How do we feel about physician-assisted suicide?  

To mark the publication of the EAPC’s latest white paper on euthanasia and physician-assisted suicide, we are publishing a special series of posts on euthanasia and physician-assisted suicide.

Lukas Radbruch (Germany), Carlo Leget (The Netherlands), Patrick Bahr (Germany) and Paul Vanden Berghe (Belgium), who are all contributing authors to the paper, discuss the background to the longer paper that is published tomorrow in Palliative Medicine Online First.

Lukas Radbruch (top) Carlo Leget

Lukas Radbruch (top)
Carlo Leget

Are we morally allowed to kill our patients when they explicitly ask for it? Or should we offer patients assistance when they want to end their life because everything else has failed? These are just two ways to frame the same question, but they show the wide range of attitudes that is visible in the discussion on euthanasia and physician-assisted suicide in the healthcare community. There is probably no one who does not have an opinion on this issue. The European Association for Palliative Care (EAPC) had published its position in 2003, stating very clearly that euthanasia and physician-assisted suicide should not be part of palliative care. The ongoing legal, political and clinical developments in many European countries made an update of this paper necessary, and in 2012 we decided to lead on this update. We did not know that it would take us three years and a lot of sweating!

The EAPC had decided that it would not be enough to have an expert opinion paper, but that we would want to get a strong consensus basis for the new paper. We drafted and organised a five-step Delphi consensus process, including an expert panel, the board of directors of EAPC and (most important) the board members of all the national associations that are collective members of the EAPC, ensuring a good representation of the European regions and of all professions involved in palliative care. All in all, more than 140 experts participated in the consensus process.

Patrick Bahr (top) Paul Vanden Berghe

Patrick Bahr (top)
Paul Vanden Berghe

It took us some time to fine-tune the recommendations in the consensus process. For six statements, we did not achieve the required level of consensus. However, we did include these statements in the white paper for two reasons: a) the level of agreement was still very high, with 68% – 93% of participants agreeing with these six statements, and b) the authors and the EAPC board strongly felt that even if formal consensus was not achieved, these results are telling and need to be included.

The EAPC position paper concludes that euthanasia and physician-assisted suicide are not a part of palliative care. Still, even with excellent palliative care some patients may ask for hastened death. These patients may present great challenges for palliative care teams. Palliative care experts should make this the starting point of holistic care, and should try to understand the motivation and attitude behind the patient’s wish. Patients should be offered the best form of symptom control, psychosocial and spiritual counselling, and alternative options such as palliative sedation or withdrawal of life-prolonging interventions. On an individual basis, patients deserve our respect and understanding in situations of misery and despair. As a society, we should clarify that we are living in an environment that is based on care and compassion and is affirmative of life.

The new EAPC white paper (1) will certainly not end the discussion on euthanasia and physician-assisted suicide, but we are happy that we finally can present the viewpoint from the palliative care community in Europe. We hope that it may contribute to an open and respectful debate surrounding this delicate topic.

1. Radbruch L, Leget C, Bahr P, Müller-Busch C, Ellershaw J, De Conno F, Vanden Berghe P. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care on behalf of the board members of the EAPC, Palliative Medicine. Prepublished 20 November 2015, DOI: 10.1177/0269216315616524. Available to download but you will need to subscribe to the journal.  

EAPC members get FREE access to this and all EAPC publications…
If you are currently an Individual or Associate EAPC Member you have full access to the EAPC website, and the chance to download a free PDF of ‘Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care’ and many other papers too. Just click here – enter your email address and membership password and choose from the list of journal articles. Download the German version in the ‘EAPC documents in other languages’ section of the website.

To join the EAPC, or renew your membership, click here. You can apply to be an Associate Member FREE of charge provided that you are a member of your country’s national palliative care association, and that the association is an EAPC National Association member.

Read more posts about euthanasia and physician-assisted suicide on the EAPC blog.

More about the authors
Lukas Radbruch is Chair of Palliative Medicine and Director of the  Department of Palliative Medicine, University Hospital Bonn, Bonn, German,  and Director of the Centre of Palliative Care, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany.
Carlo Leget is Professor of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands and vice-president of the EAPC.
Patrick Bahr is a doctoral student, Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
Paul Vanden Berghe is Director of the Federation Palliative Care Flanders, Vilvoorde, Belgium and a member of the EAPC board of directors.

Further reading
Bundesamt für Statistik. Todesursachenstatistik 2009 – Sterbehilfe (assistierter Suizid) und Suizid in der Schweiz. 2013. (abgerufen am 2.3.2014).

