A puzzling study from Belgium suggests that in nearly 80% of terminal sedations in Flanders, there was no explicit consent.
Assertions that euthanasia in Belgium is safe and voluntary have been undermined by a recently-published study in the Journal of Medical Ethics. A survey of end-of-life decisions made by Flemish doctors in 2007 has found that in nearly 80% of cases of terminal sedation, there was no explicit request from the patient. Terminal sedation, or relieving the distress of dying patients by heavily sedating them, accounts for nearly 10% of all deaths in Flanders.
In such a controversial area, precision is important. In many cases of terminal sedation, the intention of the doctor is to make patients as comfortable as possible, not to kill them. It is not necessarily “slow euthanasia”.
But it can be. In nearly 22% of terminal sedation cases, the doctor explicitly intended to end the life of the patient. In other words, the patients were euthanased, even if death did not happen immediately. If this is true, the real proportion of euthanasia cases in Flanders nearly trebles, to 3.3%, not just 1.26%, as reported in the study. Or at least that was the figure seven years ago, in 2007.
Even the authors seemed a bit rattled by the fact that in 79.7% of cases of terminal sedation, there was no explicit request from the patient. These were not necessarily unethical. There could have been proper reasons why no consent was given: patients could have been unable to give consent because they were in a coma or demented; relatives may have given consent by proxy; or there may have been a living will.
What concerns the authors is that many Flemish doctors do not understand what palliative sedation is. They conclude by recommending more education so that doctors will act within ethical and legal limits:
“Physicians seem to use ‘palliative or terminal sedation’ as an umbrella term to capture a wide variation of end-of-life practices. … the ambiguity of the use of the term can also be a barrier to a responsible, justifiable and reliable sedation practice in end-of-life care. Better knowledge of palliative sedation, including its procedural and ethical requirements and boundaries, may be necessary and would allow physicians to provide appropriate medical treatment at the end of life.”
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