Saturday, August 29, 2015

In Belgium has the Slippery Slope Begun in "Death with Dignity"?

There is controversy in Belgium about physician assisted suicide in patients with non-terminal illness.  Click here to read the New Yorker article.

“Last year, thirteen per cent of the Belgians who were euthanized did not have a terminal condition, and roughly three per cent suffered from psychiatric disorders. In Flanders, where the dominant language is Dutch, euthanasia accounts for nearly five per cent of all deaths.”  (In Washington and Oregon it is 0.2% of all deaths.) Some physicians who actively support euthanasia have concerns about “the cowboys” who push the limits on accepting patients who are not terminal, but find life unacceptable for whatever reason.  They see no difference between helping patients who are actively dying and helping a non-terminal patient die.  These controversial physicians feel that if a patient wants to die, then they support their autonomy.  Anything else is paternalism!  Has the slippery slope begun?

6 comments:

  1. The slippery slope is here in the USA already when elderly patients on Medicare who have terminal illnesses are targeted for hastened death/shortened life with unilateral covert or overt DNR Code Status when their Part A or Part C Medicare HOSPITAL Insurance will not reimburse the physician/hospital for any further life-extending care.

    The rationale is that these Medicare/Medicaid patients are old and are going to die anyway in six months to a year with their terminal illness. The legal cause of death in the hospital is always the terminal disease and never the withholding or withdrawing of life-saving treatment that is the result of the covert or overt DNR code status.

    The courts appear to allow passive euthanasia as public policy because there is no case law in the higher courts concerning the right of elderly Medicare patients to choose to live as long as is medically possible and no case law that allows patients to recover damages for being kept alive against their
    wishes expressed in an Advance Directive in accordance with the 1991 Patient Self Direction Act (PSDA). The Congress of the USA has refused to clarify the provisions of the PSDA.

    I learned all of this the hard way when my husband was the victim of unilateral DNR Code Status that we discovered in his hospital chart when the hospital appeared to be allowing my husband's oxygen to fail and refused to do a tracheotomy until my son threatened the treating oncologist. Too long of a story to tell here but definitely a BAD experience for the patient and the family.


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    1. I've very sorry to hear about your husband's death which sounds both difficult and tragic. Having worked in Critical Care and following Medicare guideline, I have a different take on care at the end of life. If anything, doctors are overusing treatments and ventilators which prolong the dying process. I've made it very clear to my family. If I have a bad disease and a bad outlook, please treat me with loving care but not intervention like chemo, ICU days, etc. I write this after watching heroic painful struggles when no one, not the patient or family, was realistic about death. I want to die at home if possible with my loved ones nearby.

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  2. I have two distant relatives (an elderly couple) who have aggressive palliative care instructions in their wills. The wife (@ 94) recently broke a hip, in tremendous pain, pronounced dementia . . . even though her vitals were good her children met with doctors and she was put on comfort care (morphine drip, no fluids/food unless requested). She died in about 5 days. What is your opinion? I'm disquieted by it, but . . .

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    1. I think your relative's wishes for aggressive palliative care were honored, and that the treatment she received is within the current ethical standard of care. The intent of the morphine was to manage her pain, not to shorten her life. A feeding tube or IV's would likely have cause more harm than good. I don't take these decisions lightly and they can be disquieting. Each situation has a unique characteristic. I'm glad that they offered food and fluids when requested. If not, that would be abuse. It sounds to me that he comfort care was state of the art.

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  3. Even when you have all your plans put in place, you need to be around to implement them and in the event that you are not your loved ones, your family members should not be left high and dry. http://www.magruderagency.com/

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