Position on medical end-of-life decisions and euthanasia
· Scientific Association of Flemish General Practitioners
· Academic Center for General Practice of the Catholic University of Leuven
· Department of General Practice, Ghent University
Press conference
Theses
End-of-life care and all possible associated medical decisions are part of the general practitioner's duties.
Euthanasia is one of the possible options for end-of-life care, and should be framed and embedded in a total palliative care that transcends individual care.
The care regions must organise multidisciplinary further training and education on end-of-life care. We commit ourselves to scientifically and didactically supervise this in collaboration with the Federation of Palliative Care Flanders and the LEIF medical forum. In this way, we want to avoid polarising groups with their own training and interpretations.
We oppose the creation of euthanasia teams or euthanasia centers. Doctors must be supported and guided and strategies must be developed when they cannot comply with a euthanasia request from their patient for practical or ethical reasons.
Both the other and the second physician to be consulted in the context of the euthanasia decision must be highly skilled in the field of palliative total care.
Every physician has the right to consider euthanasia or another end-of-life decision as inconsistent with his personal ethics. This physician is then obliged to inform his patient of this in a timely and clear manner and to ensure a smooth referral.
Position on medical end-of-life decisions and euthanasia
· Scientific Association of Flemish General Practitioners
· Academic Center for General Practice of the Catholic University of Leuven
· Department of General Practice, Ghent University
The medical profession is not prepared for the application of the recent legislation concerning patient rights and euthanasia. The thorough personal reflection of the doctor on his attitude in this regard must be nourished and supported by collegial consultation. The Scientific Association of Flemish General Practitioners wants to scientifically guide the medical profession in this process of reflection. The association wants to make this concrete by means of research and by organising further training [1] , education and training on decision-making in all end-of-life decisions. It wants to do this in close cooperation with the other general practitioner organisations and with the Federation for Palliative Care Flanders and the Leifartsenforum. It wants to avoid polarising groups with their own training and interpretations. It wants to help search for an optimisation of end-of-life guidance in which recommendations and laws are recognised and applied in an open atmosphere of continuous reflection and assessment.
The GP circles have an important task here. The care region is the level at which everything related to end-of-life care should be inventoried and at which the necessary further training should preferably be organised multidisciplinary. We would therefore like to invite the palliative networks to prepare themselves positively for this evolution.
End-of-life actions are part of the task and function of the general practitioner. Home care for a patient with a fatal prognosis is best done by the general practitioner. However, multidisciplinary cooperation and consultation are necessary in the phase preceding death and in which important decisions have to be made. This also requires that the other disciplines, including those in secondary care, recognise the general practitioner in his specific task and are prepared for this multidisciplinary cooperation. Requesting support from multidisciplinary home care teams for palliative care is generally advisable because not all doctors are sufficiently familiar with the possibilities and specific objectives of palliative care. All possibilities must first be discussed with the patient so that he can also make a well-informed choice for euthanasia. Psychological and/or spiritual guidance, support for informal carers, care in a palliative unit are options that must be investigated. The latter requires a special and mutual commitment from the general practitioner and the specialist to work well together transmurally. Although many patients still prefer the “colloque singulier”, a doctor must be convinced of the added value of a multidisciplinary approach. The patient who remains stuck in the phase of denial must also be able to count on respect and understanding for this attitude. The multidisciplinary and open consultation between the various care providers involved will help them to provide appropriate care and support even in this difficult situation.
To do this in a quality manner, accepting the autonomy of the patient is a first requirement. Moving away from the concept of the 'benevolent' doctor who decides on life or death is very confronting and confusing for some doctors. The new concept in which the patient decides on his own health, illness and manner of dying requires the doctor to adopt an adapted attitude and enormous communication skills. Communication and consultation form the core of 'informed consent', 'shared decision making' and possibly drawing up an "information and communication contract" in which the doctor and patient agree to what extent the patient wishes to be informed and who, if the patient himself no longer wishes to be informed, is his confidant with whom the doctor can make further agreements.
This skill is certainly not yet generally acquired in the medical profession today . Doctors must pay the necessary attention to this in their ongoing training. Many patients are also not yet familiar with this new vision of the doctor-patient relationship and may react uncomfortably to it and even feel worried.
A patient's thoughts on euthanasia should be discussed in advance and recorded in the medical file.
The GP as the healthcare provider who guides the patient's life is well placed to discuss, monitor and record the patient's wishes regarding the end of his life in the medical file. In certain cases, the doctor must initiate this conversation himself to avoid that less informed patients or patients with less communication skills are denied their right to a euthanasia request.
In the palliative phase, these data are transferred to the palliative care file.
Euthanasia can be a possible choice of end-of-life care, framed and embedded in total palliative care.
It follows that the establishment of euthanasia teams and euthanasia centres should be avoided.
It is our belief that the other and second physician required for the application of euthanasia must be highly skilled in the field of palliative care and more specifically in the field of possible medical decisions at the end of life. The physicians associated with the multidisciplinary home care teams palliative care are certainly eligible for this.
When euthanasia is not in line with the personal ethics of the physician, he must inform his patient of this in a timely and clear manner. Together they can then find another treating physician for the patient. It is up to the general practitioner circles to develop and offer appropriate strategies for this within a care region.