2019-03, due care criteria not complied with
Non-straightforward notification, requirement that the physician performing euthanasia must in principle himself consult the independent physician and at least take note of the independent physician’s findings.
After receipt of the case file, it emerged that the termination of life on request had been performed not by the (attending) psychiatrist who had submitted the notification, but by the patient’s general practitioner. The psychiatrist had completed the model reporting form and signed it; the general practitioner had also signed it.
In response to questions from the committee, the psychiatrist said that he had guided the entire process, but that several weeks before the procedure was carried out he had agreed with the general practitioner that the latter would carry out the procedure to terminate the patient’s life. They decided this because the psychiatrist had little experience in inserting an IV cannula. The psychiatrist had considered having a paramedic do it. However, the general practitioner did not think it was a good idea to have stranger insert the IV cannula when the time came to perform euthanasia. Moreover, he was experienced in the procedure. The general practitioner also felt that if he inserted the IV cannula, he should also administer the euthanatics.
The Act stipulates that the physician who performs euthanasia must also submit the notification. The committee therefore found that in this case the general practitioner should have submitted the notification, not the psychiatrist. The general practitioner then submitted a report.
As regards consulting at least one independent physician, the committee noted the following. It emerged from the reports of the attending psychiatristand the general practitioner, and from the interview the committee held with the general practitioner that it was the attending psychiatrist who consulted the SCEN physician and took note of the latter’s report. The general practitioner had no contact with the independent physician, nor did he read the independent physician’s report and was therefore unable to ascertain from her report whether she was of the opinion that the due care criteria had been fulfilled. Instead, he relied on what the attending psychiatrist had told him about this. The general practitioner was therefore also unable to reflect on the independent physician’s report before performing euthanasia.
The independent physician did not know that the general practitioner was going to perform the euthanasia procedure (and not the psychiatrist who consulted her). She was therefore not in a position to affirm her independence in relation to the physician.
The committee noted that in this case there was no emergency that required the procedure to be carried out urgently. In fact, the general practitioner and the attending psychiatrist had decided long before euthanasia was performed that the general practitioner would insert the IV cannula and administer the substances. There would therefore have been enough time for the general practitioner to take over the entire euthanasia process at an earlier stage. After all, he had been involved in the process for a year and was himself satisfied that the due care criteria had been fulfilled. In that event, the general practitioner could have consulted the independent physician himself and read her report.
The committee noted that the aim of the physician and the attending psychiatrist had been to perform the procedure in a way that would place the least possible burden on the patient. They both felt strongly committed to the patient and they performed the euthanasia procedure in this way with the best of intentions. Neither of them realised that the physician performing euthanasia should have consulted the SCEN physician and taken note of the independent physician’s findings.
The committee found that the physician had not acted in accordance with the due care criteria laid down in section 2 (1) (e) of the Act.
The other due care criteria were complied with.