Elu lpu otsused Eutanaasia meditsiinilised aspektid MariLiis Ilmoja

Elu lõpu otsused Eutanaasia – meditsiinilised aspektid Mari-Liis Ilmoja SA Tallinna Lastehaigla

“The limits of our language are the limits of our world” Ludwig Wittgenstein

• Ravi / hooldus elu lõpus (End-of-life Care - EOLC) • Elu lõpuga seotud otsused (End-of-life Decisions - EOLD) • Ravi lõpetamine (Withdrawal of treatment) • Aktiivravi lõpetamine (Cessation & removal of on-going medical therapy with explicit intent not to substitute another treatment) • Ravi alustamisest hoidumine (Withholding treatment) • Otsus mitte alustada ravi, mis tavatingimustes võiks olla tulemuslik, kuid konkreetse haigusjuhu puhul ei muudaks lõpptulemust (Decision not to institute a therapy that, although in normal circumstances may be beneficial, would not alter the outcome in a specific case) Patsienditestament 3/12/2021

Patsienditestament? • Eutanaasia (Euthanasia) is defined as death resulting from medication that is administered by a physician with the explicit intention of hastening death at the explicit request of the patient. • ? (Physician assisted suicide ) Suicide effected with the assistance of another person, especially the taking of lethal drugs provided by a doctor for the purpose by a patient suffering from a terminal illness or incurable condition. • ? (Physician assisted death)

Holland 2002 (al 12. eluaastast; Belgia 2002 ( 2014. a. lastel) Luksemburg 2009 2005. a. < 1. a. ) Nii eutanaasia kui ka arsti-abistatud enesetapp Ø Inimene peab avaldama vabatahtlikult soovi Ø Inimesel peab olema pidev ja talumatu füüsiline või psüühhiline kannatus

o 2 eutanaasia juhtu 5 aasta jooksul alla 1 aastastel o 7 eutanaasia juhtu 15 aasta jooksul 12 – 18 aastastel

Šveits 1982 Oregon 1997 Washington, Vermont, California, Colorado, Hawaii, New Jersey Ainult arsti-abistatud enesetapp

Oregon Death with Dignity Act

Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey B Onwuteaka-Philipsen, et al. Lancet 2012; 380: 908– 15

Oregon, USA Eesti Holland 4, 3 milj 17, 3 milj Sureb 38 000 Sureb 15 184 153 383 sureb PAS 0, 5% surmadest 0, 5% = 75 inimest Eutanaasia 4% PAS 0, 1% surmadest 4% = 600 inimest

Kellele? Oregon, USA 65 – 74. a. – 29, 3% 75 – 84. a. - 28, 7% Pahaloomuline kasvaja 68 % Neuroloogiline haigus 14% Hingamissüsteemi haigused 7% Holland 70 – 79. a. – 32, 4% 80 +a. - 23, 5% 60 – 69. a. - 22, 2% Pahaloomuline kasvaja Kombineeritud haigused Neuroloogiline haigus 66 % 12% 6%

Miks? Oregon, USA

Kas ainult meditsiiniline küsimus? Euthanasia is not medical treatment J. Donald Boudreau, J. Donald Boudreau * †Department of Medicine, and Core member, Center for Medical Education, Faculty of Medicine , Mc. Gil. British Medical Bulletin, Volume 106, Issue 1, June 2013,