Executive Director, World Hospice Palliative Care Alliance (WHPCA); clinical psychologist.
The views of palliative care professionals on this issue are very important and under researched, so thank you to the IAHPC for delving into this issue. As expected, palliative professionals have very mixed views on euthanasia and physician-assisted dying. Based on the survey results generally, most palliative care workers are opposed to—or think access to— assisted dying should be limited or restricted in some ways. My view on this topic is that we should not be legislating access to assisted dying (or euthanasia, which is part of assisted dying) before ensuring that all people have access to competent palliative care. I believe that palliative care takes a middle position between those who espouse the right to death and those who believe that the right to life is paramount at all times.
Palliative care professionals believe that we must first identify and address the causes of suffering, what is driving the desire for assisted dying, and provide competent palliative care. However, we also have a philosophical belief that people have the right to autonomy and agency in making all decisions about the care they receive or do not receive. Not all suffering can be eliminated in all cases, and I’ve seen enough patients we could not make whole despite our best efforts. So, if a patient decides they want to end life, despite all we can do, we must respect that choice if it is fully informed.
This survey is a good beginning to help us understand the problems we face as more and more territories legalize assisted dying practices. We could do more to delve into the challenges that our colleagues face when forced to choose whether to participate in assisted dying, and the personal, ethical, and moral impact of their decisions. We also need to be clear on the definitions of assisted dying, as palliative sedation is not, in my view, an example of assisted dying. Palliative sedation is solely aimed at relieving intolerable suffering. Also, euthanasia is not always “voluntary” at the person’s explicit request, as has been done not infrequently in the Netherlands.
We also need to better understand the longer-term impact of these decisions on family members, potentially either positive or negative. One of the arguments against legalization is the possibility that patients may face overt or covert family pressure to choose premature death. Very little is known about this potentiality. In any event, the trend toward legalization of assisted dying is growing, and we as palliative care professionals must find our way forward in this new environment.
Stephen Connor has spent close to two decades working on palliative care development internationally in Sub-Saharan Africa, Eastern Europe, Asia, and Latin America.