I have seen few topics that can simultaneously enliven a dinner party conversation and create such moral divides as the debate about euthanasia and physician-assisted suicide. Conversation increases in volume and speed. Wine glasses are clutched tightly to chests. Slippery slopes, autonomy, choice, sanctities and human rights to life and death are bandied across the room. Other party-goers are drawn in, almost against their will.
While this dinner party conversation may eventually give way to renovations or school holiday plans, the public debate continues.
Perhaps it takes hold so readily because we all share such a deep stake in the issue. Whether committed to autonomous, communitarian, religious, ideological or professional positions, we are all part of a broader community, sharing a common experience of human life and death.
But do we, as a community, have sufficient awareness and access to accurate information to enable a constructive debate? Or does the combination of inadequate practical experiences with death and dying, or unrealistic expectations of medical technology, make us vulnerable to misinformation? For example, Professor Megan-Jane Johnstone has warned that public fears about particular illnesses (for example, dementia), fuelled by inappropriate media imagery, have the potential to spread misinformation and inappropriately sway public opinion in the euthanasia debate.
Are we capable of finding information, common ground, and a satisfactory resolution? And, if there is a future that includes euthanasia or physician assisted suicide (PAS), what are the implications for the discipline of palliative care?
Palliative Care Australia’s recently released position statement on euthanasia and physician assisted suicide maintains a clear position that “the practice of palliative care does not include euthanasia or physician assisted suicide”.
This position statement also makes the point that significant awareness raising and education is required, in order “to engage in constructive deliberations about euthanasia and physician assisted suicide”. Palliative Care Australia also advocate for timely access to high quality palliative care, advance care planning and support for carers. (See here for the previous position statement).
It is, of course, interesting to examine the situation in other countries, in which this debate has been similarly contested, even if resulting in different outcomes. When considering the ongoing role and contribution of palliative care, it is instructive to consider how this discipline has responded in countries where euthanasia is legalised. In Belgium, palliative care professionals have transitioned their practice over the last decade, from initially refusing patient requests for euthanasia and referring to external practitioners, to a more engaged stance of ‘euthanasia accompaniment’. Instead of disengaging with the process, palliative care professionals instead took on a range of ancillary roles, including “clarification of the request, communication with the family, consideration of other possibilities, medical and other assistance if euthanasia is performed, and support of the team afterwards.” (Vanden Berghe et al 2013, p266).
It may be that this example is useful not so much in providing a model for the future, but instead to demonstrate how commitment to a discipline’s values, rather than a particular position, is helpful in managing uncertainty and change. Societal contexts, laws and our collective beliefs, transition and change over time. Likewise our positions, the statements of intent that are built on these transitory contexts and beliefs, must also change with time.
Like death and taxes, change is one of the few certainties. It may be that committing to being responsive, and re-imagining how the values of palliative care might thrive in whatever future emerges, is a position that can unite.
Join Palliverse @palliverse and Palliative Care Australia @PCACEO as we jointly host our October #pallanz tweetchat on the topic of euthanasia and physician assisted suicide, moderated by Craig Sinclair @csinclair28. Community members, patients, carers, and health professionals are invited to join in a respectful discussion and sharing of experiences, research and ideas about this topic.
Topic 1 (T1): What facts and issues need to be understood as part of a considered discussion about euthanasia or PAS
Topic 2 (T2): What role can palliative care play in informing discussion about euthanasia or PAS?
Topic 3 (T3): The year is 2023. Euthanasia or PAS has been legalized in your country. What happens next?
Topic 4 (T4): What role could palliative care play in a future that may include euthanasia or PAS?