Buiting Hilde, van Delden Johannes, Onwuteaka-Philpsen Bregje, Rietjens Judith, Rurup Mette, van Tol Donald, Gevers Joseph, van der Maas Paul, van der Heide Agnes
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
BMC Med Ethics. 2009 Oct 27;10:18. doi: 10.1186/1472-6939-10-18.
An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees' attention.
We examined 158 files of reported euthanasia and physician-assisted suicide cases that were approved by the review committees. We studied the physicians' reports and the verdicts of the review committees by using a checklist.
Physicians reported that the patient's request had been well-considered because the patient was clear-headed (65%) and/or had repeated the request several times (23%). Unbearable suffering was often substantiated with physical symptoms (62%), function loss (33%), dependency (28%) or deterioration (15%). In 35%, physicians reported that there had been alternatives to relieve patients' suffering which were refused by the majority. The nature of the relationship with the consultant was sometimes unclear: the consultant was reported to have been an unknown colleague (39%), a known colleague (21%), otherwise (25%), or not clearly specified in the report (24%). Review committees relatively often scrutinized the consultation (41%) and the patient's (unbearable) suffering (32%); they had few questions about possible alternatives (1%).
Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees' control seems to focus on (unbearable) suffering and on procedural issues.
荷兰安乐死法案所依据的一项重要原则是医生有责任减轻患者的痛苦。荷兰法案规定，如果主治医生的行为符合适当照护标准，安乐死和医生协助自杀不构成犯罪。这些标准涉及患者的请求、患者的痛苦（无法忍受且无可救药）、向患者提供的信息、是否存在合理的替代方案、与另一位医生的会诊以及所采用的结束生命的方法。为证明其合规性，该法案要求医生向一个审查委员会报告安乐死情况。我们研究了荷兰医生用哪些论据来证实他们遵守这些标准，以及哪些方面引起了审查委员会的关注。
我们审查了158份经审查委员会批准的报告安乐死和医生协助自杀案例的档案。我们使用一份清单研究了医生的报告和审查委员会的裁决。
医生报告称，患者的请求经过了深思熟虑，因为患者头脑清醒（65%）和/或多次重复请求（23%）。无法忍受的痛苦通常以身体症状（62%）、功能丧失（33%）、依赖（28%）或病情恶化（15%）来证实。35%的医生报告称，存在减轻患者痛苦的替代方案，但大多数患者拒绝了这些方案。与会诊医生关系的性质有时不明确：报告称会诊医生是不认识的同事（39%）、认识的同事（21%）、其他情况（25%），或者报告中未明确说明（24%）。审查委员会相对经常审查会诊情况（41%）和患者（无法忍受的）痛苦（32%）；他们对可能的替代方案几乎没有疑问（1%）。
荷兰医生以不同方式证实他们遵守这些标准，重点是身体症状。他们提供的信息在大多数情况下足以进行充分审查。审查委员会的管控似乎侧重于（无法忍受的）痛苦和程序问题。
