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The recent article by Inghelbrecht and colleagues1 has led to startling interpretations in the media of unethical practice by Belgian nurses involved in palliative care. Assisted death without patient consent, runs the theme.
The study shows that medical decisions were made without the patient’s explicit request, but it is vague on the role of the decision-makers choosing for the patient. The appendices to the article are only suggestive: Why does the flow chart not show the response to question 10.7 (i.e., whether discussion with relatives had occurred)? Also, the article shows in tabular form that, of the “unexplicitly requested” assisted deaths, nurses discussed the patient’s or relatives’ wishes in 41% of cases when they were involved in decision-making. Why is this not mentioned in the text? In the other cases, was the physician involved? Or others? The nurse answering the questionnaire may not have known, but the interpretation seems to be that no discussion was held.
The article makes several important supported claims that describe evasion or overlooking of the law and policy, but the most startling suggestion — that half the cases of assisted death are without consent — is the least supported. The evidence clearly does not permit such an interpretation.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/9/905#532533