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English version of first Luxemburg’s Review Commissions report published

Follwing earlier publication of the Euthanasia Commmission in March this year (see concerning publication on this site by clicking here), the English version of the Luxemburg Review Commission Report was published on April 23, 2011. The full text  reads as follows….

National Commission for Control and Assessment of the law on Euthanasia and Assisted Suicide of 16 March 2009

FIRST REPORT (years 2009 and 2010)

Introduction

The law of 16 March 2009 on euthanasia and assisted suicide stipulates in its art. 9 that the National Commission for control and assessment present a report to the Chamber of Deputies, as from the 2nd year of the establishment of the law and thereafter, every 2 years. :

  • a statistical report based on the informations collected from the 2nd part of the registration document completed by doctors according to art. 8 of the Law,
  • a report containinig description and evaluation of the application of the law, 
  • if applicable, recommendations leading to further measures concerning the application of the law.
  • The present report concerns the declarations received during the period since the application of the law until December 2010.

The report contains a further 5 annexes : 1) the text of the Law of 16 March 2009 2) the conditions for nomination of the members of the commission 3) the Grand ducal ruling of September 9, 2009 4) the brochure with general information to the public., 5) various forms elaborated by the Commission.

Description and evaluation of the application of the law; The functions of the commission

From May to June 2009, the Commission met weekly in order to elaborated and finalize the official documents as stipulated by the law : – the request for euthanasia and assisted suicide ; – two documents for official declaration of a performed euthanasia for use by medical doctors who have performed euthanasia (either in response to a written request, or in accordance with end-of-life provisions) ; – end-of-life-provisions documents for adult capable persons, able to write, date and sign ; – end-of-life-provisions documents for adult capable persons, permanently physically unable to draft and sign their request. End of July 2009, the Commission adopted these documents and made them available to the public via their website.  The regular monthly meetings by the commission members have been dedicated to the examination of the official euthanasia declarations received. None of the examined cases raised the least doubt of irregularities and the Commission was thus able to accept unanimously each of the cases. The requested quorum of 7 members of the 9 to be present for decisions to be taken is sometimes difficult to reach for decisive meetings. After lenghty discussions, the Commission came to the conclusion that death resulting from euthanasia must be considered a death by natural causes.

Conditions and illnesses leading to euthanasias

All conditions leading to a euthanasia were, at the moment of it’s application, conform to the legal requirements : incurable and serious, each medical diagnosis was cancer.

Ages of the patients and location of the practised euthanasia

The small number of patients does not allow for statistical evaluation concerning the variables of “age” and “location”: 3 women and 2 men over the age of 60 were helped according to their end-of-life-provisions ; 3 of them in hospital, 2 in their homes. The only precision given is that none of the euthanasias was practised in an old age home or in a public care-centre.

End-of-life-declarations registered by the end of March 2011

A total of 681 of which 285 male and 396 female Nature of suffering With most of the patients, several complaints, physical as well psychological were present simultaneously. They were described as constant and unbearable. The estimated character of unbearable and without hope of recovery was repeatedly discussed by the members of the Commission. It was agreed that the character of unbearable suffering must be examined in depth between the patient and the doctor.

How euthanasia was practised with what substances

In each of the cases, death was provoked by inducing deep unconsciousness through general anaesthetic, injecting biopental intravenously, followed by in intravenous injection of a neuromuscular paralysing agent bringing about death through cardio-respiratory arrest. In all cases, a serene and rapid death within minutes was reported by the doctors. No euthanasia has been practised by injecting morphine alone or in combination with a sedatif. No assisted suicide has been reported.

Doctors consulted

No illegal prescription has been noticed.

Procedure followed by the doctor

In each case, the procedure followed by the doctor was correctly observed as set out by law under point 7 of the registration document.

The Commission’s decisions

All declarations examined (under II) were accepted and the Commission did not need to open chapter I to lift the anonymity. No doubtful points were discovered which would have contravened the law and thus, no case has been forwarded to the Collège médical or to the Court of Justice.

Recommendations by the Commission concerning the application of the Law

  1. Concerning the necessity of information: The Commission estimates that good information is essential for a correct practice of euthanasia as prescribed by the law and that this information must be directed as well to the pubic as to the medical profession. Besides the information set out on the website of the Ministry of Health and brochures for the general public, the Commission sees an urgent necessity in a special brochure for the medical profession.
  2. Concerning the availability of the medical products needed for euthanasia at the patient’s home: The Commission estimates it as elementary that by prescription, the doctor concerned can avail himself to the medicines needed for a euthanasia.
  3. Concerning the instruction of medical doctors: The Commission estimates that medical studies must include a formation preparing the future doctors to face the problems of handling end-of-life situations, including palliative care and the correct use of euthanasia. The same should be encouraged for various post-university teaching cycles and continued learning programmes.
  4. Concerning the end-of-life provisions:  Art. 4 of the Law underlines that ” The doctor treating an end-of-life patient or a patient whose condition is without hope of recovery must find out from the Commission of Control and Evaluation if the patient has registered his end-of-life provisions with the commission.” Hospitals and institutions of extended residence should enquire systematically on a patient’s admission as to an existing End-of-Life Will document
  5. Concerning possible amendments to the Law of March 16, 2009 on Euthanasia and Assisted Suicide:  The Commission has come to the conclusions that no abuse or major difficulties have occurred which would necessitate legislative action.
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