2014-16, general practitioner, cardiovascular disease
KEY POINT: straightforward notification
The patient, a woman in her seventies, had been diagnosed with a pericardial effusion, a pleural effusion, heart failure and pulmonary hypertension. The patient’s suffering consisted of severe shortness of breath brought on by minimal physical exertion. She could no longer do anything, was bedridden and fully dependent on care, and felt powerless. The patient was also suffering from the lack of quality of life, a fear of suffocating and the absence of any prospect of improvement in her situation.
For the last nine years before her death, the patient, a woman in her seventies, had suffered from a pericardial and pleural effusion. In the last eight years before her death she suffered from heart failure. Her condition was deteriorating gradually and progressively and she suffered from recurrent pleural effusions. A year before her death she was diagnosed with pulmonary hypertension. The patient’s condition deteriorated in the months preceding her death. Her condition was incurable. She could only be treated palliatively.
The patient’s suffering consisted of severe shortness of breath brought on by minimal physical exertion. She could no longer do anything and felt powerless. She was bedridden and had become entirely dependent on others for her personal care. The patient was suffering from the lack of quality of life and a fear of suffocating. She was also suffering from the absence of any prospect of improvement in her situation.
The patient experienced her suffering as unbearable. The physician was satisfied that this suffering was unbearable to her and with no prospect of improvement according to prevailing medical opinion. There were no alternative ways to alleviate her suffering that were acceptable to her. The documents made it clear that the physician and the specialists gave her sufficient information about her situation and prognosis. The patient had discussed euthanasia with the physician before.
More than a week 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 two days before the termination of life was performed, after he had been informed of the patient’s situation by the physician and had examined her medical records.
In his report the independent physician gave a summary of the patient’s medical history and the nature of her suffering. He concluded, partly on the basis of his interview with the patient, that the due care criteria had been met.
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.
The committees examine retrospectively whether the physician has acted in accordance with the statutory due care criteria laid down in section 2 of the Act. They consider whether the due care criteria have been complied with in the light of prevailing medical opinion and standards of medical ethics.
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 her suffering was unbearable, with no prospect of improvement. The physician gave the patient sufficient information about her situation and 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 statutory due care criteria laid down in section 2 (1) of the Act.