Category: Ethics

Everybody’s a winner when euthanasia combines with organ donation, say doctors

BioEdge

Michael Cook

Several Dutch and Belgian doctors have proposed legal reforms to increase the popularity of combining euthanasia and organ donation in the Netherlands and Belgium.

Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure. So far, it has been performed only about 40 times in the two countries. However, there is “a persisting discrepancy between the number of organ donors and the number of patients on the waiting lists for transplantation” – which euthanasia patients could help to balance.

The authors stress that euthanasia is not a cure-all for the organ shortage. Most euthanasia patients suffer from cancer, which is a contraindication for organ transplantation. However, 25 to 30% of them do not, so there is obviously a real possibility of expanding the supply.

Furthermore, the authors say, public perception of this formerly abhorrent practice is increasingly positive:

. . . transplant coordinators in Belgium and the Netherlands notice a contemporary trend towards an increasing willingness and motivation to undergo euthanasia and to subsequently donate organs as well, supported by the increasing number of publications in popular media on this topic.

Ethically, the procedure is basically uncontroversial as long as the patient is not pressured to donate, they contend.

In the context of organ donation after euthanasia, the right of self-determination is a paramount ethical and legal aspect. It is the patient’s wish and right to die in a dignified way, and likewise his wish to donate his organs is expressed. Organ donation after euthanasia enables those who do not wish to remain alive to prolong the lives of those who do, and also—compared with ‘classical’ donation after circulatory death—allows many more people to fulfil their wish to donate organs after death.

However, there are some legal hitches in both countries. In the Netherlands, unlike Belgium, euthanasia is regarded as an “unnatural death” which has to be reported to the public prosecutor. This could delay donations. If the law were changed to allow the cause of death to be reported as the underlying condition, the procedure would be more expeditious. And “In Belgium, the current policy of determination of death by three independent physicians could be abandoned, facilitating a more lean procedure with only one physician.”

Public perceptions need to be managed as well. At the moment, it is necessary to maintain a strict separation between the request for euthanasia and the need for the organ. Partly this is needed to ensure that the donor is not being pressured. But the public also needs to have confidence that physicians will give objective advice.

Finally, there is the tradition of the dead donor rule “that donation should not cause or hasten death”. The authors imply that this could be scrapped for euthanasia volunteers:

Since a patient undergoing euthanasia has chosen to die, it is worth arguing that the no-touch time (depending on the protocol) could be skipped, limiting the warm ischaemia time and contributing to the quality of the transplanted organs. It is even possible to extend this argument to a ‘heart-beating organ donation euthanasia’ where a patient is sedated, after which his organs are being removed, causing death.

The article’s proposals were not received with great enthusiasm in the UK where there is a simmering debate on assisted dying. Tory MP Fiona Bruce told the Daily Mail: “The paper confirms the worst fears expressed by Parliament when the House of Commons conclusively voted to stop the legalisation of assisted suicide in this country. The possibility of euthanasia achieved through live organ donation, such as by removing a patient’s beating heart, as posited in this paper is shocking and chilling.”

And Lord Carlile of Berriew, a Liberal Democrat peer who is a leading lawyer, said: “I have extreme concerns about the ghoulish nature of the combined euthanasia and organ donation systems in the Netherlands and Belgium. Both can result in unbearable and irresistible pressure on an individual to die, and on a doctor to encourage death.”

cclicense-some-rightsThis article is published by Michael Cook and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

 

Junior doctors to ‘escalate’ strike action by refusing to offer emergency care in full walkout

 Evening Standard

Tom Marshall

Junior doctors are to “escalate” their industrial action by refusing to provide emergency care during a strike next month, the British Medical Association has said.

The second of two bouts of industrial action planned next month will see a full walkout from junior doctors, the BMA announced.

In previous days of industrial action, junior doctors have still provided emergency cover.

