Kevin's Watch

Posted: **Fri Dec 03, 2004 8:00 am**

Dutch ponder 'mercy killing' rules
Thursday, December 2, 2004 Posted: 1:28 AM EST (0628 GMT)

The Netherlands has already legalized euthanasia.
(CNN) -- Dutch health officials are considering guidelines doctors could follow for euthanizing terminally ill people "with no free will," including children, the severely mentally retarded and patients in irreversible comas.

Netherlands was the first country to legalize euthanasia -- ending the life of someone suffering from a terminal illness or an incurable condition, with their approval.

In recent years there also have been reports of mercy killings of terminally ill babies, and officials at one hospital say a number have been carried out there.

The Royal Dutch Medical Association (KNMG) has asked the Netherlands Ministry of Health to create an independent board to evaluate euthanasia cases for each category of people "with no free will."

Doctors now follow legal standards regarding euthanasia, or assisted suicide, for patients who are able to make such a decision on their own.

Under the rules established by KNMG and the Dutch courts, the patient's decision must be freely made, well-considered and persistent; there must be unbearable suffering; and the attending physician should consult with a colleague.

There are no official guidelines for ending the lives of those who are unable to make their own decision, such as in the case of a baby, but Groningen Academic Hospital has conducted such procedures under its own, internal guidelines.

Dr. Eduard Verhagen, clinical director of the hospital's pediatric clinic, told NPR in an interview that the babies who had been euthanized were born with incurable conditions that were so serious "(we) felt that the most humane course would be to allow the child to die and even actively assist them with their death."

"They are very rare cases of extreme suffering. In these cases, the diagnosis was extreme spina bifada."

That disorder is marked by incomplete development of the brain, spinal cord and/or their protective coverings.

Because the procedure was not legal, Verhagen said, the hospital preferred that cases be assessed by a committee of experts. The Dutch parliament legalized euthanasia for adults in 2002.

"What we would like to happen here in Holland is that we put the spotlight on these decisions because they need to be extremely secure, and instead of taking these positions in a kind of gray area, we want them to be in the spotlight," the doctor said.

Eric Van Yijlick, project manager for SCEN (Support and Consultation on Euthanasia in the Netherlands), said the Groningen cases involving newborns should be referred to as "life ending without request" rather than euthanasia, because that term indicates the dying party has requested the procedure.

Van Yijlick said that to his knowledge, the killing of newborns is not common -- just a few cases yearly. No official statistics exist on terminally ill children's lives being terminated, he said.

I don't have a problem at all with living wills...while I'm certainly not thrilled about it, I can understand why some terminally ill people without adequate pain control might want to commit suicide...but something really, really bothers me about someone being killed (even if they are already dying) without their consent.

Wouldn't it be more ethical for the doctors to give pain control to these deformed babies, severely retarded people, etc. and let them die a natural death?

Posted: **Fri Dec 03, 2004 8:06 am**

I guess this is one of those things that has no clear cut answer. I honestly can't respond.

Posted: **Fri Dec 03, 2004 8:09 am**

I guess working in hospitals for so long, its just ingrained in me to never harm a patient.

Posted: **Fri Dec 03, 2004 8:25 am**

I read an article in a Nurse's Journal where they said Nurses must use Nietzsche's philosophy, and that caring is evidence of a weak morality. Is it right to be cruel to be kind? I dont know. Good thread idea, Duchess.

Posted: **Fri Dec 03, 2004 8:28 am**

Well, it's an extremely difficult question. I fully support euthanasia, whether active or passive, as long as it is voluntary.

Of course, the problem here is that the people involved are completely unable, and probably always will be, of giving their consent, and probably of even understanding the implications.

Moreover, I respect the Dutch for placing this in the spotlight, and attempting to reach some acceptable guidelines.

On the whole, I would say that this is a scenario for passive euthanaisa. As Duchess says, give them pain control medication, but possibly nothing else, and allow nature to take its course.

If we start to say that we should allow them to live out their "natural" lives, we must also consider the strain on resources, and the possible impact on people who could utilise those resources in order to get well.

Of course, consent of a parent or guardian could also be the requirement. Afterall, it is their guardians who have responsibility in cases of diminished capacity. Certainly some consent should be obtained from somebody, if at all possible. If this is not possible, then I believe the state acts in loco parentis anyway, and so could allow it if they found it reasonable.

--Avatar

Posted: **Fri Dec 03, 2004 7:52 pm**

'involuntary euthenasia' is just a euphemism for murder!

