glasshalffull.bsky.social
338 posts
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20 following
Discussion Master
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Are you okay? You seem angry and rude for no reason.
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No moral position here. Just pointing out that morphine overdose — as a method to give terminally ill patients a peaceful death — is also a myth. Morphine toxicity is not something you'd wish to happen to a loved one.
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(not saying this pod is any better by the way)
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Morphine — at the levels prescribed by doctors to manage pain — doesn't cause or quicken death. A massive overdose could but that typically causes suffering, not a peaceful death.
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1) The perception that it's safe to cycle without helmet.
I would say this is partly earned. Infrastructure is great (cyclist do not share the road with fast car drivers) and car drivers are mindful of cyclists.
2) More comfortable.
3) Culture. Cyclists with helmets are ridiculed as "tourists".
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Meaning that their usage of morfine (more than needed to manage pain) has been counted in the research data as non-voluntary euthanasia ("life-ending without explicit request"), because their intention was to hasten death ... even though most likely it seldom had that effect.
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Just FYI: I came across this article and it reminded me of your comment about morfine.
pure.amsterdamumc.nl/en/publicati...
So yes, it seems many physicians acted based on these misconceptions about morfine.
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📌
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Somewhat ironically, disability organisations from the UK seem worried about something that is not even in scope of the bill. Whereas in The Netherlands, which *does* allow AD for people who are not terminally ill, local disability organisations seem pretty content with the Dutch model.
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I believe it was designed this way because for a patient dying in agony, there's often not enough time to go through a review committee's evaluation. And also because primarily the choice is seen as the outcome of a dialogue between patient and their doctor (often the family GP)
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There's no panel that gives pre-approval in The Netherlands for minors unders 16 or psychiatric patients. The same model is used for everyone (doctors decide, afterwards a reviews committee checks whether the due diligence process was followed correctly)
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Your interpretation of events might also be the right one of course. I guess I'm more optimistic about the government's motivation.
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... protection within the existing law (e.g. the protest-free zone that Utrecht implemented was cancelled out by a judge when pro-life activists took the city to court), it's time for the national government to step in and create new legislation.
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Okay, let me rephrase. I think as a general principle the national government should be reluctant to limit free protest. I think that's why they haven't set a nationwide ban yet. Not because they don't care.
But now that it has become clear that cities are unable to provide enough ...
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Makes sense to me. Let's hope the next ruling government will be less conservative right-wing. Elections coming up in a few months, I believe.
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The Dutch government seems to think that cities have the means and responsibility to stop the harassment. The city of Arnhem has been mentioned as an example.
Some political parties (on the left) have been calling for a stronger, national ban.
In Dutch:
eenvandaag.avrotros.nl/artikelen/de...
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Dementia patients are most definitely permitted to change their minds.
What I'm saying is that, based on the 7 weeks assessment of the patient, the doctors came to the conclusion this patient had no capacity left. There was no "mind to change" as she didn't even understand the choice at hand.
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Thank you too.
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*Lawyer
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I very much enjoy our conversation. I don't have any of your real life experience, so it's very insightful to read your responses and challenges.
I don't know what is morally "best". Not sure I ever will tbh.
But I do recognise misinformation, and so that's why I called out that other person.
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Then I respond sometimes to challenge these hoax stories but apparently that makes me ableist 🤐
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Of course, in typical X fashion, the news about the booklet got twisted by people and now there are a million false posts on X claiming that "Dutch elderly are so afraid of involuntary MAD that they carry don't-euthanize-me cards"
And then others read that and go "See, those evil capitalists"
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There's even a little booklet nowadays ("health & treatment passport") that elderly or ill people can fill in to specify their wishes. For example whether treatment should alway be continued etc. It's broader than just MAD, it covers all kinds of choices. I think it gives patients more agency.
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Oh... that sounds risky.
What happens in those countries if the patient doesn't die after taking the barbiturate (which I've understood to happen in roughly 10% of cases)?
Laywer takes a pillow and...?
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I think a positive outcome of the Euthanasia Act is that it has become more normal for doctors and patients to talk about end-of-life options pro-actively. Rather than waiting until the family is around the bed and now it's unclear what the patient would have wanted but they are clearly suffering...
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1) It's a medical procedure, with potentially very painful consequences for the patient if a medical layman botches the job.
2) Doctors can opt out at any time. Some never get involved with MAD requests
3) Often the doctor has cared for the patient for 10+ years & there's a trust relationship.
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I think this is probably one of the strongest arguments against it. Theo Boer is one of the most vocal criticasters, and I believe he often makes the point that when it started in The Netherlands it was intended for extremely heartbreaking cases. He claims it has been normalised too much since then.
