Wednesday, June 17, 2015

Brave new world

In September, 2011, Godelieva saw Distelmans at his clinic. Four months later, she sent an e-mail to her children: “I have filed a euthanasia request with Prof. Distelmans based on psychological distress. I have gone through the entire procedure and am now waiting for the result.”…

On April 20, 2012, three months after Godelieva sent the e-mail, Tom received a short letter from his mother that was written in the past tense. She reported that her euthanasia had been carried out on April 19th, at the university hospital of the Free University of Brussels. “I donated my body to science,” she wrote. On the back of the letter, she’d left the phone number of a friend who had the keys to her house.
Tom immediately drove to the house of the friend, who offered him a drink and then explained that she and her husband had driven Godelieva to the hospital. Tom accused the couple of coöperating with a suicide. They were defensive: they said that it was Godelieva’s choice, and they didn’t want her to have to take a taxi to the hospital alone. Later, they admitted to Tom that in the car Godelieva was chatting and laughing, and they had begun to wonder if they knew her as well as they’d thought...
De Wachter believes that the country’s approach to suicide reflects a crisis of nihilism created by the rapid secularization of Flemish culture in the past thirty years. Euthanasia became a humanist solution to a humanist dilemma. “What is life worth when there is no God?” he said. “What is life worth when I am not successful?” He said that he has repeatedly been confronted by patients who tell him, “I am an autonomous decision-maker. I can decide how long I live. When I think my life is not worth living anymore, I must decide.” He recently approved the euthanasia of a twenty-five-year-old woman with borderline personality disorder who did not “suffer from depression in the psychiatric sense of the word,” he said. “It was more existential; it was impossible for her to have a goal in this life.” He said that her parents “came to my office, got on their knees, and begged me, ‘Please, help our daughter to die.’ ”…
Belgium was the second country in the world, after the Netherlands, to decriminalize euthanasia; it was followed by Luxembourg, in 2009, and, this year, by Canada and Colombia. Switzerland has allowed assisted suicide since 1942. The United States Supreme Court has recognized that citizens have legitimate concerns about prolonged deaths in institutional settings, but in 1997 it ruled that death is not a constitutionally protected right, leaving questions about assisted suicide to be resolved by each state. Within months of the ruling, Oregon passed a law that allows doctors to prescribe lethal drugs for patients who have less than six months to live. In 2008, Washington adopted a similar law; Montana decriminalized assisted suicide the year after; and Vermont legalized it in 2013…
In Oregon and Switzerland, studies have shown that people who request death are less motivated by physical pain than by the desire to remain autonomous. This pattern of reasoning was exemplified by Brittany Maynard, a twenty-nine-year-old newlywed who moved to Oregon last year so that she could die on her own terms rather than allowing her brain cancer to take its course. Her story appeared on the cover of People, which described her as having the “soul of an adventurer and the heart of a warrior.” She became the poster child for assisted death—a far more palatable one than Jack Kevorkian, who had previously filled that role. Unlike the patients whom Kevorkian attended to with his makeshift “suicide machine,” Maynard appeared neither passive nor vulnerable. Since her death, seven months ago, lawmakers in twenty-three U.S. states have introduced bills that would make it legal for doctors to help people die…
“There’s a great difference between helping people who are already dying and helping people to die,” he told me. He didn’t understand why physicians were framing the latter as a patient’s right. “My colleagues are so against paternalism that they say, ‘You want to die? O.K., I’ll kill you.’ ”
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  1. Parliament in Belgium has passed a bill allowing euthanasia for terminally ill children without any age limit, by 86 votes to 44, with 12 abstentions.

    When, as expected, the bill is signed by the king, Belgium will become the first country in the world to remove any age limit on the practice.

    It may be requested by terminally ill children who are in great pain and also have parental consent...

    Under the Dutch conditions, a patient's request for euthanasia can be fulfilled by a doctor if the request is "voluntary and well-considered" and the patient is suffering unbearably, with no prospect of improvement.

    One man in the public gallery of Belgium's parliament shouted "murderers" in French when the vote was passed, Reuters news agency reports...

    The law states a child would have to be terminally ill, face "unbearable physical suffering" and make repeated requests to die - before euthanasia is considered...

    "The law says adolescents cannot make important decisions on economic or emotional issues, but suddenly they've become able to decide that someone should make them die," Brussels Archbishop Andre-Joseph Leonard, head of the Catholic Church in Belgium, said at a prayer vigil last week.

    Some paediatricians have warned vulnerable children could be put at risk and have questioned whether a child can really be expected to make such a difficult choice.

    Last week 160 Belgian paediatricians signed an open letter against the law, claiming that there was no urgent need for it and that modern medicine is capable of alleviating pain.

  2. Voultsos P, Chatzinikolaou F. Involuntary euthanasia of severely ill newborns:
    is the Groningen Protocol really dangerous? Hippokratia. 2014

