Euthanasia

Palinurus

The Living Force
Source (Dutch only): ‘Euthanasie bij kinderen is moeilijk, dat moet zo blijven’

DeepL Translator said:
End of life
'Euthanasia in children is difficult, it has to stay that way'




Theo Boer, professor at the Protestant Theological University Groningen - Image reyer boxem

Ethicist Theo Boer is not against euthanasia in children, but against legal rules for it. 'When a child suffers unbearably, you have to be able to apply far-reaching palliation.'

Marten van de Wier - 6 March 2020, 14:53


The ending of life of children who cannot ask for euthanasia themselves falls into a 'twilight zone'. And that's where it has to stay. This is what medical ethicist Theo Boer argues today on the occasion of his farewell as professor of ethics at the Theological University of Kampen. Boer has become a professor at the Protestant Theological University of Groningen.

He is known as a critic of the current Dutch euthanasia practice. Nevertheless, Boer is not opposed to doctors ending the life of a seriously suffering little patient in exceptional cases. Laying this down in a regulation goes too far, he thinks.

A majority of pediatricians do believe that a regulation should be made for children between 1 and 12 years of age. This was the conclusion of a study conducted last autumn by pediatrician Eduard Verhagen of the University Medical Center Groningen, commissioned by the Ministry of Public Health. The Cabinet will soon decide what it will do with the results.

"I do understand the call of physicians," says Boer. "Maybe it is the result of straightforward Calvinism, but in the Netherlands there is merciless action against those who do not paint within the lines." Boer cites as an example the general practitioner from Tuitjenhorn who was suspended in 2013 by the Health Care Inspectorate after giving a large dose of painkillers to a dying patient. Subsequently, physician Nico Tromp put an end to his life and was only rehabilitated years later in court.

Boer believes that Tromp was wrongly tackled. Society should have more respect for medical action in the twilight zone, he states. "Trust doctors when they are somewhat creative with the morphine syringe. That's how they've done it over the centuries."

Recourse to force majeure

A doctor should be able to end a child's life in exceptional situations, Boer believes. "When a child suffers heartbreakingly but does not respond to painkillers, or is allergic to them," says the professor.

In addition, according to him palliative sedation can be applied generously. It puts an adult or child into a deep sleep to relieve the suffering. Patients sometimes die sooner as a 'side effect'. According to the physician's standards, it is allowed to induce patients with a life expectancy of no more than two weeks into deep sleep. "When a child suffers unbearably, I think you should be able to apply far-reaching palliation, even if that accelerates death in a child that might have a long life to live," says Boer.

According to the law, physicians already have the possibility to end children's lives, Boer claims, invoking 'force majeure', if there is nothing else they can do against the suffering. According to pediatrician Verhagen and his fellow researchers, that gives doctors insufficient legal certainty.

"I understand that doctors want a settlement, but the arguments against it are more weighty for me," says Boer. "That we only kill people who ask for it, is a cornerstone of our euthanasia system." He fears that when there will be an arrangement for children, other groups could follow later: patients who, like incapacitated children, are not able to discuss their own death.

He believes that doctors should take responsibility. "If they end a child's life, let them report it. Let them stand up for their actions. It's difficult, but it must remain difficult."

____________________________________
Euthanasia in children

Euthanasia is possible for children over 12 years of age who endure unbearable and hopeless suffering. They have to grasp what their death means, and for children up to the age of 16 parents have to agree. Also, in the case of newborn children, life can be terminated by a doctor with the consent of the parents. This applies to children who face a life of hopeless and severe suffering.

For children between 1 and 12, life cannot be terminated in accordance with a regulation. This also applies to anyone older than 12 who does not understand what his death means, for example because of an impairment.


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

Other parts of this series (Dutch only):
Marinka wilde haar zoon (4) menswaardig laten sterven, maar euthanasie mocht niet. ‘Dat deed zo'n pijn’
Een jong kind laten sterven, is dat politiek haalbaar?
 

Palinurus

The Living Force
Source (Dutch only): Het aantal duo-euthanasieën is vorig jaar verdubbeld

DeepL Translator said:
Death
The number of duo-euthanasias doubled last year

More couples get euthanasia together, according to the annual report of the euthanasia committees.


Marten van de Wier - 17 April 2020, 16:59

Partners who are both seriously ill may choose to die together. More couples than before arrange such joint euthanasia, according to the annual figures of the Regional Euthanasia Review Committees. Last year it was 17 couples, or 34 patients. That is almost a doubling: in 2018 there were 9 couples (18 patients).

There are no figures from before 2018, but the review committees have been seeing an increase for several years. That was the reason for actually counting the number of 'duo-euthanasias' over the past two years. "They are often patients who are, so to speak, both at an angle to one another. That's how they can cope. But if you remove one, the other also falls over," says Jacob Kohnstamm, chairman of the joint assessment committees.

