Although palliative care and legalised euthanasia are both based on the medical and ethical values of patient autonomy and caregiver beneficence and non-maleficence,1 they are often viewed as antagonistic causes. A popular perception, for instance, is that palliative care is the province of religiously motivated people and the advocacy of euthanasia that of agnostics or atheists.2 3 The European Association for Palliative Care has voiced concerns that legalising euthanasia would be the start of a slippery slope resulting in harm to vulnerable patients such as elderly and disabled people and that it would impede the development of palliative care by appearing as an alternative.4 Data from the Netherlands and Belgium, where euthanasia is legal, do not provide any evidence of a slippery slope.5 6 Here, we focus on the effect of the process of legalisation of euthanasia on palliative care and vice versa by reviewing the published historical, regulatory, and epidemiological evidence
Sky Television’s documentary showing an assisted suicide has provoked a storm in UK tabloids, but the medical ethicist Daniel K Sokol says it has reinforced his belief in the moral permissibility of helping people die in exceptional circumstances.
John Coggon The German National Ethics Council has recently published its Opinion on Self- Determination and Care at the End of Life. 1 The Opinion raises and attempts to resolve issues that are troubling many people in many jurisdictions. Perhaps unsurprisingly, given the well-rehearsed range of views on euthanasia, assisted-suicide, suicide, and care for the dying, the Council’s Opinion is neither extreme in its suppositions nor in its proposals. This may not satisfy campaigners and commentators who sit on the polar edges of the debate, but it represents a predictable compromise, and will satisfy medical practitioners and those who are increasingly concerned with the inadequacy of palliative care for the elderly, the dying, and the chronically sick.
The National Ethics Council has intensively discussed the issues involved in dealing responsibly with dying. It has perused a large volume of material, obtained expert opinions, consulted with doctors and other medical specialists, and held meetings in Augsburg and Münster at which it exposed itself to public debate. The outcome is enshrined in the Opinion now presented. Self-determination and care at the end of life continues the examination of the themes addressed in the Opinion The advance directive published in June 2005. The present analysis, in conjunction with the clarification of terminology here proposed, may facilitate interpretation of the recommendations set out in that Opinion.
Disabling pain or symptoms can occur at any age from many different causes. Pain and palliative specialists are able to relieve most pain and symptoms, although repeated adjustments to modalities, medications and doses may be needed. Because pain and palliative specialists comprise only a small percentage of physicians, many patients find it difficult to access them or obtain pain relief. Globally, there are too few such specialists to meet existing needs. Most are affiliated with hospice and palliative units, so their accessibility to patients without terminal conditions is negligible. Doctors outside pain and palliative specialties are often unfamiliar with pain guidelines and sceptical about patient reports of unrelieved pain. They are therefore likely to undertreat it. Undertreating pain, however, violates respect for persons and beneficence.
Subsequent to an intensive three-year period of reflection, the CMQ is revealing its perspective and conclusions today regarding end-of-life care and euthanasia. The CMQ embraces the point of view of the patient who is confronting imminent and inevitable death. In such a situation, the patient looks to their physician and generally requests that they be able to die without undue suffering and with dignity. Neither surveys, nor attorneys, nor politicians can properly advise the physician and the patient facing this situation. In the majority of cases, the patient and their doctor find the appropriate analgesia that respects the ethical obligation of physicians not to preserve life at any cost, but rather, when the death of a patient appears to be inevitable, to act so that it occurs with dignity and to ensure that the patient obtains the appropriate support and relief.
Until quite recently bioethicists have had little of depth and probity to say about the duty of healthcare professionals in general and physicians in particular to relieve pain and suffering associated with disease and/or its treatment. The singular exception is the now arguably canonical work by physician and ethicist Eric Cassell, titled The Nature of Suffering and the Goals of Medicine.2 I invoke the word ‘‘canonical’’ on the grounds that to my knowledge no one has offered a sustained critique of Cassell’s conceptual analysis of suffering or of his inextricable linkage of its nature to the essential features of persons. In doing so, Cassell suggests not that living beings without the status of persons cannot suffer, but rather that the suffering experienced by persons is unique precisely because of their essential features.
Sa mère est morte il y a six ans, mais Bernard Bruyère, 67 ans, ingénieur à la retraite, parle encore des conditions de son décès avec souffrance. En 2011, après l'affaire Bonnemaison (ce médecin soupçonné d'avoir provoqué la mort de patients), il avait écrit au courrier des lecteurs du Monde pour témoigner et s'insurger contre la loi Leonetti qu'il juge "inappropriée et indigne".
Il est normal qu'en période électorale les sujets de société s'invitent dans les programmes des candidats. Il est en revanche toujours regrettable que, sur ces sujets majeurs qui engagent notre vision des équilibres humains, les propositions mélangent le flou et l'improvisation. Cette situation est clairement dangereuse lorsqu'il s'agit de notre conception de la fin de vie et de la mort. M. Hollande propose que "toute personne majeure [en fin de vie] puisse demander, dans des conditions précises et strictes, à bénéficier d'une assistance médicalisée pour terminer sa fin de vie dans la dignité." Le Parti socialiste a évoqué "un pas vers l'euthanasie", bien que le terme ne soit pas mentionné. L'euthanasie signifie la possibilité ouverte de donner la mort à un malade qui le réclame. Est-ce cela que souhaite M. Hollande . Si c'est le cas, pourquoi, une fois de plus, ne pas le dire clairement ? "Un pas vers l'euthanasie", c'est l'euthanasie.
A l'heure où les candidats à l'élection présidentielle devront se positionner vis-à-vis du souhait de certains de légiférer sur l'euthanasie, je voudrais dire ceci : commencez par faire appliquer la loi qui existe ! Ensuite engagez une réflexion citoyenne autour des rares situations qui ne peuvent être résolues dans ce cadre. Nous sommes nombreux de tous bords à souhaiter que ces souffrances extrêmes puissent être soulagées au risque de transgresser la loi. Mais nous sommes conscients aussi de notre responsabilité vis-à-vis des plus vulnérables, ceux dont on décidera peut-être un jour que leur vie ne vaut pas la peine d'être vécue. Le code pénal, qui interdit au médecin de donner délibérément la mort, les protège. Une solution doit pouvoir être trouvée sans toucher à cet interdit de tuer qui structure notre société.
The total number of deaths studied was 11,704 of which 1517 involved continuous deep sedation. In Dutch hospitals, CDS was significantly less often provided (11%) compared with hospitals in Flanders (20%) and U.K. (17%). In U.K. home settings, CDS was more common (19%) than in Flanders (10%) or NL (8%). In NL in both settings, CDS more often involved benzodiazepines and lasted less than 24 hours. Physicians in Flanders combined CDS with a decision to provide physician-assisted death more often. Overall, men, younger patients, and patients with malignancies were more likely to receive CDS, although this was not always significant within each country. Conclusion Differences in the prevalence of continuous deep sedation appear to reflect complex legal, cultural, and organizational factors more than differences in patients’ characteristics or clinical profiles. Further