The prudential requirements are set out, both in relation to the ethical value of life, and in relation to the application of euthanasia in non-terminally mentally ill patients.
This post is a continuation of the previous one.
Joaquín Díaz Atienza
The prudential requirements act as an extension of the legal requirements, specifying and expanding them in cases of euthanasia in non-terminally mentally ill patients.
Below are the recommendations from the Brothers of Charity document. They are classified into those related to content and those related to form.
A. Prudential requirements regarding content
They propose three requirementsThe first two refer to the requirements regarding the application of euthanasia and the third to life.
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Clarity of the demand
Must be volunteer, Reflective, repeated, and reiterated. There can be no pressure, nor can it be based on feelings of guilt, as happens in cases of dependency or incapacity, during which caregivers are sometimes considered a burden.
The reflective nature The demand means that the patient makes their decision without internal influences due to their psychiatric condition. According to the report, there are two criteria: The patient decide clearly The first stage involves deciding whether to continue living in the face of suffering and a lack of options (in these cases, the patient's feelings are often quite ambivalent). The second stage establishes an evaluation process between continuing to live despite the limitations of the illness or choosing to end their life. The patient must understand the information provided, both about their illness and the possible solutions.
La repeated and reiterated will The decision not to continue living is born after a reflective process on the part of the patient and no less than several months.
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Dead-end medical situation
This situation is reflected in the Euthanasia Law of 2002. Their adaptation to the mentally ill and in relation to their unbearable characterIt depends on the tangible nature of the suffering and the relationship between the weight of the burden and the capacity to bear it. continuous character It will depend on how the disease presents itself, its development, as well as the persistence of the suffering.
The lack of a way out According to the document, this means that there is no possibility of reducing suffering and that the mental illness causing it is incurable. However, as the document itself acknowledges, it can never be stated definitively that a particular illness will remain incurable or that suffering cannot be reduced or eliminated at some point. Therefore, they prefer to speak of "absence of a reasonable prospect of treatment, rather than incurability."
Likewise, it is necessary to medically ensure that The patient's suffering is of medical origin, serious and incurable.
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Lack of a reasonable solution
This third prudential requirement It refers to the perspective of life and focuses on the finding that there is no reasonable prospect of treatment.
What does a reasonable treatment outlook mean? First, that appropriate treatment offers prospects for improvementDoes this mean that adequate treatment had not been implemented previously? Secondly, they raise that the improvement should occur within a foreseeable timeframe. Finally, there must be a reasonable relationship between expected results and drawbacks. This last observation is presented as a way to prevent the therapeutic obstinacy.
The patient's consent is required for the proposed new treatment. The document states that if the patient rejects the proposed new treatment, euthanasia cannot be performed if it is reasonable.
It is equally important that aspects related to transference and countertransference be carefully considered during the deliberation. It literally states: "One must be attentive to expressing feelings of countertransference, feelings of distress or helplessness, or the savior syndrome.
B. Formal prudential requirements
They are a continuation of the formal legal conditions, although specifying them in the case of psychic suffering in non-terminal patients.
Five measures are proposed, which are specified in: interviews with the patient, interviews between doctors, interviews with the interprofessional team, interviews with the family and relatives, and the opinion of the support group.
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Interviews with the patient
Belgian law requires that interviews be held with the patient to inform them about their illness, treatment options, the possibilities offered in intensive care, and their consequences. In cases where euthanasia is considered even if the patient is not terminally ill, the law requires that at least one month elapse between the written request and the administration of euthanasia.
It should be considered that the timing for interviews to be frequent and intensiveThe degree of cognitive and emotional impairment will be assessed in order to adapt the information provided. The document considers the one-month period between signing the petition and performing euthanasia to be excessively short. They propose a minimum of six months.
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The interviews between the doctors
The attending physician must consult with another physician to assess the illness, its severity, alternative treatment options, and the degree of psychological distress. This second physician must be informed beforehand of the reason for the consultation and will ultimately issue a report.
In cases of non-terminal patients, another physician with the same indication as the first should be consulted, and there should be no relationship between them in order to maintain the greatest possible independence. It states verbatim: "The formal prudential requirement is that the three physicians examine the patient and that each independently verify the three prudential requirements related to the content: the clarity of the request, the hopeless medical situation, and the conviction that there is no reasonable solution." It is essential that, once the evaluation is completed, the physicians involved hold a verbal consultation and seek a consensus.
Insist that doctors must be independent with respect to the patient and the doctor responsible for the patient, and that they do not work in the same establishment.
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Interview with the interdisciplinary team
The prudential requirement is that these interviews not be optional, but mandatory and conducted in sufficient number and depth. Their purpose is to seek consensus when discrepancies exist. With the patient's permission, the physician may even consult with previous caregivers and the patient's family doctor.
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Interview with family and close friends
With the patient's consent, interviews should be conducted with the patient's family and close associates. The information obtained from these interviews can be important, and therefore, this is considered a prudent and desirable requirement.
If the patient refuses, the underlying reasons for the refusal must be analyzed and clarified.
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Opinion of the support group
It consists of informing the group of Brothers of Charity. His opinion is merely indicative and does not bind the physician responsible for the patient.
UltimatelyIn my humble opinion, while an attempt is made to follow a thorough evaluation process, there is one aspect that is inherently contradictory: There is an insistence on the a thoughtful, clear-headed decision, free from internal or external pressure Regarding the patient, this situation raises the following question: if a mental patient is experiencing the kind of psychological suffering described, are they truly lucid and autonomous enough to make an irreversible decision? Because a living will or advance directives made during a period of acceptable mental health is one thing, and quite another is making decisions when the patient has lost all hope.
