Abstract
Before asking about consultation, I asked the interviewees to focus on one issue that I consider as ethically problematic: Whether a physician should suggest euthanasia or assisted suicide to his or her patients. The KNMG report on euthanasia describes a situation in which the physician has the impression that the patient would like to start a conversation about the end of his life and his wishes concerning the end of his life, but hesitates to start this conversation. If this is the case, then the physician might choose to start this conversation. However, this has to be done with the utmost precaution in order to avoid making the patient feel pushed in a certain direction.1 The 1990 study shows that 36% of specialists, 24% of home physicians, and 65% (!) of general practitioners believed that there can be situations in which the physician should raise euthanasia as a possibility with the patient.2 The 1990 prospective study shows that the initiative for discussion about the action to be performed at the end of life came from the patient in only about half of the cases.3 Van der Maas and van der Wal estimated that of all cases of euthanasia, PAS and the ending of life without the patient’s explicit request, the physician initiated the discussion in 21 percent.4 Another study holds that 54 percent of physicians believe that in certain situations it is the physician’s professional duty to raise euthanasia as an option with the patient.5 Neither the physicians nor the study’s investigators seem to acknowledge to what extent the voluntariness of the process may be compromised by such a suggestion.6
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References
Inzake Euthanasie. Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (1995), p. 15. ISBN 90-71994-10-4. See also “Discussienota van de Werkgroep Euthanasie,” van de Koninklijke Maatschappij tot Bevordering der Geneeskunst (KNMG), Medisch Contact, Vol. 30 (1975): 7–16.
P.J. van der Maas, J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, Health Policy Monographs (Amsterdam: Elsevier, 1992), p. 102.
J.J.M. van Delden, and L. Pijnenborg, Euthanasia and other Medical Decisions Concerning the End of Life, Health Policy Monographs (Amsterdam: Elsevier, 1992) Ibid., p. 156.
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Herbert Hendin, Seduced by Death (New York: W.W. Norton, 1997), p. 52.
On the quality of life concept in medicine, see R. Cohen-Almagor and M. Shmueli, “Can Life Be Evaluated? The Jewish Halachic Approach vs. the Quality of Life Approach in Medical Ethics: A Critical View,” Theoretical Medicine and Bioethics, Vol. 21, No. 2 (August 2000): 117–137. On the power of the word and certain terminology, see R. Cohen-Almagor, “Language and Reality at the End of Life,” J. Law, Medicine & Ethics, Vol. 28, No. 3 (Fall 2000): 267–278, and see Andrea Nye (ed.), Philosophy of Language (Maiden, Mass.: Blackwell, 1998).
Personal communication on July 10, 2000.
Cf. Richard B. Balaban, “A Physician’s Guide to Talking About End-of-Life Care,” Journal of General Internal Medicine, Vol. 15, Issue 3 (March 2000): 195; A. Chopra, “Communicating Effectively at the End of Life,” J. Am Osteopath Assoc, Vol. 101, No. 10 (October 2001): 594–598; S. Z. Pantilat, A. J. Markowitz, “Perspectives on Care at the Close of Life. Initiating End-of-Life Discussions with Seriously Ill Patients,” JAMA, Vol. 285, No. 22 (2001): 2906.
A letter to the Editor, New Eng. J. of Med., Vol. 336, No. 19 (May 8, 1997): 1386.
Herbert Hendin, Seduced by Death, (op. cit.), p. 53. One study, which compared attitudes and practices concerning end-of-life decisions between physicians in Oregon and in the Netherlands, showed that an equal proportion of Dutch physicians considered euthanasia and PAS as ethically acceptable. Conversely, American physicians were consistently less likely to find euthanasia acceptable as compared with PAS. Cf. Dick L. Willems, Elisabeth R. Daniels, Gerrit van der Wal, P.J. van der Maas and E.L. Emanuel, “Attitudes and Practices Concerning the End of Life: A Comparison Between Physicians from the United States and from the Netherlands,” Arch Intern Med., Vol. 160 (2000): 63–68. See also RJ. Kohlwes, T.D. Koepsell, L.A. Rhodes, and R.A. Pearlman, “Physicians’ Responses to Patients’ Requests for Physician-assisted Suicide,” Archives of Internal Medicine, Vol. 161 (March 12, 2001): 657–663; R. Cohen-Almagor and Monica G. Hartman, “The Oregon Death with Dignity Act: Review and Proposals for Improvement,” Journal of Legislation, Vol. 27, No. 2 (2001): 269–298.
