Lukas Radbruch, chair of palliative medicine, and Patrick Bahr, doctoral student, Department of Palliative Medicine, University Hospital Bonn, Germany.
My palliative care work in the past three months has been overshadowed by the public discussion on assisted suicide in Germany. The Minister of Health wanted to draft a new law banning professional organisations such as Dignitas in Germany, but the discussion has turned around and is now more focused on physician-assisted suicide: should it be banned, or allowed, or allowed with strict restrictions? This discussion, culminating in a four-hour debate in the German parliament in November, has also led to a renewed public interest in palliative care – a sort of positive collateral damage. It is frustrating, no matter how often we explain the benefits of modern pain management and palliative care, that throughout the debate so many people seemed to be in favour of assisted suicide, if pain becomes unbearable.
The ongoing discussion on euthanasia and physician-assisted suicide (PAS) in Germany, as well as in many other European countries, has led the Board of Directors of the European Association for Palliative Care (EAPC) to commission an online survey on this topic from the palliative care perspective. The results from this survey will inform an EAPC white paper, as an update to the paper of Materstvedt et al. published in 2003.
Main topics of the survey are:
- Definition of palliative care, euthanasia, physician-assisted-suicide, non treatment-decisions as well as of palliative sedation
- Palliative care values
- Reasons for the request for euthanasia in palliative care
- Strategies to deal with such requests
- (Attempts to) legislate for euthanasia and PAS
- Debate about the role of euthanasia and PAS in palliative care
- Position of the EAPC in this debate.
The survey – as well as the white paper – has to take the broad range of cultural settings and attitudes in different European countries into consideration. This will be done by using a structured consensus procedure with a five-round Delphi process.
The first round with international palliative care experts has been finished successfully, as well as one round of the online survey with the board members of all collective member associations of the EAPC. These two rounds of the Delphi process have already shown a high level of consensus with the statements that had been prepared by the writing group.
Only seven out of the 21 statements did not reach the high level of consensus required, even though a high degree of agreement was scored for these seven statements (cut-off score for adequate consensus: interquartile range IQR = 0 and level of agreement > 80%).
The third round, which has just started, will close on Friday 23rd January, and will again be addressed to the board members of the collective member associations of the EAPC. If you are a board member, you have the opportunity to state your opinion on those statements that have not yet reached consensus.
We hope to finalise the Delphi process and analyse the results in time for the EAPC Congress in Copenhagen in May this year. We are looking forward to the discussion with you on this very important topic!
Join us in Copenhagen …
The 14th World Congress of the European Association for Palliative Care: Building Bridges takes place in Copenhagen, Denmark, on 8-10 May 2015. Register now before Early Bird registration closes on 15 February 2015.