2017-42, due care criteria complied with

Non-straightforward notification, particular caution in cases involving patients with a psychiatric disorder.

The patient, a man in his sixties, had been suffering from a mood disorder since his late teens. As a young man he had been admitted to institutions for long periods of time. He also received prolonged outpatient treatment. Many pharmaceutical therapies were tried, which were either unsuccessful or had too many side effects.

Five years before the patient’s death, he was admitted to an institution after attempting suicide, and underwent ECT (electroconvulsive therapy, whereby the patient is anaesthetised and an electric current is passed across the brain through electrode patches). After 10 of the 12 scheduled treatments he said he wanted to stop, because he was not experiencing any improvement. He could not be motivated to undergo other forms of treatment. For years, he had cooperated with all treatment, without there being any improvement.

The patient’s suffering consisted of constant anxiety. He spent his days almost entirely in his room or on the balcony and only dared go outside in the evening. Whenever he went outside he suffered from feelings of paranoia and delusions of reference (when an everyday or coincidental event is believed to have a personal meaning). As a result he became socially isolated. In addition, the patient was permanently unable to adapt to unavoidable changes in situations or to give purpose to his life.

The man had never been able to get used to having moved into sheltered housing and the fact that his job at a sheltered workshop came to an end. As he grew older, the expectation was that he would become increasingly dependent on others for his personal care, which wouldplace ever greater demands on his social adaptability. This was unbearable to him. The patient experienced his suffering as unbearable.

The physician was satisfied that his suffering was unbearable and without prospect of improvement according to prevailing medical opinion. Around six weeks before the patient’s death the physician consulted an independent psychiatrist. She asked him how he would diagnose the patient, whether this diagnosis matched what was indicated in the records, and whether there were any treatment options left for the patient.

The independent psychiatrist concluded that the primary diagnosis (schizoaffective disorder) was correct and that there were also several chronic psychotic features (a condition whereby a person’s grasp of reality is severely impaired; they may, for instance, see images or hear voices that are not there). According to the independent psychiatrist there were still some treatment options, but given the patient’s history they had little chance of success and the prognosis was therefore poor. The independent psychiatrist considered the patient to be decisionally competent regarding his request for euthanasia.

The physician consulted an independent physician who was also a SCEN physician. The independent physician also considered the patient to be decisionally competent regarding his request for euthanasia. The independent physician concluded that the due care criteria had been complied with.

The committee noted that physicians must exercise particular caution when dealing with a euthanasia request from a patient suffering from a psychiatric disorder. The committee found that in the case under review the physician, who was a psychiatrist, did so.

Besides the independent SCEN physician, the physician also consulted an independent psychiatrist. The psychiatrist considered the patient to be decisionally competent regarding his request for euthanasia and was of the opinion that the available alternatives to relieve suffering would not work for this patient.

The committee found that the physician could be satisfied that the patient’s request was voluntary and well considered and that he was suffering unbearably with no prospect of improvement. The other due care criteria were also fulfilled, in the committee’s view.