Guidelines issued for assessing and executing requests for euthanasia and assisted suicide from people with mental disorders, including addictions such as alcoholism, by the Netherlands Federation of Medical Specialists and the National Council of the Order of Physicians of Belgium essentially authorise doctors to agree with a patient that abandoning all hope - as if they were at the gates of hell in Dante's Divine Comedy - is the only proper response to their mental illness or addiction.
This plaque could appropriately be put on the office door of Dutch and Belgian doctors who give effect to the guidelines.
Christophe, a father of four young children aged 4, 6, 7 and 10 years old, has begun the process of seeking euthanasia in Belgium, after the Belgian health system refused funding support for the only available treatment for the rare blood disease - paroxysmal nocturnal hemoglobinuria – which he has suffered from since he was 17 years old.
In an open letter signed by 1181 New Zealand doctors it is affirmed that "that physician assisted suicide and euthanasia are unethical, even if they were made legal".
On Wednesday 26 June 2019 the End of Life Choices Bill passed its second reading in the New Zealand Parliament by 70 votes to 50. This does not guarantee its ultimate passage into law as several of those who voted for the Bill at this stage nonetheless expressed grave reservations, especially about the dangers of coercion and elder abuse.
The key concerns with the Bill, which would permit assisted suicide and euthanasia for any New Zealander with a “grievous and irremediable medical condition”, are the risks for people with disability, elder abuse and coercion, unavoidable medical errors in prognosis, diagnosis and identifying mental illness, and undermining suicide prevention, including for young people.
The much vaunted mandatory training for doctors before they are licensed by the State of Victoria to prescribe a deadly poison to people for the purpose of suicide or administer a lethal injection to them is supposed, among other things, to ensure these doctors are competent to assess decision making capacity and voluntariness in those requesting assisted suicide or euthanasia.
However, a comparison of the total of 10 minutes training provided on these topics in the Victorian mandatory training with the thoughtful proposals presented in an article published in the Internal Medicine Journal in January 2019 entitled "Biggest decision of them all – death and assisted dying: capacity assessments and undue influence screening” leads to the conclusion that the bar has been set very low indeed in Victoria and that there will be wrongful deaths in Victoria due to this failure.
The answer to bad deaths is not euthanasia. The answer is a better understanding of basic medical ethics, of palliative medicine, of what happens to the body when it is dying, and how to care for someone at the end of life.
Dr Amanda Landers, community palliative care physician and senior clinical lecturer at the University of Otago, Christchurch