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
Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.
Physician assisted death (both voluntary active euthanasia and physician assisted suicide) has been openly practised in the Netherlands for more than 25 years and formally legalised since 2002. The practice has been analysed in four major national studies between 1990 and 2007.1 2 A more restricted form of physician assisted death (physician assisted suicide only) was legalised in Oregon in 1997 and is the subject of an annual report. Although these studies do little to resolve the moral and religious questions surrounding these practices, they do answer the following questions about the risks and benefits of legalisation.
The book strives for as complete and dispassionate a description of the situation as possible and covers in detail: the substantive law applicable to euthanasia, physician-assisted suicide, withholding and withdrawing treatment, use of pain relief in potentially lethal doses, terminal sedation, and termination of life without a request (in particular in the case of newborn babies); the process of legal development that has led to the current state of the law; the system of legal control and its operation in practice; and, the results of empirical research concerning actual medical practice.
Proponents for the legalization of physician assisted suicide (PAS ) argue that it has been legal in Oregon since 1997 and that it works well. They maintain that palliative and hospice care can co-exist comfortably with the option for PAS. My aim was to examine these claims, in two cities in the Northwest of America; Seattle where there is no legalized PAS and Portland where PAS is legal.
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.
Around a third of doctors say they have given drugs to terminally ill patients or withdrawn treatment, knowing or intending that it would shorten their life. A study of doctors in charge of the last hours of almost 3,000 people finds decisions almost always have to be made on whether to give drugs to relieve pain that could shorten life and whether to continue resuscitation and artificial feeding. In 211 cases (7.4%), doctors say they gave drugs or stopped treatment to speed the patient's death. In 825 cases (28.9%), doctors made a decision on treatment that they knew would probably or certainly hasten death. One in 10 patients asked their doctor to help them die faster. What doctors do varies according to their religious beliefs, according to Prof Clive Seale, who carried out the research. But, he said, there was no evidence of a "slippery slope": that deaths of the most vulnerable, such as very elderly women and those with dementia, are being hastened more than others.
The House of Lords in Purdy forced the DPP to issue offence-specific guidance on assisted suicide, but Jacqueline A Laing argues that the resulting interim policy adopted last September is unconstitutional, discriminatory and illegal. In July 2009, the law lords in R (on the application of Purdy) v Director of Public Prosecutions [2009] All ER (D) 335 required that the DPP publish guidelines for those contemplating assisting another to commit suicide. The DPP produced a consultation paper (23 September 2009) seeking to achieve a public consensus, albeit outside Parliament, on the factors to be taken into account in determining when not to prosecute assisted suicide. Although the consultation exercise is hailed by proponents of legislative change as a democratic, consensus-building and autonomy-enhancing initiative, there is much to suggest that, on the contrary, the guidance is unconstitutional, arbitrary and at odds with human rights law, properly understood.
Raphael Cohen-Almagor, University of Hull FROM NEW MEDICAL ETHICS TO INTEGRATIVE BIOETHICS, Ante Covic, Nada Gosic, Luka Tomasevic, eds., pp. 197-216, Zagreb, Pergamena, 2009
British Columbia’s Supreme Court ruled last week [in Carter v AG Canada] that provisions of the Criminal Code that ban physician-assisted suicide are unconstitutional. Madam Justice Lynn Smith suspended her ruling for one year to give Parliament time to draft new legislation. A government spokeswoman said Ottawa is still reviewing the judgment, but her reminder that Parliament voted not to change the physician-assisted suicide law just two years ago has only added to the sense that there will be an appeal. Ms. Taylor – a 64-year-old who suffers from Lou Gehrig’s disease – was granted a constitutional exemption that permits her to proceed with physician-assisted suicide during the one-year period, though she must meet a number of conditions.