The BMA said the move “follows the continued refusal by the Government to step back from its decision to impose a new contract on junior doctors from August this year and resolve the dispute by re-entering talks”. . . [Full text]

 

Canadian Association of Physician Assistants wants objecting physicians forced to refer for euthanasia, assisted suicide

Sean Murphy*

A policy statement by the Canadian Association of Physician Assistants asserts that physician assistants “should play a supportive role” in euthanasia and assisted suicide and states that physician assistants should be allowed to personally provide the procedures under the direction of a physician.

PAs as well as other health professions can play an active role in helping to facilitate PAD and supporting physicians throughout the process.

 

The statement purports to respect objecting physician assistance “freedom of choice” (the term used is not “freedom of conscience”) , stating that those “who have a conscientious objection based on moral and/or religious beliefs should not be required to assist in this process.”  However, it adds that the Association “supports the requirement for an effective referral process” – which would require physicians unwilling to kill patients or help them commit suicide to find someone willing to do so.

The unsettled status of conscientious objection in the UK

BioEdge

Michael Cook

What are the rights of doctors who have a conscientious objection to certain procedures in the United Kingdom? The slightly confusing status quo is the subject of an article in the Journal of Medical Ethics by a Cambridge University academic, John Adenitire.

Dr Adenitire sketches a gradation of hostility towards conscientious objection.

1. At the very top there are Julian Savulescu and others who have argued that conscientious objection is “a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine” and has little place in modern medical practice. This is not a widely shared view.

2. Then there is the British Medical Association (BMA), the profession’s “trade union”, which defends conscientious objection only in three specific scenarios. It “should ordinarily be limited to those procedures where statute recognises their right (abortion and fertility treatment) and to withdrawing life-prolonging treatment from patients who lack capacity, where other doctors are in a position to take over the care.”

3. And then there is the General Medical Council (GMC), the profession’s regulator in the UK, which allows conscientious objection, albeit with a number of caveats. According to its 2013 policy statement, Personal beliefs and medical practice: “You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them.‡ And you must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs.”

4. Most accommodating of all is a ruling of the European Court of Human Rights (ECtHR) in the British case of Eweida in 2013. It applied Article 9 of the European Convention on Human Rights to several cases of discrimination in the UK. Article 9 guarantees “the right to freedom of thought, conscience and religion”, “subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others”.

It is Dr Adenitire’s contention that the Eweida ruling “effectively provides that medical professionals have the right to conscientiously object to providing certain healthcare services well beyond the scope endorsed by the BMA”.

This implies that “Given the unsettled nature of the law on the topic, [National Health Service] employers will have to proceed very cautiously as it will not always be clear whether denying a request will be considered lawful by a court. This entails that NHS bodies may be at risk of expensive legal challenges by medical professionals whose requests have been denied.”

Dr Adenitire therefore believes that the BMA’s policy should be changed to align more closely to the Eweida ruling.

However, the law is still unsettled and Dr Adenitire is not necessarily hostile to proposals for legalised assisted dying which are currently being debated in the UK. In an unpublished paper he goes on to argue that in certain circumstances doctors already have a “conscience-based right to provide assistance in dying”.

cclicense-some-rightsThis article is published by Michael Cook and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees. Some articles on this site are published under different terms.

Some Quebec doctors let suicide victims die though treatment was available: college

National Post

Graeme Hamilton

MONTREAL  –  Quebec’s College of Physicians has issued an ethics bulletin to its members after learning that some doctors were allowing suicide victims to die when life-saving treatment was available.

The bulletin says the college learned last fall that, “in some Quebec hospitals, some people who had attempted to end their lives through poisoning were not resuscitated when, in the opinion of certain experts, a treatment spread out over a few days could have saved them with no, or almost no, aftereffects.”

It goes on to spell out a physician’s ethical and legal duty to provide care, even to patients seeking to end their own lives.

Yves Robert, the college’s secretary, told the National Post that an unspecified number of doctors were interpreting suicide attempts as an implicit refusal of treatment. They “refused to provide the antidote that could have saved a life. This was the real ethical issue,” he said. . . [Full text]