New York Times
LONDON — A court in the Netherlands on Wednesday acquitted a doctor who had been accused of unlawful euthanasia for administering a lethal injection to a patient with dementia, a case that raised questions about the clarity of the country’s law in such circumstances.
The patient, 74, who has not been publicly identified, had asked in writing for doctors to end her life if she had to be admitted to a nursing home, and if she thought the time was right. But, when she entered the home, incapacitated, she appeared to have changed her mind, giving “mixed signals,” about her intentions, prosecutors said. . . . [Full text]
The number of euthanasia requests submitted to the End of Life Clinic in The Hague this year increased by 15 percent compared to last year. According to the clinic, officially called the Euthanasia Expertise Center from Wednesday, the increase is due to the judiciary’s harsher attitude towards euthanasia, the Volkskrant reports.
The clinic was established in 2012 as a safety net for patients whose own doctor will not listen to their request for euthanasia. A few years ago the number of euthanasia requests to the clinic seemed to stabilize at around 210 a month. . . . [Full text]
Marike E de Boer, Marja F I A Depla, Marjolein den Breejen, Pauline Slottje, Bregje D Onwuteaka-Philipsen, Cees M P M Hertogh
The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient’s relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.
de Boer ME, Depla MFIA, den Breejen M, Slottje P, Onwuteaka-Philipsen BD, Hertogh CMPM. Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners. J Med Ethics. 2019 Jul;45(7):425-429. doi: 10.1136/medethics-2018-105120. Epub 2019 May 15.
Christopher de Bellaigue
Last year a Dutch doctor called Bert Keizer was summoned to the house of a man dying of lung cancer, in order to end his life. . . . Keizer is one of around 60 physicians on the books of the Levenseindekliniek, or End of Life Clinic, which matches doctors willing to perform euthanasia with patients seeking an end to their lives, and which was responsible for the euthanasia of some 750 people in 2017. . . [Full text]
A 42-year-old married woman with three children was referred to our department for treatment of treatment-resistant depression. Pharmacotherapy, psychotherapy, and ECT were unsuccessful. We applied deep brain stimulation, which was partially effective and reduced depressive symptoms by 30%, but the patient still suffered. During our struggle to find optimal deep brain stimulation parameters in the course of treatment, the patient requested that her general physician provide euthanasia. Following guidelines in the Netherlands, our team was consulted, but we disapproved because her suffering was not prospectless and there still were treatment options with deep brain stimulation. Although we had treated her intensively for 2 years, our advice was disregarded. Eight weeks later we received the obituary of the patient.
Denys D. Is Euthanasia Psychiatric Treatment? The Struggle With Death on Request in the Netherlands. Am J Psychiatry. 2018 Sep 1;175(9):822-823. doi: 10.1176/appi.ajp.2018.18060725.
Doctor-assisted deaths of four women in the Netherlands found to warrant criminal inquiries
Criminal investigations have been launched into four cases of euthanasia in the Netherlands after a sharp rise in the number of doctor-assisted deaths.
The cases follow the opening of a criminal inquiry last year into the euthanasia of a 74-year-old woman who was described by prosecutors as “seriously demented” and legally incapable of choosing whether to die or not. . . [Full Text]
The number of dementia patients killed by euthanasia has risen fourfold over the past five years
A Dutch euthanasia regulator has quit her post in protest at the killings of patients suffering from dementia.
Berna van Baarsen, a medical ethicist, said she could not support “a major shift” in the interpretation of her country’s euthanasia law to endorse lethal injections for increasing numbers of dementia patients.
She has now resigned from one of Holland’s five regional assessment committees set up to oversee the provision of euthanasia. . . [Full Text]
Ronald W. Pies*
When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, “How do I get out of this mess?”
As a physician, I dreaded the question that might follow: Would I help her end her life by prescribing a lethal drug? . . . [Full Text]
In July, 2017, Canadian euthanasia/assisted suicide (EAS) practitioners and advocates alleged that patient access to euthanasia and assisted suicide was in danger because of “barriers” and “disincentives” to physician participation. Dr. Stefanie Green, president of their professional association, described the situation as “a crisis.”1 There was, in fact, no crisis — only a false perception of crisis fuelled by unrealistic expectations about levels of physician participation in euthanasia and assisted suicide.2
Nonetheless, it is reasonable for policy makers to respond to their concerns that physicians are discouraged from participating in euthanasia and assisted suicide. Indeed, objecting physicians are less likely to experience disadvantage and coercion if policy-makers seriously consider suggestions by EAS practitioners and advocates about how to encourage physician participation in euthanasia.
Removing barriers and disincentives to physician participation
Minimizing procedural and administrative requirements
Returning to the complaints and concerns of Canadian euthanasia practitioners (see Canada’s Summer of Discontent2), reducing or streamlining procedural requirements and minimizing burdensome paperwork might encourage more physicians to participate. However, this raises a question that may prove difficult to answer. Is a procedural requirement a “barrier” — or a necessary safeguard? A “disincentive” — or an essential ethical prerequisite? The difficulty is illustrated by developments in Belgium. . . .[Full text]
Physicians can make more doing paperwork than performing this legal, but emotionally demanding, service. For many, it’s just not worth it.
Back in March, Dr. Tanja Daws took time off from her family practice to travel from B.C.’s Comox Valley to a remote community on Vancouver Island and provide an elderly patient who was dying and suffering with medical assistance in dying (MAID). After the five-and-a-half hour endeavour, which involved some of the most emotionally and technically difficult work Daws has ever done, the physician calculated that, after factoring in her staffing costs and other office expenses, she had lost about $28 for every hour she worked.
“It struck me that I can’t keep doing this,” says Daws. “I can work for nothing, but I can’t work for a loss.” . . . [Full text]