After a slight decline in 2018, the total number of euthanasia cases increased again slightly last year, by 3.8 percent to 6361, according to the annual report. This is less than in record year 2017, when euthanasia was granted 6585 times. It seems the number of euthanasia cases is stabilizing, after years of increase.

Heavy requirements for due diligence


A 'duo-euthanasia' remains rare: it concerns only half a percent of all euthanasia cases. Kohnstamm emphasizes that both partners must independently comply with all due diligence requirements of the euthanasia law. Each must suffer unbearable and hopeless suffering caused by illness. It is rare that this applies to two partners at the same time.

According to the euthanasia code, doctors must also ensure that there is 'no undue pressure' from one partner on the other. After the couple's own physician (or physicians), two independent physicians assess the request of both partners separately.

"A tricky question is: to what extent does one want death because the other also wants death," says Bert Keizer, geriatrics specialist and Trouw columnist. "In theory, that shouldn't play a role. An example: a man is demented and his wife gets colo-rectal cancer. Without her he has to go to a nursing home. If she had lived on, he would have lived on too. Still, the review committee allows you to euthanize in such a case. And I think that's right. A man like that is already suffering, and once she's dead he'll be in nothing but misery."

Romeo and Juliet

Theo Boer, professor of ethics of health care at the Protestant Theological University in Groningen, believes that duo-euthanasia should be possible, for example in partners with advanced cancer. But he gets 'gloomy' from the increase. "For the trend of 'if you go, I go too', like the story of Romeo and Juliet, we really have to be on our guard."

"Often one of the two has a longer life expectancy, and mourning also plays a part in the death wish. This is very understandable from the patient's perspective, because the death of your partner turns your life upside down. The effect is comparable to that of depression," says Boer. Mourning is not a medical reason for euthanasia, and can cloud a patient's capacity for judgement, Boer warns.

Kohnstamm argues that euthanasia is only granted on the basis of suffering with a medical basis. All cases of duo-euthanasia have been carefully re-examined by the assessment committees.

Dick Bosscher, board member of the Dutch Society for a Voluntary End of Life, thinks it is good that requests for duo-euthanasia can be granted. According to him, the increase is related to the fact that more people are familiar with the possibility.


Willem and Marianne Meuwese both suffered from an unbearable and hopeless illness. They died together
last year on request.


Marianne and Willem Meuwese died hand in hand

Marianne and Willem Meuwese did everything together since their retirement. They both painted. They visited art fairs. And when they were still healthy, they went to New York every year for a month to visit museums. They died on December 17 last year. He, former property developer, was 70. She, former speech therapist, 68.

They were both seriously ill. "That they were eligible for euthanasia was obvious," says eldest son Harm, 44. That partners both meet the euthanasia criteria at the same time is exceptional, he knows. "You'd almost say, how did they get it done?"

Willem had been ill for two years. He had cancer in his tailbone. Just when he seemed to be getting better, Marianne had an epileptic fit. A brain tumor turned out to be the cause. Not long after that, the cancer returned to her husband.

"In October last year, we celebrated their 40th wedding anniversary. We hoped that they would both have some time left", says Roel Meuwese (40), their youngest son. At the end of October it became clear that Willem's last stem cell transplant had not caught on. Marianne had a second epileptic seizure at the beginning of December. Her cancer grew rapidly.

"My mother always liked to be in control. Now she lived with a constant fear of a seizure, and of its consequences," says Harm. "The tumor would start to push all sorts of things away. She'd get more and more trouble of it and maybe even go into a coma." Her biggest fear was that she might not be able to ask for euthanasia anymore.

With Willem there was less time pressure, but also for him the disease became more difficult to bear. Body functions fell out. "He had severe pain, much more pain than we expected," says Harm.

At the beginning of December the couple put the question to their sons. What would they think about whether their parents would go together? "It was clear to us," says Harm. "Their bodies were gone. Imagine if one of the two had had to carry on for a short time without the other. That would have been terrible for both of them."

They had breakfast with their sons in the morning. After coffee they went to the bedroom. There they gave each other a hug, and thanked each other for the beautiful life. They drank the euthanaticum themselves, under the supervision of the doctor, their sons around their bed. They died hand in hand, Roel says. "My mother, always in control, only after she saw that my father had fallen into sleep."



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

Palinurus

The Living Force
Source: Supreme Court clears euthanasia doctor of murdering severe dementia patient - DutchNews.nl

Supreme Court clears euthanasia doctor of murdering severe dementia patient

April 21, 2020

The Dutch Supreme Court on Tuesday upheld a lower court decision in which a doctor who performed euthanasia on a patient with severe dementia was found not to have broken any laws.

The Supreme Court also tore up the written reprimand that the doctor, since retired, had been given by the medical sector’s disciplinary board.

