Home CommentaryOpinions Physician-assisted death should have no place in palliative care

Physician-assisted death should have no place in palliative care

by Lester Liao November 10, 2015
Physician-assisted death should have no place in palliative care

Lawmakers have until February to decide if and how to regulate the practice

The discussion about physician-assisted suicide and euthanasia, or PAS/E, has not been very clear. The situation is often portrayed as mercifully ending suffering versus cruelly allowing people to suffer. The problem with this is twofold. It falsely portrays the motives of people who disagree with PAS/E and it takes advantage of ambiguity cloaked in language like ‘suffering.’ Let’s tackle both options here.

Graphic by Charlotte Bracho.

Graphic by Charlotte Bracho.

Firstly, people who are opposed to euthanasia are not cruel. They are compassionate, which at its root means with and suffering. They want to be with people who are suffering and give them support. Their motive is to care. It is harder to walk with those who are suffering and enter into their experience than it is to end their lives.

Second, it is unclear to many what suffering entails. Suffering is a word that evokes a strong response in us. We don’t like suffering and we want to do away with it. Call something suffering and people will believe it is evil and should be eliminated. But what suffering are we talking about? Terrible pain? This is often suggested but is simply not the case. I’m a McGill grad, physician in training at Western University and currently on my palliative care elective. Physicians are typically able to make patients comfortable. Studies have shown that people who desire to die can change their minds once effective care manages to relieve their pain. Compassion, and knowing that alleviating pain often gives people comfort in their final days, surely plays a role in why the vast majority of palliative physicians are against euthanasia, according to an internal survey by Canadian Society of Palliative Care Physicians.

I believe the issue at hand is more related to the god our society loves to worship: autonomy.  We want to get what we want when we want it. Can’t we see the bait and switch? The whole issue is framed as suffering and thrives off the notion of terrible pain. But this is not the case.  The pain can be dealt with. The issue is not getting what we want. We don’t typically call not getting what we want ‘suffering.’  But continue to call it ‘suffering’ and you have produced sympathy in your listeners based on a false reality convenient for the cause. This is not surprising. I agree with the journalist G. K. Chesterton in his book Eugenics and Other Evils when he said, “evil always takes advantage of ambiguity.”

We must clarify the issue. This does not suggest that people who personally desire euthanasia don’t experience any form of difficulty or are somehow being deceptive. However, I’d suggest that those who support euthanasia use ambiguity to their benefit.

So what then of autonomy? Would my desire for someone to end my life warrant a law that mandates it be done? In our heart of hearts, I believe everyone knows our individual independence cannot be our ultimate arbiter. In practical life we restrict autonomy based on the principle to do no harm. If a random stranger asked you to kill him, would you do it? No; you would refuse on the basis that it is wrong to kill. Do you make qualifications? Do you say, “I will not kill you because you’re healthy” or, “your life is enjoyable?”

No. Your instinct tells you that this simply must not be done.

Now the example I have given may seem bizarre, but it is at the root the very same as our reasoning for PAS/E today. People are suffering and they want us to give up our own right to self-determination in order to honour what they see as their right to end their life. Suffering is a subjective criterion. How can I tell you that your suffering is not great? If we accept suffering as a criterion for PAS/E, who can we turn away? And yet every day we strive to change this subjective perception through encouraging friends, appreciating what we have, and seeing psychiatrists. Why do we do that? Inherently we know autonomy cannot be our ultimate arbiter. Having to make any justification at all suggests we are operating with another arbiter in mind whether or not we like to believe so.

And what is that? To do no harm.

There is confusion between the differences of active and passive responses to people suffering. I believe PAS/E advocates also take advantage of this. They suggest there is no difference between passive and active ending of life. Yet there is a world of difference between letting a disease take its course and knowingly infecting someone with a disease that kills them. They are two different causes of death.

Some still object and say that if a man is choking and you do nothing then you are letting him die, but that is not acceptable. Of course, this is true if you have no sense of intention and only know how to focus on outcomes. But consider how intent is everywhere in human interactions. Deliberately shooting a man and gleefully doing nothing as he chokes both fall under the umbrella of intent to end life. But aiming to kill versus accidentally pulling a trigger? We have different names for those people.

Medicine is built on helping people, on those who are strong and able taking care of those who are sick and weak and in need of others. It is altruism.  But we are seeking to forsake this in our new outlook. We are rejecting the cultivated ethic of caring for the weakest in our society.  Instead we are nurturing a new idea that people suffering have unworthy lives so we should actively take measures to remove them. Or let’s get back to the language game. We help them die. Or better yet, we mercifully bestow them an elixir that eliminates all suffering… by making them dead.

The reality of this world is that we do not always get what we want. Our bodies don’t always work the way we want. But we cannot end our lives whenever things do not turn out the way we hope. For the very autonomy we wish to have is built on natural life, and neglecting the Hippocratic principle to do no harm destroys the very life that makes autonomy possible. I propose a move towards solidarity, a time of coming alongside those who are at the end of their life, to show them that their lives are valuable and that we care.

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