A doctor who chose an assisted death

A Belgian generalist’s family helped him through the assisted dying process once the pain from cancer had become unbearable, his daughter, a dermatologist, tells Richard Hurley

“Suddenly, when he knew that the exit was close, he was a different man.” On the day he had chosen to die, 8 May 2012, Veronique Bataille’s father seemed to have been freed from the increasing, persistent, and excruciating pain that had resulted from bone metastases secondary to prostate cancer.

“I think that it was because he knew exactly when he was going to go that he had four or five hours of amazing lucidity. He got up. He washed on his own. He shaved,” she said. He had even requested an outfit from his wife; “He really wanted to plan the day well. He looked amazing.”

And now, at his chosen time and looking his best, he sat on the hospital bed with his wife and four children around him. “Thank you for allowing me to go the way I want to go,” he told them.

Powerless to help his own patients

Henri Bataille, born in 1935, had spent his life as a family doctor in rural southern Belgium. He had often felt powerless to help his own patients who were dying in pain, and he welcomed Belgium’s legislation on assisted dying in 2002. “I will want it if ever I’m in that situation,” he told his family.

Henri Bataille had prostate cancer diagnosed in his late 60s. Treatment brought remission for five years. Then the discovery of metastases led Bataille to register for an assisted death, before the pain and drugs that were certain to accompany the end of his life would make such a wish even harder to bring about.

Uncontrollable pain was most likely what led to his admission to the local hospital, Bataille’s daughter said; but this was a Catholic institution, and when he mentioned assisted dying he was told that this was not possible. “Even in Belgium, where it’s legal, the nurses and doctors refused to acknowledge that he’d been through the process [of registering for assisted dying],” said Veronique, a dermatologist who has practised in the United Kingdom for 30 years. “It was traumatic.”

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Assisted dying: law and practice around the world

Definitions and dispute25

Proponents and opponents do not all agree on the terminology used to describe the process.

Assisted dying—Proponents of the current Assisted Dying Bill in England and Wales and others argue that this term best describes prescribing life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting strict legal safeguards. Assisted dying, as defined like this, is legal and regulated in the US states of Oregon, Vermont, and Washington and is what the bill in England and Wales proposes.

Assisted suicide—This term is used to describe giving assistance to die to disabled and other people who are not dying, in addition to patients with terminal illness. Drugs are self administered. Some opponents of the Assisted Dying Bill in England and Wales do not accept “assisted dying” as distinctly different. Assisted suicide, as defined like this, is permitted in Switzerland.

Voluntary euthanasia—This term describes a doctor directly administering life ending drugs to a patient who has given consent. Voluntary euthanasia is permitted in the Netherlands and Belgium.

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Researchers Narrow In On Common Cystic Fibrosis Infection

Cystic fibrosis patients are prone to lung infections that can be deadly. One of the most common infections – caused by Pseudomonas aeruginosa bacteria – is particularly difficult to treat. The opportunistic bacteria is able to persist even after treatment. Researchers from the University of Washington have just discovered why: After the bacterium infects the lungs, populations become isolated and then evolve region-specific traits.

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Mother’s education and adverse birth outcomes

Babies born too soon or too small face many difficulties, including increased rates of mortality and lifelong disability.1 The 2012 Global Action Report on Preterm Birth ‘Born Too Soon’ presents a sobering picture: 15 million (1 in 10) babies every year are born too soon, with these rates appearing to be rising globally.1 Low levels of maternal education have been clearly associated with adverse birth outcomes such as preterm birth and low birth weight.2–4 While education is only one risk factor—alongside other critical factors such as maternal age, birth order and spacing, multiple pregnancies, body weight, chronic disease, mental health, infectious diseases, health risk behaviours such as smoking, intimate partner violence, and access to screening and health services1 ,5—it matters, because education enables girls and women to make informed decisions about their reproductive health and interactions with the healthcare system.6 Increasing education levels is a key component of programmes directed at reducing adverse birth outcomes.1

While the prevalence (and burden) of preterm birth is highest in the poorest countries, namely sub-Saharan Africa and southern Asia, it also affects richer countries including those in the Americas and Europe. More country-specific data are needed to assist our understanding of the extent of the problem and the complex interplay of contributory risks. This is why the paper by Ruiz et al7 is a welcome addition to the literature. The authors examine the association between attained educational qualifications of mothers and two adverse birth outcomes (preterm birth, low for gestational age birth weight) in their infants. Conducted as part of the ‘DRIVERS for Health Equity’ research programme, this meta-analysis has systematically analysed data from studies of over 75 000 babies in 12 countries across Europe (France, the Netherlands, the UK, the Czech Republic, Ukraine, Finland, Norway, Sweden, Greece, Italy, Portugal and Spain). Notably, these countries represent the northern, western, southern and central/eastern parts of Europe, thus providing a more complete picture of how maternal education may influence disparities in pregnancy duration and infant birth weight.

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GMOs, Herbicides, and Public Health — NEJM

Genetically modified organisms (GMOs) are not high on most physicians’ worry lists. If we think at all about biotechnology, most of us probably focus on direct threats to human health, such as prospects for converting pathogens to biologic weapons or the implications of new technologies for editing the human germline. But while those debates simmer, the application of biotechnology to agriculture has been rapid and aggressive. The vast majority of the corn and soybeans grown in the United States are now genetically engineered. Foods produced from GM crops have become ubiquitous. And unlike regulatory bodies in 64 other countries, the Food and Drug Administration (FDA) does not require labeling of GM foods.

Two recent developments are dramatically changing the GMO landscape. First, there have been sharp increases in the amounts and numbers of chemical herbicides applied to GM crops, and still further increases — the largest in a generation — are scheduled to occur in the next few years. Second, the International Agency for Research on Cancer (IARC) has classified glyphosate, the herbicide most widely used on GM crops, as a “probable human carcinogen”1 and classified a second herbicide, 2,4-dichlorophenoxyacetic acid (2,4-D), as a “possible human carcinogen.”2

 

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