Académique Documents
Professionnel Documents
Culture Documents
Pattern
Individual physicians, faced with
novel and difficult cases, prepared to
commit euthanasia and then have
the courts decide whether it was
legitimate. Hence, law continues to
get stretched, but under lots of
scrutiny.
Chabot case
She was a fifty-year-old social worker She was
divorced. She had been physically abused by
her former husband for many years. She had
two sons. One son, Peter, died by suicide in
1986, at the age of twenty. She then underwent
psychiatric treatment for her marriage crisis
following his suicide. At that time, she strongly
wished to commit suicide, but decided that her
second son, Robbie, age fifteen, needed her as
a mother. .. Robbie died of cancer in 1991, at
the age of twenty. Before his death, she
decided she did not want to continue living
after he died. She attempted suicide, but did
not succeed (In Thomasma et al., 1998, 375).
Chabot case
This competent woman confronted me 1) with a well-considered
request, that was durable (not an impulse, it existed for five years),
without any pressure from those around her. On the contrary, they
had tried all they could to make her change her mind. Equally
important, 2) she convinced me that her suffering, although it came
from psychic trauma, was for her unbearable and unacceptable.
Lastly, 3) a prospect of relief was out of reach given her well
considered refusal of anti-depressants and mourning therapy both
of which, in her situation, offered only a small chance of success.
Nevertheless, all this wasnt enough for me to give deadly pills in
such an unusual case of massive grief. What tipped the balance to
assist, for the first time in my life, someone to commit suicide, had
something to do with her extraordinary personality She was a
strong and sensitive person [with a] firm and consistent
deeply felt longing to fuse with her beloved sons. Her one and only
value in life was her children, the cornerstone on which everything
else was built. Once that stone was gone, the very idea of a future
for her collapsed, became repulsive And that understanding made
me cross the border into unknown territory to assist her in finding
a dignified death (in Thomasma, 1998, 381).
Chabot case
Convicted but not punished
Vast majority of cases far more
typical although cases like Chabot
are the ones that receive
international attention.
Reporting
Paragraph 2 of The Burial and Cremation Act
stipulates that in the case of euthanasia or
PAS, the physician shall not issue a death
certificate, as would be the case in all natural
deaths, but shall instead promptly notify the
municipal autopsist or one of the municipal
autopsists of the cause of death by
completing a form. The physician shall
supplement this form with a reasoned report
with respect to the due observance of the
requirements of due care referred to in Article
2 of the Termination of Life on Request and
assisted Suicide (Review Procedures) act.
Power of Physicians
25,000 patients every year seek
assurance from their physicians that they
will receive assistance if their suffering
becomes unbearable.
Only about 9,000 actually request
euthanasia.
Of these requests, 2,300 patients received
euthanasia, 1.8% of all deaths 400
cases of assisted suicide occur annually
Comparison to current
situation in US and Canada
(excluding Oregon and Washington)
Canada
Justice Sopinka in majority decision re
Rodriquez:
That there is a right to choose how ones
body will be dealt with, even in the context
of a beneficial medical treatment, has long
been recognized by the common law. To
impose medical treatment on one who
refuses constitutes battery, and our common
law has recognized the right to demand that
medical treatment which would extend life
be withheld or withdrawn.
Canada
Canadian courts have recognized a common
law right of patients to refuse consent to
medical treatment, or to demand that
treatment, once commenced, be withdrawn or
discontinued (Ciarlariello v. Schacter, [1993] 2
S.C.R.. 119). This right has been specifically
recognized to exist even if the withdrawal from
or refusal of treatment may result in death
(Nancy B. v. Hotel-Dieu de Quebec (19902), 86
D.L.R. (4th) 385 (Que. S.C.); Malette v. Shulman
(1990) 72 O.R. (2d) 417 (C.A.) ((Rodriquez v.
British Columbia (Attorney General) (1993);
also see, Downie, 2004, 20.
Remmelink Report
1990
1994
2001
Assisted suicide
400
400
Withholding or withdrawing
treatment
22,500
27,300
with explicit intention
to shorten life
11,594
17,637
Termination because of
intensification of pain and
symptom management
22,500
20,000
28,215
also with the
intention to shorten
life
5,150
4,070
2,800
(van der Wal & van der Maas, 1996; van der Maas et al., 1996; van der Wal et al., 2003; Cited in ten Have, 2005, 153)
34,700
300
900
28,360
18,249
Remmelink Report
1990
2001
Assisted suicide
400
300
[Current
1994
135,675
34,500
9,700
400
Remmelink Report
Discussion
Euthanasia and PAS still against the
law in the Netherlands (Article 293 1)
Article 293 2 offers a way of doing an
(otherwise) illegal act so that it will
not be prosecuted
The law is retrospective rather than
prospective
This has led to reporting problems
Reporting problems
During 1970s and 1980s only approximately
20% of euthanasia and PAS reported as such
After 1990 Remmelink report and a push by
RDMA, rates to approximately 50%
A recent change from prosecutors office to
regional committees comprised of at least
three person panel: a lawyer, as Chair, an
ethicist or moral theologian, and a physician.
They report only problematic cases to
prospector's office
Reporting now approximately 60%.
Autonomy vs Beneficience
Truth telling
Sufficient vs full information
Uncertainty about future
Doing nothing not reasonable
response to uncertain future
Medical miracles?
Wrong diagnoses and/or prognoses?
Re 1 (e): Independent
consult
Room for improvement
SCEN doctors
Cases where MDs have been
prosecuted for inadequate
consultation