Dear Madam:

Thank you for your reply to our letter of 23 July, 2004, concerning your Standpunt over medische beslissingen rond het levenseinde en euthanasie.

I am pleased to see that you do not mean to compel conscientious objectors to participate in euthanasia. This common point of departure promises a fruitful discussion of related issues.

The text of the statement from the Federatie Palliatieve Zorg Vlaanderen does clarify your understanding of the relationship between euthanasia and palliative care, but some points remain obscure.

On the one hand, the statement describes euthanasia as a legitimate part of the continuum of palliative care, so much so that a member of a palliative team might act as the second physician in processing a euthanasia request. On the other, the statement insists that a palliative care team member must not be expected to perform euthanasia. The rationale for this division of responsibilities is unclear. If euthanasia is a natural and morally legitimate extension of palliative care, upon what grounds do you insist that palliative care physicians must not directly participate in it?

Similarly, the Standpunt seems to emphasize the importance of multidisciplinary teamwork and the involvement of general practitioners, yet you state that you do not intend to make euthanasia part of the provision of normal health care. How can this separation be maintained if euthanasia is to be performed by medical personnel as part of a continuum of care, but not by specialists or euthanasia teams or clinics?

The formal statement appears to go further than your letter in its expectations of objecting physicians. The Standpunt asserts that an objecting physician must refer a patient to a physician willing to perform euthanasia, while your letter suggests that it would be sufficient to inform a patient of the existence of the helpline. I would like to be certain which of these assertions expresses the position of the signatories to the Standpunt.

The Standpunt includes, in English, references to "informed consent" and "shared decision making." ["Communicatie en overleg vormen de kern van het 'informed consent', de 'shared decision making' . . ."] The Project has found that these terms are now being used to override conscientious objections of physicians in order to serve the autonomy of the patient. Please advise what English language source was drawn upon in drafting this section of the document.

Finally, I would appreciate it if you would provide a copy of that part of your Patients' Rights Act that refers to a physician's obligations to provide a patient with information about "all possible therapeutic options". You indicate that this obligation is accompanied by the right to fully express one's moral objections to a procedure, and I would like to see how the statute is phrased to strike this balance. The provision may suggest a means to resolve conflicts about the provision of information to patients.

Sincerely,

(Sean Murphy)
Administrator