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Better communication needed between pharmacists and doctors about doses and techniqus for euthanasia

Dr. Jan Glerum tells about his experience: in one out of five cases of euthanasia or medically-assisted suicide there are problems or complications. To Dr. Glerum this is far too much. As a pharmacist and hospital doctor, Dr. Glerum himself was often involved with euthanasia and in the attempts of people to kill themselves.

According to Dr. Glerum, there can be various complications. These may include “unrest, too fast a coma, before the lethal potion has been drunk, or unplanned recovery,” or the failure of people to die, who then recovered.

He explained that he had been phoned twice, both times on Sunday afternoon, by a doctor and an apothecary, who came with the disturbing information: ‘the patient has recovered from his euthanaticum, what can I do now?’

Dr. Glerum argues that these dramatic situations could have been prevented had there been communication in time and on the technique.

Sometimes there is an obvious choice for a special euthanaticum, but it is the pharmacist who should evaluate the risks. For example, if a patient has been taking valium for a long time already, the pharmacist needs to know so that he or she can make the most appropriate choice and means for a euthanaticum – one that would work best with such a patient. The pharmacist should know this.

So it is important that the patient should inform the doctor and the apothecary and that he receives the correct euthanaticum. For the doctor so that he gives the correct euthanaticum and for the apothecary that he provides the correct means of euthanaticum.

Glerum gives an overview of the whole process: there is the recipe. This should contain the information that it will be an euthanaticum, so that it is obvious that euthanasia is involved.

Preparation and delivery is the responsibility of the apothecary. He should know whether the pills are lethal and should have the desired effect. Therefore he needs information from the doctor.

Importantly, this discussion should be made before the means are delivered.

There is always time for such a discussion. Euthanasia is seldom a case of an acute situation.

And most important is the technical aspect of a particular case of euthanasia. This discussion gives the two most important actors a feeling of togetherness, which is of vital importance.

Of course, there are apothecaries who do not wish to provide anyone with a euthanaticum, and Jan Glerum has respect for them. If this is the case, then alternatives should be found and organized.

The Paradox of Euthanasia

The best and most reliable euthanaticum is the direct injection into the blood vessel or the infusion, according to Jan Glerum. This in contrast to people who try to take pills on their own. For Glerum this is the paradox of euthanasia:

“I think that as long as it is possible people should take the lethal means themselves, but at the same time, being an apothecary, this method involves a great deal of risks. Therefore, it is so vital that a doctor is near, who knows what to do.” Dr. Glerum adds, “By the way, I am against the taking of pills that have been saved by the patient him or herself. I have seen so much misery, also with Vesperax. These are irresponsible risks.”

Dr.Glerum continued by saying, “The means and the method are very important. It is often vital to take a pill against vomiting, even if people tell you that they are never sick. In practice, it is often different. Also, never drink from a straw, this takes too much time. Therefore, it is an absolute must, a necessity that a doctor is nearby’.

For Professor Jan Glerum , personally and professionally, it is an obvious belief that for people who are really at the end of the chain of professional helpers and who impossibly can go on, there should be suitable assistance for a self chosen death. He often experienced dramatic situations of half-successful attempts with the most atrocious effects. “Therefore it is so important that there are people with whom you can discuss this issue. I am certain that our government [in the Netherlands] will create this space in our legal system, so that it will be controllable and realistic. This would be a godsend for a number of people who are now urged to use cruel means of self-killing.”

Translated extract from ‘Relevant’ (NVVE) Vol.26, number 3, July 2000 Summary by Beatrijs Trip. This has further been edited from Beatrijs Trip’s message issued August 1, 2000 on the nonprofit ERGO! electronic mailing list.