THIRD EVALUATION OF END OF LIFE ON REQUEST AND ASSISTED SUICIDE (REVIEW PROCEDURES). The breakdown of the number of euthanasia reports in the five separate regions can be found on the website (www.
DISORDERS INVOLVED IN 2017
Many of the case reports involving a psychiatric disorder came from SLK physicians: 52 out of 83 reports (more than 62%). Four of the other five cases involved the criteria of a voluntary, well-intentioned claim, intolerable suffering with no prospect of improvement, and no reasonable alternative, usually combined.
LOCATIONS
3 COMMITTEE PROCEDURES – DEVELOPMENTS
R E VIE W PROCEDUR E 1
The agreement is that if any of the committee members feel that a live case raises questions, it is referred to the monthly committee meeting for discussion. A further 19% of notifications received raised questions that required in-person discussion (for example due to a complex context such as psychiatric disorders or dementia, or due to
R E VIE W PROCEDUR E 2
A small number of notifications that were initially assessed as simple (92 cases, 1.4% of the total number of notifications) were later assessed as non-simple and were subsequently discussed at a committee meeting. The average time that elapsed from the receipt of the notice to the time the results were sent to the doctor was 52 days, which is slightly more than the six-week deadline specified in Article 9 of the law.
R E VIE W PROCEDUR E 3
A revised version of the 2015 Code of Practice will be published in Spring 2018, entitled 'Euthanasia Code 2018'. The Euthanasia Code 2018 describes aspects that RTEs consider important in relation to their statutory mandate. It aims to provide a clear explanation – particularly for euthanasia practitioners and independent practitioners – of how RTEs apply and interpret statutory standards of care.
CASES
1 INTRODUCTION
PHYSICIAN ACTED IN ACCORDANCE WITH THE DUE CARE CRITERIA
- Five representative cases
As stated in Chapter 1, the vast majority of euthanasia cases involve patients with cancer, neurological disorders, cardiovascular disease, and pulmonary disease. In the first case we have included almost the entire text of the finding, to give the reader an idea of what RTE's findings look like. Three of the cases have an additional, more unusual feature, such as early consultation, a combination of euthanasia and organ donation, and a patient whose primary residence was abroad.
CASE 2017-68 CANCER
In her report, the independent physician provided a summary of the patient's medical history and the nature of his suffering. The patient was not yet suffering unbearably and no specific request for euthanasia had been made. The doctor consulted at least one other, independent doctor who saw the patient and gave a written opinion on whether the criteria of due care had been met.
CASE 2017-84
The committee subsequently investigates whether the doctor has acted in accordance with the legal due care requirements as laid down in Article 2 of the law. In view of the above facts and circumstances, the committee is of the opinion that the doctor could be convinced that the patient's request was voluntary and well-considered and that his suffering was unbearable and hopeless. The doctor has acted in accordance with the due care requirements as laid down in Article 2, first paragraph, of the law.
CASE 2017-86
Upon request, the physician performed the termination of life using the method, substances, and doses recommended in the KNMG/KNMP Guidelines for Physician-Assisted Euthanasia and Suicide published in August 2012.5.
NEUROLOGICAL DISORDER
The doctor was convinced that this suffering was unbearable for her and without prospect of recovery according to the prevailing medical opinion. He also consulted an independent (SCEN) doctor who concluded that the conditions of care had been met. The committee found that the doctor had acted in accordance with the due diligence criteria.
CASE 2017-49
She knew there was no prospect of improvement in her situation and that the only prognosis was deterioration. After consultation, she was put under anesthesia at home and a tube was placed in her trachea so that she could be given oxygen.
PULMONARY DISEASE
CASE 2017-59
CARDIOVASCULAR DISEASE
Four cases illustrating one of the due care criteria in the Act
The law states that the doctor must be convinced that the patient's request is voluntary and well-considered. A written request is not required by law, but in some cases it can be useful if there is a written request, as shown in the following case.
CASE 2017-12
The committee ruled that the doctor could be convinced that the patient's request was voluntary and well-considered and that her suffering was unbearable and without hope. Although it was impossible to communicate with the patient when the euthanasia was performed, she showed signs of unbearable suffering. Unbearable suffering with no prospect of improvement The doctor must be convinced that the patient is suffering unbearably and that there is no prospect of improvement.
