2014-12, general practitioner, neurological disorders
KEY POINT: straightforward notification
The patient, a man in his fifties, had been suffering from motor neurone disease for two years. He suffered from loss of muscular control, shortness of breath, hypoventilation, hypersalivation and increasing difficulty in communicating and swallowing. The patient was extremely fatigued, wheelchair-bound and entirely dependent on care. He was also afraid of suffocating. The patient wanted to be in control of the situation and to end his life consciously and with dignity. As he could no longer speak, he communicated via a voice output communication aid on his computer.
Two years before his death, the patient, a man in his fifties, was diagnosed with motor neurone disease. Since then, the patient’s condition had continued to deteriorate; in the weeks before his death this process accelerated. His condition was incurable. He could only be treated palliatively.
The patient’s suffering consisted of loss of muscular control, progressive shortness of breath and hypoventilation. He also suffered from hypersalivation and experienced increasing difficulty in communicating and swallowing. The patient was extremely fatigued and lacked energy. He had become wheelchair-bound and was entirely dependent on care. He was suffering from the progressive nature of his symptoms and the fear of suffocating. The patient indicated he was ‘worn out’. He wanted to be in control of the situation and to end his life consciously and with dignity.
The patient experienced his suffering as unbearable. The physician was satisfied that this suffering was unbearable to him and with no prospect of improvement according to prevailing medical opinion. There were no alternative ways to alleviate his suffering that were acceptable to him. The documents made it clear that the physician and the specialists
gave him sufficient information about his situation and prognosis. The patient had discussed euthanasia with the physician before.
More than a week before his death, the patient asked the physician to actually perform the procedure to terminate his 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 five days before the termination of life was performed, after she had been informed of the patient’s situation by the physician and had examined his medical records. As the patient could no longer speak, he communicated via a voice output communication aid on his computer.
In her report the independent physician gave a summary of the patient’s medical history and the nature of his suffering. She concluded, partly on the basis of her interview with the patient, that the due care criteria had been met.
The physician performed the termination of life on request using the method, substances and dosage recommended in the KNMG/KNMP’s Guideline ‘Performing euthanasia and assisted suicide procedures’ of August 2012.
The committees examine retrospectively whether the physician has acted in accordance with the statutory due care criteria laid down in section 2 of the Act. They consider whether the due care criteria have been complied with in the light of prevailing medical opinion and standards of medical ethics.
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, and that his suffering was unbearable, with no prospect of improvement. The physician informed the patient sufficiently about his situation and his prognosis. The physician came to the conclusion, together with the patient, that there was no reasonable alternative in the patient’s situation. The physician consulted at least one other, independent physician, who saw the patient and gave a written opinion on whether the due care criteria had been complied with. The physician performed the euthanasia with due medical care. The physician acted in accordance with the statutory due care criteria laid down in section 2 (1) of the Act.