Causing death: Euthanasia and palliative care

Palliative care practitioners and organizations tend to hold a position of causal ‘neutrality’ whereby the process of dying is stated to be neither hastened nor prolonged intentionally, and to oppose euthanasia. Public policy and public opinion often do not support these positions.

Euthanasia is a deeply divisive issue that cannot come to a tidy resolution, as it taps into deeply entrenched political and religious fault-lines within societies. Differentiation between palliative care and euthanasia is necessary because intended outcomes of treatment need to be explicit and clearly communicated to patients, families, and professional colleagues. Palliative care must be transparent, lawful and accountable, and applicable to all persons, whatever their views, beliefs, and wishes with regard to death causation.

To this reader, an examination of the academic literature and public records of jurisdictions where VAE/PAS/AS are permitted, however, shows no evidence of the so-called slippery slope trends that are frequently postulated by many palliative care writers.

In a secular liberal democratic political world view, it is hard for some of us to argue against the entitlement of a dying person to choose how and when to die, but the rendering of assistance is a much more difficult issue for all concerned, given its ethical, emotional, spiritual and psychological ramifications. The professional issues are clearly complex and often personal.

Despite these profound differences, we can all walk a long way together in the quest to improve care and decision-making at the end of life in our societies, regardless of our ultimate divergences of opinion about euthanasia. Palliative care itself is much less controversial and enjoys wide public support internationally, and it can meet many of the challenges that lead to euthanasia support, as long as it does not appear to claim that it can solve all of them. Palliative Care is known and remembered for its actions rather than its opinions.

Further Reading:
 • Deliens L , van der Wal G. The euthanasia law in Belgium and the Netherlands.
   Lancet 2003; 362: 1239-40.
 • Bernheim JL et al. Development of palliative care and legalisation of euthanasia:
   antagonism or synergy? Br Med J 2008; 336: 864-7.
 • Bernheim JL, Mullie A. Euthanasia and palliative care in Belgium:
   legitimate concerns and unsubstantiated grievances. J Palliat Med 2010; 13: 798-9.
 • The Case Against Assisted Suicide, For the Right to End-of-Life Care.
   Foley K and Hendin H. Baltimore, The Johns Hopkins University Press, 2002.
 • Euthanasia examined. Ed Keown J. Cambridge, CUP, 1995.
 • Physician-Assisted Dying. The case for palliative care and patient choice.
   Baltimore, The Johns Hopkins University Press, 2004.
 • Euthanasia and law in Europe. Eds Griffiths J, Weyers H, Adams M. Oxford, Hart, 2008.
 • Ashby M. Natural Death? Palliative care and death causation in public policy and the law.
   MD (Doctor of Medicine) Thesis. Department of Medicine, Faculty of Health Sciences,
   University of Adelaide, 2001.
 • Ashby M. The Futility of Futility: Death Causation is the ‘Elephant in the Room’
   in Discussions about Limitation of Medical Treatment. Journal of Bioethical Inquiry,
   2011; 8: 151-154.