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The Dutch legislators - based on the input from the medical community - have decided to put that decision firmly in the hands of doctors. Because doctors are considered the professionals with medical expertise who can evaluate suffering, treatablility, pain relief, mental capacity, etc. Not laywers.
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I don't know who you are addressing and which evidence is lacking.
I responded to two (sets of) tweets. For the first, I added some context. For the second, I called out the author for misleading with false information. I suppose if you need evidence, it's on them to provide it.
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Pressure on physicians is a concern. Unfortunately I do not have free access to this research publication.
jme.bmj.com/content/45/7...
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(oops, I meant between 1990 and 2020 of course, not 2030. Sorry. But I think you already understood it was a typo)
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One reason for the rate declining quite radically in The Netherlands (between 1990 and 2030) could be because doctors nowadays have a much better understanding of what you just said?
Just a hypothesis.
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Of course. That's why the doctor (who had decades of experience as a geriatric doctor) took 7 weeks to evaluate the patient, consult other physicians. She's been transparent about the fact that it was a complex decision in which she needed to weigh conflicting data and emotions.
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If people want to argue that this level of trust is ungrounded, too risky, or otherwise negative.... (in The Netherlands or in their own country or in any capitalist country)... that's fair. I cannot prove or disprove such opinion.
What bugs me is people twisting facts to suit their narrative.
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I think if she had had some capacity left in the summer of 2016, the doctors would not have proceded with the MAD.
Which means that I trust this doctor to respect her patient's wishes and her ability to establish capacity.
Plenty of Dutch doctors just don't even "take" risky cases ike this.
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I'm not sure I understand your question or why this is relevant.
The doctor needed a few months to conduct a proper assessment, consult two other physicians, etc.
Especially in a super complex case such as this, taking the time to be extra diligent... is a good thing, right?
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The more recent data (2021) I can only find in Dutch. Here's the Google Translate version if you're interested.
I lack the medical knowledge to have an opinion about it.
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You think people should be euthanized while they are still relatively happy?
The suffering she wanted to avoid (according to her request) started for her when her mind went and she needed to live in a care home.
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Well, now you come to the crux I suppose. According to the doctorS (plural) who evaluated the patient, she no longer had ANY capacity.
Wheras for the many years before, while she did still have capacity, she had explicitly requested this, and many times re-confirmed it regularly & consistently
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My understanding, but with your real life experience you probably know more than me about it, is that this happens at similar rates in other countries (e.g. 0.3% of deaths in the UK in 2007), but there's less data available because people don't like to talk about it.
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Afaik in 0.3% of deaths (in The Netherlands in 2021) there's a grey area where dying patients are suffering, but cannot request euthanasia anymore. This leads to the "extra shot of morphine" that is a form of non-voluntary euthanasia
pubmed.ncbi.nlm.nih.gov/24846111/
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I think that's a core reason for why family members cannot request euthanasia on behalf of a loved one. The request always needs to come explicitly from the patient.
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Yes, that would be a terrible train of thought. Luckily that was not the consideration, neither the doctor's nor the Supreme Court's. Just a figment of the imagination of the person writing these tweets (who blocked me as soon as I challenged their premises politely and with sources)
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... legislators included the advance directive option in the law. If doctors hold on to the requirement that the patients confirms the request (which implies the mental capacity to understand the choice) then there's really no point to the advance directive which was intended to give people agency.
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... they still want to die.
Is it allowed to honour the patient's initial request (as expressed in an advance directive) if, fast-forward a couple of years, the patient doesn't even know what we are asking when we ask "do you still want this?"
Supreme Court: yes, that is exactly why the...
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Mind you, there's been a lot of criticism expressed by a large portion of Dutch doctors. Afaik their argument is that — when a patient's mind is so far gone that they don't even understand the choice anymore, let alone confirm or withdraw consent — how can anyone have sufficient certainty that ...
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Report: patient woke up and tried to sit up during procedure, seemed confused.
Expert witnesses (anesthesists): common reaction when sedated patients prematurely wake up. Sitting up is a body reflex, not a conscious decision.
Tabloids: she was kicking and screaming "Noooo, I want to live!".
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Well I've read the Supreme Court's considerations and conclusions about the first case you mentioned.
Things like "clear NO" and "thrashing resistance" were reported by sensationalist tabloids, but not at all factual.
Here's a decent summary of the case onlinelibrary.wiley.com/doi/10.1002/...
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That didn't happen.
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You're basically saying Dutch early stage dementia patients should just buckle up for years of suffering against their will & not have any agency about their end-of-life (like for example terminal cancer patients have in The Netherlands), .... but I'm the ableist here.