Euthanasia

[Palinurus]

UPDATE on post #157 above (Sep 26, 2019).

Source (Dutch only): Advies aan Hoge Raad: euthanasie bij wilsonbekwamen mag

Recommendation to the Supreme Court: euthanasia in the case of incapacitated persons is allowed

NOS News - Domestic - Today, 14:55

Doctors do not have to discuss euthanasia with an incapacitated patient in all cases. This is what the Attorney General advises the Supreme Court. "If a doctor comes to the conclusion that this is pointless and unnecessarily burdensome for the patient, this medical-professional judgment must in principle be respected by the judge", writes Jos Silvis.

The highest court in the Netherlands is currently considering a case in which a nursing home doctor in The Hague ended the life of a severely demented woman of 74. The doctor was discharged from all legal proceedings in September, after which the Public Prosecutor's Office was left with questions. The Public Prosecution Service then asked the Supreme Court for clarification in a so-called cassation in the interests of the law.

Euthanasia is also allowed in the case of incapacitated persons.

Attorney General Silvis states that although it is the norm in the medical world to be able to communicate with a patient receiving euthanasia, the law does not require this in all circumstances.

According to him, the legislator wanted to prevent incapacitated patients from ending up in a situation of desperate suffering if, precisely because they did not want that to happen, they had previously asked in writing for euthanasia.

In short: people who have drawn up a declaration of euthanasia and who at some point experience unbearable and hopeless suffering are entitled to receive euthanasia, whether or not they are aware of it themselves.

The Supreme Court will probably give its verdict in the cassation case next spring.

Translated with www.DeepL.com/Translator (free version)

NOTE: the advice of the Attorney General is almost always followed in the subsequent verdict.

Other source (Dutch only):
Advies aan Hoge Raad: euthanasie op demente patiënt toegestaan

 

[Palinurus]

Source: Dozens of psychiatric patients on waiting lists for euthanasia: report

Dozens of psychiatric patients on waiting lists for euthanasia: report

By Janene Pieters on December 19, 2019 - 12:50

Many doctors in the Netherlands are not willing to provide euthanasia to people with psychological problems. As a result, the seven psychiatrists at the Expertise Center Euthanasia are flooded with patients. The waiting time for a euthanasia trajectory for psychiatric patients is currently more than a year. And there are around 100 people on the waiting list, the Expertise Center Euthanasia told Trouw [in Dutch].

Gerty Casteleen, a psychiatrist at the Expertise Center Euthanasia, formerly called the End of Life Clinic, described the waiting time as "dramatic". The reason for the influx is that fewer and fewer psychiatrists are willing to grant euthanasia, Casteleen said. The Expertise Center has work for 20 psychiatrists, but only employs seven because it is impossible to attract new employees, he said.

This year a total of 800 psychiatric patients reported to the clinic with a request for euthanasia, compared to 692 last year. Only a small group actually qualify. According to Casteleen, 90 percent of patients dropped out after their first interview. Many people abandon their request once they were able to seriously discuss it with a doctor, the expertise center said.

Elnathan Prinsen, chairman of the Dutch Association for Psychiatry, called the waiting time "too long for someone who is suffering unbearably". But he also understands the "restraint" of many psychiatrists, he said to Trouw. According to him, it is difficult to determine whether someone really exhausted all treatment possibilities, and whether the wish to die is not a symptom of the disorder.

Last year the Expertise Center Euthanasia gave euthanasia to 56 people with psychological problems. Doctors outside the center provided euthanasia to 11 psychiatric patients.

Similar coverage:
More psychiatric patients want euthanasia but psychiatrists are wary - DutchNews.nl

 

[Palinurus]

Source (Dutch only): Een wegwijzer in het doolhof van voltooid leven

End of life
A signpost in the maze of completed life concepts

This will be the year of the completed life debate. At the end of this month, a study will be published that the Cabinet had commissioned to be carried out on this subject. Among other things, it will show how many over-55s live with a death wish. D66 subsequently comes up with a proposal for a Completed Life Act. What do you need to know before the discussion starts? A signpost in this ideologically charged maze of concepts.

Marten van de Wier and Wilma Kieskamp and Peter Henk Steenhuis - 11 January 2020, 1:00


The Completed-Life Debate was on hold for a while. The four coalition parties agreed that this Cabinet would not come up with proposals on 'Completed Life', but would commission an investigation into this sensitive subject. At the end of this month that study will be published.

The researchers want to answer the question: how many Dutch people have a 'persistent death wish', without being seriously ill?

Usually 'completed lives' are about the elderly, but the researchers chose the broad age group of 55 years and older. In this way they hope to find out what influence age has on having a death wish. Twenty thousand Dutch people from this age group completed a questionnaire last year. The researchers conducted 34 in-depth interviews with people with a death wish, and also questioned several general practitioners. Project leader Els van Wijngaarden of the University of Humanistics in Utrecht also investigates the background of those death wishes.

