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Doctors prefer terminal sedation

Taken from Relevant, magazine of Right to Die-NL (NVVE)
Volume 30, nr. 3, July 2004

by Marleen Peters

In 2003, the five regional review committees that assess medical care in cases of euthanasia, received 1815 reports, 1626 of which concerned euthanasia, 148 assisted suicide, and 41 a combination of the two. In comparison with 2002, 67 fewer cases than in the previous year (from the Annual Report 2003 of the Regional Testing Committees) were reported.
A vast majority of the cases was reported by the family doctor. Cancer was the main reason (88%) to perform euthanasia, followed by heart and vascular trouble, affections of the nerves , lung diseases, aids, or a combination thereof. In eight cases the committees concluded that the doctor had not (fully) acted according to the rules; they were forwarded to the Public Prosecutor and the Health Inspection.

It is likely that the results are due to a decreasing number of euthanasia’s being performed. In former years, the percentage of reported cases increased gradually, from 18% in 1991, to 41% in 1995 and 54% in 2001. There are rather strong indications that doctors are increasingly prepared to report euthanasia since 2001.

According to the review committees the decrease in reported euthanasia cases could lie in the improvement of palliative care which, in some cases, renders euthanasia unnecessary. Also, it is possible that terminal sedation is used instead of for euthanasia.
Rob Jonquière, NVVE chief executive officer: “I wouldn’t be surprised if that were the case. Terminal sedation (the patient is brought into deep sleep so that he is free from pain and anguish) is medically correct in cases of severe suffering, and eases natural death. If it is the patient’s choice, made in full consciousness, it is all right with me. But if terminal sedation is used as an alternative for euthanasia (with the rigmarole of statutory reporting) I have a problem. The patient should make his decision when fully conscious, which in case of terminal sedation is impossible. I admit that, in practice, it is hard to resist a doctor who reassuringly promises: ‘Don’t worry, I will make you sleep so that you won’t feel pain or anxiety.'”

The Dutch government promised to investigate this matter further in 2005. Also, a publicity campaign will be started for doctors to stress that reporting euthanasia is obligatory. The Royal Dutch Medical Association agrees with the action. The Association also pleads for an anonymous databank, in which the committees’ decisions are explained. This could lessen the doctors’ reluctance to report euthanasia.

Jonquière: “The review procedure is an integral part of euthanasia. The committee members are professional specialists. If one sticks to the rules, there is no reason for any doctor to feel threatened.”