GESTIÓN EN SALUD PÚBLICA: Netherlands euthanasia case under renewed scrutiny

domingo, 11 de marzo de 2018

Netherlands euthanasia case under renewed scrutiny

Netherlands euthanasia case under renewed scrutiny

Bioedge

Netherlands euthanasia case under renewed scrutiny

by Xavier Symons | 10 Mar 2018 |

In a new article in the Journal of Medical Ethics, researchers from the National Institutes of Health offer an insightful analysis of one of the most controversial cases of euthanasia to have occured in the Netherlands.

Bioethicists David Gibbs Miller, Rebecca Dresser and Scott Kim analyse the official medical records of a severely demented woman who was euthanized in Holland in 2016. The woman, who was in her 70s, had her life ended by a geriatrician in aged care facility after having written an advance directive indicating her wishes for receiving euthanasia.

The advance care directive was written several years before her death, and there has been much discussion about whether it remained binding.

The most controversial feature of the case, however, was the manner in which the woman was euthanised. The supervising doctor mixed sedatives into the coffee of the woman without her knowledge. When the sedatives did not work, the doctor administered a stronger drug subcutaneously.

While the doctor was administering the lethal dose, the patient tried to get up and had to be restrained by family members.

The authors observe that there is insufficient scrutiny of the process by which Advance Care Directives are prepared:

...physicians and the RTE [Dutch regional euthanasia review committees] accept a low threshold of decisional capacity for preparing AEDs. The RTE’s Code of Practice states that in early dementia, "the patient generally…is decisionally competent in relation to his request for euthanasia". This apparent presumption of capacity in early AD (and in the case [of this patient], a much more advanced state) is incompatible with existing data on Alzheimer’s disease and decisional capacity.

The authors also question whether an Advance Care Directive should override the contemporaneous wishes of a severely demented patient:

The failure to provide adequate protection to a vulnerable patient was exacerbated by the failure to respect her contemporaneous interests and statements. By privileging the AED as the expression of Mrs A’s ‘real self ’—a judgement that itself was dubious in light of her questionable capacity and understanding when she made the AED—physicians failed to protect her … when they disregarded her contemporaneous statements and actions.

A recent US documentary recounts the story of an Oregon couple who committed suicide together in April 2017. The couple, Charlie and Francie Emerick, had both been diagnosed with terminal illnesses. They felt that, after having been married and together for some sixty odd years, it was only fitting that they exit this world as a couple.

Talk of “fittingness” in the context of death draws our attention to a broader topic, namely, the aesthetics of death. Just as we seek beauty in life, so also do we seek beauty in death.

There is a certain beauty to ending the narrative arc of our lives with a “fitting” poetic flourish. And in the context of euthanasia, it seems that many cases are underpinned by a desire not just for a peaceful death, but a beautiful death.

In 2016, a 41-year-old Californian multi-media and performance artist, Betsy Davis, ended her life with lethal medication. Davis wanted her suicide to be a “final act” in her artistic career, and she organised an elaborate weekend of celebrations and performances before consuming the lethal dose on a canopy bed by a hillside.

I wonder if, in seeking a beautiful death, we should look the wisdom the ages, rather than following our own artistic intuitions. The 15th century Latin tract Ars Moriendi provides persons in extremis with guidance for a good death. It encourages readers to face death bravely, to avoid temptations to despair, impatience or pride, and to surround oneself with those loved ones who, in life, have brought joy to one’s soul.

I’m not sure that the authors of the text had assisted suicide in mind when they outlined the elements of the ars moriendi.

XAVIER SYMONS
Deputy Editor