Member of Parliament Pia Dijkstra of D66 is expected to come next month with her initiative bill on completed life, which was parked until after the research. It will first go to the Council of State for advice and then to the House of Representatives. There is not much chance that they will vote on it during this term of the Cabinet.

As far as Dijkstra is concerned, care professionals trained as end-of-life counselors should assess whether a person's dying wish is 'voluntary, well-considered and sustained'. D66 thinks of a lower limit of 75 years. The VVD does not want an age limit.

Completed life, tired of life

The word combination 'completed life' appears after a plea by law professor Huib Drion in 1991. Drion wrote in an opinion piece in NRC Handelsblad that attention should not only be paid to the possibility of euthanasia for sick people, but also to 'the old human being, who thinks he has lived long enough'.

The citizens' initiative 'Uit Vrije Wil' [Voluntarily], which included Hedy d'Ancona, Frits Bolkestein, Mies Bouwman, Dick Swaab, Jan Terlouw and Paul van Vliet, put 'completed life' on the agenda of the Lower House in 2010. The proposal was rejected in 2013, but the discussion remained.

'Completion' (Dutch: voltooien) consists of vol = 'full', which originally means 'to the end', and tooien = 'ornamenting', which used to be synonymous with 'making'. Someone with a completed life, the language says, has completed his life to the end. It is a term that emphasizes the individual: only a person himself can judge whether his life is complete.

It is an alternative to the word 'tired of life' which has a much older history: Vondel used it as early as the 17th century in a poem about a greybeard who asks Death to fetch him. But 'completed life' has a more positive side. Emeritus professor of ethics Govert den Hartogh considers the term an 'unfortunate euphemism', he wrote in a journal for bioethicists. "As if life is like a job done at some point. Apparently it must be concealed that we are talking about people who are seriously suffering and therefore no longer see any other way out, for we must above all maintain the impression that this is a culmination of free self-expression". According to ethicist Frits de Lange, the term creates the 'illusion' of a life project that we can plan and complete.

Euthanasia, the soft death

Euthanasia used to have a broad meaning in international medicine, based on the Greek 'euthanasia', a 'soft death'. In 1950, for example, Van Dale [dictionary] also included pain relief for the dying.

Euthanasia, which was regulated by law in the Netherlands in 2002, now has a much narrower definition. According to the modern 'Van Dale', it is about 'ending the lives of patients who endure unbearable and hopeless suffering, at their own request'. By a doctor, you should add. Help with suicide by anyone else, outside the euthanasia rules, is punishable. Those who, according to doctors, do not suffer unbearably, do not qualify for euthanasia.

Supporters of a Completed Life Act want help with suicide to be allowed under certain conditions, if people feel their lives are complete. In this respect, their own assessment is decisive, not that of another person, such as a doctor.

According to D66, the euthanasia law has a 'strictly medical perspective', and dying with a completed life should also be possible without medical complaints. That is why the party does not use the word euthanasia, and D66 wants to regulate 'completed life' outside the euthanasia law. What such a death should then be called, is still undecided. D66 speaks of a 'dignified end of life'. Critics warn against the image that this could conjure up: that a natural death would be 'unworthy'.

Some ethicists prefer the government to regulate completed life within the euthanasia law. It is possible that euthanasia then takes on a broader meaning. Dutch Bureau of Statistics (CBS) already used it: last autumn it reported that 55 percent of Dutch people are in favor of 'euthanasia' for 'people who are tired of life'.

Suffering from life

Just because you find your life complete doesn't necessarily mean you want to die too. According to critics, the term 'completed life' is therefore not appropriate. The 'suffering' is hidden away with this phrase. Without suffering there will be no wish for death, according to a committee of the KNMG doctors' organization, for example, in 2004. According to them, 'Suffering from life' is a better description.

According to the Dutch Association for a Voluntary End of Life (NVVE), an advocate of self-determination around death, it is the other way round: not everyone who 'suffers from life' also wants to leave life, as would be the case with a completed life situation, according to the NVVE.

To make things even more complicated: there is also a group of people who are not suffering, but do have a death wish and consider their life to be complete, as the Schnabel Committee wrote in 2016 in an advisory report on 'completed life'.

On its website, D66 opts for both concepts, describing 'completed life' as 'suffering from a life that has become too long for people'. Suffering then is what the older person himself understands by it, the party emphasizes. In any case, proponents of a completed life law do not want the term 'suffering' to oblige a doctor to judge that suffering, as is the case with euthanasia.

Incidentally, the researchers who are working on a completed life study commissioned by the Cabinet use yet another definition: in their view, these are people with a 'persistent death wish' who are not seriously ill.

