Euthanasia/ Sterbehilfe

Blue: active sterbehilfe allowed Yellow: assisted suicide allowed (not medicalized in Germany: loved ones can assist) Green: passive sterbehilfe allowed (stopping life support) Red: none of these allowed Black: unclear legislation

Definition Deliberate termination of life By a doctor At a patient’s specific request not the same as physician assisted suicide, because then the doctor doesn’t administer the lethal medication, but the patient him or herself: both are legal under the same law in the Netherlands, we’ll discuss both today

Memento Mori unknown photographer, 1845, Rijkmuseum memento mori: do not forget we are all mortal that is the only certainty in life: we will all die one day. We just do not know how.

Strong will to live Natural, most people

but there are circumstances under which individuals have no joy and prospect in living anymore. for example when you are suffering from an incurable fatal disease. circumstances under which you would rather die quickly and in a dignified manner than continue suffering. the philosophical debate is about whether you should have the autonomy to decide about the way and the moment you will die. that is philosophy, but the origins of our current euthanasia legislation are .....

Pragmatic

Contents ‘Conflict of obligations’ Euthanasia Act 2002 ‘Slippery slope’? Documentary Discussion

Contents ‘Conflict of obligations’ Euthanasia Act 2002 ‘Slippery slope’? Documentary Discussion

Imagine you’re a doctor treating a cancer patient poor prognosis, curation impossible no treatment options left bedridden pain, pressure sores, short of breath

what if this patient asks you to help him die? please doctor, give me something to let me no longer suffer worldwide this happens every day what would you do?

Conflict of obligations Helping your patient Protecting life according to the hippocratic oath you should do both, but in this situation they are conflicting

Solution?

Solution? with the excuse of pain relief or relief of suffocating: administering large doses of morphine, that will make you unconscious and then give a respiratory depression that leads to death 1. doesn’t always work 2. this must be kept secret! the intention is not pain relief, but ending the patients life.

Dutch approach Pragmatic This does happen How to deal with it out in the open?

consensus Ending a person’s life is considered homicide, Act 293 in Dutch Penal Code: Any person who terminates another person’s life at that person’s express and earnest request shall be punishable by imprisonment not exceeding twelve years or a fifth-category fine (up to € 45.000) but... Physician cannot be punished if he/ she acted according to ‘criteria of due care’ jurisprudence, from several cases that eventually led to the euthanasia act in 2002

Contents ‘Conflict of obligations’ Euthanasia Act 2002 ‘Slippery slope’? Documentary Discussion Not the official name

2002 Termination of Life on Request and Assisted Suicide Act Physician cannot be punished if acted according to criteria of due care

Criteria of due care voluntary and well-considered request hopeless and unbearable suffering the patient is fully informed on situation and prognosis joint conclusion: no other reasonable and acceptable solutions are available an independent second physician has written a report with the same conclusion the procedure is carried out in a medically correct manner

Medically correct manner Euthanasia: intravenous sleeping medication - induces coma intravenous muscle relaxant

Medically correct manner 2 Physician assisted suicide oral method: patient drinks the medication anti-emetics barbiturate: induces respiratory depression followed by death only possible with relatively strong patients: must be able to sit upright, must be able to swallow and must have a normal hydration status and bowel function

afterwards The municipal forensic doctor / coroner does autopsy reports to public prosecutor for permission of burial/cremation sends the results to regional review committee, that will assess whether the physician has complied with the criteria there are five regional review committees, with at least one legal expert, one physician and one ethics expert

Question? Is it a right to have euthanasia in the Netherlands?

Answer No, the physician may refuse minors: 12-15: possible with permission parents 16-18: possible with parents involved it remains a request as opposed to refusal of treatment which is a right

Numbers reported 2012 4188 3965 euthanasia 185 physician assisted suicide 38 combination where were they performed? at home: 3335 (GP) (hospital, nursing home, hospice are much more rare) only ten were not in accordance with the due criteria and were sent from the review committees to the public prosecutor and health inspector, in none of these cases prosecution followed though

Mortality the Netherlands 2010 total number deceased: 136.058 euthanasia 2,8% ass. suicide 0,1 % pain control and sedation 36%

Question? Is palliative sedation euthanasia?

No You only induce coma There is no intention to terminate the life immediately, the intention is to make the patient as comfortable as possible, unaware of his/her suffering For some patients it can be an alternative for euthanasia It can take away the fear of dying in an undignified or horrendous manner Only for patients with < two weeks life expectancy

Contents ‘Conflict of obligations’ Euthanasia Act 2002 ‘Slippery slope’? Documentary Discussion

What to do with: Psychiatric patients? Dementia patients? Infants? ‘Tired of life’ category? non-physicians who want to assist with suicide?

Ethical debate Autonomy self determination

Discussion

The proper terminology? euthanasia is a word that in Germany is a taboo, because it is the same term as was used by the nazis for their T4 programme: the extermination of ‘life not worthy of living’: Only in veterinary medicine term used. is the association correct? what is the important difference?