Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future.
A decision in the Netherlands to approve the euthanasia of a woman with advanced Alzheimer’s disease has raised questions over how far mercy killing can apply to patients with dementia. Under Dutch law doctors performing euthanasia must ensure that the patient has made a voluntary and well considered request. This requirement has generally excluded patients with advanced dementia, as they are no longer considered competent to express their wishes. Now the Euthanasia Assessment Committee, to which doctors must report the cases of patients they have helped to die, has made an exception in the case of one woman, emphasising her long history of requesting euthanasia and the degree of communication still possible at her death. It is seen as the first case of euthanasia of a “heavily demented” patient. The Dutch Right to Die Society, which campaigns for euthanasia, supports the case but points out on its website that the woman was “officially incompetent.”
New scheme called 'Life End' will respond to sick people whose own doctors have refused to help them end their lives at home. A controversial system of mobile euthanasia units that will travel around the country to respond to the wishes of sick people who wish to end their lives has been launched in the Netherlands.
RAPSI spoke with Penney Lewis, a law professor at King’s College London and expert on end-of-life issues. Lewis explained that “There aren't any current legislative proposals (being considered by the legislature) although debates are held in the House of Commons on the Director of Public Prosecutions' (DPP) policy on assisted suicide.” Lewis is critical of the DPP’s current policy due to its failure to include any reference to a patient’s condition or experience on the basis of discrimination concerns, its preferential treatment of amateur rather than medically assisted suicide, and its focus on the motives of the suspect rather than those of the patient.
The total number of deaths studied was 11,704 of which 1517 involved continuous deep sedation. In Dutch hospitals, CDS was significantly less often provided (11%) compared with hospitals in Flanders (20%) and U.K. (17%). In U.K. home settings, CDS was more common (19%) than in Flanders (10%) or NL (8%). In NL in both settings, CDS more often involved benzodiazepines and lasted less than 24 hours. Physicians in Flanders combined CDS with a decision to provide physician-assisted death more often. Overall, men, younger patients, and patients with malignancies were more likely to receive CDS, although this was not always significant within each country. Conclusion Differences in the prevalence of continuous deep sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients’ characteristics or clinical profiles. Further
This paper examines the controversial and complex issues of euthanasia and physician-assisted suicide (PAS). I begin by defining and distinguishing these two terms and explain how they relate to each other. I also describe the medical doctrine of double effect, in which relieving pain comes at the expense of hastening death. Then, I give a brief overview of the common law defense of necessity, which is practically the sole defense available to or used by physicians accused of committing euthanasia or PAS. Finally, I analyze the legal doctrines of euthanasia and PAS, focusing on legislation and cases in the European Union — primarily the United Kingdom, the Netherlands, and Switzerland — and the U.S. states of Oregon, Washington, and Montana.
A large number of films and documentaries on euthanasia available to watch online. Quite a few in English including documentaries by Terry Pratchett and John Zaritsky on Dignitas. Also a documentary on Philip Nitschke and the law in the Northern Territory of Australia.
Artsen menen vaak dat patiënten met een verlaagd bewustzijn niet lijden en dat euthanasie daarom niet mogelijk is. Maar in sommige situaties mag dit wel. De KNMG heeft, op verzoek van het College van procureurs-generaal en de Inspectie voor de Gezondheidszorg, een richtlijn opgesteld over euthanasie bij een verlaagd bewustzijn. Deze richtlijn brengt geen verruiming van de wet, maar heeft tot doel artsen houvast te bieden in deze moeilijke situatie. Het College heeft aangegeven dat als artsen handelen volgens deze richtlijn, er in beginsel geen reden is voor strafrechtelijk optreden.
Hoe ga je als SCEN-arts om met vragen van collega-artsen? De KNMG-richtlijn Goede steun en consultatie bij euthanasie geeft aan wat van SCEN-artsen mag worden verwacht, maar ook waar SCEN-artsen op mogen rekenen als de behandelend arts hen inschakelt. SCEN-artsen verschillen van opvatting over de omgang met vragen van collega-artsen om steun en consultatie, zo bleek uit een SCEN-evaluatie. Zij willen toe naar meer uniformiteit in oordeelsvorming en werkwijze. De KNMG heeft, na raadpleging van de SCEN-groepen, vuistregels vervat in de richtlijn Goede steun en consultatie bij euthanasie. Deze beoogt meer eenduidigheid en daarmee zekerheid te bieden aan SCEN-artsen, maar daarmee ook aan consultvragers en patiënten.