The principle of self-determination

Three main ethical principles govern the debate on euthanasia and completed life: self-determination, mercy and the right to life. Proponents of a law of completed life emphasize self-determination: everyone should be able to decide for themselves what to do with their body, or life. This can be at odds with the right to life, which is enshrined in international treaties. This dictates that the government must protect the lives of citizens. If the Netherlands wants to allow life to end with a completed life, then the government must therefore build in guarantees that someone voluntarily chooses death, the Dutch Human Rights Board stated in an advisory report.

According to health lawyer Esther Pans, in the euthanasia law of 2002, 'self-determination' is not the guiding principle, but 'mercy'. After all, a doctor may only grant euthanasia if someone is suffering unbearably and hopelessly. After 2002, self-determination gained an increasingly prominent place in the debate on euthanasia and completed life. Anyone who insists on self-determination believes that someone with a completed life should not be dependent on mercy.

Dignified ageing

Is there an alternative possible to the frame of a 'completed life' behind which you can put a full stop? The ChristenUnie launched a counter-offensive in 2017 under the name of 'dignified aging'. Together with broadcaster MAX, the Elderly Unions and parties SP and CDA, the party published a manifesto with which they want to increase the well-being of the elderly. The ChristenUnie, opponent of active termination of life in case of a completed life, believes that efforts should first be made on 'preventing a completed life'.

The initiators want a society 'in which the elderly are noted and appreciated', said Christian Union leader Gert-Jan Segers, and the advocates of self-determination agree with this. D66-leader Alexander Pechtold signed the manifesto, and the cabinet with D66 and VVD adopted it last year. But better care for the elderly, so that they can grow old with dignity, is, according to D66, still separate from the need of some elderly people to make active termination of life possible.

The manifesto puts forward a perspective on communality: one that places the responsibility for the welfare of the elderly with society. It is a plea for caring, mercy and solidarity. Completed life' and 'dignified aging' do not exclude each other, but place a different emphasis. 'Decent ageing' is less about the individual, and more about the role of all the others.


Translated with www.DeepL.com/Translator (free version)

To make this rather abstract discussion more tangible and to put faces on cases Trouw daily has started a series of portraits of people with a persistent death wish, as well as regular columns by staff members about this issue. They can be read via translators such as DeepL, Google, or MS Bing.

The first two of these are (Dutch only):
‘Als er een pil van Drion op mijn nachtkastje zou liggen, nam ik die meteen’
Voltooid leven gaat niet over een wanhoopsdaad

 

[Palinurus]

Source: Research shows 10,000 over-55s have a death wish - DutchNews.nl

Research shows 10,000 over-55s have a death wish

January 30, 2020 - By Senay Boztas

New research commissioned by the Dutch government has found that around 10,000 people of 55 and over have a serious death wish.

The Van Wijngaarden commission, tasked with looking into how many people might want euthanasia because they simply no longer wish to go on living, said 0.18% of people over 55 would like to die.

In a briefing [in Dutch] to MPs, health minister Hugo de Jonge wrote: ‘There is no doubt that the results show this is a major social issue both for this government and for society. This group of people’s death wish is serious and the report underlines the need for action.’

De Jonge, a Christian Democrat MP and also deputy prime minister, said government policies should do everything possible to ‘help these people find meaning in life again’.

However, the report is set to divide the coalition government, which unites the liberal VVD, two Christian parties and the liberal democratic D66.

Pia Dijkstra, who leads on ethical issues for D66, immediately announced [in Dutch] that she would next month submit a private members’ bill calling for a new ‘completed life’ law to allow people over 75 without unbearable medical conditions to request euthanasia. ‘Studies show there is broad support for people to manage a dignified end to their own lives,’ she said on Twitter.

However, De Jonge said in his briefing that the death wish ‘is not static’ and so the answers would not be found in broadening euthanasia legislation or introducing new rules.

ChristenUnie MP Carla Dik-Faber told the NOS broadcaster that her party fiercely opposed such legislation too. ‘Making a suicide pill available would be the most cynical response to people with a death wish,’ she reportedly said. ‘We would be giving up on them instead of wanting to be there for them.’

Similar coverage:
Over 10,000 older NL residents say they're ready to die in new euthanasia study

Further coverage in Dutch:
Het PERSPECTIEF-project_ Perspectieven op de doodswens bij voltooid leven: de mens en de cijfers - ZonMw
Coalitie parkeerde 'voltooid leven' bij commissie, rapport komt vandaag
Rapport 'voltooid leven': ruim tienduizend 55-plussers met doodswens
D66 komt met wetsvoorstel voor hulp bij voltooid leven
Wat zijn we nu wijzer geworden over de doodswens van 55-plussers?

‘Hiermee hoef ik nooit van een arts afhankelijk te zijn’


Other news - Source (Dutch only):
Belgische artsen staan terecht: euthanasie of moord door vergiftiging?

Background - Court case euthanasia

Belgian doctors on trial: euthanasia or murder by poisoning?

It is hardly conceivable that the Flemish doctors who were involved in the euthanasia of a 38-year-old woman, are actually taken away on Thursday as murderers with cuffed hands. But that is what they are on trial for in Ghent. Murder by poisoning.

