2015-82, general practitioner, pulmonary disorders, voluntary and well-considered request, unbearable suffering without prospect of improvement

KEY POINTS: reduced consciousness, no perceptible signs of suffering

The euthanasia process was started for a patient with severe lung disease. However, one day before her death, her condition deteriorated so badly that she was sedated. Despite her state of reduced consciousness, the physician proceeded with euthanasia. The committee found that performing euthanasia was justified.

Twenty years before her death, the patient, a woman in her sixties, was diagnosed with pulmonary fibrosis. In the period between the diagnosis and her death, the patient had suffered several respiratory infections. At first the patient’s condition deteriorated slowly, but each respiratory infection was followed by an accelerated decline. The patient’s suffering was unbearable. Her condition was incurable. She could only be treated palliatively.

The patient had discussed euthanasia with the physician previously, and approximately one month before her death she asked her general  practitioner to actually perform the procedure to terminate her life. The independent physician consulted was satisfied that the due care criteria had been complied with.

One day before the euthanasia was due to be performed, the patient’s condition deteriorated rapidly and her shortness of breath worsened. After consultation she was given morphine to help her sleep. A few hours later she developed Cheyne-Stokes respiration and became somnolent, but she did respond to stimuli and at times she was agitated. After consultation with her family it was decided to proceed with the euthanasia as planned, because the physician and the family were satisfied that the patient did not want to be in this situation.

The committee made the following observations. The patient had  previously made a specific request for euthanasia, and two days before the procedure to terminate her life was performed the patient had been seen by an independent physician. The physician’s report made it clear that, when euthanasia was performed, the patient was somnolent as a result of having been given morphine. She was in a state of reduced consciousness, an unintended side effect of medication administered to reduce symptoms as part of palliative care. It is possible that the state of reduced consciousness would have been reversible if the medication had been ceased. The patient would then have been returned to a situation of unbearable suffering. Under these conditions, the possible reversible nature of the state of reduced consciousness is therefore no reason to bring the patient back to a conscious state, and to do so is considered undesirable. In these circumstances, the committee finds performing euthanasia to be justified, even if there are no perceptible signs of suffering (see also KNMG Guideline ‘Euthanasia for patients in a state of reduced consciousness’, section 3.3, p. 31).