Advance request in euthanasia and assisted suicide of patients with severe dementia.

Background - To permit euthanasia or assisted suicide (EAS( the medical ‘due care criteria’ of the Termination of Life on Request and Assisted Suicide Act (TLRASA) should be met, i.e., the request should be (1) voluntary and well considered and (2) expressed after informed consent about diagnosis and prognosis. (3) Suffering should be unbearable, with no prospect of improvement and (4) no reasonable alternatives should be available. Aim - To explore key elements influencing the RTE’s judgement on whether the due care criteria have been met of EAS cases in severe dementia based on written advance euthanasia requests. Methods - Qualitative study of reports of the RTE published online (n=21) in which a written euthanasia directive was mentioned and considered incompetent to make a decision regarding EAS. Two independent researchers (AvdB, GM) extracted factual data independently of one another (see appendix) and judged the due care criterion 'competence to make a decision regarding EAS'. Results & conclusion - Examination of the RTE’s judgment underlines the need for a clear euthanasia directive in advance request cases, as in 2 cases the criteria voluntary and well considered were not met because of this. Additionally, it becomes apparent that it is essential that the patient confirms their request after writing the directive. The RTE did not consider consulting an independent expert to establish the patient’s decision-making capacity essential for the due care criteria to be met. However, this solely applied when physicians acted diligently. Recommendations – We would recommend updating a written directive at least every year

Intraperitoneal photodynamic therapy of the rat CC531 adenocarcinoma.

The goal of this study was to investigate the efficacy of photodynamic therapy (PDT) of a single tumour growing intraperitoneally. For this purpose the CC531 colon carcinoma, implanted in an intraperitoneal fat pad of Wag/RijA rats, was treated with intraperitoneal photodynamic therapy (IPPDT) using Photofrin as the photosensitiser. Two illumination techniques have been compared. An invasive illumination technique using Perspex blocks to illuminate 30 cm2 of the lower abdomen gave a significant delay in tumour growth with 25 J cm-2 applied 1 day after Photofrin. A minimally invasive illumination technique using a balloon catheter to illuminate 14 cm2 resulted in an equivalent growth delay with 75 J cm-2. The route of administration of the photosensitiser did not influence regrowth times of the tumour. Mitomycin C (MMC), a bioreductive agent, was used to exploit the known PDT-induced hypoxia. The combination of IPPDT with MMC resulted in an increased tumoricidal effect. In conclusion, IPPDT led to a significant growth delay for a single tumour implanted intraperitoneally and repetition of the PDT treatment was possible using a minimally invasive illumination technique. Repeated treatments resulted in increased tumour response