The case first hit the headlines in 2016 because it was the first of its kind involving a doctor who carried out euthanasia on a patient with dementia.

The public prosecution department had accused the doctor of murder arguing she should have done more to establish that the patient wanted to go through with the process. Despite lower courts ruling in the doctor’s favor, the public prosector took the case to the Supreme Court, saying this was necessary not to dispute the verdict, but to clarify the law.

The Supreme Court ruling [in Dutch] now establishes in law that a doctor may honor a written request for euthanasia if the patient is no longer capable of giving their assent because of advanced dementia. The ruling also sets out how all the requirements can be met in this specific situation.

Living will

The case centered on a 74-year-old woman who had drawn up a living will some years before her admission to the nursing home and had regularly stated that she wanted to die.

The doctor told the lower court last year that she had spoken three times to her patient about her wish to die, but not about her living will because ‘she could not remember anything about it’. Her long and short-term memory was shot and she no longer recognized her husband, the doctor said.

The woman’s daughter said in a written statement in court that she had no doubt her mother wished to die. ‘The doctor freed my mother from the mental prison which she ended up in,’ the statement said.

Rare

Euthanasia for people with severe dementia is rare and accounted for just two cases in 2018. In that year, 2.4% of the 6,126 notifications of euthanasia involved someone with dementia.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be suffering unbearable pain and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

Since the legislation was introduced in 2002, there have been a number of controversial cases, including a woman suffering severe tinnitus and a serious alcoholic.

Similar coverage: Euthanasia allowed for dementia patients who gave prior consent: Supreme Court


Official sources in Dutch:
LiDO - Document met links
ECLI:NL:HR:2020:712, Hoge Raad, 19/04910
Arts mag gevolg geven aan schriftelijk verzoek tot verlenen euthanasie bij mensen met vergevorderde dementie

News coverage in Dutch:
Hoge Raad: arts mag euthanasie uitvoeren bij diepe dementie
Hoge Raad bevestigt: euthanasie bij zwaar demente vrouw was zorgvuldig
Hoge Raad: arts mag euthanasie uitvoeren bij diepe dementie
Hoge Raad: arts mag euthanasiewens patiënt met dementie interpreteren
 
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Palinurus

The Living Force
Source (Dutch only): Arts wordt niet vervolgd in euthanasiezaak

DeepL Translator said:
NOS News - Interior - Today, 14:36

Doctor is not prosecuted in euthanasia case

A doctor who had accompanied an 84-year-old woman during her euthanasia in 2017 will not be prosecuted. That is the conclusion following a criminal investigation into this case. According to the Public Prosecutor's Office, there is insufficient evidence to blame the doctor for not having acted in accordance with the standards of due care. From now on, however, the doctor will have to explain her decision making a little better.

The woman in question was seriously ill. Physical conditions made it impossible for her to move around properly. She was also in pain because her medication did not work correctly and she suffered from all kinds of side effects. There was unbearable and hopeless suffering and the woman refused to be treated further. She asked her family doctor for euthanasia. She referred her to the Stichting Levenseindekliniek (SLK) [Expertise Center Euthanasia]. There, her case was discussed and twice a positive advice was given for euthanasia.

Other treatments

But the Regional Euthanasia Review Committees (RTE) thought otherwise. They felt that the doctor in question had not looked sufficiently at other treatment options. Perhaps there might have been other solutions to take the suffering away and the suffering would then not have been hopeless.

The criminal investigation later showed that there was no doubt about the diagnosis made by the doctor. Other treatments had been considered, but among the options available no real improvement of the symptoms could be expected.

No criminal accusation, but explaining better

The College of Procurators General has the opinion that there is no evidence for a criminal accusation. The doctor could indeed speak of hopeless and unbearable suffering and was allowed to conclude that there was no other solution to alleviate the suffering. However, the doctor was criticized because she had not made her motives sufficiently clear when the RTE started assessing her actions. It was only during the criminal investigation that there emerged more information which provided the necessary context.

The doctor should have motivated better at an earlier stage (also to non-medics) why she was convinced of the hopelessness and unbearableness of the patient's suffering. She should also have more clearly substantiated that there was no other way to alleviate the suffering. The doctor has been asked to improve on this in the future.


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

Ambassador
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FOTCM Member
Thanks a lot for keeping abreast of this very important topic, Palinurus. :flowers: I think it is deeply troubling that they are pushing the envelope on euthanasia in these times where old people are already at such a disadvantage. But the fact that the Supreme Court came with this ruling while there is such a backlog of court-cases should tell us something. When I talked to my mother's GP last year he told me that many doctors wouldn't want to euthanise people with advanced dementia, but given the gross negligence of some doctors and nurses in New York City who are experimenting on patients which results in their death I am not so sure anymore. If no family are around to advocate for these people medical staff will be able to do God knows what.
 
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