2014-25, general practitioner, cancer
KEY POINT: reduced consciousness
The patient, a woman in her fifties who was suffering from metastasised uterine cancer, was suffering from severe shortness of breath. She had indicated orally and in writing that if she were to be sedated for that reason, she wanted euthanasia. On the day of her death, the patient’s situation had deteriorated, and she asked for euthanasia to be performed as soon as possible. Several hours before performing euthanasia the physician administered midazolam, and the patient said she did not want to wake up again. Eventually she fell into a restless sleep. In accordance with the patient’s euthanasia request and her signed directive concerning her wish for euthanasia in the event of reduced consciousness, the physician then performed the procedure for termination of life.
About a year before her death, the patient, a woman in her fifties, was diagnosed with uterine leiomyosarcoma. The patient underwent surgery, but six months before her death pulmonary and peritoneal metastases were discovered. Her condition was incurable. She could only be treated palliatively.
The patient’s suffering consisted of severe dyspnoea, despite maximum therapy, as a result of tumour growth in her lungs. The patient could only sit up straight and was unable to rest. Because she was coughing a lot, she was not sleeping well. She became increasingly exhausted. In addition she was suffering from severe oedema. After she had coughed up blood several times, the patient became afraid of suffering a fatal pulmonary haemorrhage. The patient experienced her suffering as unbearable. She wanted to be allowed to die with dignity. The patient had discussed euthanasia with the physician before.
Around two and a half weeks before her death, the patient asked the physician to actually perform the procedure to terminate her life. She repeated her request several times. The physician concluded that the request was voluntary and well-considered.
The physician twice consulted the same independent physician who was also a SCEN physician. In the first consultation, the independent physician saw the patient two weeks before the termination of life was performed, after having been informed of the patient’s situation by the physician and examining her medical records.
In the report the independent physician gave a summary of the patient’s medical history and the nature of her suffering. At the time of the independent physician’s visit, the patient said she was not yet suffering unbearably. However, if the shortness of breath and pain became more severe, and she became dependent, that would be the limit for her. If she needed to be sedated in connection with dyspnoea or a haemorrhage, she also wanted euthanasia. In the first report, the independent physician concluded, partly on the basis of the interview with the patient, that the due care criteria had not yet been met.
On the day of the patient’s death, the physician consulted the independent physician again, by telephone. The physician informed the independent physician of the deterioration in the
patient’s condition. The physician said that the patient was bedridden and no longer able to speak or sleep due to the dyspnoea. The physician said that the patient had asked that day for euthanasia to be performed as soon as possible.
In the second report, the independent physician concluded, partly on the basis of the conversation with the physician, that the due care criteria had been met.
Several hours before performing the termination of life procedure, the physician administered 15mg of midazolam because the patient was having severe difficulty breathing. The patient indicated that she absolutely did not want to wake up again. Half an hour later, the patient was somewhat drowsy, but could still communicate. Around two hours after the first dose, the patient was given another 15mg of midazolam. She then fell into a restless sleep. The patient was gasping for breath, looked ashen and was sitting with her upper body bent half forward. In accordance with the patient’s euthanasia request and her signed directive concerning her wish for euthanasia in the event of reduced consciousness, the physician performed the termination of life on request around an hour and a half after administering the second dose of midazolam, using the method, substances and dosage recommended in the KNMG/KNMP’s Guideline ‘Performing euthanasia and assisted suicide procedures’ of August 2012.
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.