Legalised euthanasia will violate the rights of vulnerable patients

George, Rob; Finlay, Ilora; Jeffrey, David

doi:10.1136/bmj.331.7518.684

Cited by 39 publications

(33 citation statements)

References 12 publications

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“…Concern has been expressed (Saunders, 1992;George, Finlay & Jeffrey 2005;Finlay, 2006) that the legalisation of assisted dying could lead to a 'slippery slope' in which the lives of elderly people or those without the capacity to express themselves, become devalued. For example, there is some evidence (Seale & Addington-Hall, 1995a) to suggest that very elderly people -particularly elderly widows -are less likely to have family members with a strong emotional investment in the prolongation of their lives.…”

Section: Introductionmentioning

confidence: 99%

Hastening death in end-of-life care: A survey of doctors

Seale

2009

Social Science & Medicine

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In end-of-life care the application of medical technology to prolong life at the expense of quality of life is widely debated. A national survey of 3,733 UK doctors reporting on the care of 2,923 people who had died under their care is reported. There was no time to make an 'end-of-life decision' (deciding to provide, withdraw or withhold treatment) for 8.5%. A further 55.2% reported decisions which they estimated would not hasten death and 28.9% reported decisions they had expected to hasten death. A further 7.4% reported deaths where they had to some degree intended to hasten death (=100%). Where patients or someone else had made a request for a hastened death, doctors were more likely to report expecting or at least partly intending to hasten death. Doctors usually made these decisions in consultation with colleagues, relatives and, where feasible, with patients. Intensive care specialists were particularly likely to report a degree of intention to hasten the end of life and to have treated patients lacking the capacity to discuss these decisions. Palliative medicine specialists were the least likely to report decisions they expected or at least partly intended to end life, in spite of reporting a high incidence of requests from their patients for a hastened death. Doctors with strong religious beliefs or who opposed the legalisation of assisted dying were unlikely to report such decisions. Elderly women and those with dementia are groups considered vulnerable in societies where a permissive approach is taken to hastening death in end-of-life care, but doctors describing these deaths were no more likely to report decisions which they expected or at least partly intended to end life. The survey suggests that concerns about the sanctity of life, as well as estimates of the quality of life, enter clinical decision-making.

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Section: Introductionmentioning

confidence: 99%

Hastening death in end-of-life care: A survey of doctors

Seale

2009

Social Science & Medicine

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“…11,[18][19][20][21] Our finding that the use of life-ending drugs without explicit patient request occurred predominantly in hospital and among patients 80 years or older who were mostly in a coma or had dementia fits the description of "vulnerable" patient groups at risk of life-ending without request. [7][8][9][10] Attention should therefore be paid to protecting these patient groups from such practices. However, when compared with all deaths in Flanders, elderly patients and patients dying of diseases of the nervous system (including dementia) were not proportionally at greater risk of this practice than other patient groups.…”

Section: Discussionmentioning

confidence: 99%

“…Opponents of euthanasia often argue that legalizing the procedure will lead to a rise in the use of life-ending drugs without a patient's explicit request, especially in vulnerable patient groups. [7][8][9][10] Thus far, however, no indications of this have been found in studies of physician-assisted deaths before and after legalization in Belgium and the Netherlands. 9,11,12 In Belgium, the percentage of deaths in which life-ending drugs were used remained stable, and the proportion without an explicit request from the patient decreased.…”

mentioning

confidence: 98%

Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey

Chambaere¹,

Bilsen²,

Cohen³

et al. 2010

Canadian Medical Association Journal

118

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Background: Legalization of euthanasia and physician-assisted suicide has been heavily debated in many countries To help inform this debate, we describe the practices of euthanasia and assisted suicide, and the use of life-ending drugs without an explicit request from the patient, in Flanders, Belgium, where euthanasia is legal. Methods: We mailed a questionnaire regarding the use of life-ending drugs with or without explicit patient request to physicians who certified a representative sample (n = 6927) of death certificates of patients who died in Flanders between June and November 2007. Results: The response rate was 58.4%. Overall, 208 deaths involving the use of life-ending drugs were reported: 142 (weighted prevalence 2.0%) were with an explicit patient request (euthanasia or assisted suicide) and 66 (weighted prevalence 1.8%) were without an explicit request. Euthanasia and assisted suicide mostly involved patients less than 80 years of age, those with cancer and those dying at home. Use of life-ending drugs without an explicit request mostly involved patients 80 years of older, those with a disease other than cancer and those in hospital. Of the deaths without an explicit request, the decision was not discussed with the patient in 77.9% of cases. Compared with assisted deaths with the patient's explicit request, those without an explicit request were more likely to have a shorter length of treatment of the terminal illness, to have cure as a goal of treatment in the last week, to have a shorter estimated time by which life was shortened and to involve the administration of opioids. Interpretation: Physician-assisted deaths with an explicit patient request (euthanasia and assisted suicide) and with-out an explicit request occurred in different patient groups and under different circumstances Cases without an explicit request often involved patients whose diseases had unpredictable end-off life trajectories. Although opioids were used in most of these cases, misconceptions seem to persist about their actual life-shortening effects

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“…20 Opposition is founded on both moral grounds and a perception that assisted dying is unnecessary and/or potentially detrimental to either society as a whole or to vulnerable subsections within it. 21 It is unlikely that the moral argument can ever be resolved because morality is a set of beliefs of uncertain origin which change with time and are not set out authoritatively in any universally acknowledged source. The perceived value of human life is of such moment to most people that the concept of foreshortening it in any way places such an act among those considerations which, in the words of Dame Mary Warnock, are 'matters of ultimate value which are not susceptible to proof '.…”

Section: The Role Of Statutementioning

confidence: 99%