Sacha Kester - January 29, 2020, 22:31

The start of a hearing of the trial of three Belgian doctors accused of murder by poisoning because they
allegedly did not carefully perform a euthanasia - Image Belga


The life of Tine Nys (borderline, suicidal, out of treatment) was terminated in 2010 at her own urgent request by GP Jo Van H. However, according to the Belgian Public Prosecutor's Office, he did not comply with the conditions of the euthanasia law. Moreover, the two other doctors whom Van H. was obliged to consult were not independent, according to the Public Prosecution Service.

This is the first time since the introduction of the euthanasia law in Belgium in 2002 that doctors have been brought to trial for violating that law, and the trial caused a great deal of commotion in Flanders. Is the euthanasia law now in jeopardy? After the case was initially dismissed, has the Catholic Church exerted pressure to allow the trial to go ahead anyway? And above all: should these doctors, one of whom has obviously fiddled with the execution of the euthanasia, really stand trial in a murder case?

Painful details

Tine Nys' personal life has been thrown out on the streets in all its painful details during this media storm. She was beaten a lot as a child, already had a death wish when she was 14 years old and made six suicide attempts (after which in one case she was in a coma for ten days and sat in a wheelchair for another year and a half). She was admitted to a psychiatric institution fifteen times, prostituted herself and, according to friends and social workers, was relieved that her suffering was over.

But the euthanasia did not go by the book. Tine was supported by her psychiatrist and her family doctor, but euthanasia for mental suffering requires a third signature. That is why Tine's former family doctor, Frank D, was contacted. He had always resisted his patient's death wish and, after a passionate plea from Tine, wrote on a note that he supported her request, but regretted it. He had a still standing appointment with her and hoped to talk it out of her mind, but to his horror he learned that the euthanasia had already been carried out two hours after he had written the note.

Walter van Steenbrugge, Joris Van H.'s counsel, during his closing speech Wednesday - Image Belga

There were more irregularities. General practitioner Van H. had forgotten his plasters, so that it was precisely Tine's father who had to press the needle during the injection. And the paperwork, which normally has to reach the Federal Control and Evaluation Committee within four days, only arrived after 51 days. In it Van H. mentioned himself as the 'second doctor' who approved the euthanasia, while he was the first.

Afterwards, Tine's family decided that it wasn't right after all: Tine had been 'pushed to death' by the doctors. At first the case was dismissed, but the family appealed, after which it was decided to prosecute anyway. The idea that the Church is behind this is nourished by the fact that the family is assisted by two lawyers, who previously represented Bishop Roger Vangheluwe and Cardinal Danneels in cases of child abuse within the Church. One of them had to withdraw this week when it turned out that he had also played a role in the euthanasia commission that had to evaluate Tine's case.

A drawing of the three doctors on trial: psychiatrist Godelieve Thienpont (left), general practitioner Frank D.
and general practitioner Jo Van H. - Image Belga

In a remarkable turn of events, both Tine's family and the public prosecutor on Wednesday asked for an acquittal for general practitioner Frank D. because his signature 'had been abused'. For the other two doctors they were adamant. 'If the doctor is going to fill in the rules himself, the door is open for unsavory practices. Euthanasia is irreversible'.

It is up to the twelve members of the people's jury on Thursday to judge whether the two doctors are guilty of murder.


Translated with www.DeepL.com/Translator (free version)

 

[Tuatha de Danaan]

I would not like to be called up for jury service on this case. All the witnesses on both sides appear to have ''motives''.

Dreadful case.!

 

[Palinurus]

Thanks for your reaction Tuatha de Danaan. I hear you and concur.

By the way, according to Wikipedia only sixteen countries world wide have a jury based judicial system. I was surprised to learn Belgium is one of them.

 

[Palinurus]

Source (Dutch only): Artsen in spraakmakende Belgische euthanasiezaak vrijgesproken

NOS News - Abroad - Today, 13:16

Doctors acquitted in high-profile Belgian euthanasia case

The defense of the doctors at the court in Ghent earlier this month - Image AFP


After almost ten years, a high-profile euthanasia case has been ruled in Belgium. The case revolved around 38-year-old Tine Nys, who received euthanasia in 2010 after unbearable psychological suffering. The three doctors involved have now been acquitted of manslaughter by poisoning.

According to the Belgian Public Prosecutor's Office, the conditions of the euthanasia law were not met at the end of Nys' life. Since 2002 there has been a law in Belgium which allows patients who suffer from unbearable and hopeless suffering to undergo euthanasia.

The court case, the first on this subject since the introduction of the law, divided Belgium considerably. The doctors' defense warned that a conviction would probably mean the end of euthanasia in Belgium, because afterwards any and all euthanasia cases could be treated as poisoning.