The Dutch Voluntary Euthanasia Society’s (NWE) internet address is: http://www.nwe.nl
See J.R. Peteet, “Treating Patients Who Request Assisted Suicide. A Closer Look at the Physician’s Role,” Arch Fam Med, Vol. 3, No. 8 (August 1994): 723–727; E. Rosenthal, “When A Physician Is Asked, ‘Help Me Die,’” New York Times (March 13, 1997), pp. A1, B4.
See E.J. Emanuel and L.L Emanuel, “Four Models of the Physician Patient Relationship,” JAMA, Vol. 267 (1992): 2221–2226.
Deborah Cook, “Patient Autonomy vs. Paternalism,” Critical Care Medicine, Vol. 29 (2001): N24–N25.
Cf. Ronald Dworkin, Taking Rights Seriously (London: Duckworth, 1977), pp. 22–28.
Personal communication on August 27, 2000.
Of course, second opinions may lead to contradictory recommendations. As difficult as conflicting recommendations can be for patients, these recommendations still leave patients with the option of accepting one recommendation or another, rather than feeling like they made the entire decision by themselves. When patients face difficult decisions, they are often going to learn that there is no simple right or wrong medical answer. In these situations, it is plausible to think that a series of even contradictory physician recommendations is more comforting than a series of nonrecommendations. Cf. Peter A. Ubel, “‘What Should I Do, Doc?’ Some Psychologic Benefits of Physician Recommendations,” Archives of Internal Medicine, Vol. 162, No. 9 (May 13, 2002).
Gerrit K. Kimsma and Evert van Leeuwen, “Comparing Two Euthanasia Protocols: The Free University of Academic Hospital Amsterdam and the Medical Center of Alkmaar,” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma, and Chris Ciesielski-Carlucci (eds.), Asking to Die (Dordrecht: Kluwer Academic Publishers, 1998), p. 119.
Evert van Leeuwen, “Comparing Two Euthanasia Protocols: The Free University of Academic Hospital Amsterdam and the Medical Center of Alkmaar,” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma, and Chris Ciesielski-Carlucci (eds.), Asking to Die (Dordrecht: Kluwer Academic Publishers, 1998) Ibid., p. 124.
Cf. T.L. Beauchamp and J.F. Childress, Principles of Biomedical Ethics (New York: Oxford University Press, 1989), 3rd edition.
“Annie Asked, ‘Are You Going to Help Me?,’” in David C. Thomasma, Thomasine Kimbrough-Kushner, Gerrit K. Kimsma, and Chris Ciesielski-Carlucci (eds.), Asking to Die, op. cit., p. 279.
Ezekiel J. Emanuel, Diane L. Fairclough, Elisabeth R. Daniels and Brian R. Clarridge, “Euthanasia and Physician-assisted Suicide: Attitudes and Experiences of Oncology Patients, Oncologists, and the Public,” Lancet, Vol. 347 (June 29, 1996), p. 1808. The Assisted Suicide Consensus Panel asserts that physicians should not encourage patients to hasten death, even when practicing in jurisdictions that allow assisted dying. Cf. James A. Tulsky, Ralph Ciampa and Elliot J. Rosen, “Responding to Legal Requests for Physician-Assisted Suicide,” Annals of Internal Medicine, Vol. 132 (March 21, 2000): 494–499. For further deliberation, see Timothy E. Quill, “Initiating End-of-Life Discussions with Seriously Ill Patients: Addressing the ‘Elephant in the Room,’” JAMA, Vol. 284, No. 19 (November 15, 2000): 2502; Susan D. Block, “Psychological Considerations, Growth, and Transcendence at the End of Life,” JAMA, Vol. 285, No. 22 (June 13, 2001): 2898; Maria E. Suarez-Almazor, Catherine Newman, John Hanson and Eduardo Bruera, “Attitudes of Terminally Ill Cancer Patients About Euthanasia and Assisted Suicide: Predominance of Psychosocial Determinants and Beliefs Over Symptom Distress and Subsequent Survival,” Journal of Clinical Oncology, Vol. 20, Issue 8 (April 2002): 2134–2141.
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(2005). Should Physicians Suggest Euthanasia To Their Patients?. In: Euthanasia in the Netherlands. International Library of Ethics, Law, and the New Medicine, vol 20. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-2251-7_9
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