“We Don’t Do That Here”: Overcoming Obstacles to Euthanasia in Nursing Homes

“We don’t do that here,” a woman with Parkinson’s disease was told in the nursing home when she requested euthanasia (30/09). Euthanasia, defined in law as active termination of life at the patient’s request, is usually a matter for the general practitioner in the Netherlands: 80 percent of the 8,720 reported cases last year were done by the general practitioner.

Geriatric specialists perform euthanasia much less often (316 times last year). This is partly due to the type of patient: almost 60 percent of euthanasia is given to people suffering from cancer. Nursing homes are mainly home to people with chronic physical conditions or dementia. Because the mind of the latter is affected, euthanasia is much more difficult: if dementia no longer allows proper conversation, many doctors shy away from actively ending life. Understandable, because you don’t just kill your patient. You only do that if you are very sure that this is what she wants and there is no other way to alleviate her suffering. And for this, doctors want to be able to have a series of good conversations with the person themselves.

Dorothea Touwen is a lecturer in medical ethics (LUMC) and former member of a Regional Euthanasia Review Committee

The issue is different for patients with physical problems and also for competent patients with early dementia. The lady was clear about her wish in her letter. It is possible to have a conversation with her – or so it seems from her letter. If she wants to die and is suffering unbearably and without hope, then there should be no obstacle to euthanasia.

‘We don’t do that here’ is the least convincing motivation you can give as a doctor. An essential aspect of being a doctor is that you have your own professional responsibility. This means that you always have to think for yourself about what you think is good care for the patient at this stage of their illness or suffering. You may have reasons for not complying with a request for euthanasia, but the institution where you work cannot prohibit you from providing euthanasia. You act within the norms of the profession and the law. Neither is an obstacle to euthanasia for someone who voluntarily and deliberately asks for death and suffers without hope and unbearable.

Responsibility

‘We don’t do that here’ can also be the statement of caregivers, who prevent the patient’s request from reaching the doctor. A geriatric specialist has the responsibility to know her patient, to know what they need and to provide that care.

Perhaps the reluctance comes from the specialist himself. I can imagine that the professional field plays a role. These doctors always work in the face of death, in the very last chapters of their patients’ lives. Like no other specialty, geriatric medicine specialists are familiar with the boundaries of medicine. They have been trained like no other to keep their hands behind their backs: not to continue with treatment, but to respect the finite nature of existence. Maybe it’s that familiarity with suffering and finitude. Nursing home residents suffer so much that as a doctor you become accustomed to it. The individual patient who asks for action to get out of it requires a change in the work of the geriatric specialist: relieving suffering not by offering comfort but by active intervention.

‘We don’t do that here’ is the least convincing motivation there is

As a former member of a Regional Euthanasia Review Committee, I have read many files from geriatric specialists who responded to the request of their suffering patient. It is certainly seen by several colleagues as part of their responsibility. This should apply to all geriatric medicine specialists. The nursing home is a blessing, where we receive care when things are no longer going well at home. But don’t let it become a trap from which people can no longer escape if they want active assistance in dying.

2023-10-05 14:22:57
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