Euthanasia

Euthanasia is about ‘Actions that end someone else's life at their explicit request’ (KNMG, 2003).

These are actions:

• that intentionally end life,
• by someone other than the patient,
• at the explicit request of the patient.

Assisted suicide is ‘the provision of drugs by someone else for suicide’ (KNMG, 2003). These are actions:

• that intentionally end life,
• by the patient,
• at the explicit request of the patient.
• The difference between euthanasia and assisted suicide is a difference in the execution. With euthanasia, the drugs are administered by someone other than the patient. With assisted suicide, the patient himself takes the drug that has been prescribed by the doctor.

Other medical decisions surrounding the end of life

A number of medical decisions surrounding the end of life can be distinguished whereby death can be speeded up, but that do not fall under the heading euthanasia or assisted suicide.

End of life without explicit request

This form of life terminating action is distinct from euthanasia and assisted suicide at the point of the request of the patient. This is an action with the explicit intention of ending life. To this end, a drug is administered without resting on the explicit request of the patient (Van der Wal & Van der Maas, 1996).

Pain and other symptoms treatment

The adequate treatment of suffering forms a part of normal medical treatment. An unintended side-effect can be a shortening of life. This unintended side-effect is deemed acceptable if it is inseparably linked with pain treatment that is necessary for the patient. If a higher dose is intentionally administered than is necessary from the perspective of adequate pain treatment, then there is an intentional effect of speeding up the end of life. Depending on whether this is based on a request from the patient, this is really euthanasia or termination of life without an explicit request.

Stopping or not performing a medically senseless treatment

This means situations in which there is no longer a reasonable proportion between the objective to be achieved by treatment and the resources to be used for that purpose (KNMG, 2003). According to the KNMG (2003), the basis for a careful decision is formed by both professional criteria and the situation/opinion of the individual patient.

Not administering fluids and food

This is about situations in which a patient cannot or can hardly take in fluids and/or food and the decision is taken not to start or stop with the artificial administration of fluids and/or food (Pasman et al., 2003). This is also called terminal dehydration.

Palliative sedation in the terminal stage

With palliative sedation (also known as terminal sedation), it is about situations in which medication is administered in order to keep a patient in a deep sedation or coma until death comes, whereby the artificial administration of fluids and food is refused (Van der Wal & Van der Heide et al. 2003). This concerns terminal patients with whom symptoms (such as pain, fear and shortness of breath) cannot be adequately treated with the usual medication. The deep sedation or coma is then the treatment of symptoms.