Assisted Death -- Relaxing Rules and Regulations

A court in The Hague ruled that the doctor did not have to re-establish the wishes of her patient at the time of administering euthanasia.    Credit...Aleks Furtula/Associated Press

"This freedom has been there in law [Netherlands euthanasia law] from the beginning, but the law is being interpreted more and more broadly."

"Nobody can look inside the head of someone with dementia."

Jaap Schuurmans, researcher

"[In cases where a patient has advanced dementia], It is not necessary for the doctor to agree with the patient the time or manner in which euthanasia will be given."

Netherlands right-to-die medical code change

The Netherlands recently updated their euthanasia rules to permit doctors to use sleeping pills for patients to prevent patients suffering from dementia from becoming violent preparatory to receiving lethal injections to end their lives. Dissolving pills in a patient's drinks will serve to pacify their urge to violence, avoiding the inconvenience of an awkward end to their lives. The amended code supports the use of sedatives in food or drink of patients with advanced dementia should any concerns arise that the patient might be "disturbed, agitated or aggressive".

"It's only two or three cases a year but this might  help doctors to have less fear of a penal case", suggested Jacob Kohnstamm, chair of the regional euthanasia review committee, stating this to be a needed clarification to relieve fears of prosecution in the instance of reasonable, professional judgement carried out by doctors when faced with such situations requiring action to be taken to end a sufferer's life humanely.

The changes were occasioned when a court ruling overturned a murder charge against a nursing home doctor. Marinou Arends had surreptitiously placed a sedative into a 74-year-old's coffee, who was suffering from dementia, before he proceeded to administer a lethal injection. Having reached an advanced stage of dementia, the woman was no longer capable of any kind of informed consent on the treatment's timing. The doctor was in possession of an instruction from the woman who had stated she wished to die when she felt "the time was right".

Dr. Arends received a written reprimand by the Dutch medical board for having acted on "advance directives". According to critics of the doctor's actions, the patient had been victimized, a dignified end that euthanasia is meant to provide, having been denied her. A relative present during the procedure had pushed the woman back down on the bed when the had sat up in an effort to avoid being given the injection. There was obviously no comfort given the dementia patient as death was delivered.

According to the Dutch Supreme Court, the doctor had acted within the country's euthanasia law, enacted in 2002. The court ruled that should a patient no longer be capable of consent due to dementia, medical professionals were given discretion to determine for themselves when the correct time had arrived to terminate said patient's life. Opponents of euthanasia were alarmed at the ruling. The Netherlands, a pioneer in the practice of euthanasia, according to opponents has taken to interpreting set rules ever more inclusively.

Contradicting the critics, the country's euthanasia review committee is of the belief that the amendments to its code provides doctors with additional legal support in such instances where it is deemed to be "pointless" to attempt consent by the patient. Some Dutch medical practitioners have opposed the ruling. Over 200 doctors issued a statement that no doctor should be allowed to secretly sedate patients before euthanasia, when news of Arends's case emerged in 2018.

Coincidentally, in Germany, two terminally ill patients being treated for COVID-19, ages 47 and 50 were administered medication by a senior doctor that led to their immediate deaths. Employed at the University Hospital in Essen city in North Rhine-Westphalia, the 44-year-old doctor was arrested and charged with manslaughter this past week, and remain in custody. Essen police have divulged that in one case the doctor stated his intention was to end further suffering of the patient and his relatives.

A newspaper account described the two patients as suffering from coronavirus infections, their condition in his ward, according to the doctor "very critical". No further information was forthcoming relative to the treatment the patients had received. In Germany, seriously ill patients have the freedom to request assistance in ending their lives, under a court ruling of last year. Whether this happened in the doctor's case is as yet unclear; several steps are required before the provision of such assistance. An investigation is ongoing.

The doctor was employed at the Essen University Hospital

The unnamed doctor is facing manslaughter charges, in a country where assisted death is an extremely sensitive topic, considering the legacy of six million European Jews experimented on, used as starved slave labour in Nazi Germany's munitions factories, and finally annihilated by the regime during the Holocaust years amidst the Second World War.

At Your Own Risk, Chinese e-Cigarettes

"Once the national standard comes out, I can follow its targets and make big investments."
"I won't have to worry that something will happen, but now I don't know which day the sword would fall."
Ou Junbian, owner, Sigelei, e-cigarette exporter

"We can guarantee that they [cannabis e-cigarettes] are safe to be consumed through the stomachs, but is it safe enough to be absorbed through the lungs?"
"To be honest, in this respect, neither we nor the industry has evidence that is particularly solid."
Jiang Xingtao, director of flavors, RELX, e-cigarette seller

Reuters

China, in response to a vaping boom among young Chinese, is preparing to mandate compliance by producers of e-cigarettes to standardizing ingredients and manufacturing. With the establishment of a "national standard", producing companies are expected by law to provide details on the number and dosage of ingredients, to place warnings on packages and to devise methods of testing e-cigarettes, ensuring compliance.

Up to the present, the government of China has permitted the industry free rein, enabling them to thrive, no supervision by any government agency to ensure quality and safety. The vast country has over 9,500 e-cigarette production companies many with haphazard quality controls, resulting in knockoffs, unsafe ingredients and leakage of vape liquid. Vaping oils with nicotine levels higher than the package states were produced by eight of those companies.

Obedience to the new guidelines will have the effect of production costs increasing, a circumstance likely to result in hundreds of small e-cigarette exporters going out of business. The new standards when brought into law will have an opposite effect for most manufacturers since clear guidelines will ensure that manufacturing companies who comply may then legally sell their product in the vast Chinese market.

This is an industry that has viewed China as a haven, where ninety percent of the world's e=cigarettes are made. High-profile venture capital funding has invested hundreds of millions in some of the nation's top e-cigarette brands such as RELX, FLOW and Yooz. Chinese e-cigarette exporters have seen their sales drop precipitously to the United States in the wake of vaping-related health crises where thousands of American users have become seriously ill, and 47 have died.

Coincidentally, the domestic market which began to open up three years earlier appears to have taken up the slack, with an increasing interest in vaping in China. An estimated ten million Chinese e-users has turned Beijing's attention to the popular pastime, mostly young people among whom it is appealing to vape sleek devices with flavours such as chilled strawberry and orange soda.

China's e=cigarette market alone was valued at $750.4 million in 2018, according to global market research consultancy, Euromonitor, almost triple the 2014 valuation. Of a population of close to 1.4 billion people, there are over 300 million smokers. Vaping among the young has raised public concern, urging that regulations be drawn up and put into law and into practise to ensure public health safety in vaping.

It was revealed in early November on the website of People's Daily, the Communist Party's official news organ, that most e-cigarette companies went on selling their products online in defiance of the ban. China Central Television, the state broadcaster, filmed Beijing authorities calling on e-cigarette companies to comply with the ban and a day later Alibaba's Taobao and JD.com., two of the nation's most popular e-commerce platforms, no longer listed their availability.