Biting off tongue

The prosecutor wanted to acquit Nys' GP, but the doctor who performed the euthanasia and the psychiatrist involved were guilty, according to the prosecution. When the three doctors were acquitted by the jury after eight hours in the hall, there was applause, to the displeasure of the court that this was inappropriate.

The executive doctor, Joris Van Hove, is happy with the verdict, he says to the VRT (in Dutch). "But no one has won here. We've all suffered damage."

The psychiatrist Lieve Thienpont also said to the broadcaster that she is relieved. "This is a big load off my heart. That's ten years we carry with us. That means ten years of silence: we couldn't defend ourselves in any context. That's like biting your tongue off."

Appeals still possible

An appeal against the judgment is still possible. The van Nys family, who previously appealed against a decision not to prosecute the doctors, has not yet responded to the ruling.


Translated with www.DeepL.com/Translator (free version)

Similar coverage (in Dutch):
Drie beschuldigde artsen vrijgesproken op euthanasieproces in Gent, opluchting bij artsen: "Groot pak van mijn hart"

 

[Palinurus]

Source: Record number of euthanasia requests at expertise center

Record number of euthanasia requests at expertise center

By Janene Pieters on February 7, 2020 - 16:00

The Euthanasia Expertise Center received a record number of 3,122 requests for help last year, an increase of 22 percent compared to 2018. "Every working day, 13 people come to us and say: Help me, I can't go on. The need is great," Steven Pleiter, director of the center, said to NOS [in Dutch].

It is especially complex requests for euthanasia - due to dementia, old age and psychiatric issues - that end up at the Expertise Center, which was created as a safety net for patients whose own doctors do not want to consider their euthanasia requests. Of the requests for help received last year, 29 percent or 898 were granted. That is a percentage comparable to the year before.

In 2017 and 2018, the number of requests for help at the Euthanasia Expertise Center, which used to be called the End of Life Clinic, stabilized for the first time. But halfway through last year, there was a sharp spike in requests. In July, the center received over 300 requests for help in a month for the first time. The same happened again in October.

Like the healthcare sector in general, the Expertise Center is facing staff shortages. "We currently have vacancies on all fronts: doctors, psychiatrists and nurses." The shortage of psychiatrists is particularly harrowing, and the doctor shortage is largest in The Hague and Rotterdam regions.

Partly due to the staff shortages, the waiting time for a euthanasia trajectory due to psychiatric problems has increased to a year or more. The trajectories for euthanasia due to other complaints are much shorter - the intake process is usually started within 15 days of a request.

Similar coverage: Specialist euthanasia clinic faces 22% increase in requests for help - DutchNews.nl

Coverage in Dutch:
Aantal aanvragen euthanasie stijgt hard: iedere werkdag 13 verzoeken
'Mijn moeder wilde sterven, maar kon dat niet meer uitspreken'

 

[Palinurus]

Source (Dutch only): Vrouwen met psychiatrische problemen vragen vaker om euthanasie

Research
Women with psychiatric problems are more likely to ask for euthanasia

For the first time, researchers have investigated on a large scale who the psychiatric patients are who ask for euthanasia. They are around fifty, often depressed and the majority are women.

Marten van de Wier & Rianne Oosterom - 17 February 2020, 16:01


Women with psychiatric problems ask for euthanasia more often than men: they submit sixty percent of euthanasia requests. This is evident from a large dossier study by the Euthanasia Expertise Center (formerly the Levenseinde-kliniek) at the request of the Ministry of Public Health. For the first time, researchers mapped out who the psychiatric patients are who want euthanasia.

The fact that women are over-represented is striking because men and women are equally prone to mental illness. However, men more often commit suicide, and it is known from earlier research that they are less likely to seek help from mental health care. Men who knock on the door of the Euthanasia Expertise Center are more likely to suffer from addiction problems, and women are more likely to suffer from mood disorders.

The Expertise Center examined part of the more than 3,500 files of patients with a psychiatric disorder that it treated between 2012 and 2018. The Expertise Center included 1700 patients in an analysis by age group and gender; of 1308 patients the entire file was examined.

Bullying, sexual abuse or trauma often play a role

Bullying, sexual abuse or trauma play a role in a relatively large number of patients. Depressive mood disorder was the most common disorder across the board: in more than a quarter of cases. The majority of patients have more than one disorder, and have been suffering from complex psychiatric problems for at least ten years.

Only 9.5 percent of the cases studied by the researchers ended with euthanasia. These are 149 patients. In other cases, the euthanasia request was rejected or the patient withdrew it. In addition, 59 patients killed themselves, most of them during the trajectory prior to a decision or while on the waiting list; 8 after a rejection. 37 patients died a natural death.

Of the requests from patients with a mental disorder, 43 per cent were rejected, for example because the doctors still see treatment options, or do not consider the suffering to be unbearable. 20 percent are withdrawn by patients themselves, most often because they no longer want to die.

