The Martlet

Euthanasia could now be the new “cure-all” for those suffering, but a possible legalization has many asking, “are we ignoring the tools we already have?”

This past July, the Quebec College of Physicians proposed that euthanasia be legalized as part of appropriate medical care. 

This proposal came from a poll that claimed the support of 77 per cent of the Quebec medical community. But less than one-quarter polled actually responded.

In fact, only 17.4 per cent of those polled said they were, “certainly or probably in favour of legalizing euthanasia provided that the practice was strictly regulated.”   

The spokesperson for the college defined euthanasia as: “administering very high dosages of opiates to control pain even at risk of death.” That is already a legal and ethical part of palliative care.

In fact, euthanasia is “the intentional killing by act or omission of a dependent human being for his or her alleged benefit.” It is not euthanasia unless death is intended. 

The Quebec College of Physicians definition of euthanasia, and their stated level of support from their members, appears to deliberately mislead the public — 17 per cent in favour is hardly support.

In Holland, voluntary euthanasia has been practiced without sanctions since 1984, and legally since 2002. 

The requirements are that requests should be freely made, well considered and persistent; unbearable suffering that cannot be relieved in any other way; the physician receiving the request should consult with a colleague and indicate euthanasia on the death certificate.  

Almost from the beginning, Dutch physicians were performing involuntary euthanasia, called “termination of the patient without explicit consent” — a euphemism for murder.   

The Remelink Report showed that in 1990, 5,495 voluntary patients and 5,941 involuntary patients (a number of whom were fully competent) received euthanasia. Another 400 patients were assisted to commit suicide. Only 26 per cent noted euthanasia on the death certificate.  

In 2005, 10 per cent of all Dutch deaths were due to some form of euthanasia.

Since 1991, Dutch patients receiving euthanasia have expanded from those with unbearable physical pain to those with anticipated or actual psychological pain, including grief. In certain circumstances, children as young as 12 can consent. 

The Dutch experience shows that once unleashed, euthanasia is very difficult to monitor and control, or restrict to only those that request it.

Those involuntarily euthanized are often people with disabilities, dementia or certain chronic conditions.  Patients need to be able to confide in their doctor without fearing they will be knocked off. Their safety and freedom is threatened by euthanasia. 

Euthanasia’s intention is to reduce suffering.  Palliative care already does this.

Traditionally restricted to end-of-life care, euthanasia is now used in a wider context, and addresses more than pain.

Unfortunately, it is not available to all patients who would benefit from it. Holland had no full-time palliative care physicians in 2007 — perhaps because euthanasia is cheaper. 

As a former nurse and someone who suffered severe chronic pain for years, I have a unique understanding of suffering. 

When I started nursing in Britain in the early 1960s, patients had far fewer options.  Often the best thing we could give them was love — shown through our presence and physical touch. I realized just being with someone during their suffering can make a difference.  

But watching someone suffer can be harder on the observer than the sufferer. The Dutch physician who euthanized a woman grieving the death of her two children may have done so to kill his own feelings of helplessness rather than to support her. After all, physicians need support in order to support their patients. 

Coming to terms with whatever is causing us to suffer leads to growth and can reduce pain since psychological pain intensifies physical pain. People facing death generally have to work through many things, and depression and fear of pain may lead them to want death quickly — but this can change.

A 1995 study of 200 terminally-ill patients, reported in the American Journal of Psychiatry, found that the desire to die was correlated with pain and low family support, but mostly with depression. Follow-ups with six patients two weeks later found the desire to die had decreased in four of them.

Physicians also euthanize to save patients loss of dignity while dying. I see the gradual dissolution of the body and loss of functions as an important part of preparing for death through dissolving the ego. We spend half our life building our ego and the second half trying to get rid of it. I have seen huge shifts in people as they approach death.

Euthanasia is a flawed response to suffering and would be difficult to monitor and control. It threatens the psychological and physical health and safety of vulnerable groups and risks interfering with the patients trust in their physicians — and perhaps ultimately with the role of the physician in society.

Instead, provinces should work to strengthen palliative care and give physicians more support mechanism for the difficult decisions they have to make.