[Right_to_die] British Medical Journal article on Dutch euthanasia

[right_to_die_2 at mailman.efn.org]

Dutch euthanasia law should apply to patients "suffering through living,"
report says Tony Sheldon

BMJ  2005;330:61 (8 January), doi:10.1136/bmj.330.7482.61

Doctors can help patients who ask for help to die even though they may not
be ill but "suffering through living," concludes a three year inquiry
commissioned by the Royal Dutch Medical Association. The report argues that
no reason can be given to exclude situations of such suffering from a doctor
's area of competence.

The conclusion has reopened a fierce debate over what constitutes grounds
for requesting euthanasia, as it contradicts a landmark Supreme Court
decision that a patient must have a "classifiable physical or mental
condition." The 2002 ruling upheld a guilty verdict on a GP for helping his
86 year old patient die, even though he was not technically ill but obsessed
with his physical decline and hopeless existence (BMJ 2003;326:71).

The Dutch euthanasia law does not specifically state that a patient must
have a physical or mental condition, only that a patient must be "suffering
hopelessly and unbearably."

The new report does not rule on how doctors should respond if a patient
without a classifiable condition should approach them for help but says that
doctors believe that some cases of "suffering through living" could be
judged "unbearable and hopeless" and therefore fall within the boundaries of
the existing euthanasia law.

The report argues that the Supreme Court criteria are unhelpful in defining
the limits of medical practice in varied and complex cases. It is "an
illusion," it argues, to suggest that a patient's suffering can be
"unambiguously measured according to his illness."

Jos Dijkhuis, the emeritus professor of clinical psychology who led the
inquiry, said that it was "evident to us that Dutch doctors would not
consider euthanasia from a patient who is simply 'tired of, or through with,
life,'" (terms used in the original court case). Instead his committee chose
the term "suffering through living," where a patient may present a variety
of physical and mental complaints.

He said there was "enormous protest" from doctors to the Supreme Court's
ruling. "In more than half of cases we considered, doctors were not
confronted with a classifiable disease. In practice the medical domain of
doctors is far broader . We see a doctor's task is to reduce suffering,
therefore we can't exclude these cases in advance. We must now look further
to see if we can draw a line and if so where."

His report recommends caution, saying that doctors currently lack sufficient
expertise and that their roles remain unclear. It recommends drawing up
protocols by which to judge "suffering through living" cases and collecting
and analysing further data. In the meantime it recommends an "extra phase"
to treatment, where therapeutic and social solutions can first be sought.

Henk Jochemsen, director of the anti-euthanasia Lindeboom Institute for
Medical Ethics, said that the report has dangerous signs, to the effect that
"we as a society should say to people who feel their life has lost meaning:
right you had better go away."

The association plans to continue the debate, believing that such cases
could become more common. Research shows that 30% of doctors have had
patients request euthanasia even though they do not have "a serious physical
or psychiatric condition." (Lancet 2003;362:395-9)

Op zoek naar normen voor het handelen van artsen bij vragen om hulp bij
levensbeëinding in geval van lijden aan het leven (In Search of Standards
for the Treatment by Doctors of Requests for Help in Ending Life Because of
Suffering Through Living) is accessible on the website of the Royal Dutch
Medical Association, www.knmg.nl

-----------------------------------------
This article appears online at
http://bmj.bmjjournals.com/cgi/content/full/330/7482/61
forwarded to ERGO by Chris Docker (EXIT - Edinburgh UK)



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