2019-125, due care criteria complied with

Straightforward notification, full report of findings, unbearable suffering, absence of a reasonable alternative, End-of-Life Clinic.

The patient, a man in his fifties, had a congenital disorder of the iris (aniridia) as a result of which he gradually became blind. His condition was incurable. His medical history also included diabetes mellitus, tinnitus and recurring episodes of kidney stones which regularly caused him severe pain.

The patient’s suffering consisted of deteriorating sight and increasing lack of self-reliance. The knowledge that he would eventually become completely blind and hence dependent on other people and various aids distressed him. He did not want that. He was adamant on this point. On the advice of his physician, the patient had tried to learn to use aids for the visually impaired. But he had come to the conclusion that this did not suit his personality at all. His physician understood his feelings in this regard. The patient could not countenance the idea that he had to adapt his former active lifestyle to his disability. The idea that people in his social circle would feel pity was repugnant to him. The patient had therefore sharply scaled back his social life and had gradually stopped visiting, and receiving visits from, his friends. Shortly before the patient’s death he was diagnosed by his ophthalmologist as legally blind.

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.

Six weeks before his death, the patient was examined by an independent psychiatrist on the advice of the first independent physician consulted by the physician. The independent psychiatrist was asked to examine whether the fact that the patient found it so difficult to accept his disability was due to a psychiatric disorder. The psychiatrist characterised the patient as a jovial person with a ‘no-nonsense’ mentality and the associated ‘all or nothing’ mindset. She concluded that he was not suffering
from a psychiatric disorder.

The first independent physician consulted by the physician was a SCEN physician. This independent physician saw the patient about four months before his death. In her report, the independent physician concluded that the due care criteria had not been complied with. She advised the physician to arrange for an examination of the patient by a psychiatrist, the outcome of which is described above. After the patient had been examined by the psychiatrist, the physician consulted a second independent physician who was also a SCEN physician and a psychiatrist. The second independent physician was satisfied that the due care criteria had been complied with, emphasising that this patient found his suffering unbearable.

The committee paid particular attention to the requirement that the physician be satisfied that the patient’s suffering is unbearable and to thequestion of whether the physician together with the patient could be satisfied that there was no reasonable alternative, especially in the light of the patient’s condition. The committee found that the physician had put forward adequate reasons for his conclusion that this patient’s blindness was unbearable to him. The physician could view the finding of the independent psychiatrist as confirming his conclusion. This was also confirmed by the second independent physician. Given the physician’s clear description of the patient’s personality, the committee had no reason to form a different opinion.

With regard to the requirement that physician must come to the conclusion together with the patient that there is no reasonable alternative, the committee found that the physician could be satisfied that this was the case. The physician prevailed upon the patient to contact an institute for the visually impaired and to seek their advice. The physician could be satisfied, again in light of the patient’s personality, that the solutions offered did not suit the patient because they were too far removed from
his independent lifestyle.

The other due care criteria had also been fulfilled, in the committee’s