2016-34, elderly-care specialist, other conditions, unbearable suffering without prospect of improvement

KEY POINT: medically unexplained physical symptoms (MUPS)

The patient, a woman in her sixties, had had persistent abdominal symptoms for seven years. Over the years she had consulted dozens of specialists, including surgeons, internal medicine physicians, rehabilitation specialists, neurologists, psychiatrists and pain specialists. She had also seen several alternative practitioners.

Her symptoms persisted and it remained unclear what was causing them. The woman’s symptoms consisted of chronic pain, including abdominal pain, nausea and vomiting, muscle spasms throughout her body, ‘locked’ muscles, a swollen abdomen, a crick in the neck, problems with swallowing, incontinence, difficulty walking, loss of energy and fatigue.

The symptoms were severely debilitating, to the extent that she could not lead a normal life. The patient no longer left the house, had become increasingly bedridden and was socially isolated. She felt she had no quality of life and suffered from the absence of any prospect of improvement in her situation.

The physician was satisfied that this suffering was unbearable to her and that there was no prospect of improvement. The independent physician concurred. Another independent physician, a psychiatrist, was consulted with regard to the patient’s request for euthanasia.
This physician concluded that her symptoms were not amenable to psychiatric treatment.

In the committee’s opinion the physician had exercised due care. He had advised the patient to follow several lengthy courses of treatment to establish the cause of her symptoms. When that proved unsuccessful, the physician concluded, together with the patient, after frequent and intensive contact that her suffering was unbearable and without prospect of improvement. The committee found that the physician could be satisfied that this was the case. The other due care criteria were also fulfilled.