2017-68, due care criteria complied with

Straightforward notification, early consultation because metastases in the brain meant there was a danger of the patient losing the ability to communicate in the near future.

The patient, a man in his seventies, was diagnosed with severe skin cancer eight years before his death. He had received treatment for his condition. Four months before his death metastases were found in the lungs and brain. In the month before his death the patient had an epileptic fit, after which his condition deteriorated rapidly. 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 confusion, drowsiness and urinary and faecal incontinence. He was also suffering from an increasing inability to communicate. There was nothing he was capable of doing: he could hardly walk by himself, had become bedridden and was completely dependent on others for his personal care. He knew that only further deterioration would follow and was suffering from the futility of his situation, the absence of any prospect of improvement, the loss of quality of life and his further physical decline.

The patient experienced his suffering as unbearable. 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. The documents made it clear that the physician and the specialists had given him sufficient information about his situation and prognosis.

The patient had discussed euthanasia with the physician before. Three days 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.

The physician twice consulted the same independent physician, who was also a SCEN physician. In the first consultation, the independent physician saw the patient around two months before euthanasia was performed, after having been informed of the patient’s situation by the physician and examining his medical records.

This early consultation took place because there was a danger of the metastases in the brain making communication impossible in the near future. In her report the independent physician gave a summary of the patient’s medical history and the nature of his suffering. She concluded, partly on the basis of her interview with the patient, that the due care criteria had not been met. The patient was not yet suffering unbearably and no specific request for euthanasia had been made.

The independent physician saw the patient a second time one day before the procedure to terminate his life, after having been informed by the physician of developments in the patient’s condition since her first visit. In her second report the independent physician gave a summary of these developments. In her report of this second visit the independent physician concluded that the due care criteria had been complied with. The patient was now suffering unbearably and a specific request for euthanasia had been made.

The physician performed the termination of life on request using the method, substances and dosage recommended in the KNMG/KNMP’s Guidelines for the Practice of Euthanasia and Physician-Assisted Suicide, published in August 2012.

The committee examines retrospectively whether the physician acted in accordance with the statutory due care criteria laid down in section 2 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.

The physician acted in accordance with the due care criteria laid down in section 2 (1) of the Act.