Raphael Cohen-Almagor, University of Hull FROM NEW MEDICAL ETHICS TO INTEGRATIVE BIOETHICS, Ante Covic, Nada Gosic, Luka Tomasevic, eds., pp. 197-216, Zagreb, Pergamena, 2009
In the legal performance of the euthanasia procedure, unbearable suffering, one of the requirements of due care, is difficult to assess. Evaluation of the current knowledge of unbearable suffering is needed in the ongoing debate about the conditions on which EAS can be approved. Using an integrative literature review, we evaluated publications with definitions of suffering in general or in end-of-life situations and with descriptions of suffering in the context of a request for EAS.
Surveys in different countries (e.g. the UK, Belgium and The Netherlands) show a marked recent increase in the incidence of continuous deep sedation at the end of life (CDS). Several hypotheses can be formulated to explain the increasing performance of this practice. In this paper we focus on what we call the ‘natural death’ hypothesis, i.e. the hypothesis that acceptance of CDS has spread rapidly because death after CDS can be perceived as a ‘natural’ death by medical practitioners, patients' relatives and patients. We attempt to show that the label ‘natural’ cannot be unproblematically applied to the nature of this end-of-life practice. We argue that the labeling of death following CDS as ‘natural’ death is related to a complex set of mechanisms which facilitate the use of this practice. However, our criticism does not preclude the view that CDS may be clinically and ethically justified in many cases.
Battin et al examined data on deaths from PAS in Oregon and on PAS and VE in The Netherlands. This paper reviews the methodology used and questions the conclusions drawn from it—namely, that there is for the most part ‘no evidence of heightened risk’ to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues that the highest resort to PAS in Oregon is among the elderly and that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.
In their critique of our paper "Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups," I.G. Finlay and R. George claim to challenge our underlying assumptions and methodology with "another perspective on Oregon's data." In our view, however, they miss the point of our paper and address a quite different issue. While we welcome their attempt to further explore issues about assisted dying, we do not believe they have in any way undercut our argument that where assisted dying is already legal (at the time of our study, Oregon and the Netherlands), there is no current evidence for the claim that legalized physician-assisted suicide or euthanasia will have disproportionate impact on patients in vulnerable groups.
Paar weken geleden een euthanasie gedaan. De patiënt was een hoogbejaarde rechtshandige intelligente vrouw met hartfalen. Ze werd opgenomen met een hemiparese rechts ten gevolge van een diep herseninfarct in de linkerhemisfeer. Ik zag haar op de derde dag na de ictus en er was geen enkele verbetering van de neurologische uitval. Toen ze onomwonden om euthanasie vroeg, kon ik haar eigenlijk direct goed begrijpen en we zijn de procedure ingegaan. Haar stelligheid, dankbaarheid en humor zal ik niet vergeten. Zo’n euthanasie slaat echt een gat. Het contact is intensiever en het einde abrupter dan normaal.
Artsen steunen euthanasie bij dementie Publicatie Nr. 27 - 08 juli 2011 Jaargang 2011 Rubriek NieuwsReflex Auteur Joost Visser, KNMG Pagina's 1684 Een op de vijf artsen steunt het burgerinitiatief van Uit Vrije Wil, een op de drie vindt hulp bij zelfdoding aan patiënten met een chronische depressie of beginnende dementie te rechtvaardigen.
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.
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 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 ...
The study objective is to determine if quality of care, symptoms of depression, disease characteristics & quality of life of patients with ALS are related to requesting EAS & dying due to EAS. … 31% of patients requested EAS, 69% of whom eventually died as a result of EAS (22% of all patients). 10% died during CDS; only 1 of them had explicitly requested death to be hastened. Of patients who requested EAS, 86% considered health care to be good or excellent, 16% felt depressed, 45% experienced loss of dignity & 42% feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. … Our findings do not support CDS being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS & the quality & quantity of care received, quality of life & symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS.