'm assuming that you do, but if you don't that's understandable, of what percentage of deaths that have occurred in the Netherland occur as a result of euthanasia? Dr. Rob Jonquière: The latest report ... you must know that every five years, we do a large survey asking doctors about their actions at the end of life, and we have such large and solid responses on it that you can extrapolate your whole population, so you see that the last time, it was a little more than 3%, and I think in the last year, when we had the report from the committees, it was practically 4% of all deaths cases in the Netherlands. Dr. Bob: Okay. Does that seem low to you? It seems a little low to me, for some reason. Dr. Rob Jonquière: Yes. Well, it is low, as many people think. Sometimes, if you don't know the numbers, they give you the idea that in the Netherlands, when you walk in the street, and you look a bit ill, you are killed by euthanasia. That is not happening at all, and I would say it is only 4%. We see a gradual increase in the numbers and in the percentage. I think it is too early yet to see whether that is going be a steady phase, or whether we're still growing, growing further, but certainly, it is not as many, especially opponents suggested, as soon as you legalize, you open the door to thousands of- Dr. Bob: The floodgates come in, and people are knocking down the doors looking to be euthanized. Dr. Rob Jonquière: But, of course, I realized when I was working with the Dutch Society that since we are a rather small country, so our total death cases are about 140,000 every year if you talk about 4 percent, you talk about 6,000 euthanasia cases every year. If you live in a country like the States, where you have millions more, probably a higher death number, and then you talk about only 4%, you're talking about a large, larger numbers which are, if you look at what papers or communications say about it, it is, of course, more impressive than when we started to talk. We had 2,000 cases every year, which you can say, oh it's only 2,000. Dr. Bob: Well, this has been really educational, and I think fascinating, and I know many of the listeners will appreciate what you shared, now you're speaking around the world. You go to the Federation meetings, and is their information or issues that you feel would be important to bring out that I didn't have a chance to ask about? Is there anything that you think that you hear questions over and over again that you feel would be valuable? Dr. Rob Jonquière: Oh, I think what we addressed today is more or less what is generally felt. It's of course important that if you talk, if you're interested in the issue that you should orient yourself on the right arguments and don't listen too much to the opponents, because many times, I see opponents misusing ... for example, the numbers we produce in the Netherlands, just to give you a small example, we had in '85 or '90, the first large survey and it appeared at that moment that a thousand times every year, a doctor terminates the life of a patient without having a request from the patient. Of course, everybody said that is wrong. I mean, you only do it if there's a request. If you don't do it on request, you're actually committing a murder. We see that number getting down to the last time, I think it was about 100 cases every year, and even there, we know those 100 cases were no murders but were specific situations, for example, very small children who were suffering enormously where doctors terminated life or terminated suffering actually, and officially, performing euthanasia without request, because a small child cannot ask it, so it is a very small number, and even that small number can be explained from humane actions by doctors, and still our opponents tell that in the Netherlands, they kill a thousand patients without request, and that kind of messages, I see everywhere in the world getting around, and getting first at patients or people who are interested in the issue. So, one of the things I mostly do when I speak around the world is explaining our situation in the Netherlands, and say, it is different from what you hear from the papers because they use those wrong figures. Dr. Bob: Well, that's really helpful, and I think it is important to caution people to be careful about the information that you are letting and- Dr. Rob Jonquière: Especially nowadays, don't take in fake news. Dr. Bob: Yeah. And if people want to get more information or learn more about you and the Federation, the website is www.worldrtd.net. Right? Dr. Rob Jonquière: Yes. That's right, and there you can get every information. You can get general information of what's happening around the world, and of course, you can find the addresses of the 52 national societies with emails and with website addresses, so from there on, you can click wherever you want to go.