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In our article, the finding that half of cases of assisted death are performed without the patient’s explicit request is very much supported by the data. There was patient consent or a patient’s wish in some of these cases, but for the administration of life-ending drugs, this is legally not sufficient. A request or wish from relatives acting as surrogate decision-makers is also insufficient to justify such an act. But ethical and legal criteria aside, it is true that most decisions to administer life-ending drugs without explicit patient request are discussed between physicians and nurses as well as relatives.
In another study, also set in Belgium but surveying physicians instead of nurses, Chambaere and colleagues found that in only 6.5% of such cases, the physician had made the decision without consulting others.1 The relatives were involved in 79.4% of cases, and other professional caregivers (colleague physicians or nurses) were consulted in 71%. Given these figures, it is safe to assume that a decision to administer life-ending drugs without explicit patient request is rarely made without some form of consent or agreement, be it from the patient, relatives or colleague caregivers. However, consent (even from the patient) does not constitute sufficient legal grounds to perform this act.
Our article focused explicitly on the role of nurses in decision-making and the preparation and administration of life-ending drugs in cases of assisted death with and without explicit patient request. Our questionnaire asked whether there was discussion between the nurse and the relatives in those cases — which happened in 68.9% of cases. We did not include this finding in the article because involving the relatives, especially in the case of patient incompetence, is ultimately the responsibility of the physician, as is the decision itself, with input from relatives and nurses.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/9/905#569310