Chambaere K, Bilsen J, Cohen J, Onwuteaka-Philipsen BD, Mortier F, Deliens L (2011). Trends in Medical End-of-Life Decision Making in Flanders, Belgium 1998-2001-2007. Med Decis Making 31(3): 500-10.

Chambaere K, Vander Stichele R, Mortier F, Cohen J, Deliens L (2015). Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium. N Engl J Med.

Commission Nationale de Contrôle et d’Evaluation de la loi du 16 mars 2009 sur l’euthanasie et l’assistance au suicide. Deuxieme rapport à l’attention de la Chambre des Députés (Années 2011 et 2012). 2012. (abgerufen am 19.2.2014).

Dan B, Fonteyne C, de Clety SC (2014). Self-requested euthanasia for children in Belgium. Lancet 383(9918): 671-2.

Director of Public Prosecutions. Policy for Prosecutors in respect of Cases of Encouraging or Assisting Suicide. 2014. (abgerufen am 16.3.2015).

Federale Controle- en Evaluatiecommissie Euthanasie. Vijvde Verslag aan de Wetgevende Kamers (2010 – 2011). 2012. (abgerufen am 28.2.2014).

Federale Controle- en Evaluatiecommissie Euthanasie. Zesde Verslag aan de Wetgevende Kamers (2012 – 2013). 2014. (abgerufen am 28.2.2014).

Levenseinde Kliniek. Levenseindekliniek helpt opnieuw meer mensen. 2015. (abgerufen am 15.3.2015).

Ministerie van Justitie. Wet betreffende de euthanasie (1) 2002.  (abgerufen am 18.2.2014).

Ministre de al Santé et de la Sécurité Sociale. Legislation reglementant les soins palliatifs ainsi que l’euthanasie et l’assistance au suicide. 2009. (abgerufen am 18.2.2014

Northern Territory of Australia. RIGHTS OF THE TERMINALLY ILL ACT 1995. 1995.  (abgerufen am 18.2.2014).

Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJ, van Delden JJ, van der Heide A (2012). Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet 380(9845): 908-15.

Oregon Health Authority. The Oregon Death with Dignitiy Act, Oregon Revised Statutes.  (abgerufen am 18.2.2014).

Oregon Health Authority. Oregon’s Death with Dignity Act 2014. 2015. (abgerufen am 18.2.2015).

Parliament of Australia. Bills Digest 45 1996-97 Euthanasia Laws Bill 1996. 1996.  (abgerufen am 18.2.2014).

Regionale Toetsingscommissies Euthanasie. Jaarverslag 2014. 2015.  (abgerufen am 11.11.2015).

Regionale Toetsingsocmmissies Euthanasie. Jaarverslag 2013. 2014.  (abgerufen am 15.3.2015).

Schmidlin E, Elger BS, McLennan S (2014). Assisted suicide in Switzerland:- where do we come from and where are we going? European Journal of Palliative Care 21: 61-65.

Staten-Generaal EKd. Toetsing van levensbeëindiging op verzoek en hulp bij zelfdoding en wijziging van het Wetboek van Strafrecht en van de Wet op de lijkbezorging (Wet toetsing levensbeëindiging op verzoek en hulp bij zelfdoding). 2001.  (abgerufen am 18.2.2014).

Steck N, Egger M, Maessen M, Reisch T, Zwahlen M (2013). Euthanasia and assisted suicide in selected European countries and US states: systematic literature review. Med Care 51(10): 938-44.

Supreme Court of Canada. Carter v. Canada (Attorney General), 2015 SCC 5. 2015. (abgerufen am 16.2.2015).

Washington State Department of Health. 2013 Death with Dignity Act Report. 2014.  (abgerufen am 27.9.2014).

Ysebaert D, Van Beeumen G, De Greef K, Squifflet JP, Detry O, De Roover A, Delbouille MH, Van Donink W, Roeyen G, Chapelle T, Bosmans JL, Van Raemdonck D, Faymonville ME, Laureys S, Lamy M, Cras P (2009). Organ procurement after euthanasia: Belgian experience. Transplant Proc 41(2): 585-6.

Vanden Berghe P, Mullie A, Desmet M, et al. Assisted dying – the current situation in Flanders: euthanasia embedded in palliative care. Eur J Palliat Care 2013; 20: 266–272.


This entry was posted in EAPC ACTIVITIES, EAPC Board Members, EAPC White Papers, Guidelines & Recommendations, Euthanasia and physician-assisted suicide and tagged , . Bookmark the permalink.

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