A s s i s t e d S u i c i d e & E u t h a n a s i a
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1 A s s i s t e d S u i c i d e & E u t h a n a s i a Cape Town - April 18, 2016 St. Mary s Cathedral Pastoral Centre Dr. Jan Jans Associate Professor of Ethics Tilburg School of Humanities
2 Preamble To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Oath of Hippocrates of Kos, 5 th BC => Assisted Suicide and Euthanasia: not just a modern ethical issue 2
3 Introduction - 1 Legislation The Netherlands: Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding (2001/2002) (Termination of Life on Request and Assisted Suicide Review Procedures) Belgium: Wet betreffende de euthanasie - Loi sur l euthanasie (2002) (Law on Euthanasia) Grand Duchy of Luxemburg: Législation reglementant les soins palliatifs ainsi que l euthanasie et l assistance au suicide (2009) 3
4 Introduction - 2 Terminology Assisted Suicide = active involvement in a person ending his/her own life Euthanasia = intentionally terminating life by someone other than the person concerned, at the latter's request. Reported Numbers NL: 4188 in 2012; 4829 in 2013; 5306 in 2014 (estimated requests pro year: ) BE: 1133 in 2011; 1430 in 2012; 1807 in
5 Current debate in the Netherlands 1 Citizens initiative Voltooid leven signatures (May 2010) Proposal for a bill Out of free will (March 2012) Autonomy of patient without medical reference Completed life or Ready with life : subjective but because of existential suffering KNMG: change of law unnecessary, but preference for assisted suicide Committee Schnabel (2016) : no need to change the law 5
6 Current debate in the Netherlands 2 End of Life Clinic (2012) Euthanasia request within limits of the law, but not granted by own MD On location of patient Period of acquaintance & checks and balance 2014: 1035 // : 1234 // 365 6
7 Current debate in the Netherlands 3 Auto-euthanasia: Exit (B. Chabot) End one s own life in a humane way violence / mutilation Not in individual isolation Provide reliable and precise information: Medications Self-starvation Helium-method 7
8 Current debate in the Netherlands 4 Dutch Society for Voluntary End of Life Self determination as central notion Living will, non-reanimation declaration (token) Discussion to abolish the legislation ~ 15 years without abuse 8
9 Current debate in Belgium 1 Change with regard to underage patients Impact of casuistry ~ age Not the Dutch model : 12 15; => No age defined but criterion of Competence to discern what such a request means Extensive exchange with child psychologist / psychiatrist Agreement of parents needed Singed into law on March 3, 2014 by king Philip 9
10 Current debate in Belgium 2 Relationship between Palliative Care and Euthanasia? Public debate sparked by Marc Desmet, palliative care doctor for more than 20 years ànd Jesuit Enemies; neighbours, friends? 10
11 Current debate in Belgium 3 Enemies Dogmatic : absolute incompatible => forbidden! Refusal to discuss border areas or exceptions In case of persistant request: withdrawel of palliative team & referral of patient Desmet: probably majority (~ Catholic Church; European Association of Palliative Care; ) 11
12 Current debate in Belgium 4 Neighbours Pragmatic : maintain difference but respect each other Centrality of patient ~ take request serious Euthanasia only in the context of palliative care and as ultimate means (~ lesser evil ) Desmet: accompany patient until the very end but does not himself apply euthanasia 12
13 Current debate in Belgium 5 Friends Programmatic: both are equal alternatives The programme : broaden the legislation Absolute respect for the request of patients Provocative with regard the limits of the law Desmet: a reversal of the dogmatic position JJ: from autonomy to ego-nomy and duty of MD? ( conscience clause ) 13
14 By way of conclusion In the Netherlands, the evil of euthanasia is well regulated (Msgr. Philippe Bär OSB, former bishop of Rotterdam, March 2002) Euthanasia and Assisted Suicide: bring an end to life / or / shortening of debilitating dying process? The dead end street of therapeutic obstinacy ( How doctors die ) Explore and deepen neighbour model for theoretical and practical reasons ~ ethics of care 14
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