Psychological suffering too complicated

The average age at which psychiatric patients requested euthanasia was 50 in women and 49 in men. In the youngest group of patients, under the age of 30, neuro-biological development disorders (such as autism) are most common among men. Young women suffer the most from mood disorders.

Psychiatric patients often end up at the Euthanasia Expertise Center because other doctors find euthanasia in psychological suffering too complicated, or do not want to participate. According to the various evaluations of the Euthanasia Act, psychiatrists have become increasingly reluctant to do so, partly because they are wary of the emotional burden that such a request entails.

According to the researchers, there is 'room for improvement in discussion and decision making regarding termination of life in the mental healthcare system'. Euthanasia for this group requires 'great caution', according to the researchers, because a death wish can be a symptom of a psychiatric disorder, and the social debate about when and if a patient has been or will be fully treated is still in progress.


Translated with www.DeepL.com/Translator (free version)

 

[Palinurus]

Archiving news reports in English about the above research results:

Women over represented among mental health patients requesting euthanasia
Psychiatric patients requesting euthanasia are more often women: study - DutchNews.nl

 

[Palinurus]

Source (Dutch only): Portugal waarschijnlijk het vierde EU-land met een euthanasiewet

NOS News - Abroad - Today, 12:44 pm

Portugal probably the fourth EU country with a euthanasia law

Protests in Porto against the euthanasia law, last Saturday - EPA

Rop Zoutberg - Spain correspondent

Portugal is likely to become the fourth European country where euthanasia is regulated by law. This afternoon the Portuguese parliament will vote for the second time on the introduction of a law on euthanasia. This time it seems that the plans can count on a majority.

In 2018, the Portuguese parliament already voted on termination of life legislation one time before, and then the proposal was rejected by five votes. But due to the elections in last October, the support is now greater.

Presumably, the plans will receive 133 out of 230 votes, from the Partido Socialista (PS) of prime minister Costa, the Left Block and ecological parties. Against the euthanasia law are the liberal PSD, the communist party and other groups; a total of 97 votes.

Voting according to one's own conviction

All parliamentarians are free to vote as they see fit, but that is unlikely to change the expected outcome. "We are not going to negotiate about who will vote what," says Ana Catarina Mendes, group chairman of the PS. "Everyone is free to decide on the way in which we should deal with the suffering of a human being."

The new law allows euthanasia in cases of unbearable or prolonged suffering or in cases of incurable disease. According to the proposal, euthanasia is always initiated by the patient, if he or she is able to decide for him/herself. It also requires a medical diagnosis and approval by a medical committee. Euthanasia of minors or mentally ill people is forbidden.

Population is divided

Portugal is divided about the law. A recent poll shows that only about fifty percent of the population is in favor of a euthanasia scheme. Among the opponents are primarily the Catholic Church and other religious groups. A quarter of the Portuguese have no opinion about it.

Even doctors' organizations do not yet know what to do with the introduction of the law. "Anyone who is going to perform euthanasia in the near future is acting against the ethical code of doctors", the Orden de Médicos writes in a letter. A number of organizations hope to halt the new law by enforcing a referendum, even though they do not yet have enough votes to enforce such a referendum.

When the Portuguese parliament votes in favor, Portugal becomes the fourth European country, after the Netherlands, Belgium and Luxembourg, where euthanasia is regulated by law. The left-wing government of its Catholic neighbor Spain also wants to make a proposal this year to include assisted suicide in the legislation.


Translated with www.DeepL.com/Translator (free version)

 

[Palinurus]

Source (Dutch only): Voltooid-leven-wet ondermijnt euthanasiepraktijk

Completed-life-law undermines euthanasia practice

'Completed life' is mainly an ideological discussion, writes Paul Schnabel. A new law is unnecessary.

Paul Schnabel was chairman of the Completed Life Committee.
He is a former director of the Social and Cultural Planning Office
(SCP) and a former Member of the Senate (D66).

25 February 2020 at 5:48 p.m.

Four years ago, the Completed Life Committee advised Minister Schippers (VVD) of Public Health not to change anything about the euthanasia law. As chairman of that committee, I am pleased with the results of the recent Perspective Study [in Dutch] led by Els van Wijngaarden into the death wish of elderly people who are not seriously ill.

The question the researchers had to answer for the cabinet was how many people would really like to die. In our advice in 2016 [in Dutch], we could say no more about this than that there probably aren't quite that many. This is confirmed by the Perspective Study. But much more importantly, this study shows how difficult it is to make a wish into a firm decision and indeed to carry it out.

Of the whole idea that people long for death because their lives are complete, not much remains standing. Out of more than 21,000 respondents aged 55 and older, Van Wijngaarden came across 23 people who really wanted to put an end to their lives; 13 of them wanted help with this and 10 indicated that they had always held out a death wish. This group, if you can call it that, consisted mainly of low-educated women who lived alone. They worry a lot, feel lonely and are afraid of deteriorating.

