Fortbildungen / Formations continues 2012 - IUMSP

PRESSESPIEGEL – REVUE DE PRESSE
voy ist kein personalisiertes Medikament und
weist also einen anderen Wirkungsmechanismus
auf. Wie bei anderen Krebsmitteln ist auch
bei Zelboraf der Nutzen für den Patienten stark
umstritten. Im Vergleich zur Behandlung mit der
herkömmlichen Chemotherapie verlängert das
Roche-Mittel die Lebensdauer der Patienten
im Durchschnitt um 13,2 Monate statt um 9,6
Monate. Mit dieser Differenz von dreieinhalb
Monaten werde das Sterben lediglich hinausgezögert,
das Leben aber nicht spürbar verlängert,
kritisiert Patientenschützerin Kessler. Die
Gesellschaft müsse sich die Frage stellen, ob
sie bereit sei, so viel Geld für die kurze Lebensverlängerung
auszugeben.
Geringe Heilungschancen
Mediziner sprechen hingegen von einem Durchbruch
bei der Behandlung des schwarzen Hautkrebses.
«Mit Zelboraf beobachten wir in den
ersten drei Monaten der Behandlung praktisch
keine Todesfälle mehr», sagt Dummer, der an
den klinischen Studien des Medikaments mitgearbeitet
hat. Bei der üblichen Chemotherapie
sterbe in den ersten drei Monaten im Durchschnitt
einer von fünf Patienten. Doch auch bei
dem neuen Medikament sind die Chancen auf
Heilung gering. Die Wahrscheinlichkeit, dass jemand
dank Zelboraf geheilt werde, liege wahrscheinlich
bei 10 Prozent, sagt Dummer. Kessler
ist der Meinung, Roche nütze die Angst von
Krebspatienten aus, die wegen der unheilbaren
Erkrankung mit dem Tod konfrontiert seien, und
verdiene damit viel Geld.
Die Branche, Roche allen anderen voran, propagiert
die personalisierte Medizin schon seit
Jahren. Bis auf wenige Ausnahmen liess der Erfolg
bisher aber auf sich warten. Eine Ausnahme
bildet das Brustkrebsmedikament Herceptin,
das ebenfalls vom Basler Pharmakonzern
stammt. Nun wird neben Zelboraf eine ganze
Reihe personalisierter Medikamente auf den
Markt kommen. Allein Roche, führend in diesem
Gebiet, arbeitet an fünf weiteren solchen
Präparaten: vorwiegend im Krebsbereich.
Tages-Anzeiger, 3. April 2012
Pushing assisted suicide
limits
Some in Netherlands see troubling trends as
the practice gains acceptance
It was 1989, and Dr. Petra de Jong, a Dutch
pulmonologist, was asked for help by a terminally
ill patient, a man in great pain with a large
cancerous tumor in his trachea. He wanted to
end his life.
She gave the man pentobarbital, a powerful
barbiturate — but not enough. It took him nine
hours to die.
«I realize now that I did things wrong», Dr. de
Jong, 58, said in an interview in her of�ce here.
«Today you can Google it, but we didn’t know.»
Her warm and sincere manner belies, or perhaps
attests to, her calling. The man was the
�rst of 16 patients whom Dr. de Jong, now the
head of the euthanasia advocacy group Right
to Die-NL, has helped to achieve what she calls
a «digni�ed death.»
Founded in 1973, Right to Die-NL has been at
the forefront of the movement to make euthanasia
widely available in the Netherlands, even
as the practice remains highly controversial
elsewhere. Polls �nd that an overwhelming majority
of the Dutch believe euthanasia should
be available to suffering patients who want it,
and thousands formally request euthanasia every
year.
Right to Die-NL, which claims 124,000 members,
made worldwide headlines in early March
with the news that it was creating mobile euthanasia
teams to help patients die at home.
The organization has also courted controversy
with its call for legislation to make euthanasia
available to anyone over age 70, sick or not.
Dr. de Jong said more than 100 requests have
been made for the mobile service. Several of
them are being evaluated, and euthanasia has
been performed in one case.
Advocates and critics of assisted suicide are
watching the organization’s efforts closely. Rick
Santorum, the Republican presidential candidate
from Pennsylvania, created something of a
stir in February when he asserted — wrongly —
that euthanasia accounted for 5 percent of all
deaths in the Netherlands, and that many elderly
Dutch wore wristbands that said «Do not
euthanize me». Dutch of�cials quickly countered
the claims.
«Internationally, the Dutch have pushed the
conversation on both the wisdom of allowing
people to choose how and when they die when
they’re in great suffering, and on the nature of
compassion in dying,» said Paul Root Wolpe,
director of the Center for Ethics at Emory University
in Atlanta.
Under the Netherlands’ 2002 Termination of
Life on Request and Assisted Suicide Act, doctors
may grant patients’ requests to die without
fear of prosecution as long as they observe
certain guidelines. The request must be made
voluntarily by an informed patient who is undergoing
suffering that is both lasting and unbearable.
Doctors must also obtain the written
af�rmation of a second, independent physician
that the case meets the requirements and report
all such deaths to the authorities for review.
Dr. de Jong said Dutch physicians typically euthanize
patients by injecting a barbiturate to
induce sleep, followed by a powerful muscle
relaxant like curare to stop the heart. For assisted
suicide, the doctor prescribes a drug to
prevent vomiting, followed by a lethal dose of
barbiturates.
Almost 80 percent of all such deaths take
place in patients’ homes, according to the
Royal Dutch Medical Association. In 2010, the
latest year for which data are available, doctors
reported 3,136 noti�cations cases of «termination
of life on request.» Serious illnesses —
late-stage cancer, typically — lie behind a vast
majority.
Euthanasia is responsible for about 2 percent
of all deaths annually in the Netherlands, according
to Eric van Wijlick, a policy adviser for
the association.
Euthanasia is typically carried out by the general
practitioners, doctors who often have enjoyed
long relationships with their patients and
know their feelings well. Mr. van Wijlick said the
euthanasia law was possible because of «the
moderate and open climate we have in the
Netherlands, with respect for other points of
view», and acknowledged that it would be dif-
�cult to carry out elsewhere, because everyone
in the Netherlands has access to health care,
an income and housing.
«There are no economic reasons to ask for euthanasia,»
he said, something that might not
be true in the United States, with its for-pro�t
health care system.
The mobile teams were needed, Dr. de Jong
said, because many general practitioners, either
for moral reasons or perhaps because of
uncertainty about the law, refused to help suffering
patients to die after it had become too
late to �nd another doctor. The mobile teams
will work to help them do so, she said.
Say a hypothetical 82-year-old man with metastasizing
prostate cancer and poor prospects
is told by his doctor that does not qualify for
euthanasia. The man could contact the Right
to Die-NL’s new «life-ending clinic,» and if he
appeared to meet the criteria, a doctor and a
nurse would go to his home to make an assessment.
If all the conditions were met, he would
be euthanized, ideally with his family beside
him. Dr. de Jong emphasized that a patient
could never be euthanized on the initial visit,
because the law requires that a second physician
has to be consulted.
98 Schweizer Krebsbulletin � Nr. 2/2012