5th Global Conference

Conference Programme, Abstracts and Papers

Session 10b: How do you Know when Suffering is Unbearable?
D.G. van Tol
Henri Wijsbek

Henri Wijsbek
Amersfoort, The Netherlands

How do you know when suffering is unbearable? One of the most important criteria for legal euthanasia in the Netherlands is that the physician has convinced herself that her patient is suffering unbearably. Drawing on the work done by Eric Cassell on suffering, I first give a definition of the concept of suffering, carefully distinguishing it from what initiates it. I stress that suffering should not be confused with physical symptoms and that it is a much broader concept than pain. One of my aims is to sort out whether and to what extent suffering is subjective, and how its alleged subjectivity influences the possibility for physicians to establish that their patients are suffering. In particular, I take issue with the claim that patients can decide sovereignly whether they are suffering or not. I then consider how to establish that a patient is not just suffering, but is suffering unbearably. I argue that the unbearableness is encoded in an open social norm that serves as a regulative ideal for physicians and the euthanasia review committees to base their decisions on. Since last year these decisions (about 2000 a year) are available on the internet; together with jurisprudence, notably judgments passed by the Dutch Supreme Court, these decisions make the norm converge on something ever less indefinite.

Donald van Tol
Departments of Medical Ethics & Public Health, ErasmusMC, Rotterdam, The Netherlands

A central criterion for legal euthanasia in the Netherlands is that the physician should be convinced that the patient who requests to die is suffering unbearably. Aim of the empirical study was to see how professionals apply the 'unbearable suffering' criterion in practice. What do they consider unbearable, where do they draw the boundaries, and do they do this in similar ways? General practitioners, consultant physicians (another important criterion for legal euthanasia is that the doctor has to consult another independent doctor), public prosecutors and members of the Regional Euthanasia Review Committees were asked to judge 8 comprehensive vignettes of patients with different types of conditions. Central question asked was if respondents consider the requirement of unbearable suffering to be fulfilled. The vignettes were based on 'real life' cases, that is, on physicians' reports to the review committees. Besides a 'standard case' of unbearable suffering various other conditions were investigated such as: extreme dependence, fear of future decay, loss of dignity, loss of personal integrity and imposing burdens on others. Do respondents consider these conditions as aspects of unbearable suffering, and if so, why (not)? Main result of the study is that respondents draw the boundaries of unbearable suffering criterion very differently. Systematic differences where found between the various professional groups. But also within groups opinions differ widely. What one doctor considers unbearable suffering, the next does not. This suggests requests for euthanasia by comparable patients in similar conditions might be refused by one and granted by the next doctor. Results will be presented and discussed.

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