View across the Outer Harbour of Stornoway

Monday, 12 March 2012


As I type this, the BBC news is running its lead news item on the plight of a man, suffering from "locked-in syndrome", who wants his doctor to kill him. The man is mentally alert, but paralysed from the neck down and unable to communicate other than through a computer that reacts to the blinking of his eye, or through a perspex board, mounted with large letters. The courts have now decided that the man can challenge the application of the law on murder in a case like this, as the pre-meditated ending of life is murder.

A discussion has been raging in the UK for some time on assisted suicide, where people are helped to end their own lives. So far, that has also been illegal. The case that today's furore is all about is different, as the sufferer is unable to take any medication independently.

This discussion has also been held in Holland, and over the last decades of the 20th century, euthanasia was permitted. It is still not legal to end someone's life, but the public prosecutor will decide not to prosecute, provided the certain conditions have been met in carrying out the euthanasia: I quote the criteria, in translation.
Please note that the link will show a Google Translation, which I have cleaned up below. 
Euthanasia criteria, Netherlands
The GP must be certain that the request for euthanasia from the patient is voluntary and informed.

Explanation: The request for euthanasia should not be made under pressure or under the influence of others, or because of a mental disorder. The patient has complete insight into his illness, the likely course and its treatment options. He has also repeatedly expressed a desire to die.

The GP must be certain that there is hopeless and unbearable suffering of the patient. The patient is informed about his situation and the prognosis, and the patient is convinced that there is no reasonable alternative.

At least one other physician consult, who sees the patient and will report on whether in his opinion due diligence was exercised in performing the euthanasia or medically assisted suicide.

Notes: The doctor should perform the act himself. He must not leave it to others. In the case of assisted suicide, the physician will be present at the patient's side until death has occurred.

Euthanasia doctor may deny the request
A physician has two obligations to his patient. The first is to alleviate or eliminatethe suffering of the patient. The second is to save the life of the patient. The second obligation is diametrically oppoed to a request from a patient to die with help from the doctor. Doctors therefore refuse a request for euthanasia. Also, nurses may refuse to cooperate in the preparation of euthanasia.

A doctor or nurse may never be prosecuted for such a refusal to cooperate. The law ensures that a doctor or nurse is not in conflict with his own conscience. The doctor who himself rejects euthanasia, must refer the patient to a colleague who may be prepared to honour the request for euthanasia.

The procedure
After the death of the patient, the doctor carried out the euthanasia will write a report on the events. The non-natural death should be reported directly to the municipal coroner. The pathologist examines the body of the deceased, examines how and by what means the euthanasia was carried out and explains the findings in a separate report.

Both reports with the required attachments (eg, if present, the written directives of the patient) was sent to the regional assessment in the area where euthanasia has occurred and the local prosecutor receives the findings of the municipal coroner, because he has to give permission for the body to be released for burial.

Regional review committees
There are five regional review committees in the Netherlands: Groningen, Arnhem, Haarlem, Delft and Den Bosch. The regional review committees consist of an odd number of members, including in each case, a lawyer, a doctor and an ethicist, and they view each case whether the due diligence by the doctor who carried out the euthanasie has been observed. If this is the case, no action will be taken against him. If the opinion is that the doctor has acted contrary to the requirements or that there is doubt, then the Public Prosecutor and the regional health care inspector will be informed. When there is a criminal offense, a prosecution may follow. The inspector assesses whether disciplinary action should be taken against the physician.

What is not euthanasia:

Discontinuation or non-imposition of medical treatment at the request of the patient.
The waiver of a futile medical treatment by the doctor (this is part of normal medical practice).
Easing the pain with progressively heavier drugs (like morphine) and the stopping of artificial fluids and nutrition as a side effect that they shorten life (called palliative sedation).
The termination of life of non-viable or severely handicapped newborns and coma patients are not covered euthanasia and not by the regional review committees evaluated, or by the Public Prosecutor.
Dementia is not as unbearable and hopeless suffering, provided the person has made a euthanasia declaration before the disease has struck.