The last time 'involuntary euthenasia' was legal was in Germany, 1939, authorised by Hitler - which in itself speaks volumes.

Once the concept is acceptable, where do you draw the line?

Posted: **Fri Dec 03, 2004 8:51 pm**

Well put, Edge.

Posted: **Fri Dec 03, 2004 9:25 pm**

I am undecided--primarily because of the slow, horrifically painful death of my grandmother. She had days of utter and unbearable (yet it had to be borne) agony. The medical personnel, who had given her "2 days to 2 weeks" to live refused to give her enough morphine to deaden the pain stating first that it was "addictive" and then that it "might be lethal." Well, duh! She was dying anyway. What did it matter if the morphine hastened her certain death?

I certainly do NOT approve and never will approve of euthanizing people just because they are imperfect--as in mentally or physically handicapped.

And, I wouldn't even say I was in favor of Euthanizing my grandmother in her agony--just in favor of giving her enough medicine to stop the agony. Even if it hastened (though really didn't cause) her death.

My two cents.

Posted: **Fri Dec 03, 2004 10:22 pm**

I have actually seen studies of doctors, where many of them (at least here in America) do not prescribe pain medication in sufficient quantities to control the pain of terminally ill patients. One of the most often cited reasons is the fear of addiction. In my mind, if someone is dying, why would addiction even be a concern?

Lawsuits are another large concern -- but this might be tipping in the other direction, as a family in California has won a large lawsuit when a famliy member was not given adequate pain care.

www.aarp.org/bulletin/yourhealth/Articl ... tml/page=1

www.cancer.org/docroot/NWS/content/NWS_ ... r_Pain.asp

Posted: **Sat Dec 04, 2004 1:23 am**

The medical personnel, who had given her "2 days to 2 weeks" to live refused to give her enough morphine to deaden the pain stating first that it was "addictive" and then that it "might be lethal

I'm so sorry, Cho. The ignorant attitude of those people is inexcusable.

I've stated my position on this in the other thread so I won't repeat it here. Let me just say that I'm often consulted to help care for terminally ill patients in these situations. Their comfort is my primary concern. I inform the family that I will give them the doses required to keep their loved one comfortable. I tell them that I will try to allow the patient to remain lucid if possible (to allow for family members to say and have their goodbyes) but that this may not always be possible. I also tell them that the doses that I'm using may hasten the end. No family member has ever expressed any disagreement with my plans. After the patient passes I always ask the family if he or she was comfortable at the end. This seems to help bring closure.

This may sound morbid so please don't misunderstand, but I find it professionally gratifying to know that I helped these patients when they needed it most.

Posted: **Sat Dec 04, 2004 1:27 am**

And I wish that there were a lot more health care professionals out there like you, dlb!!! Many of the patients (and their families) whom I have talked to are a lot more afraid of the pain than of the actual death.

Posted: **Sat Dec 04, 2004 1:31 am**

dlbpharmd wrote:
The medical personnel, who had given her "2 days to 2 weeks" to live refused to give her enough morphine to deaden the pain stating first that it was "addictive" and then that it "might be lethal
I'm so sorry, Cho. The ignorant attitude of those people is inexcusable.

I've stated my position on this in the other thread so I won't repeat it here. Let me just say that I'm often consulted to help care for terminally ill patients in these situations. Their comfort is my primary concern. I inform the family that I will give them the doses required to keep their loved one comfortable. I tell them that I will try to allow the patient to remain lucid if possible (to allow for family members to say and have their goodbyes) but that this may not always be possible. I also tell them that the doses that I'm using may hasten the end. No family member has ever expressed any disagreement with my plans. After the patient passes I always ask the family if he or she was comfortable at the end. This seems to help bring closure.

This may sound morbid so please don't misunderstand, but I find it professionally gratifying to know that I helped these patients when they needed it most.

My respect for you has grown immensely.

Posted: **Sat Dec 04, 2004 3:33 am**

The end of life is a difficult time for all involved. Family, loved ones, medical staff - it presents difficult choices and challenges. I know that when my Grandmother died, half of her children wanted to "do everything possible" to prolong her life, even though the extra hours or days of life that would've been provided by "aggressive treatment" would've been painful and miserable for her. Eventually, the side of the family that just wanted her last days to be comfortable won out. I don't know that the fact that she passed peacefully made them more comfortable with the decision, but Ido believe that it was the right decision to make.