CASE 2017-07
The committee noted the following in connection with the unbearable nature of the patient's suffering. On the basis of the above facts and circumstances, the committee found that the doctor could be satisfied that the patient's approach was voluntary and well-considered, and that her suffering was unbearable with no prospect of recovery. The doctor and the patient must come to the conclusion together that there is no reasonable alternative in the patient's situation.
CASE 2017-08
About four months before the termination of life, the doctor asked an independent psychiatrist to assess whether the patient's suffering was hopeless and to evaluate possible treatment alternatives. The depression did not respond to protocol treatment, leading an independent psychiatrist to suspect that the patient had a genetic vulnerability. Even the independent doctor was of the opinion that the patient was suffering unbearably with no prospect of improvement.
CASE 2017-82
Cases concerning people with a psychiatric disorder, dementia or multiple geriatric syndromes
CASE 2017-42
An independent psychiatrist held that the patient was competent to make decisions regarding his request for euthanasia. The independent doctor also considered the patient competent to decide on his request for euthanasia. The psychiatrist felt that the patient was competent to make decisions about his request for euthanasia and was of the opinion that the alternatives available to alleviate suffering would not work for this patient.
CASE 2017-06
CASE 2017-14
ADVANCED-STAGE DEMENTIA
About a month before the patient's death, an independent geriatric specialist, at the doctor's request, examined the patient for her legal capacity. According to the geriatric specialist, the patient appeared to have no insight into her disease, prognosis and limitations. The latter concluded that the patient was competent with regard to her euthanasia request and that her request was voluntary and well-considered.
CASE 2017-38
Although the consultant noted that the patient had to make more and more concessions and did so. It had taken many conversations to convince the doctor that the patient was suffering unbearably. The doctor was of the opinion that a second independent doctor would probably not be able to penetrate the patient's facade.
CASE 2017-19
PHYSICIAN DID NOT ACT IN ACCORDANCE WITH THE DUE CARE CRITERIA
Cases where the RTEs find that the doctor has not acted in accordance with the conditions of care always lead to longer lasting results than other cases. In the year under review, the RTEs found in 12 cases that the doctor had not acted in accordance with all the necessary care criteria in performing euthanasia or assisting suicide. If there are no signs that the patient is suffering, euthanasia cannot be performed.
CASE 2017-73
The committee also noted that the independent physician consulted by the physician saw the patient. The independent physician's findings regarding the patient's condition did not match those of the physician. The committee considered this difference in observation between the independent physician and the physician to be conceivable given the fluctuating conscious state of the patient.
CASE 2017-103
The independent physician concluded that the patient was not suffering unbearably and that the advance directive was not sufficiently clear. The law requires the doctor to be satisfied that the patient's suffering is unbearable, with no prospect of improvement. The doctor indicated that the independent doctor could have decided to see the patient a second time.
CASE 2017-31
The doctor reported that the patient had been suffering from airway constriction (COPD) for years, for which she was treated with inhaled medication. In the present case, the committee also expected the doctor to ensure that the cause of the shortness of breath had been sufficiently clearly established and whether the patient had been treated adequately. From the files and the doctor's further explanation, the committee understood that the patient suffered from asthma/chronic.
CASE 2017-79
The doctor was of the opinion that there were no other treatment options for the patient. When asked, the physician indicated that the patient's pain and shortness of breath could possibly have been alleviated by prescribing additional medications. The decisive factor for the doctor was that there was nothing left to gain in terms of improving the patient's mobility.
CASE 2017-24
The doctor has not sufficiently investigated whether there are reasonable alternatives besides euthanasia that would alleviate the patient's complaints, thereby reducing the unbearable nature of her suffering. The committee is therefore of the opinion that the doctor could not convince that there were no other options to alleviate the suffering and that there was therefore no prospect of improvement. The doctor has not acted in accordance with the legal due care requirements as laid down in Article 2, first paragraph, parts b and d, of the law.
CASE 2017-10
The committee considered that although there is no legal requirement that the doctor and patient be in a treatment relationship, a doctor other than the patient's attending physician would generally need to credibly argue that sufficient time was taken to assess the patient's situation in relation to the legal criteria of appropriate care (see Euthanasia Code 2018 p. 16). In the present case, however, the doctor came to the conclusion in a very short space of time that there was no reasonable alternative.
CASE 2017-02
CASE 2017-11
CASE 2017-28
CASE 2017-118
PUBLICATION INFORMATION