Een 61-jarige man uit Lelystad krijgt geen straf voor het helpen bij het beeïndigen van het leven van zijn vrouw eind 2011. De vrouw had haar echtgenoot uitdrukkelijk verzocht om haar te helpen bij haar keuze voor euthanasie. Het bleef bij een poging omdat de man zijn vrouw niet met een kussen wilde laten stikken. De vrouw maakte in mei 2012 zelf alsnog een einde aan haar leven.
Rechtsonzekerheid voor artsen bij uitvoering euthanasie onacceptabel Artsen houden zich goed aan de euthanasiewet, zo blijkt uit de tweede evaluatie van deze wet. Maar zij worden geconfronteerd met rechtsonzekerheid over het toetsingskader. Daarom steunt de KNMG de aanbeveling van een code of practice voor de toetsingscommissies en dringt zij aan op duidelijkheid over de waarde van de schriftelijke wilsverklaring bij wilsonbekwame patiënten. De KNMG reageert hiermee op de tweede evaluatie van de Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding (Wtl).
In the Netherlands, euthanasia and physician-assisted suicide (PAS) are considered acceptable medical practices in specific circumstances. The majority of cases of euthanasia and PAS involve patients suffering from cancer. However, in 1994 the Dutch Supreme Court in the so-called Chabot-case ruled that “the seriousness of the suffering of the patient does not depend on the cause of the suffering”, thereby rejecting a distinction between physical (or somatic) and mental suffering. This opened the way for further debate about the acceptability of PAS in cases of serious and refractory mental illness. An important objection against offering PAS to mentally ill patients is that this might reinforce loss of hope, and demoralization. Based on an analysis of a reported case, this argument is evaluated. It is argued that offering PAS to a patient with a mental illness who suffers unbearably, enduringly and without prospect of relief does not necessarily imply taking away hope and can be eth...
No country has a blanket policy of mandatory psychiatric review but the specialty contributes in circumstances of exclusive mental disorder or when there is doubt regarding capacity and sound judgement. The absence of a mandatory role for psychiatrists means that reversible psychopathology may be missed. As a result, the patient's decision to end his/her life may be more informed by treatable mental disorder than by his/her lifelong preferences.
This week, lobbyists for euthanasia appeared to be winning people over to their way of thinking. The 71-year-old physicist Stephen Hawking gave an interview to the BBC in which he was asked whether he supported assisted suicide. “Those who have a terminal illness and are in great pain should have the right to choose to end their lives, and those that help them should be free from prosecution ...” he replied. “But there must be safeguards that the persons concerned genuinely want to end their life and are not being pressurised into it, or having it done without their knowledge and consent.”
This article examines the reporting requirements in four jurisdictions in which assisted dying (euthanasia and/or assisted suicide) is legally regulated: the Netherlands, Belgium, Oregon and Switzerland. These jurisdictions were chosen because each had a substantial amount of empirical evidence available. We assess the available empirical evidence on reporting and what it tells us about the effectiveness of such requirements in encouraging reporting. We also look at the nature of requirements on regulatory bodies to refer cases not meeting the legal criteria to either prosecutorial or disciplinary authorities. We assess the evidence available on the outcomes of reported cases, including the rate of referral and the ultimate disposition of referred cases.
Background In the Netherlands, euthanasia is allowed if physicians adhere to legal requirements. Consultation of an independent physician is one of the requirements. SCEN (Support and Consultation on Euthanasia in the Netherlands) physicians have been trained to provide such consultations. Objective To study why euthanasia requests are sometimes judged not to meet requirements of due care and to find out which characteristics are associated with the SCEN physicians’ judgments. Methods During 5 years (2006, 2008-2011) standardized registration forms were used for data-collection. We used multilevel logistic regression analysis to assess the associations of characteristics and SCEN physicians’ judgments. Results We analyzed 1631 euthanasia requests, involving 415 SCEN physicians. Patient characteristics that were associated with a lower likelihood to meet due care requirements were: being tired with life, depression and not wanting to be a burden. Physical suffering and higher patien
Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine ...