Euthanasia is a deliberate intervention undertaken with the express intention of ending a life so as to relieve intractable suffering
☛ if performed at the person’s request or with their consent, it is voluntary
☛ otherwise it is non-voluntary
Physician-assisted suicide: the physician provides the knowledge and means necessary, but the act is completed by the patient
☛ from the physician’s standpoint, it is a deliberate act with the express intention of ending life and should not be ethically distinguished from euthanasia
Palliative Care
☛ recognizes human suffering and seeks to relieve it
↳ but it does not accept that euthanasia is ever the answer
☛ recognizes that a request for euthanasia is a plea for better care
Withholding or withdrawal of medical treatment
☛ terminally ill patients should not be subjected to futile therapies
☛ there is no requirement or justification to sustain life at all costs
↳ a doctor has no right to prescribe a prolonged or lingering death
☛ withholding or withdrawal of futile treatment from the terminally ill does not shorten life or hasten death
↳ it does not artificially prolong life
☛ withholding or withdrawal of futile therapy from the terminally ill is not euthanasia
↳ the intention is to allow death to occur naturally, not to deliberately terminate life
‘Double effects’
☛ medications given for the relief of distressing pain or symptoms may, on occasions, hasten the moment of death, the so-called ‘double effect’
o there is no evidence that good palliative medicine shortens life
o effective symptom control is just as likely to extend as shorten life
o studies indicate that the appropriate use of sedatives and opioids at the end of life is not associated with life-shortening
☛ providing that appropriate drugs are given for appropriate medical reasons and in appropriate doses, this is not euthanasia
↳ the hastening of death may or may not be foreseen, but it is never intended
Palliative sedation
Palliative sedation is the use of sedating medications at the end of life to relieve refractory and intolerable symptoms (e.g. pain, dyspnoea, agitated delirium) after all other measures have failed.
☛ provided it is performed with the informed consent of the patient or surrogate decision-maker, employing appropriate drugs in appropriate doses and carefully titrated, it is ethically sound and is not euthanasia.
☛ the possibility of a ‘double effect’ exists, although studies of patients treated with palliative sedation in this manner do not demonstrate lifeshortening.
☛ the practice of ‘terminal sedation’ (with the intention of keeping a patient unconscious until they die) and palliative sedation for ‘existential distress’, as reported from the Netherlands, probably constitute euthanasia.
Euthanasia may be requested or advocated for various reasons
☛ unrelieved pain and physical symptoms (or fear of)
↳ which should occur infrequently given optimal multiprofessional palliative care
↳ terminal sedation may be considered for patients with pain or other symptoms that are refractory to optimal palliative care; this does not constitute euthanasia
☛ severe anxiety and depression
↳ which should be controlled given optimal multiprofessional palliative care
☛ intolerable suffering, existential distress
↳ which should be controlled given optimal multiprofessional palliative care
☛ carer fatigue
↳ is preventable
☛ autonomy and self determination
↳ in modern society, the existence of a right to request and receive euthanasia is controversial—every ‘right’ is balanced by a responsibility
☛ iatrogenic - the ‘nothing more can be done’ syndrome
↳ would not occur if patients were referred to a palliative care service
↳ requires professional education
Uncontrolled suffering in the terminally ill should be considered a medical emergency and not an indication for euthanasia
Legalization of euthanasia is associated with risks
☛ voluntary euthanasia leads to non-voluntary euthanasia
↳ reports from the Netherlands indicate that as many as a thousand patients a year are subjected to euthanasia without request, never mind consent
☛ euthanasia for the terminally ill leads to euthanasia for those not terminally ill
↳ e.g. the Dutch reports of euthanasia for men with early AIDS and life expectancy measured in years
☛ euthanasia for the terminally ill leads to euthanasia for persons with potentially treatable conditions like depression
↳ as documented in the Dutch and Australian reports
☛ the vulnerable will experience pressure to request euthanasia
↳ the aged, the sick, the disabled and those who feel a burden
↳ as reported from Holland
There is no place for euthanasia in a caring society that provides
palliative care services
Further articles concerning euthanasia are to be found on the Ethics Page of the IAHPC website
↳
Source:
The IAHPC Manual of Palliative Care 3rd Edition
https://web.archive.org/web/20210122105526/https://hospicecare.com/uploads/2013/9/The%20IAHPC%20Manual%20of%20Palliative%20Care%203e.pdf
