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