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.
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.
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 from OnlineFirst – you will need to subscribe to the journal.
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.
Follow the EAPC blog on Monday 23 November for the next post in this series when the authors will be discussing Assisted suicide – legal regulations and practices.
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