President, European Association of Palliative Care (EAPC); Professor, Palliative Medicine, University Hospital Erlangen Nürnberg, Germany
The European Association of Palliative Care has 56 national member associations from 30 European and three non-European countries, as well as individual members from a total of 52 countries worldwide. The EAPC aims to bring together those with an interest in, or working in, hospice and palliative care. Under the motto "One Voice—One Vision," EAPC aims to help prevent or reduce unnecessary suffering for people with life-threatening illnesses and their families worldwide, and to ensure that all people, wherever they live in the world, have equal access to hospice and palliative services as an integral part of the health care system.
As a large and multinational palliative care association, even though we have an official position on euthanasia and assisted suicide,1 it is important to accept the heterogeneity of positions on these issues within our peer group. The results of the IAHPC survey underpin this heterogeneity. The survey results demonstrate wide-ranging attitudes between international members, most of whom work in the field of hospice and palliative care. These views include a variety of positions, from outright opposition to a significant group who support patients’ access to euthanasia and say that this practice should be a part of palliative care.
It is likely that this heterogeneity equally applies to the EAPC. However, without undertaking similar work in Europe, it is not possible to speak on behalf of the entire EAPC. My personal view is that (many) EAPC members may have a differing view and position to my own, thus, I am presenting my own personal perspective, but wearing my EAPC glasses.
In a growing number of countries around the world, euthanasia—through legislation or decriminalization—is becoming a normal part of health care. In countries where euthanasia has been legalized for some time, evidence suggests that in all of these countries the criteria for euthanasia have been successively expanded over time. In 2016, the EAPC stated in its white paper on euthanasia and physician-assisted suicide (PAS): "the EAPC respects individual choices for euthanasia and PAS but stresses the importance of refocusing attention onto the responsibility of all societies to provide care for their older, dying and vulnerable citizens. A major component in achieving this is the establishment of palliative care within the mainstream healthcare systems of all countries supported by appropriate finance, education and research."1 For me, it remains clear that "euthanasia is not part of palliative care." 1
National regulations, and how they are interpreted, may vary from service to service, from expert to expert. However we, as palliative care associations, services, and experts, cannot bury our heads in the sand like an ostrich, but must find a way to deal with the situation in our countries without betraying the principles of palliative care. What is also true is that our goal—that all people, no matter where they live, should have equal access to hospice and palliative services—is far from being achieved. We, as EAPC—and this is true for all of our members—will continue to work to achieve this goal!
1. Radbruch L, Leget C, Bahr P, Müller-Busch C, Ellershaw J, de Conno F, Vanden Berghe P. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliat Med 2016; 30(2): 104-116.