2018-31, due care criteria complied with
Non-straightforward notification, particular caution in cases involving patients with a psychiatric disorder, consulting an independent psychiatrist, no reasonable alternative, combination of anxiety disorder, depression and personality disorder.
The patient, a man in his fifties, had been suffering from psychiatric problems and addiction since late adolescence. He suffered from chronic depression and social anxiety disorders. In addition he suffered from a personality disorder characterised by avoidance and dependence, a limited ability to cope with frustration and difficulty controlling anger.
Since adolescence the patient had intermittently had a wish to die and had previously attempted to end his life on several occasions. He received several courses of medication and therapy, one of which was ECT (electroconvulsive therapy, whereby the patient is anaesthetised and an electric current is passed across the brain through electrode patches), but this produced no lasting result.
His symptoms persisted despite the therapy and medication administered according to multidisciplinary guidelines. The patient also suffered from brain damage after the ECT.
The patient’s suffering consisted of chronic low spirits, not feeling connected, chronic pain and limited mobility. He was unable to shake off the low spirits and negative thoughts. He had been lacking in motivation for many years, and was unable to put his mind to anything. Not being able to make contact with other people contributed to his unbearable suffering, as did the absence of any prospect of improvement in his situation. Every day was a struggle. He spent most of his time in bed, because he lacked the energy and the will to be anywhere else. Every day was one too many for him. He experienced his suffering as unbearable.
About two months before the patient’s death, at the physician’s request an independent psychiatrist examined him. The independent psychiatrist said that there was little chance of long-term, more intensive psychological treatment leading to a considerable and lasting improvement.
The physician was satisfied that this suffering was unbearable to the patient 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. He had had a clear wish for euthanasia for four years prior to his death. At the time the physician had been considering a number of treatment options in the depression protocol. The patient had cooperated fully with the treatment options proposed by the physician.
The patient’s sustained and consistent wish for euthanasia dated from just under a year before his death. About nine months before his death, he asked the physician to actually perform the procedure to terminate his life, after which he consistently repeated his request for euthanasia.
The above-mentioned independent psychiatrist said that the patient’s mind was clear and that he was capable of logically coherent decision-making. According to the physician the patient understood the legal framework governing his request for euthanasia and was able to appreciate the consequences of his decision. The physician concluded that the request was voluntary and well considered.
The physician consulted an independent physician who was also a SCEN physician and an elderly care specialist. The independent physician saw the patient eleven days before he died. According to the independent physician the patient was able to grasp the consequences of his request for euthanasia. The independent physician was satisfied that the due care criteria had been complied with.
With regard to the request being voluntary and well considered, the suffering being unbearable and there being no prospect of improvement, the committee noted the following: physicians must exercise particular caution when dealing with a euthanasia request from a patient suffering from a psychiatric disorder. The committee found that in this case the physician did so.
The physician, who had been the patient’s attending psychiatrist for nine years, also consulted an independent psychiatrist in addition to the independent SCEN physician. The independent psychiatrist confirmed the physician’s opinion that, after a long period in which the patient had undergone numerous and intensive courses of psychiatric treatment without any lasting improvement, it could be concluded that there were no longer any realistic alternatives for the patient, that his unbearable suffering was therefore without prospect of improvement and that his request was voluntary and well considered. The independent physician confirmed the physician’s assessment that the statutory due care criteria had been complied with.
The committee found that the physician had acted in accordance with the due care criteria.