Federal Court rules patients should have access to life-ending drugs

(Deutsche Welle, 2 Mar 2017) For more than a decade a 74-year-old man fought for legal access to fatal drugs for his paralyzed, now-deceased, wife. A German court has now ruled that her extreme suffering should have been taken into account.

Germany’s federal court ruled … that people “in extreme circumstances” should have legal access to drugs to end their own lives. The federal administrative court in Leipzig ruled in favor of “the right for a patient who is suffering and incurably ill to decide how and when their life should end” provided the patient “can freely express their will and act accordingly.”

The purchase of deadly drugs in Germany is forbidden, but the court found that the right of self-determination meant there should be exceptions for extreme cases “if, because of their intolerable life situation, they had freely and seriously decided to end their lives” and if there were no palliative-medical alternatives. Read more …

Bundestag debates proposals to legalize physician-assisted suicide (PAS) in 2014

A short video of presentations made to parliament (Bundestag). A year later, members were free to vote according to their conscience, not along party lines as is customary in Western democracies. As a result, PAS remains illegal in Germany and new legislation was passed prohibiting commercial organizations from providing medical assistance to people wishing to die without the help of a physician.

Note the use of  “euthanasia” in the voice-over, a term rarely used in Germany due to its association with Nazi atrocities.

Credit: Deutsche Welle, 13 Nov 2014

 

A certain Dr. Heyde, Nazi war criminal

Heyde as art by Gerhard RichterWerner Heyde was chief administrator of “Aktion T4“, the Nazi involuntary euthanasia program that killed an estimated 350,000 people between 1939 and 1945.

After the war, the good doctor lived unnoticed under the false name Dr. med. Fritz Sawade in Flensburg, working as a neurologist and expert legal witness. His true identity was only revealed by chance and after a brief attempt to flee he turned himself in voluntarily on 12 November 1959. In 1964, just days before he was put on trial for crimes against humanity, Heyde-Sawade committed suicide.

Image: “Mr. Heyde” a 1965 “blurred photo painting” by Gerhard Richter.sold for US$2.6 mill. by Christie’s of New York in 2006. Something creepy about the art, the purchaser, and the price tag, methinks.

German medicine and National Socialism in 1933

Hanauske-Abel, Hartmut M. “Not A Slippery Slope Or Sudden Subversion: German Medicine and National Socialism in 1933.” British Medical Journal, vol. 313, no. 7070, 1996, pp. 1453-63, doi:10.1136/bmj.313.7070.1453.

Abstract. The history of medicine this century is darkened by the downfall of the German medical profession, exposed during the doctors’ trial at Nuremberg in 1946. Relying largely on documents published during 1933 in German medical journals, this paper examines two widely accepted notions of those events, metaphorically termed “slippery slope” and “sudden subversion.”

The first connotes a gradual slide over infinitesimal steps until, suddenly, all footing is lost; the second conveys forced take over of the profession’s leadership and values. Both concepts imply that the medical profession itself became the victim of circumstances.

The slippery slope concept is a prominent figure of argument in the current debate on bioethics. The evidence presented here, however, strongly suggests that the German medical community set its own course in 1933. In some respects this course even outpaced the new government, which had to rein in the profession’s eager pursuit of enforced eugenic sterilisations.

In 1933 the convergence of political, scientific, and economic forces dramatically changed the relationship between the medical community and the government. That same convergence is occurring again and must be approached with great caution if medicine is to remain focused on the preservation of physical and medical integrity.

Current acceptance rate of assisted suicide by nurses and doctors, for their patients and themselves

Zenz, J., M. Tryba, and M. Zenz. “Tötung Auf Verlangen Und Assistierter Suizid: Einstellung Von Ärzten Und Pflegekräften.” Der Schmerz, vol. 29, no. 2, 2015, pp. 211-6. Partial abstract below; article in German.

Background. The current debate about end-of-life decisions in Germany focuses on physician-assisted suicide (PAS). The aim is to explore attitudes of physicians and nurses with a special interest in palliative care and pain medicine using a case-related questionnaire.

Methods. An anonymous questionnaire was distributed to all participants of a palliative care congress and a pain symposium. The question was: Should euthanasia or physician-assisted suicide (PAS) be allowed. In addition, the participants were asked what they wanted for themselves if they were the patient concerned.

