2016-03, general practitioner, cancer, unbearable suffering without prospect of improvement, voluntary and well-considered request

KEY POINT: man with an intellectual disability

As a young child, the patient had been diagnosed with tuberous sclerosis complex (a hereditary disease causing abnormal cells to grow in various vital organs, causing loss of function in those organs). Over the years he experienced problems with many of his organs and developed epilepsy. As a result of the disease, he also developed an intellectual disability.

Later in life, some years before his death, he was diagnosed with cancer. Metastases were found in the liver and there was increasing tumour growth in his abdomen. The patient’s condition was incurable. He could only be treated palliatively (care aimed at improving quality of life).

The patient, by now in his thirties, had discussed euthanasia with the physician before. Two months before his death, he asked the physician to actually perform the procedure to terminate his life.
At the physician’s request, a physician specialising in the care of people with intellectual disabilities and a psychologist assessed the patient’s decisional competence in relation to his request for euthanasia. They concluded that he had insight into his situation and his prognosis. In their opinion he was able to make an independent choice and understand the consequences. They thus established that he was decisionally competent.

The physician and the experts concluded that the request was voluntary and well-considered.

Because the man had an intellectual disability, the committee added an extra consideration to its findings. The committee held that in this case, in which an intellectual disability was established in addition to severe somatic suffering caused by the disease, there needed to be a special focus on decisional competence in relation to the request for euthanasia.

The committee found that the physician had exercised due care by consulting an expert physician and a psychologist, who established that the patient was decisionally competent in relation to his request for euthanasia. The other due care criteria were also fulfilled.