Developments in the Practice of Physician-Assisted Death Since Its Legalization in the Netherlands

Jacob J.E. Koopman, MD, PhD*

Public prostitution, freely available marijuana, conventional same-sex marriage—yet the Netherlands is, perhaps, best known around the world for pioneering physician-assisted death. Outside of the country, its reputation is easily misconceived and sometimes blown out of proportion. For example, in 2012 the Dutch were astonished to hear this assertion of former U.S. Senator and presidential candidate Rick Santorum . . .  Full Text

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Writing in the Journal of Medical Ethics, they report valuable unpublished information about the prevalence of the procedure.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.”


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Dutch court allows family to euthanize incapacitated 80-year-old woman against doctor’s protest

LifeSite News

Jeanne Smits

An 80 year-old woman in the Netherlands was euthanized last week after her family obtained a court order obliging the care facility for the elderly where she was living to let her leave in order to fulfill her “death wish.” The woman was incapable of expressing her will. She was legally killed one day after having left the Clinic “Ter Reede” in Flushing. The management, medical staff, and the woman’s general practitioner were all opposed to the euthanasia. . . [Full text]

 

 

Euthanasia cases leap 73% at cautioned clinic

NL Times

Janene Van Jaarsveldt

The Levenseindekliniek helped 232 people with their request to die in 2014, 98 more than in 2013. The clinic also had 1,035 requests for euthanasia last year, substantially more than the previous year, the Levenseindekliniek announced.

The Levenseindekliniek received two reprimands last year. The Regional Euthanasia Review Committee (RTE) reprimanded the clinic last month for the euthanasia of a woman with severe tinnitus (ringing in the ears), without performing a psychiatric examination. In August the clinic was also reprimanded for assisting in the suicide of an elderly woman without sufficient motivation. . . [Full Text]

 

Dying Dutch: Euthanasia Spreads Across Europe

Newsweek

Winston Ross

In one of the last photographs my family took of my grandmother, she looks as if she’s been in a fistfight. Jean Bass Tinsley is lying in a hospital bed in Athens, Georgia, wearing a turquoise button-up shirt and staring blankly at the camera. A bandage obscures her fractured skull, along with the bridge of her bloodied nose. She is 91 years old.

My grandmother essentially did this to herself. In June 2013, she fell out of her wheelchair headfirst, after ignoring her caregivers’ warnings not to get out of bed without help. Earlier that year, she’d broken both of her hips, in separate falls. Before that, her pelvis-all while trying to do what for most of her life she’d managed just fine on her own: walk.

In her last year, dementia crept into my grandmother’s mind. The staff at her long-term-care facility plotted ways to protect her from herself. It’s against the law in Georgia to restrain patients in such facilities, so they lowered her bed to the floor and put a pad down next to it. They even installed an alarm that went off if she left her mattress. My grandmother disabled the alarm, moved the pad and freed herself, repeatedly. In the end, she was both too weak and too strong. [Full text]