Following last week’s post ‘Bringing the EAPC white paper to the centre of the Portuguese debate’, Sandra Martins Pereira, Pablo Hernández-Marrero and Ana Sofia Carvalho from the Instituto de Bioética, Universidade Católica Portuguesa, Porto/ UNESCO Chair in Bioethics, Porto, Portugal, continue the debate …
Euthanasia and physician-assisted suicide (PAS) are nowadays hot topics in Portugal, undergoing dramatic public, societal, legal, cultural, ethical and political debates. This followed a citizens’ initiative, Dying with Dignity’ (Morrer com Dignidade), which requested the Portuguese Parliament to legalize these two practices.
What does it mean to die with dignity? Are dignity and autonomy equal in their entity and definition? Should the discussion about the legalization of euthanasia and PAS be mediated by the use of expressions such as “dying with dignity”, as if they were synonyms or as if those who die in a different way are not “dying with dignity”? Why do the advocates of this movement deliberately choose to use euphemisms to describe their cause instead of referring to it by its name? Will the legalization of euthanasia and PAS diminish therapeutic obstinacy? Is palliative sedation a form of euthanasia already implemented in clinical practice in Portugal? These are only a few of the questions currently under fire in Portugal, with citizens and healthcare professionals positioning themselves in two opposing directions: pro-legalization versus non-legalization.
In our opinion, there are two main issues in the Portuguese debate to which we would like to draw particular attention.
First, we have a major concern about the apparently increasing public support for euthanasia and PAS disseminated through diverse media channels. Biased wording is being systematically used and several concepts are not correctly defined. It is our perception that citizens, journalists, politicians and healthcare professionals are positioning themselves based on inaccurate perceptions, lack of information and lack of knowledge about palliative and end-of-life care, decisions and practices. In fact, the majority of professional, public, societal, ethical and political debates are being framed by mere opinions and by the use of euphemisms and inaccurate expressions. Crucial terms are being left undefined or, even worse, ambiguously and wrongly presented, causing confusion and misunderstanding. This, in our opinion, is determining and influencing the debate, misleading citizens and professionals alike.
The Portuguese translation of the EAPC White Paper on Euthanasia and Physician-Assisted Suicide may indeed have a positive impact and highlight the debate by providing clear definitions and consensus on several ethical issues at the end of life.
Second, very little is known about end-of-life decisions and decision-making processes in Portugal. Hence, there are unresolved issues needing additional research. We consider that there is also a further need not only to investigate the attitudes toward euthanasia and PAS, but also the willingness to perform these practices, especially among those trained and involved in palliative care. This is the main focus of our current and ongoing research project entitled EPASP: Euthanasia and Physician-Assisted Suicide in Portugal; preliminary results to be released soon.
References and links
Radbruch L, Leget C, Bahr P, Müller-Busch C, Ellershaw J, de Conno F, Vanden Berghe P; Board Members of EAPC. Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliat Med. 2016 Feb; 30(2): 104-16. doi: 10.1177/0269216315616524. Epub 2015 Nov 19.