2017-12, due care criteria complied with

Non-straightforward notification, case involving a patient in a state of reduced consciousness, advance directive.

The patient, a woman in her sixties who had been living with cancer and its effects for years, was again diagnosed with recurrent lung cancer six months before her death. The cancer was accompanied by pleurisy and doctors suspected that her lymphatic vessels had been damaged. Her condition deteriorated rapidly in the final days before her death.

Her suffering consisted of increasing pain, shortness of breath and confinement to her bed. She suffered from the loss of quality of life and the fact that her condition could only deteriorate further. She experienced her suffering as unbearable.

The patient had discussed euthanasia with the physician before. About a year before her death she had handed the physician an advance directive. Three days before her death, the patient asked the physician to actually perform the procedure to terminate her life. The physician concluded that the request was voluntary and well considered.

The physician consulted an independent physician who was also a SCEN physician. The independent physician saw the patient on the day euthanasia was performed, after he had been told about her situation by the attending physician and had examined her medical records. At the time of his visit, the patient was no longer able to communicate.

The independent physician saw that the patient was extremely emaciated, was gasping for breath and that her face was tensed and contorted. He got the impression that she was suffering continuously and without prospect of improvement. As the patient could no longer communicate her request, her advance directive was decisive in the independent physician’s assessment of whether her request was voluntary and well considered. In his report he concluded that the due care criteria had been complied with.

The committee found that the physician could be satisfied that the patient’s request was voluntary and well considered and that she was suffering unbearably with no prospect of improvement. Although it was impossible to communicate with the patient when euthanasia was performed, she did show signs of unbearable suffering. As stated in the Euthanasia Code 2018 (p. 46), in such cases euthanasia can be performed despite the fact that the patient is in a state of reduced consciousness.

As regards the consultation, the committee considered that it was apparent from the documents that at the time of the consultation it was no longer possible to communicate with the patient. However, the independent physician established that there were signs of unbearable suffering and he was satisfied that the patient had previously expressly stated that she did not want to experience such suffering.

Section 3.6 of the Euthanasia Code 2018 states that the criterion of consulting an independent physician can still be met, even if communication with the patient is no longer possible at the time of the independent physician’s visit. The independent physician will then have to base his opinion regarding the due care criteria on information from the physician, the advance directive, the medical records and information from other sources.

The committee found that the physician had acted in accordance with the due care criteria.