Euthanasia in non-terminally mentally ill patients (2). Support during the process

The document proposes patient support through two paths: the patient's life and the patient's autonomy

Joaquín Díaz Atienza The previous post addressed the fundamental ethical values ​​involved in the euthanasia process. This one focuses on the support and pathways available within it.

B) Accompaniment on two paths

The authors state that, while the trajectory of protecting life is fundamental for the Brothers of Charity, it does not have absolute value when the demand for euthanasia is seriously considered. Both the trajectory regarding the perspective of life and the demand for euthanasia are linked to the relationship of care. This is what they define as "two trajectories of the same accompaniment" («two trajectoires d'un même accompagnement"). Caregivers may react in two ways to these two approaches: Some believe they cannot combine both perspectives because their purposes are different. They advocate for them to be separate professionals. Others, on the contrary, do consider it possible, emphasizing either the pro-life perspective or the request for euthanasia, depending on the specific characteristics of each request.

1. 1. Life perspective trajectory

"This is the path favored by the Brothers of Charity." It is argued that patient accompaniment gains credibility when serious alternatives to euthanasia are offered, with the aim of opening new perspectives on life. Four alternatives are presented to the patient. The first It consists of developing and improving the ongoing treatment based on a bio-psycho-social and existential approach.  The second, It would consist of the development of a rehabilitation program focused on psychological recovery. The thirdIt would be to propose some psychiatric palliative care and aimed at alleviating psychological suffering, those of a somatic and psychosocial nature. Last, The development of a support program aimed at finding meaning in life is proposed. Patients could find meaning in their lives through a intensive support Regarding rereading his biography and with the aim of finding a purpose and a new life project, these alternatives could be implemented. provided the patient accepts them.

2. 2. Trajectory of the demand for euthanasia

During this type of care process, the patient's request for euthanasia is taken seriously, the legal conditions are studied, and prudential requirements are followed (which we will explain in the next post). The law is primarily designed for terminally ill patients. In non-terminal situations, it requires consultation with another doctor and a delay of at least one month before performing euthanasia. However, in the case of mentally ill patients, the situation is more complex, so additional prudential measures are implemented, which, according to the Euthanasia Act of 2002, are in accordance with it (Art. 4, 2).

3. 3. Support from professionals

The Brothers of Charity propose three measures to support professionals involved in euthanasia. The first, focuses on derived functions from the Central End-of-Life Support Group. For example, consulting with expert professionals outside the institution, although provided the patient authorizes it. The second It consists of the creation of Local End-of-Life Support Groups. These are interdisciplinary groups. Although they are part of the establishment, they can consult with other external professionals. Here, too, action would be taken with the prior patient consent. Lastly, You can also consult with the doctors at LevensEinde Informatic Forum/ Forum Eol. With the aim of delving deeper into the motivational evaluation and justification of euthanasia, we present in Figure 1 an example of how the LEIF operates. In conclusion, What is described in this section is the standardized approach to addressing, in an interrelated manner, the support provided in establishing an alternative to euthanasia (life perspective pathway), the pathway of the euthanasia request itself, and support for the medical and care professionals involved in the process. Two aspects stand out.: patient autonomy This is the one that acquires priority value, both in terms of its decision (provided that prudential criteria are met), and in terms of allowing or not allowing consultation with other professionals or specific institutions. Therefore, although it is said that everyone the ethical values ​​involved They are at the same level of respect, as the process unfolds, the trajectory of life perspective It is subordinate to the autonomy principle. The next post will address the prudential requirements.