Sahm-WMA EoL Presentation Vatican-Nov2017

Sahm Ketteler-Krankenhaus 2017 DKD
Ø Clinic for Gastroenterology/
Oncology, Palliative Care
Ketteler Hospital Offenbach,
University Center for Tumour
Diseases (UCT)
and
Ø Institute of History and Ethics
in Medicine, Frankfurt University
On Death and Dying –
Medical Concepts and Ethics in Palliative Care
Prof. Dr. med. Stephan Sahm
Sahm Ketteler-Krankenhaus 2017
I: The philosophy behind: on rights and duties at
the end of life
II: Normative concepts of medical acts at the
end of life
III: Flaws and fallacies in the case for
euthanasia and assisted suicide
Medicine at the End of Life
Sahm Ketteler-Krankenhaus 2017
Ø right to non-interference vs. claims
on others
Ø foundational rule: preference of existence to
non – existence of members of human society
Ø justification of state interference to protect life
Moral and Political Rights
Sahm Ketteler-Krankenhaus 2017
§70% of deaths in clinics
(US-Hospital society)
§50% limitation of specific
treatments
(Van der Heide, 2003)
§ Stopping any treamtent
in 10% of all cases in an IC-Unit
(Wunsch 2005)
Foregoing treatment as
a clinical routine
(a survey)
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curative palliative
palliation is an indispensable obligation
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Medical acts at the end of life:
normative view
– Change of the Goal of Treatment
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Inappropriate concepts
– passive euthanasia
– indirect active euthanasia
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Ø symptome guided sedation if they are not to be
relieved otherwise / depending on medical
indication and consent
Ø reversible and to be controlled: with respect to
deepness of sedation
A side remark:
palliative sedation
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Ø frequency of unwanted side effects not higher, yet,
even lower than with other medical treatments
Palliative sedation
Ø Indication and performance not distinct from other
medical treatments
Ø Caveat: palliative sedation may be used as a pretence to practice euthanasia
without retrospective surveillance (s. Derde evaluatie 2017)
Sahm Ketteler-Krankenhaus 2017
– there is no medical indication
to intend ending a patient´s life
Interim summary
– limitation of therapies
are part of clinical routine
– the preference for life is the
foundation of human rights
Sahm Ketteler-Krankenhaus 2017
Is there a case to overcome what
had been laid out so far?
v patients‘ right to self-determination?
v Medical necessity or emergency?
Sahm Ketteler-Krankenhaus 2017
Flaws and fallacies in the case for
assisted suicide
v assistance with sucide contradicts self-determination
– a) if restricted to cases of terminal illness
– b) it suggests social acceptability
v @ b): because refraining from judgement is the only appropriate
attitude in order to preserve liberty
Sahm Ketteler-Krankenhaus 2017
Flaws and fallacies in the case for
assisted suicide
v assistance with suicide does not prevent suicidal acts/
rather it is an independent risk factor increasing frequency
v suicide is „contagious“
v it underestimates palliative care and misinterprets
medical acts at the end of life
Sahm Ketteler-Krankenhaus 2017
Sahm Ketteler-Krankenhaus 2017
Suicides in Switzerland:
with/ without assistance and total
0
200
400
600
800
1000
1200
1400
1600
1800
without Ass. with Ass. total
Year 2000/ Data from Sitte, T: Inaugural thesis, 2015
Sahm Ketteler-Krankenhaus 2017
Suicides in Switzerland:
with/ without assistance and total
10
210
410
610
810
1010
1210
1410
1610
1810
without Ass. with Ass. total
Year 2013; Data from Sitte T: Inaugural thesis, 2015
Sahm Ketteler-Krankenhaus 2017
Euthanasia in the Netherlands
0
1000
2000
3000
4000
5000
6000
7000
2003 2016
Derde evaluatie / Wet toetsing levensbeëindiging op verzoek
en hulp bij zelfdoding 2017
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To restrict euthanasia and assisted suicide by law
does not criminalise state-of-the-art palliative care
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Final Summary
– There is no moral claim justifying
euthanasia and assistance with suicide
– rather, liberalising endangers great many
patients
– physicians should withstand any attempts to
introduce such practices in their respective
countries
Sahm Ketteler-Krankenhaus 2017
Thank you for
your attention