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 The increased use of continuous deep sedation for patients nearing death in the Netherlands and the limited use of palliative consultation suggests that this practice is increasingly considered as part of regular medical practice.
Rurik Löfmark, Tore Nilstun, Colleen Cartwright, Susanne Fische, Agnes van der Heide, Freddy Mortier, Michael Norup, Lorenzo Simonato and Bregje D Onwuteaka-Philipsen for the EURELD Consortium
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.
The Government has published the End of Life Care Strategy - promoting high quality care for all adults at the end of life which is the first for the UK and covers adults in England. Its aim is to provide people approaching the end of life with more choice about where they would like to live and die. It encompasses all adults with advanced, progressive illness and care given in all settings. The strategy has been developed by an expert advisory board chaired by Professor Mike Richards, National Cancer Director, and including key stakeholders from statutory health, social care, third sector organisations, professional and academic organisations. The strategy has been informed and shaped by the work on end of life care undertaken by strategic health authorities for the NHS Next Stage Review.
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.
Physician assisted suicide has been legal for a decade in the US state of Oregon. But palliative care specialist David Jeffrey says there are grave questions about whether people are being helped to die, when treatment for depression could be a highly successful alternative. In this week's Scrubbing Up column Dr Jeffrey, who is based at the University of Edinburgh, says a patient should be free to end their life - but doctors should not be involved.
Test Santé vient de publier les résultats d'une enquête sur les actes de fin de vie et l'euthanasie. Elle est le prolongement de l’enquête récente sur les soins palliatifs. Pour cela, Test Santé a donné la parole aux personnes concernées : proches, médecins et infirmiers. Il en ressort que les soins palliatifs, aussi efficaces soient-ils, n'empêchent pas certains de souhaiter mourir. L’enquête souligne le fait que la demande vient le plus souvent exclusivement du patient lui-même (47% des cas contre 38% de la famille), et c’est encore plus vrai pour les patients en soins palliatifs (61%). Par ailleurs, Test Achats constate que l’euthanasie joue un rôle dans le débat sur la qualité de la fin de vie et que celle-ci est meilleure lorsque l’euthanasie est appliquée «à un moment plus naturel de la mort » (ou même avant dans certains cas) plutôt qu’après un acharnement thérapeutique.
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.