    Advances in medicine can reduce active euthanasia of newborns with severe anomalies or unusual prematurity, but they cannot eliminate it. In the Netherlands, voluntary active euthanasia among adults and adolescents has been allowed since 2002, when the so-called Groningen Protocol (GP) was formulated as an extension of the law on extremely premature and severely ill newborns. It is maintained that, at bioethical level, it serves the principle of beneficence. Other European countries do not accept the GP, including Belgium. Admissibility of active euthanasia is a necessary, though inadequate, condition for acceptance of the GP. Greece generally prohibits euthanasia, although the legal doctrine considers some of the forms of euthanasia permissible, but not active or involuntary euthanasia. The wide acceptance of passive newborns euthanasia, especially when the gestational age of the newborns is 22-25 weeks ("grey zone"), admissibility of practices within the limits between active and passive euthanasia (e.g., withholding/withdrawing), of "indirect active euthanasia" and abortion of the late fetus, the tendency to accept after-birth-abortion (infanticide) in the bioethical theory, the lower threshold for application of withdrawing in neonatal intensive care units compared with pediatric intensive care units, all the above advocate wider acceptance of the GP. However, the GP paves the way for a wide application of involuntary (or pseudo-voluntary) euthanasia (slippery slope) and contains some ambiguous concepts and requirements (e.g., "unbearable suffering"). It is suggested that the approach to the sensitive and controversial ethical dilemmas concerning the severely ill newborns is done not through the GP, but rather, through a combination of virtue bioethics (especially in the countries of the so-called "Mediterranean bioethical zone") and of the principles of principlism which is enriched, however, with the "principle of mutuality" (enhancement of all values and principles, especially with the principles of "beneficence" and "justice"), in order to achieve the "maximal" bioethical approach, along with the establishment of circumstances and alternatives that minimize or eliminate the relevant bioethical dilemmas and conflicts between the fundamental principles. Thus, the most appropriate/fairest choices are made (by trained parents and physicians), considering all interests involved as much as possible.

    Vizcarrondo FE. Neonatal euthanasia: The Groningen Protocol. Linacre Q. 2014

    For the past thirty years, voluntary euthanasia and physician-assisted suicide of adult patients have been common practice in the Netherlands. Neonatal euthanasia was recently legalized in the Netherlands and the Groningen Protocol (GP) was developed to regulate the practice. Supporters claim compliance with the GP criteria makes neonatal euthanasia ethically permissible. An examination of the criteria used by the Protocol to justify the euthanasia of seriously ill neonates reveals the criteria are not based on firm moral principles. The taking of the life of a seriously ill person is not the solution to the pain and suffering of the dying process. It is the role of the medical professional to care for the ailing patient with love and compassion, always preserving the person's dignity. Neonatal euthanasia is not ethically permissible.

  3. Eduard Verhagen AA. Neonatal euthanasia: lessons from the Groningen Protocol.
    Semin Fetal Neonatal Med. 2014 Oct;19(5):296-9.

    Decisions about neonatal end-of-life care have been studied intensely over the last 20 years in The Netherlands. Nationwide surveys were done to quantify these decisions, provide details and monitor the effect of guidelines, new regulations and other interventions. One of those interventions was the Groningen Protocol for newborn euthanasia in severely ill newborns, published in 2005. Before publication, an estimated 20 cases of euthanasia per year were performed. After publication, only two cases in five years were reported. Studies suggested that this might be partly caused by the lack of consensus about the dividing line between euthanasia and palliative care. New recommendations about paralytic medication use in dying newborns were issued to increase transparency and to improve reporting of euthanasia. New surveys will be needed to measure the effects of these interventions. This cycle of interventions and measurements seems useful for continuous improvement of end-of-life care in newborns.

    Gesundheit B, Steinberg A, Blazer S, Jotkowitz A. The Groningen Protocol - the
    Jewish perspective. Neonatology. 2009;96(1):6-10.

    Despite significant advances in neonatology, there will always be newborns with serious life-threatening conditions creating most difficult bioethical dilemmas. Active euthanasia for adult patients is one of the most controversial bioethical questions; for severely ill neonates, the issue is even more complex, due to their inability to take part in any decision concerning their future. The Groningen Protocol introduced in 2005 by P.J. Sauer proposes criteria allowing active euthanasia for severely ill, not necessarily terminal, newborns with incurable conditions and poor quality of life in order to spare them unbearable suffering. We discuss the ethical dilemma and ideological foundations of the protocol, the opinions of its defenders and critics, and the dangers involved. The Jewish perspective relating to the subject is presented based on classical Jewish sources, which we trust may enrich modern bioethical debates. In Jewish law, the fetus acquires full legal status only after birth. However, while the lives of terminally ill neonates must in no way be actively destroyed or shortened, there is no obligation to make extraordinary efforts to prolong their lives. Accurate preimplantation or prenatal diagnosis might significantly reduce the incidence of nonviable births, but active killing of infants violates the basic foundations of Jewish law, and opens the 'slippery slope' for uncontrolled abuse. Therefore, we call upon the international medical and bioethical community to reject the Groningen Protocol that permits euthanization and to develop ethical guidelines for the optimal care of severely compromised neonates.

  4. Verhagen E, Sauer PJ. The Groningen protocol--euthanasia in severely ill
    newborns. N Engl J Med. 2005 Mar 10;352(10):959-62.

    There are, however, circumstances in which, despite all measures taken, suffering cannot be relieved and no improvement can be expected. When both the parents and the physicians are convinced that there is an extremely poor prognosis, they may concur that death would be more humane than continued life. Under similar conditions, a person in the Netherlands who is older than 16 years of age can ask for euthanasia. Newborns, however, cannot ask for euthanasia, and such a request by parents, acting as the representatives of their child, is invalid under Dutch law. Does this mean that euthanasia in a newborn is always prohibited? We are convinced that life-ending measures can be acceptable in these cases under very strict conditions: the parents must agree fully, on the basis of a thorough explanation of the condition and prognosis; a team of physicians, including at least one who is not directly involved in the care of the patient, must agree; and the condition and prognosis must be very well defined. After the decision has been made and the child has died, an outside legal body should determine whether the decision was justified and all necessary procedures have been followed...

    Two court cases, decided in the mid-1990s, regarding euthanasia in infants in the Netherlands provide some guidance for both judges and physicians. In the first case, a physician ended the life of a newborn who had an extreme form of spina bifida. In the second case, a physician ended the life of a newborn who had trisomy 13. Both cases involved a very limited life expectancy and extreme suffering that could not be alleviated. In their verdicts, the courts approved the procedures as meeting the requirements for good medical practice.