Cools H J M
Leids Universitair Medisch Centrum, afd Huisartsgeneeskunde en Verpleeghuisgeneeskunde, Leiden.
Ned Tijdschr Geneeskd. 2006 Mar 18;150(11):594-6.
In the last week of life, the extent and kind of medical practice differ both in intention and in the degree of orientation on the outcome. Patients tend to put long-term prescriptions aside or ask for symptom-relieving medication and sometimes for palliative sedation, euthanasia or physician-assisted suicide. Competent physicians are able to offer or withhold treatment. In case of unconsciousness or severe cognitive impairment, proxies may ask for medical relief of disturbing symptoms. Medical practice is subject to the Dutch Medical Treatment Act (1995). At the start of the specific Dutch law specifying judicial review of euthanasia and physician-assisted suicide (1993, implemented in 2002) 1.8% of deaths concerned euthanasia. In 2005, standard drugs (choice, dose and route of administration) were highly effective in all cases of euthanasia in which they were used (76%): death within a median of 3-4 min, maximum 90 min. In the absence of medical indications for drug overdose, morphine and other choices are now considered obsolete for euthanasia and physician-assisted suicide. The definition of euthanasia must be based exclusively on a standard method and outcome: death on request by a standard medical method with a standard judicial review.
在生命的最后一周，医疗实践的范围和类型在意图以及对结果的关注程度上均有所不同。患者往往会搁置长期处方，或要求使用缓解症状的药物，有时还会要求进行姑息性镇静、安乐死或医生协助自杀。有行为能力的医生能够决定提供或停止治疗。在患者失去意识或存在严重认知障碍的情况下，代理人可要求缓解令人不安的症状。医疗实践受荷兰《医疗治疗法》（1995年）的约束。在荷兰专门针对安乐死和医生协助自杀进行司法审查的特定法律出台之初（1993年，2002年实施），1.8%的死亡案例涉及安乐死。2005年，在所有使用标准药物（选择、剂量和给药途径）的安乐死案例中（占76%），这些药物都非常有效：中位死亡时间为3至4分钟，最长90分钟。在没有药物过量的医学指征的情况下，吗啡和其他选择现在被认为不适用于安乐死和医生协助自杀。安乐死的定义必须完全基于标准方法和结果：应要求通过标准医疗方法并经过标准司法审查后死亡。
