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Monday 21 April  
Criteria for euthanasia
Hans de Vreij's picture
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Utrecht, Netherlands
Utrecht, Netherlands

Euthanasia advice redefines suffering

Published on : 8 September 2011 - 4:28pm | By Hans de Vreij (Photo: Tizwas01)
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A new position paper just published by the Dutch Physicians Association (KNMG) says unbearable and lasting suffering should not be the only criteria physicians consider when a patient requests euthanasia.

The KNMG says the new guidelines will clarify the responsibilities, possibilities and limitations that physicians have within the regulations of the 2002 euthanasia law (Termination of Life on Request and Assisted Suicide [Review Procedures] Act or Euthanasia Act for short).

Dutch euthanasia law

Photo: FlickR/Donna Da Yettta

Euthanasia, or assisted suicide, is legal in the Netherlands. But it can only be applied under very strict conditions, under medical supervision, and at the request of the patient.

A 2002 law, the Termination of Life on Request and Assisted Suicide [Review Procedures] Act, stipulates the following conditions:

  • Euthanasia is available to individuals aged 16 or over
  • Euthanasia is applied at the spoken or written request of the patient
  • The patient's doctor has to be convinced that the patient's suffering is interminable and unbearable
  • The doctor has explained the patient's situation to him or her
  • The doctor and the patient have agreed that all other avenues have been explored
  • An independent colleague of the doctor has agreed that the above conditions have been met
  • The doctor applies every possible medical care during the euthanasia

Doctors are not obliged to accede to a patient's euthanasia request. In such cases, patients or their families could try and find another doctor.

Euthanasia cases have to be officially registered with regional supervisory bodies. In 2010 the five supervisors registered 3136 cases (Dutch population: 17 million). That is a 19 percent increase over the preceding year. 

Until now, factors such as income or a patient's social life played almost no role when physicians were considering a euthanasia request. However, the new guidelines will certainly change that. After almost a year of discussions, the KNMG has published a paper which says a combination of social factors and diseases and ailments that are not terminal may also qualify as unbearable and lasting suffering under the Euthanasia Act.

Vulnerable
At the moment, there are approximately one million elderly people in the Netherlands with multi-morbidity (two or more long-term diseases or ailments) and that number is expected to rise to 1.5 million in the course of the coming decade. According to the new guidelines, vulnerability (or fragility) refers to health problems, and the ensuing limitations, as well as a concurrent decline in other areas of life such as financial resources, social network and social skills.

As people age, many suffer from a complex array of gradually worsening problems, which can include poor eyesight, deafness, fatigue, difficulty in walking and incontinence as well as loss of dignity, status, financial resources, an ever-shrinking social network and loss of social skills. Although this accumulation of ailments and diseases is not life-threatening as such, it does have a negative impact on the quality of life and make the elderly vulnerable or fragile. Vulnerability also affects the ability to recover from illnesses and can lead to unbearable and lasting suffering.

Loneliness
Under the Euthanasia Act, a request for euthanasia may be honoured only if a patient is undergoing unbearable and lasting suffering. The KNMG now says that, if non-medical factors such as income or loneliness are to be taken into consideration, other specialists must be consulted when a patient has requested euthanasia. In an interview broadcast on Dutch television, KNMG chair Arie Nieuwenhuijzen Kruseman said weighing up non-medical factors was far from simple:

"It's quite possible that the same constellation of factors would be experienced as unbearable and lasting suffering by one patient but quite tolerable by another. This makes it extremely difficult."

The physicians association says further investigation into non-medical factors is needed and Dr Nieuwenhuijzen Kruseman adds that euthanasia should be allowed even when a patient is not suffering from a terminal disease:

"It doesn't always have to be a physical ailment, it could be the onset of dementia or chronic psychological problems, it's still unbearable and lasting suffering. It doesn't always have to be a terminal disease."
 

(jric/rk/imm)

 

Discussion

Annette Vander Heiden 2 October 2011 - 8:02am / Australia

Twenty years ago I suffered from my second attack of severe depression. The thought of dying was the only thing that gave me any relief ,for me the emotional pain was unbearable. The only thing that prevented me taking that course of action was the impact this would have on my family,and also my faith. I'm certainly not a right wing religious funamentalist. I have a strong & sustaining Christian faith. I believe that euthanasia legislation can be abused too easily & I'm very glad that I no longer live in the country of my birth....The Netherlands. Who knows twenty years ago I may have been gently euthanased out of my misery.

Annette Vander Heiden 2 October 2011 - 8:02am / Australia

Twenty years ago I suffered from my second attack of severe depression. The thought of dying was the only thing that gave me any relief ,for me the emotional pain was unbearable. The only thing that prevented me taking that course of action was the impact this would have on my family,and also my faith. I'm certainly not a right wing religious funamentalist. I have a strong & sustaining Christian faith. I believe that euthanasia legislation can be abused too easily & I'm very glad that I no longer live in the country of my birth....The Netherlands. Who knows twenty years ago I may have been gently euthanased out of my misery.

leesf 10 September 2011 - 4:12am / USA

Please approve ASAP. It will take at least 25 years for the USA to legalize because our politicians allow right wing extremists to dictate policy. (and they vote, in droves).

Shocking in modern times people cannot die with dignity.

Andrew Barkley 10 September 2011 - 1:23am

I'm an author who supports "dignity in dying", and have dedicated the following poem to "the right to die a dignified death".

TIME

Life is retiring me, how am I to cope
Futile now it seems, my last lifeline of hope
What is to become of me, this frail life I behold
Soon I will need to be bathed, fed, and clothed
Society imposes on me, to gracefully grow old
To let mother nature decide my fate, so I am told
Where is the grace in dying, suffering without hope
Shall I call time on my lifeline, for whom the bell tolls

Anonymous 4 November 2011 - 8:32pm / usa

Mother nature does not decide our fate, we do. When the time comes that one needs to be bathed, fed and clothed it offers others to step forward and fill those shoes so they too have purpose and fulfill our Lords commands to take care of each other, love your neghbor, feed the poor and clothed the naked and so on, that would take away from others on their path home. If our mother Mary decided no I'm not married and I do not accept this pregnancy so I wanted to get rid of it, where would we be now. Why do humans think they have the right answers. We think it is ok to kill a baby growing inside the womb that is a gift from God and we think we can anyone at a different stage in life who are also a gift from God. If you would look to God for the answers he would show you the way and you would have the right answers so you too can join him in eternal life. Eternal is a long time.

Anonymous 12 September 2011 - 10:59pm / USA

Thank you for the beautiful poem.
Each words resonates within me.

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