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

South America

A request for assistance in dying because of predominantly physical suffering should be treated as a medical emergency and addressed immediately. Seek clarity on motivation. Be honest about what you can offer.

Luisa Fernanda Rodríguez-Campos
Pain & palliative care specialist, School of Medicine, Universidad de La Sabana, Colombia

As professionals in the field of palliative care, it is inevitable that we will be faced with requests for physician-assisted suicide and/or euthanasia at some point in our careers. This is regardless of our personal, ethical, and moral beliefs, and whether these practices are legally permitted or not in our regulatory framework. As a result, it is important for us to be prepared to handle these requests in a sensitive and compassionate manner, hand-in-hand with an adequate clinical approach.

When responding to a request for assisted dying or euthanasia, it is essential to conduct a thorough assessment that includes the reason for the request that allows for in-depth exploration of the patient's distress. This assessment should also involve a discussion of alternative treatments that may help alleviate suffering. An interdisciplinary approach is imperative at this point, with the objective of understanding the patient's personal conception of suffering. Furthermore, it is relevant to recognize that symptoms and suffering may not always coincide.

As part of this process, it is also important to clarify exactly what the patient is requesting and why, and if the patient is asking for care in the future or care in the present. A request for assistance in dying because of current predominantly physical suffering should be treated as a medical emergency and addressed immediately and explicitly. Prompt attention to the patient's suffering is often capable of providing timely aid that helps reduce the patient's distress. Asking patients openly to clarify exactly what they are asking for is the appropriate initial response to an inquiry of this type. There is still a lot of misinformation and misunderstanding about what is meant by adequacy of therapeutic effort, palliative sedation, advance care planning, euthanasia, and physician-assisted suicide, so education must always be provided to the patient and their family on these matters. 

Clinicians should be aware of their own limitations and boundaries, but also make every effort to be responsive to the patient's questions and situation. It is important to not mislead the patient into believing that we will help with things we know we cannot do. By being transparent and honest about what we can and cannot offer, we can ensure that we are providing the best possible care for our patients. So be aware of your limits. We, as palliative care professionals, must also emphasize our commitment to the patient, and that the patient will not be abandoned by the clinician as part of our fundamental principles, even if there are disagreements. As physicians, our personal values and principles should not be violated, even if the practice is legal and the patient meets the requirements established by law. It is important to keep in mind that the physician's autonomy does not rank above the patient's, and the patient's autonomy does not rank above the physician's, regardless of the legislation.

As members of society and professionals in the field of palliative care, it is important that we continue to open discussions on death and suffering, and work toward providing active symptom control with the objective of trying to improve the quality of life for the majority of patients with a serious illness who face suffering. This is particularly important in light of the current legal and ethical debate surrounding assisted dying and euthanasia, and the growing availability of information on end-of-life issues. 

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