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Home is where the heart is for Dutch euthanasia

Source: Michael Cook,
Reprinted with permission.

Michael Cook likes bad puns, bushwalking and black coffee. He did a BA at Harvard University in the US where it was good for networking, but moved to Sydney where it wasn’t. He also did a PhD on an obscure corner of Australian literature. He has worked as a book editor and magazine editor and has published articles in magazines and newspapers in the US, the UK and Australia. Currently he is the editor of BioEdge, a newsletter about bioethics, and MercatorNet.

There’s always something new that you can learn about how euthanasia works at the coalface. An indignant letter to JAMA Surgery by two doctors from a hospital in the Netherlands led MercatorNet back to a 2017 letter in Transplant International about home-based euthanasia + organ donation. It’s not one of the better publicised features of Dutch euthanasia.

Wherever it is legalised, euthanasia becomes more and more integrated into the practice of medicine. One of the more useful — or ghoulish – developments, depending on your point of view, is euthanasia with organ donation. In other words, a patient agrees to supply organs and allows himself to be killed so that his kidney or liver or lungs can be harvested as soon as possible.

Apparently a good number of people in the Netherlands are interested in organ donation after euthanasia, but they would still prefer to die at home. This cuts off a useful source of organs. These resourceful doctors, Johan P. C. Sonneveld and Johannes Mulder, from Isala Hospital, developed domestic organ donation after euthanasia – which even has its own user-friendly acronym, DODE – as a “newly introduced, donor-friendly donation procedure”.

The key point is “separating the experience of dying at home from subsequent biological death and organ donation in hospital using an anaesthesia bridge.” The patient is sedated and intubated at home where he lapses from consciousness surrounded by his family. Then he is taken, unconscious, to the hospital in an ambulance, and euthanised.

Here is how they describe what happens:

On the appointed day, with the anesthesiologist–intensivist attending out of sight of the patient and after the patient’s conscious last farewells, the family physician administers a sedative (midazolam). The patient gradually falls asleep; when the patient becomes non-responsive, the family physician indicates to the waiting anesthesiologist–intensivist that it is time to perform induction of anesthesia with propofol and endotracheal intubation. The family can say their last farewells to the unconscious patient and, when they are ready, the ambulance transfer to hospital takes place. In the hospital, the family physician administers the drugs for the MAiD procedure and, after death, a regular organ procurement procedure follows. Within four hours, the patient’s body can be returned home by the family’s chosen funeral director.

Commencing the euthanasia procedure at home is much more humane, they argue. “Suggesting that euthanasia must take place in the hospital disregards the deepest wishes of these donors: sick, hospital-weary human beings who have decided to end their pain in the comfort and privacy of their own home,” write the doctors.

Dutch TV network interviewed a man with ALS who had decided to donate his organs when the time came. “It’s too late for me but I can pass on my organs. And to me, that’s a really good thing,” he says. “And with the organs that are still good. Despite ALS, I can give other people hope.”

It’s not clear how often DODE happens – probably no more than a handful of cases have taken place.

When you think about it, the doctors’ sales pitch is both horrifying and compelling. You are utterly useless and taking up space. However, your life will become worthwhile if you give us your organs.  Did anyone foresee that legalising euthanasia in the Netherlands would lead to a 21st century version of body-snatching?  

Ah yes, why were these DODEs indignant? Because a 2020 article in JAMA Surgery had suggested that the best-practice location for organ donor euthanasia is the hospital, not the home. Not so, they retort. “Advocating the necessity for a hospital stay will alienate many potential donors.”

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