Volume 24, Number 4, April 2023 Supplement - Section II: Opinions

Heads of regional associations

In Africa, discussing euthanasia risks hindering or destroying nascent palliative care, and the practice goes against faith and culture. People may confuse the two, and mistakenly equate palliative care with ending life.

Emmanuel B.K. Luyirika
Executive Director, African Palliative Care Association (APCA), President of the Executive Board, CoRSU Hospital, Uganda; physician.

I am asking myself how this document will affect palliative care when it is released: I am fearful that discussing assisted dying may give pro-euthanasia groups armament to push for its inclusion in our discipline. I am hesitant for a palliative care entity to release these data in the public realm, given that without knowing the characteristics of individuals surveyed or the cultural diversity of global populations, it could generate a backlash against palliative care.  

My own opinion is that if the option of euthanasia resides within palliative care, it will create conflict with faith but also cause confusion. It even risks leading to a ban of palliative care in some countries and by some faith groups at a time when the discipline of palliative care is just being born in many countries. It will also become a stumbling block to developing good palliative care, as people look for shortcuts. 

Euthanasia could even be used by rogue authorities to target groups of patients that they do not like for early death. The stigma around HIV as a gay disease—or even as a disease of “sinners”—taught us already in Africa about unfair judgment and possible neglect. Euthanasia may expose patients to neglect and premature end to life. In much of Africa, euthanasia conflicts with faith but also culture. The HIV “resurrections” that came with good science and antiretroviral medications occurred even in patients who had been written off as about to die, and so euthanasia may hinder advances in research. 

Mentioning that we have members who are supportive of euthanasia may confirm some people’s suspicion that palliative care is about ending life. So, for the good of patients and the discipline, we hope that these findings are presented in a way that distances us from being implementers of euthanasia. We are not. Under no circumstances should euthanasia or assisted dying be lumped together with palliative care.

Merely discussing this issue within the palliative care fraternity in a manner that links palliative care to euthanasia will undo years of palliative care development, especially in some countries in Africa, and may stigmatize the discipline. 

Premature ending of lives as people cut costs or premature ending of palliative care as a discipline as countries distance themselves from it may be an actual result. How I wish this had been left to an independent research company or academic institution and not a palliative care entity to publish.

Dr. Luyirika has served on the technical committees of myriad organizations to further solutions to health challenges facing Africa.

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