2019-129, due care criteria complied with
Straightforward notification, findings letter, illness lasting
several years involving many treatments, independent physician finds in the first instance that the due care criteria not yet complied with.
The patient, a woman in her thirties, was diagnosed with breast cancer four years before her death. In spite of surgery, extensive chemotherapy and radiotherapy, metastases were found in her brain and lungs two years prior to her death. The patient underwent several operations, some palliative in nature, to remove the metastases in her brain. However, when it became apparent that another operation would soon be needed, she decided she no longer wanted to go through with it. The patient’s condition was incurable. She could only be treated palliatively.
The patient’s suffering consisted of blindness due to the metastases in her brain. Her eyes could still see, but her brain could no longer process this information. She walked into doors and could no longer eat with cutlery. As a result, she was dependent on others, and was painfully aware of this. The patient felt she could not go on, she was very tired. After developing hemiplegia, she considered that she no longer had any quality of life. The patient had already indicated, after a similar period following brain surgery, that what she had to endure amounted in her view to unbearable suffering. She was aware that there was no prospect of improvement and that her situation would only get worse.
The physician was satisfied that this suffering was unbearable to her and without prospect of improvement according to prevailing medical opinion. There were no alternative ways to alleviate the patient’s suffering that were acceptable to her. The patient had discussed euthanasia with the physician before. She wished to decide for herself when it had become too much. In those circumstances, she wanted euthanasia to avoid having to suffer in the way she had seen her parents suffer. Close family and friends were aware of her decision and supported her. There was no doubt she was decisionally
competent. One day before her death, the patient asked the physician to actually perform the procedure to terminate her life. The physician concluded that the request was voluntary and well considered.
The physician consulted an independent physician who was also a SCEN physician. The independent physician saw the patient nine days before she died. The independent physician concluded that due care criteria not yet been fulfilled because the patient had not yet made a request. The day before the patient’s death, the physician telephoned the independent physician, stating that the patient was now asking for euthanasia to be performed. The independent physician then supplemented the earlier report, indicating that the due care criteria had been fulfilled.
The committee found that the physician had acted in accordance with the due care criteria.