A small group

Converted over all Dutch citizens from that age it would amount to ten thousand people. Another thirty-three thousand people are seriously considering ending their lives or having their lives ended. Relatively speaking, this is a small group, but it definitely concerns a lot of people. Van Wijngaarden shows that even in case of an active death wish there is often hesitation and also a fluctuation of feelings. Simply put, one does not always want to die and usually not immediately, but life is never fun.

The own-initiative bill that Lower House member Pia Dijkstra wants to submit on behalf of D66, is actually not about this group. Her plans concerned non-sick people of at least 75 years of age, who would be helped by specialist death aid counselors, not necessarily doctors, to end their lives at a moment of their own choosing.

This Completion of Life Act would then be additional to the current euthanasia law. It is not difficult to predict that the current law will soon become obsolete because, in case of illness, why follow the difficult procedure of the current law if it can also be done through an easier route? Moreover, Els van Wijngaarden's research shows that the threshold age of 75 years provided for in the new law is not in line with the dying wish of the largest group. On average they are much younger.

Medical grounds or not?

The current act Assessment of termination of life on request and assistance with suicide [in Dutch] protects a doctor from prosecution if he or she has followed the procedure prescribed by law and met the due diligence requirements. The actions of the doctor are subsequently reviewed by a committee. The law says nothing about the patient's age or illness; there must be "hopeless and unbearable suffering".

The Explanatory Memorandum to the Act and decisions of the Supreme Court have limited the scope for interpretation of the Act. There must be a 'medical base'. This is diametrically opposed to the idea of 'completed life' which in principle would involve people who are not seriously ill. The Van Wijngaarden study shows that the idea of a completed life mainly comes to mind in people who have a 'medical ground' after all. The factual distance to the current euthanasia practice is then already less than it seems to be in principle.

For the proponents of a completed life regulation, the real stumbling block is that the current law assigns an important role to the physician. The law does not make euthanasia a right of the applicant, but obliges the physician to carefully examine whether he can grant the request. This is seen by these proponents as an unacceptable attack on the autonomy of the person who wants to get out of life. Suicide is indeed a freedom and in that sense one could speak of autonomy. However, suicide is not a legal right and assistance in suicide therefore neither, but an offense if the assistance is not given by a doctor and according to the rules of current law. Neither would it be possible to become a legal right, because that would affect the freedom of those who do not wish to help with suicide.

Supreme Court needs to review

The completed life discussion has a strong ideological character. It is about whether or not to enshrine autonomy in law. In practice, it would suffice if the text of the existing law could be interpreted more broadly than at present. The Supreme Court should review earlier judgments, and in the interests of the law it can and may do so.

The Euthanasia Act is now almost twenty years old and does not itself need to be revised. For the doctor, the procedure already prescribed by the law plus the subsequent review afterwards on a case-by-case basis should provide sufficient security of action. In most cases there will be a 'medical ground', even if it is not so named, but that as such needs not also to be the basis of the request itself. Above all, it is important that the foundation of the execution continues to rest on the expertise of a physician, even when it is limited to assistance with suicide.


Translated with www.DeepL.com/Translator (free version)

 

[Palinurus]

Source (Dutch only): Stervenshulp was in Duitsland bij wet verboden, en vandaag weer toegestaan

Euthanasia process
Assisted suicide was forbidden by law in Germany, and today
it is permitted again

The presiding judge of the German constitutional court, Andress Voßkuhle - Image EPA


Assistance in dying, such as physicians gave to hopelessly ill patients until 2015, will be permitted again in Germany.

Romana Abels - 26 February 2020, 15:28

A four-year-old law that made it impossible for doctors to give sick people medication if they opted for suicide was annulled by the highest court in Germany. The ban on assistance in dying is contrary to the constitution which gives the individual the right to decide about himself, judge Andreas Vosskuhle of the court in Karlsruhe determined on Wednesday.

According to Vosskuhle, the law, as it entered the Criminal Code in 2015, is therefore also contrary to the right of the individual to choose his own end of life. He advises the legislator to prevent people from contemplating suicide in other ways, for example by increasing the supply of palliative medicines.

With the new law, the German government wanted to prevent organizations such as the Swiss Dignitas from spreading their wings in Germany. The idea that sick people could obtain medication in return for payment in order to speed up their own death, was a specter. But although the law stated that 'businesslike' death aid was forbidden, the clarification showed that even doctors who assisted seriously ill patients with death aid could no longer do so. Because they repeatedly provide such help, it too was seen as 'businesslike'. They became liable to imprisonment for three years and a fine.

It remained possible for friends and relatives of people to, for example, put a few pills on a bedside table, which the patient then had to take himself. But physicians, like Michael de Ridder from Berlin, were no longer allowed to do so. In an interview in Die Zeit, 72-year-old De Ridder told about patients he helped by giving them medication and information. He revealed how he told a crippled teacher how many sleeping tablets he had to take to get a cardiac arrest. Euthanasia practice in Germany cannot go any further than that.

