2019-04, due care criteria complied with

Straightforward notification, full report of findings, request, aphasia, End-of-Life Clinic

The patient, a man in his sixties, suffered a major cerebrovascular accident (CVA), a severe stroke, nine months before his death. He followed an intensive course of rehabilitation, but was left with paralysis on one side of his body (hemiparesis) and a serious speech disorder (aphasia). Following his course of rehabilitation, patient was admitted to a nursing home. He gradually deteriorated. His condition was incurable. He couldonly be treated palliatively.

The patient’s suffering consisted of serious and permanent physical disabilities as a result of the stroke. He was dependent on round-the-clock care and completely confined to his wheelchair. He had pain in his arm, hand and leg. His ability to communicate verbally was virtually non-existent and he felt trapped in his body. The patient was suffering from the loss of his quality of life. He knew there was no prospect of improvement in his situation and that it would only deteriorate. He did not wish to experience further decline. The patient experienced his suffering as unbearable. The physician was satisfied that this suffering was unbearable to him and that there was no prospect of improvement.

The patient had already discussed euthanasia with his general practitioner and the attending elderly-care specialist. His general practitioner sympathised with the patient’s request but considered it too complex to carry out himself. The attending elderly-care specialist did not wish to perform euthanasia either. For that reason, with the help of someone close to him, the patient contacted the End-of-Life Clinic (SLK) about a month before his death. The burden of suffering on the patient was so great that a rapid procedure was necessary.

The physician saw the patient on three occasions. Because of his speech disorder, the patient could only produce a single sound. In this way he responded verbally to the physician’s questions. The patient was also able to answer the physician’s questions non-verbally by clenching his fist, squeezing the physician’s hand and by nodding or shaking his head. The patient was also supported by his wife during these conversations.

The physician’s first conversation with the patient took place a week and a half before the latter’s death. During this conversation, the patient immediately asked the physician to actually perform the procedure to terminate his life. The patient repeated his request to the physician during the two subsequent conversations. The physician did not doubt the patient’s decisional competence. The physician concluded that the request was voluntary and well considered. (A psychological examination had shown that the man was not suffering from depression.)

The physician consulted an independent physician who was also a SCEN physician. The independent physician saw the patient five days before he died. In spite of his inability to speak, the patient was able to communicate effectively with the independent physician by means of gestures. The independent physician also considered the patient to be entirely decisionally competent regarding his request for euthanasia. The independent physician concluded, partly on the basis of her interview with the patient, that the due care criteria had been complied with.

The committee found that the physician could be satisfied that the patient’s request was voluntary and well-considered. The committee reached this conclusion because the patient, despite being unable to express his wishes verbally, was able to convey them in other ways. For the physician and the independent physician, it was sufficiently plausible on the basis of the patient’s expression of his wishes and on the basis of his behaviour that his request was voluntary and well considered. 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.

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