Asia Pacific/Australia/India
Though described as a choice of care, physician-assisted dying is no choice if basic social support, health care, and quality palliative care services are not provided for.
Professor Maria Cigolini
Palliative care physician and Associate Professor of Medicine, University of Sydney, Australia
Euthanasia and physician-assisted suicide practices are highly emotive and controversial socio-political issues with legal, ethical, moral, clinical, and economic considerations playing an important role, and with significant demonstrated impacts on the safe delivery of aged and disabilities care, health care services, and palliative care.1 Last year, the IAHPC conducted an online survey of its 1,050 members examining attitudes and themes around these practices.
As with all surveys, responses to the IAHPC survey may be limited by the knowledge, information available, or experience of respondents. This is especially so when examining general concepts of physician-assisted death without exploration of explicit implications and consequences, or through limited involvement of developed palliative care services. We have seen this in the evolution of legislation within Australia and Canada, especially when surveys are contrasted with lived experiences.2,3
Physician-assisted dying is a euphemism. The survey design had inaccuracies in defining terminology clearly, but I assume was trying to be politically correct.
The euphemism placates social/political discomfort about these practices by distorting language. These patients are not imminently dying: they are being euthanized or assisted to suicide, which for many of us are not considered to be medical treatments or ethically justified medical interventions or part of palliative care. Legislation permitting the practices are usually social-politically driven.
Despite the relative wealth of our countries, significant government funding shortfalls or withholding of funding for palliative care occur in the face of increasing budgetary provision for physician-assisted death, even where palliative care is already being negatively impacted or is unavailable. Explained away as a person’s “choice” in care, this is often despite there being no choice if evidence-based, end-of-life practices and basic social support, health care, and quality palliative care services are not provided for.1, 4, 5
Experience affirms the majority view of member respondents that physician-assisted dying legalization debates and legalization itself confuses the public and legislators, conflating euthanasia and physician-assisted suicide practices with palliative care. Experience and survey results also affirm the importance of IAHPC’s Consensus-Based Definition of Palliative Care6 to not include such practices, and the necessity of inclusion of palliative care in debates surrounding service provision. Results also uphold physicians’ right for conscientious/professional/institutional objection in the face of physician-assisted dying laws. They also assist the IAHPC in understanding how to inform members about these concepts and in its representations internationally (including in service advocacy or advisory programs) to what constitutes ethical practice of palliative care, alongside the existing treaties and standards of end-of-life medical care. 2, 7
References
- Woodruff R. Euthanasia and Physician Assisted Suicide: Are they clinically necessary or desirable? 2019.
- Herx L, Cottle M, Scott J. The “Normalization” of Euthanasia in Canada: The cautionary tale continues. World Med J 2020; 66(2): 28-37.
- Coelho R, Gaind KS, Lemmens, T, Maher J. Normalizing Death as “Treatment” in Canada: Whose suicides do we prevent and whose do we abet? World Med J 2022; 70(3): 27-35.
- Palliative Care Victoria. Sustainability of Palliative Care in Victoria. 2022.
- Gately M. Palliative Care “Shortfall” in Regional Areas Leaves the Dying with Limited End-of-Life Care Options. ABC News Capricornia. Posted February 6, 2022; updated February 7, 2022.
- IAHPC Consensus-Based Definition of Palliative Care. 2019.
- World Medical Association. WMA Declaration of Venice on End of Life Medical Care. Adopted in 1983, revised in 2006 and 2022.