Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care

Abstract

The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects. It is problematic that some critics disregard the empirical evidence as epistemologically irrelevant in a normative ethical debate. Next, rejecting euthanasia because its prevention was a founding principle of PC ignores historical developments. Further, critics' ethical positions depart from the PC tenet of patient centeredness by prioritising caregivers' values over patients' values. Also, many critics' canonical adherence to the WHO definition of PC, which has as the ethical criterion is objectionable. A rejection of the Belgian model on doctrinal grounds also has nefarious practical consequences such as the marginalisation of PC in euthanasia-permissive countries, the continuation of clandestine practices and problematic palliative sedation until death. In conclusion, major flaws of essentialistic arguments against the Belgian model include the disregard of empirical evidence, appeals to canonical and questionable definitions, prioritisation of caregiver perspectives over those of patients and rejection of a plurality of respectable views on decision making at the end of life.

Impact of Medical Assistance in Dying on palliative care: A qualitative study

“…11–14 On the other hand, some countries, such as Belgium, have created an integrated model where euthanasia is embedded in palliative care practice. 15,16 Research exploring how Medical Assistance in Dying has impacted palliative care practice is limited, however. 5,7,17–19…”

Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada

“…This movement has historically positioned itself in opposition to assisted death, although this positioning is not without controversy. Bernheim and Raus,22 for example, argue that criticisms of the Belgian model of end-of-life care (which integrates both euthanasia and palliative care) fail to consider that ‘there is a plurality of reasonable and defensible views on the ethical acceptability of euthanasia’ (p493). For these authors, respecting patient autonomy in a way that makes room to consider euthanasia as an ethical option in some cases is a more authentic way of enacting empathy (a core palliative care value) than rigid adherence to historical or doctrinal positions of outright moral rejection.…”

Implementing voluntary assisted dying in Victoria, Australia

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“…- 603 Changing legislation has led to government action and legislative changes concerning broad end-of-life issues including advance care directives, medical decision-making, palliative care as well as assistance in dying. 8 In Victoria, over the implementation period, advance care planning has been strengthened and palliative care funding has increased (file:///C:/Users/moconnor/Documents/VAD/publications/Press%20Release%20-Palliative-Care-Boost-To-Support-Terminally-Ill-Victorians%20(1).pdf).…”