Europe
Belgium’s 20-year history of assisted dying is well accepted by the public and health care practitioners; ideally, it should be integrated into palliative care.
Professor Luc Deliens
Professor, Palliative Care Research, Ghent University and Vrije Universiteit Brussels, Belgium; Adjunct Professor, Queensland University of Technology, Brisbane, Australia; Chair, EAPC Reference Group on Public Health and Palliative Care
Thank you for being invited to review the IAHPC membership survey of physician-assisted suicide and euthanasia, which expresses the wide variety of opinions on assisted dying.
The presentation of results using the denominator of the total sample does not facilitate a sharp interpretation of the results. For a good interpretation, it would be highly relevant to split up and compare the results between responders living in a jurisdiction that has legalized assisted dying versus responders living in a jurisdiction that has not. When a country legalizes this last resort end-of-life practice for people with unbearable and endless suffering, the experience and understanding of assisted dying will substantially change and, accordingly, the related opinions or attitudes.
Given the evidence from, for example, several waves of the European Value Studies as well as many other attitude surveys or opinion polls, in most countries an overwhelming majority of the general public has a positive attitude toward legalizing assisted dying. In many countries, palliative care professionals have a negative attitude toward legalization. This survey confirms this majority with a negative attitude, although 51% of respondents claim that debates on assisted dying help palliative care development. Moreover, 86% claim that palliative care professionals should be involved in the discussion of assisted dying. Hence, there is at least an understanding that palliative care can have an important value when integrated into the practice of assisted dying.
This experience is very much shared in Belgium. Belgium has more than 20 years of experience with legalizing euthanasia and a long-standing tradition of “integrated palliative care” in which euthanasia is defined as part of the domain of palliative care expertise. This Belgian experience has demonstrated that:
- there has been no slippery slope in end-of-life care in Belgium;
- euthanasia assessments and also the administration of the legal drugs can be integrated into palliative care services;
- in order to have a balanced and quality assessment of a euthanasia request, it is ideally integrated into palliative care.
Many of the professional skills and knowledge for quality palliative care are very similar to these that are needed for proper exploration and assessment of a euthanasia request. In Belgium after 20 years, there is no significant political or ideological or medical or palliative care opposition against euthanasia anymore; it has been embraced by society, by clinicians, and also by palliative care associations. Furthermore, a great many palliative care professionals are involved in the practice of euthanasia.
Today, more than 300 million people live in a jurisdiction with legalized euthanasia (Belgium, Luxembourg, Netherlands, Portugal, and Spain), assisted suicide (Switzerland and more than 10 US states), medical assistance in dying (Canada), or voluntary assisted dying (almost all states in Australia). I hope that a IAHPC takes a new position on the practices that is more nuanced and more inclusive than its 2017 position statement.1
Reference
De Lima L, Woodruff R, Pettus K, Downing J, Buitrago R, et al. International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide. J Palliat Med 2017; 20(1): 8-14. DOI: 10.1089/jpm.2016.0290.