Results. Of 317 questionnaires 70 % were returned. The general support for euthanasia and PAS was high: 40.5 % supported euthanasia in case of a fatal illness (“definitely…”, “probably should be allowed”), 53.5 % supported PAS. The support decreased in case of a nonfatal illness; however, it increased when the participants were asked about their attitudes if they were the patient concerned. Nurses were more open towards euthanasia and PAS. In physicians the rejection of PAS was directly related to a higher level of qualification in the field of palliative care.

Conclusion. The fact that nurses had a more positive attitude towards euthanasia and PAS and that all respondents accepted life-ending acts for themselves more than for their patients hints to still existing severe deficits in Germany.

A transition from healer to murderer

Colaianni, Alessandra. “A long shadow: Nazi doctors, moral vulnerability and contemporary medical culture.” Journal of medical ethics, vol 38, no. 7, pp. 435-8, 2012,  doi:10.1136/medethics-2011-100372. Full text.

Abstract: More than 7% of all German physicians became members of the Nazi SS during World War II, compared with less than 1% of the general population. In so doing, these doctors willingly participated in genocide, something that should have been antithetical to the values of their chosen profession.

The participation of physicians in torture and murder both before and after World War II is a disturbing legacy seldom discussed in medical school, and under-recognised in contemporary medicine. Is there something inherent in being a physician that promotes a transition from healer to murderer? With this historical background in mind, the author, a medical student, defines and reflects upon moral vulnerabilities still endemic to contemporary medical culture.

Tod auf Verlangen. Death on demand.

Sabine Munz-Dahl is 55 years old and suffers from ALS, a progressive neuro-degenerative disease for which there is no cure. Every three hours she has to take various medications — they provide little relief from intense pain and discomfort. Husband Friedjof has been her caregiver for seven years. She wishes for a dignified way to end her life, a right, she says, we extend to any dog suffering from an incurable illness.

„Ich will nicht irgendwann oder irgendwo krepieren. Jedem Hund billigt man das Recht zu. Wir lassen ihn einschläfern wenn er sich quält. Einem Menschen wird dieses Recht nicht zugestanden. Er weiss, er läuft in einen grausamen, langsamen, qualvollen Tod.” [Text in italics is my translation in paraphrased form.]

She makes the distinction between her wish to die on her own terms and Hitler’s so-called euthanasia program (1939-1945) which killed 300,000 people deemed to be living ‘unworthy lives’ (lebensunwertes Leben).

“Das hat nichts mit dem Dritten Reich und der Ethanasie zu tun. Die Zeiten haben sich geändert. Wir sind nicht mehr bei Hitler und Göbbels.“

Deutsche Welle video http://www.youtube.com/watch?v=zC-KxhT1nQE published 25 Apr 2014.

Memorial for ‘Euthanasie’ victims

A 24-meter (80-foot) glass panel near Berlin’s Tiergarten Park serves as a monument for the circa 275,000 people, including 5,000 children (Wunder 2016), killed by Nazis medical personnel during the ‘Euthanasie’ campaign between 1939 and 1945. More …

IMG_0540.JPG

Wunder, Michael. (Mitglied der Enquete-Kommission “Ethik und Recht der modernen Medizin” in der 14. und 15. Legislaturperiode im Deutschen Bundestag.) “Die Geschichte der Euthanasie im Nationalsozialismus und die Bedeutung für heute.” 27 Jan 2016.

Debate in parliament: Peter Hintze (CDU/CSU)

Several members of parliament (Bundestag) spoke during the 2014-15 debate. Peter Hintze (CDU/CSU) pleads for access to physician-assisted suicide as part of palliative care. This excerpt is from the parliamentary record.

“Wo es um die Situation eines sterbenden Menschen geht, sollte sich der Staat, finde ich, weitgehend zurückhalten; da ist staatliche Bevormundung fehl am Platze. Ein umkämpfter Begriff in dieser Debatte ist der Begriff der Menschenwürde. Für mich gehört in einer freiheitlichen Demokratie Selbstbestimmung zum Kern der Menschenwürde. Was ein schwer leidender Mensch, der den Tod vor Augen hat, zu ertragen noch als würdig erachtet, das kann nur er selbst bestimmen.”

See also: English-language article in Deutsche Welle