Assisted dying: a palliative care physician’s view

Abstract

, but it may return to Parliament in Autumn 2006. Assisted dying is being promoted as a logical extension to patient autonomy for those who are terminally ill and suffering intolerably, and proponents claim to have overwhelming public support. Those who have most experience of caring for the terminally ill, however, come out most strongly against any change in the current law. This paper suggests that estimates of public opinion are unreliable; that assisted dying is unnecessary if we are prepared to prioritise good end-of-life care; and that a change in the law would do little to protect patients but would put other vulnerable members of society at risk.

State of Palliative Care Development in European Countries with and without Legally Regulated Physician-Assisted Dying

“…Several recent publications take the latter position, specifically challenging the Belgian construct of "integral palliative care" and arguing that physician-assisted dying and palliative care are fundamentally antagonistic causes (Jaspers, Müller-Busch & Nauck, 2009;Kettler & Nauck, 2010;Johnstone, 2012;Materstvedt, 2012). The principled rejection of "integral palliative care" is in line with traditional views in mainstream palliative care (Roy &Rapin, 1994;Hamel, 1998;Mast, Salama, Silverman, & Arnold, 2004;Meisel, 2005;Stephenson, 2006;Bosshard, Broeckaert,Clark, Materstvedt, Gordijn& Müller-Busch, 2008). Indeed, the prevention of physician-assisted dying was one of the prime motivations of the founders of the palliative care movement (Saunders, 1976) and this tenet has remained widely endorsed ever since (Gordijn& Janssens, 2000;…”

Euthanasia and assisted suicide: Who are the vulnerable?

“…[39][40][41] Ethical discourse on EAS is also concerned with the risk of harming the vulnerable, which is one of the most frequently cited reasons for opposing EAS legalisation. 20,21 Authors usually define the vulnerable by portraying concrete groups with one or more typical features, such as young or old age, impaired cognitive capacity, lower social status and similar. The American College of Physicians defined the vulnerable as the sick, the elderly, children, the disabled, the poor and members of minority groups and expressed worries about subtle biases and adverse judgements on the worth of their lives, which legalisation of EAS could bring.…”

“…I believe that this [EAS] is such a case'. 20 Despite disagreement about whether limitation of one's autonomy is justified in the case of EAS, a sensitive and respectful approach that avoids blindly 'labelling' certain people as vulnerable is crucial. 13 The most autonomous as the most existentially vulnerable…”

“…The most general is not decriminalising EAS in the country, perhaps even despite an acknowledgement that in exceptional cases, EAS practices would be justified. 20 However, as evidence shows, the prohibition of EAS does not exclude potential cases. 48,49 We would argue that the prohibition of EAS serves as an appropriate safeguard only when physicians and other health care professionals are aware of and align with the ethical grounds for it and when all suspicious cases of illegal EAS are investigated and, if necessary, prosecuted.…”

“…The most conventional one is vulnerability as a consequence of diminished autonomy or social oppression, which implies a need for protection. [19][20][21] Since protection is also exercised by limiting access to EAS for a whole group of patients (e.g., those with psychiatric disorders), strong appeals for non-discrimination against 'the vulnerable' also appear in the literature. [22][23][24][25][26] Furthermore, new interpretations of vulnerability in EAS have been identified, which suggest that those traditionally proclaimed as vulnerable are not necessarily the most vulnerable in an EAS setting, but it can be those whose autonomy is perceived to be greater due to their social status.…”