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The Subjective Dutch Doctor’s Oath
Many doctors have their hearts in the right place and their intentions are absolutely good. However, these are mainly based on the Doctor’s Oath, from which the main intention is to heal and keep the patient alive. The oath seems concrete, but below it is indicated which parts of the oath are subjective and can be interpreted in multiple ways.
I swear/promise that I will practice medicine to the best of my ability in the service of my fellow man.
Who determines the concept of ‘in the service of’ and with what criteria? Can the medical profession (the Royal Dutch Society of Medicine, KNMG) and the individual doctor decide this themselves? For the patient who suffers unbearably and in whom misery awakens with every dawn, death is a liberation. In that case, the doctor should serve the patient by prescribing a rule of death and not maintain the unbearable life with a rule of life (from the previous formulation of the oath).
I will care for the sick, promote health and alleviate suffering.
What is ‘alleviate suffering’? In the case of unbearable suffering, is that an ounce less misery, but still unbearable misery? Alleviating sometimes means bringing the patient to the light at the end of the dark tunnel of life by ending the unbearable suffering with euthanasia (if that is the patient’s voluntary and well-considered desire, previously determined by the patient’s consent). This euthanasia must be independent of the nature of that suffering: somatic, psychological, psychosomatic, psychiatric or a combination thereof, or the suffering of a completed and otherwise meaningless life.
I put the patient’s interests first and respect his views.
Do the doctors with the attitude ‘No, we are not going to do that (euthanasia of an incompetent demented person)’ respect the patient’s view, if he/she has previously indicated in a competent manner that he/she wishes to die, e.g. in the case of the need for admission to a nursing home? These ‘we’-doctors do not prescribe the euthanatic drug that could be in the interests of the person with dementia. How can a ‘we’-doctor refuse euthanasia if the euthanasia request has been recorded by the competent patient in an advance directive? Refusing any euthanasia request can lead to gruesome suicides, such as at a railway crossing or on the highway, by hanging or drowning. Or in the horrible agony of not eating and drinking, often done in utter desperation. Who will stand up for the interests of these patients and respect their views? Is this principle of The patient’s interests and Respect his views actually reality?
I will not harm the patient.
Who determines the concept of ‘harm’ and what are the criteria? For an exhausted, unbearably suffering patient, the relief of the end of life is the opposite of harm, and having to continue breathing is harm. An exhausted mortal has the right to die, according to that name. Or is it a medical dogma that death is by definition the ultimate harm? Is the refusal of euthanasia the aftereffect of the original formulation: ‘I will, to the best of my judgment and ability and for the good of my sick, prescribe a rule of life for them and never harm anyone‘? Is the principle of Not Harm actually reality?
I recognize the limits of my capabilities.
Recognizing the limits of medical capabilities sometimes means timely stopping treatment and granting euthanasia.
I do not abuse my medical knowledge, not even under pressure.
The patient may, in his/her own opinion, experience unbearable or hopeless suffering or find a solution other than euthanasia unreasonable and wishes euthanasia. If the doctor nevertheless refuses euthanasia and continues to treat the patient, the doctor is evading his responsibility and that is also an abuse. Doesn’t the patient’s interest have absolute priority?
Recommendation
The above-mentioned parts of the current medical oath are subjective. A more objective and, above all, patient-oriented oath is necessary.