Comments on Pallimed: A Hospice & Palliative Medicine Blog: Lancet editorial on euthanasia & choice

@Drew: perhaps that's an important thing too: in D...

2009-06-28T09:11:02.031-05:00

@Drew: perhaps that's an important thing too: in Dutch law no such thing as 'terminal' is mentioned. So answering your last question: if the people are trying to expand the role, they are actually free to do so. (whether or not your ethical guidelines don't agree)

(quite) Roughly translated the law is as follows:

the general prosecutor will not prosecute when the following 6 rules are abided:.
The doctor,
1. is convinced the patient's 'deathwish' is voluntary and well thought through. ,
2. is convinced the patient's situation is unbearable and without chance of relief in the future,
3. has informed the patient about his or her situation now and in the future,
4. and the patient together came to the conclusion that the current situation couldn't be dealt with using any other option.
5. has consulted at least one other independent MD, who has seen the patient en has written down his diagnosis about nr. 1-5
6. has performed the act of euthanasia following medical standards

So law also doesn't state any sort of disease, just 'unbearable' and 'without relief in the future', which means that Dutch law doesn't rule out for instance psychiatric patients. Law does however rule out newborns from euthanasia. Anyone >11 years is allowed to request euthanasia, from 16 years of age onwards you don't need your parent's permission. You lose the right the moment you are considered 'mentally unable to handle life', (psychosis, dementia, etc) which is so roughly translated it hurts.

Assisted suicide is very clearly not allowed in the Netherlands btw, but letting very old and very sick die by withholding fluids and is not unusual.

I think these facts, including a declining use of euthanasia urge for rethinking some rules, because some are incompatible (for instance a human with alzheimer's disease declaration concerning euthanasia will have a very hard time getting euthanasia, but we are letting people die by withholding fluids) If we are going to consider some lives of unmanageable quality, and others not, we'd better have some really good arguments on the basis of our ethical borders.

Erratum: in my previous reaction I mentioned a declining number of euthanised people, in contrast to more palliative care. That should be palliative sedation.

NC: thanks for the clarification! Bram: I guess I...

2009-06-26T13:04:39.488-05:00

NC: thanks for the clarification!

Bram: I guess I agree with you in part; that it doesn't have to be a slippery slope; and the Oregan PAS experience in the US for the last ~decade has shown that - there has been no discernible slippery slope there.

So, yes, it's not inevitable but that does not mean that some euthanasia advocates aren't trying to expand its role/patient eligibility beyond 'terminal' as the author contends.

I cite from the article: "There is evidence from ...

2009-06-26T06:55:59.188-05:00

I cite from the article:

"There is evidence from countries that have gone down the “assisted dying” road that, once the campaigners achieve one goal, they simply move on to the next in an attempt to widen the goalposts further. For example, in the Netherlands there is campaigning for euthanasia to be allowed for people with dementia and for a so-called suicide pill to be available for those who are “tired of life”; and in the short space of time since the Dutch 2002 Euthanasia Act was passed there has been the so-called Groningen Protocol governing the euthanasia of infants."

Personally I think the authors of the Lancet article are in error on the same subject they accuse others of: using a certain form of language to get their message across. At least, I read 'The slippery slope argument' in the piece cited above.

Also I don't think that there is a causal relation between the euthanasia laws and the groningen protocol in the way the authors of the Lancet article are making it look like. (actively moving from one 'goalpost' to another, to broaden the terms of euthanasia.)

Nevertheless; the number of euthanised patient has dropped the last years here in the Netherland (in favor of palliative care)

Also, the Groningen protocol is concerning (as I think you know) a category of newborns that is severly handicapped. The original article by Verhagen and Sauer http://content.nejm.org/cgi/content/full/352/10/959 is stating that very thoroughly. I think the authors should have mentioned the topic of the Groningen Protocol more precise, as well as who is 'campaigning' for it.

Last but not least, assisted suicide in Holland has recently been 'in court', not having a happy ending for the 'assistor'... (a nursing home patient wanted to die, but her doctor refused, she contacted a helpgroup on assisted suicide, who helped her die)

So adressing the issue in the first paragraphs of the article: there are also issues at hand at the other end of the spectrum: patients who are really suffering, with their docs at their beds, but who are 'abandoned' in these very important questions. (note that Dutch law hasn't made euthanasia 'a right', doctors aren't forced by law, nor are they supposed to find other doctors, willing to perform euthanasia patients)

Even when leaving the 'are they wrong' question aside, the question remains: have the authors taken enough efforts to be clear on these highly sensitive issues? I doubt they have.

Just to clarify - Ilora Finlay is Baroness of Llan...

2009-06-26T04:23:39.010-05:00

Just to clarify - Ilora Finlay is Baroness of Llandaff, and a member of the House of Lords i.e. conferred the honour by the Queen, as opposed to an MP who is elected by the constituency. She has for many years run a Diploma in Palliative Medicine (awarded by Cardiff University) and spoken out against assisted dying.
NC