Posted: **Sat Dec 04, 2004 4:11 am**

The problem with euthenasia is that the right to die can become the obligation to die. Paliative care becomes virtually non-existant and elderly people who are very ill my feel forced into a choice of euthenasia because that is what is expected of them. I remember reading that this has become a problem in the Netherlands recently.

Sum sui generis
Vs

Posted: **Sat Dec 04, 2004 5:57 am**

and with health so bad in this country, will hmo's be the ones pulling the plugs and administrating the lethal doses? with a push to up the retirement agae this could be a good way to save cash. better not get too sick people.

Posted: **Sat Dec 04, 2004 7:39 am**

duchess of malfi wrote:And I wish that there were a lot more health care professionals out there like you, dlb!!! Many of the patients (and their families) whom I have talked to are a lot more afraid of the pain than of the actual death.

I absolutely agree

.. in this country we do have remnants of a good health system .. and at the very least medicate adequately the terminally ill .. particularly those in palliative care.

I have sat by 2 relatives bedsides who both died slow painful deaths .. and when the pain came they were able to self-dose (a prescribed dose) to dispense the pain relief.

Those who are unable to self-dose .. or what have you .. are medicated adequately regardless of having health insurance or a particular financial status.

Its criminal to refuse to medicate those suffering on the basis of medical insurance status . I do hope this wasnt the reason Cho.

anyway regardless of the reason its still heinously inhumane!

I dont support involuntary euthenasia .. it just seems like perpetuating a harm - maybe even murder but possibly .. without malicous intent.

I think Variol has clinched it .. in his words "the right to die can become the obligation to die" .. and thats anti-thetical to the value we purport to place on life .. all life .. even that of the aged and infermed.

Posted: **Sat Dec 04, 2004 8:14 am**

Skyweir wrote:
Those who are unable to self-dose .. or what have you .. are medicated adequately regardless of having health insurance or a particular financial status.

Its criminal to refuse to medicate those suffering on the basis of medical insurance status . I do hope this wasnt the reason Cho.
.

Heh. It probably was, since my grandmother was uninsured except for medicare and was in her 80's. Though she was in horrible pain and was certainly dying, the hospital was going to send her home on Monday (She died on Sunday) because there was nothing more they could do--and there was something about them not being able to keep her there if they couldn't acutally DO something for her. I didn't really understand it all.

It was very confusing--and I felt they were jerking our chains.

I think she willed herself to die because she didn't want to put the family through the horror of having it happen at our house.

One of the nurses told my mom that as soon as she got her home, she should call the ambulence and have her taken to the emergency room--because they have to treat whomever comes into the emergency room.

What a lot of craziness.

I hope I just DROP DEAD when the time comes.

I don't want to linger and suffer and be bounced around like a ping pong ball.

Posted: **Mon Dec 06, 2004 4:44 am**

dlbpharmd wrote:This may sound morbid so please don't misunderstand, but I find it professionally gratifying to know that I helped these patients when they needed it most.

And so you should.

The problem with the question raised by this particular thread, is that the people concerned are not able to give their consent. The real question may lie in whether or not they would give their consent if they could.

It's not something we can really answer though with any degree of certainty. From my perspective, I couldn't imagine anyone choosing to live their lives, (such as they are), under those conditions. However, the people concerned know no different, and may be perfectly happy to have any kind of life at all.

We can't know, and I suppose that in thses cases, we may not have the right to decide it for somebody else. Of course, we could be wrong, and thus condemn them to a brief existence of pain and misery. Either way, we're probably denying somebodies wishes. We just can't tell which are which.

--Avatar

Posted: **Mon Dec 06, 2004 6:20 am**

Avatar: you know that i would choose life. and there are many people of religious faith that would believe their souls in peril if this happened because in a moment of weakness they consented to such a procedure. we have the paper work filled out on what can and can't be done. i urge everyone to do this. as Avatar said, don't let them guess what you want.

Posted: **Mon Dec 06, 2004 7:33 am**

Very true. always make sure that your wishes in this regard are known, in an "official" document of some sort.

I was going to say something along the lines of these children referred to in the original post will not have made any choices regarding their own religious affiliations, but I suppose that it would be the religious affiliations of their parents that count in this regard.

And, very probably, that is the answer to the entire question. Allow the parents the right to decide for their children. They are, afterall, the ones who will have to bear the burden of a disabled child.

--Avatar

Kevin's Watch

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