According to De Ridder, the law of 2015 was contrary to his professional freedom and freedom of conscience, as well as being contrary to human rights. According to De Ridder, it cannot and should not be punishable to assist seriously ill people who want to die, with their wish. He was part of a larger group of doctors and patients who had asked the court for the verdict.

Conditions

The now again allowed dying aid is, however, subject to conditions. There must always be a third person involved, in addition to the patient and a doctor. Physicians are also not obliged to carry out a request for death aid.

Not all doctors are happy with the change in the law. The German doctors' association, the 'Bundesartzenkammer', wants to prevent a 'normalization of suicide'. The doctors also have concerns about patients who may feel that they are 'entitled to assistance in the event of suicide', said chairman Klaus Reinhart after the ruling.

Due to the large-scale murder of sick people during WW II, euthanasia is much more of a taboo in Germany than in the Netherlands.


Translated with www.DeepL.com/Translator (free version)

Similar coverage in Dutch:
Duits Constitutioneel Hof: arts mag helpen bij zelfdoding

 

[Voyageur]

I found a video by Stephen Jenkinson that covers many things, Euthanasia being one of them.

Watched this just now, and must say I'll have to do so again, and perhaps again as it was a pretty profound discussion challenging cultural thinking and how our systems are set up around death and the individual on death. Could not help bring in some of the NED discussions memories here also.

Jenkinson is certainly an experienced, thoughtful and unscripted thinker, bringing many ideas to further ponder upon. He mentions, which thought was interesting, the late Leonard Cohen while using phrases from his songs in discussion during his talk.

Don't know where to go with this just know, yet thanks, iamthatis, for this window!

 

[Palinurus]

Source (Dutch only): Duitse kerken bezorgd over opheffen euthanasieverbod

German churches concerned about lifting euthanasia ban

Members of the constitutional court in Karlsruhe ruled on Wednesday morning that an important paragraph of the
euthanasia law of 2015 is unconstitutional - Image EPA, Thorsten Wagner

The German churches expressed their concern on Wednesday about the lifting of the ban on 'professional' euthanasia.

In a joint statement, the Protestant and Roman Catholic Churches reacted to the verdict of the Federal Constitutional Court. The Constitutional Court in Karlsruhe ruled on Wednesday morning that an important paragraph of the euthanasia law of 2015 is unconstitutional. That provision was adopted by the Bundestag [German Lower House] in 2015 to prohibit suicide aid. At that time, the main purpose of the intervention was to thwart organizations that offered assistance with suicide in a professional manner.

After this amendment was lifted on Wednesday, the major German churches published a joint declaration, signed by Cardinal Reinhard Marx, President of the German Episcopal Conference and by the Councilor of the Evangelical Church in Germany, Landesbischof Heinrich Bedford-Strohm.

The leaders argue that the verdict of the Karlsruhe court is an infringement of Christian culture, which aims to affirm and promote life. "We fear that allowing services for professional euthanasia may subtly put pressure on old or sick people to take recourse to it."

According to both churches, this lowers the threshold too much to commit suicide. "There is a growing danger that people in an extremely stressful life situation will come under internal or external pressure to end their own lives in this way. The measure taken in 2015 was precisely intended to protect people in their final stages of life."

Performance ability

With the ruling, German society faces fundamental questions about the way in which sickness and death are dealt with, the churches believe. "The dignity and value of a human being should not be measured by his or her performance ability, benefit to others, health or age."

The leaders point out that they believe that God created man in His image. "Thus we are responsible for our own lives before God. The quality of a society is shown precisely in the way we help and support each other."

Matthias Thöns, as one of the co-plaintiffs in the case, is pleased with the verdict. The palliative care physician felt that his practice was being unnecessarily criminalized. The paragraph 217 in question included, among other things, prison sentences of up to three years if doctors repeatedly assist patients in committing suicide.

Under the now annulled euthanasia law paragraph, professional assistance in suicide was already understood to happen when someone repeatedly does something. "This means that even when I help as a doctor in these very, very rare cases, I am already threatened by criminal law because I would probably do the same thing next time in the same situation," Thöns said to the radio Deutschlandfunk. "My conscience is not an ephemera, next time I'll see it the same way."

Opposing sound also comes from Eberhard Schockenhoff, Professor of Catholic Moral Theology at the University of Freiburg. At the radio station he pointed out the liberal euthanasia laws in Belgium or the Netherlands. "We see that the limits have steadily shifted there. In the Netherlands, for example, psychiatric illnesses were initially excluded. Later they were admitted nonetheless. Then there were rules for the protection of minors. These were later liberalized as well."

How will it be going from here on out? Experts estimate that the Bundestag will probably at least have to rewrite the role of physicians, such as that of Matthias Töns, in order to clarify how exactly the euthanasia law is now formulated.