Euthanasia debate is killing the bigger picture


The persistent media and political focus on euthanasia has skewed the debate about end of life issues and diverted attention away from adequately resourcing palliative care services that would benefit many more people, an expert says.

Dr Carol Douglas, president of the Australian and New Zealand Society of Palliative Medicine (ANZSPM), told the limbic that the ‘furore’ about euthanasia might ultimately affect between 0.5 and 5% of the population.

“The stark reality about all of this is that the energy directed towards legalisation of physician-assisted suicide with or without euthanasia, in this country, is a distraction from the real issue of improving palliative care services for the majority of people.”

“Of greater importance is how to ensure equity of access to high level palliative care for all, including culturally and linguistically diverse populations, Indigenous Australians and marginalised people.”

Dr Douglas was commenting on a Perspective in The Medical Journal of Australia that called for a more evidence-based approach to euthanasia.

Professor Ezekiel Emanuel, an oncologist and bioethicist from the University of Pennsylvania, said the data showed that euthanasia and physician-assisted suicide  (PAS) were rarely used even in countries were they had been legal for over a decade.

“Euthanasia and PAS do not solve the problem of inadequate symptom management or improving palliative care. These interventions are for the 1% not the 99% of dying patients,” he wrote.

He said about 75% of euthanasia deaths were in cancer patients however uncontrolled pain was not the main reason. Instead, patients were more likely to be wracked with ‘depression, hopelessness, being tired of life, loss of control and loss of dignity’.

“Despite the importance of psychological suffering as the main motivator, few physicians in the jurisdictions where euthanasia and PAS are legal receive psychiatric consultation,” he wrote.

He added that euthanasia was not without technical problems or complications despite the perception it was a ‘quick, flawless and painless’ way to die.

“When considering this evidence, the case for legalizing euthanasia and PAS looks less compelling,” he wrote.

Dr Douglas said last year’s Victorian Inquiry into End of Life Choices made 48 recommendations to improve end of life care and a 49th recommendation to legalise assisted dying.

“All the energy since then has been on the 49th recommendation. Skeptics would say that recommendations 1 to 48 will gather dust,” she said.

She said more people would benefit from improved funding for palliative care services, especially in the community, increased education of health professionals and better understanding of the complexities of end of life issues.

Dr Douglas said most people want to live as long as possible and will pursue exhaustive treatment in order to do so. Only a few wanted ultimate control over the timing and means of their death.

“Fear of the unknown is a very human response when facing impending death or a life limiting diagnosis. Very often requests for euthanasia go away when patients’ distresses are heard and they understand they will be supported,” she said.

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