Euthanasia yet again
I had a letter from a New Zealand friend the other day telling me that it looks as though the palliative care movement there is winning in the on-going euthanasia debate. There have been two big skirmishes and the opposition to euthanasia is now so strong and articulate that the third battle, expected in the near future, might prove to be the last. Other friends and colleagues in Hong Kong report that the debate rages on there as fiercely as ever.
In the United Kingdom we hoped that the emergence and dramatic development of palliative care would end any talk of euthanasia. Whilst never suggesting that the main objective for palliative care was to prevent euthanasia or physician-assisted suicide (PAS) many nevertheless saw palliative care as the antidote to euthanasia. “Universal access to high quality care will do away with any need for euthanasia or PAS” was the rallying call. We have been proved wrong.
Access to palliative care, though good, is not as universally available as it should be, and largely depends on the referring physician. Contrary to what some have claimed, and many others expected, it does not always eradicate all pain, all physical and psychosocial suffering, and – no surprise to many of us – restore peace, happiness and quiet contentment. If it did we would not be physicians and nurses but miracle workers on a par with our God. Many in the pro-euthanasia lobby cannot accept our ethics doctrine of ‘intent’ and accuse us of hiding behind it when, in their view, we are shortening lives but not admitting it. Interestingly, when for years they have based their case on the unrelieved suffering of cancer patients they have now shifted their focus to those with chronic neurological conditions such as MND / AML , MD , and the dementias. The latest argument they are using in the UK is that many doctors have “an agreement” with their medical colleagues that when their time comes they will be helped to die, yet they will not do the same for their patients. It is an unsubstantiated claim that puzzles many of us who have not heard of such agreements, but nevertheless one that grabs public attention.
In a country where many claim a Christian faith it was assumed that the strength of the Biblical argument against euthanasia would be an effective weapon against it. Once again we have been proved wrong. Today Biblical scholars are quoting texts in favour of and in opposition to euthanasia, and claim it is their Christian duty to do so. No less a figure than the Archbishop of Canterbury, the head of the worldwide Anglican Communion, a man renowned for his scholarship and balanced, fearless leadership has come out strongly opposed to euthanasia. This has not only failed to calm the storm – it has fomented it as religious evangelicals and liberals, some of whom are doctors and nurses, have taken sides for and against euthanasia, threatening to polarise the Church and further puzzle the public.
As I write there is an unconfirmed report that the Zurich clinic which offers physician-assisted suicide (currently legal in Switzerland ) is about to close. In the past year more than 20 people from the UK have gone there, making their relatives liable to a charge of assisting suicide on return to the UK . There have been no convictions, only further confusing the general public. Predictably we are always being told how “successful” euthanasia and PAS in Holland and Oregon are without any of the pro-euthanasia lobby citing contrary medical reports and papers from either country.
As always opinion polls are being used as ammunition and claimed to prove whatever their proponents want. What is striking is how seldom palliative care workers are questioned about how often they are asked about / for euthanasia. Seeing as we all do a thousand or more terminally ill people each year, our insights into ‘public demand’ could be statistically significant. Would the skeptics believe us? Probably not, because their minds are made up and their eyes and ears closed, in spite of their claim to speak for the suffering masses.
Is there anything we can learn from all this? I believe the clamours for euthanasia and PAS will continue with ever-increasing enthusiasm and occasional vitriol, and could soon be features of all westernised, affluent countries. Why? Because they have become secularised whilst, paradoxically, at the same time many of the citizens are seeking spiritual meaning. They are “Dispose of after Use” societies where anything no longer useful is discarded, where tolerance of suffering, of whatever kind, is unacceptable. They are societies which can see good in health and wealth but are unable to see what can come out of suffering and pain, extremely unpleasant as both are. They are societies which in their espousing of fundamentalism can no longer see grey but only white and black, health or suffering, worthy of life or better enabled to die.
As always a plea for euthanasia should be regarded, not as a plea for an expedited death, but as a plea for better care. Our responsibility in palliative care is to ensure that all who need it can access it, whatever their illness; that all we do is of the highest standard and well documented / evaluated; that we do not waste time that could be better spent with our patients, debating with those whose minds are closed and already made up. Arrogance? No, honest and realistic when we know we still have so much to learn and so little time in which to do it if palliative care is to get better and better worldwide. I suspect that when the day comes that all suffering can be relieved in every corner of this globe there will still be people demanding euthanasia. By then they will have found another reason for it! By then people like me will be long dead (without euthanasia) and forgotten.
Derek Doyle, OBE, MD, FRCSE, FRCPE, FRCGP (Scotland) |
