2016-90, general practitioner, cancer, unbearable suffering without prospect of improvement
KEY POINT: straightforward notification
Nature of the patient’s suffering, informing the patient, and alternatives
The patient, a man in his sixties, had been suffering since 2010 from a colon carcinoma which had metastasised to the liver (a malignant tumour in the large intestine, which had spread). From 2013 his condition deteriorated further, as a result of new liver metastases and new, abdominal and pulmonary metastases (in the abdomen and lungs). His condition was incurable. He could only be treated palliatively (care aimed at improving the patient’s quality of life).
The patient’s suffering consisted of constant nausea, frequent vomiting, fatigue, listlessness and loss of energy and strength. There was very little he was capable of doing and nothing gave him pleasure any more. He was suffering from the prospect of further deterioration and the loss of dignity.
The patient experienced his suffering as unbearable. The physician was satisfied that this suffering was unbearable to him and with no prospect of improvement according to prevailing medical opinion. There were no alternative ways to alleviate his suffering that were acceptable to the patient.
The documents made it clear that the physician and the specialists had given him sufficient information about his situation and prognosis.
Request for euthanasia
The patient had discussed euthanasia with the physician before. About two weeks before his death, the patient asked the physician to actually perform the procedure to terminate his life. The physician concluded that the request was voluntary and well-considered.
Consulting an independent physician
The physician consulted an independent physician who was also a SCEN physician. The independent physician saw the patient more than a week before euthanasia was performed, after he had been told about the patient’s situation by the physician and had examined his medical records. In his report the independent physician gave a summary of the patient’s medical history and the nature of his suffering. The independent physician concluded, partly on the basis of his interview with the patient, that the due care criteria had been complied with.
The procedure
The physician performed the termination of life on request using the method, substances and dosage recommended in the KNMG/KNMP’s Guideline ‘Performing euthanasia and assisted suicide procedures’ of August 2012.
Assessment
The committee examines retrospectively whether the physician has acted in accordance with the due care criteria laid down in section 2 (1) of the Act. In view of the above facts and circumstances, the committee found that the physician could be satisfied that the patient’s request was voluntary and well-considered, and that his suffering was unbearable, with no prospect of improvement. The physician informed the patient sufficiently about his situation and his prognosis. Together, the physician and the patient could be satisfied that there was no reasonable alternative in the patient’s situation. The physician consulted at least one other, independent physician, who saw the patient and gave a written opinion on whether the due care criteria had been complied with. The physician performed the euthanasia with due medical care.
Decision
The physician acted in accordance with the due care criteria laid down in section 2 (1) of the Act.