2018-80, due care criteria complied with
Non-straightforward notification, independent physician recommended that depression be ruled out.
The patient, a man in his eighties, suffered a stroke six years before his death, after which he deteriorated physically. In the years that followed he developed various somatic disorders and a half year before his death he was diagnosed with vascular dementia (dementia caused by damage to blood vessels in the brain). From then on, the patient’s condition deteriorated further.
Two months before his death he was admitted to the psychogeriatric ward of a care institution under a court order. This was because the situation at home had become unmanageable due to changes in the patient’s personality. He was aggressive at times. Due to hospitalisation and an emergency admission to a nursing home, followed by permanent admission, his condition initially deteriorated even further.
This was caused in part by the many stimuli he experienced during the admissions, the change of surroundings and the examinations. After several weeks in the nursing home his aggressive behaviour subsided and he became calmer.
The patient had become dependent on others for his personal care, which he found terrible. He suffered from the knowledge that there was no prospect of improvement and that his mental and physical capacities would only deteriorate further. He knew that the damage inflicted by the stroke was irreversible and no longer felt he had any quality of life. He was also afraid of suffering another stroke, which could mean that he would no longer be able to make his wishes clear. The patient did not want to experience further deterioration and wanted to die with dignity.
Around a month and a half before his death, the patient first spoke with the physician regarding euthanasia and immediately asked him to perform the procedure to terminate his life. During the physician’s conversations with the patient, the patient was able to fully grasp the consequences of his actions, the situation and the decision he had made. The physician considered him to be decisionally competent regarding his request for euthanasia. The physician concluded that the request was voluntary and well considered.
The physician consulted an independent SCEN physician. The independent physician noted that it had been recommended previously that the patient be seen by a psychiatrist because he was suicidal, and this had not yet been done. The independent physician also recommended that the court order be lifted or not extended, so that the patient would have more freedom and could possibly be transferred to a different residential setting that might be better suited to him. He also considered whether it might be necessary to adjust the patient’s medication.
In his interview with the committee, the physician said that it had not been the intention to extend the court order; the order had only been necessary in order to ensure the patient was admitted to an institution. The patient was by now much calmer and much more cooperative. The physician indicated that, in his opinion, the patient was anything but depressed. Despite the fact that the physician did not doubt that the patient was decisionally competent, he followed the independent physician’s advice and consulted an independent psychiatrist.
The independent psychiatrist saw the patient about a week before he died. He assessed whether depression played a role in the patient’s wish for euthanasia. The independent psychiatrist did not observe any signs of major depressive order. Though the patient was not suicidal, there were symptoms of low spirits, in response to the loss of independence and the physical and mental deterioration. The independent psychiatrist considered the patient to be decisionally competent regarding his request for euthanasia. He saw no reason whatsoever to change the patient’s psychiatric medication. The medication had already been reduced to a minimum, and the patient’s difficulties in functioning had remained the same.
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 were also fulfilled, in the committee’s view.