Palliative care and legal euthanasia can be mutually beneficial

April 17, 2008

Supporters of legalising euthanasia and those who wish to develop better palliative care services can help each other, according to a study published today on bmj.com.

The traditional view that palliative care and euthanasia are two alternative and antagonistic causes is not necessarily the case, say researchers.

Jan Berheim and colleagues from the End-of-Life Care Research Group of the Vrije Universiteit Brussel, reviewed historical, regulatory and epidemiological evidence from Belgium, which was the second country to legalise euthanasia in 2002, and has some of the best developed provisions for palliative care, third only to Iceland and the UK.

The authors show that the movement for the legalisation of euthanasia promoted the development of palliative care and the existence of adequate palliative care made the legalisation of euthanasia ethically and politically acceptable.

According to the authors one of the reasons for the overall lack of acrimony in the Belgian debate was that the two movements developed side by side with shared workers. As the societal debate about euthanasia grew, so did the provisions for palliative care.

They found no evidence that legalising euthanasia resulted in harm to vulnerable patients or disabled people, or that it impeded the development of palliative care in Belgium--concerns voiced by The European Association for Palliative Care. In fact, ethically disputable practices, such as clandestine physician-assisted dying, actually decreased in the run up to the euthanasia law being enacted.

People advocating euthanasia law in Belgium supported palliative care and did not present euthanasia as an alternative but as a possible complement, an option at the end of the palliative care pathway, with the patient's preferences coming first.

The euthanasia law passed in Belgium stated that patients asking for euthanasia had to be informed of the possibilities of palliative care and it was passed at the same time as another Act which ensured people's right to palliative care in every hospital, nursing home and at home, while doubling its public funding.

The process of legalisation of euthanasia was ethically, professionally, politically and financially linked to the development of palliative care, says the study.

The authors conclude: "The societal debates made clear that most values of palliative care workers and advocates of euthanasia are shared. If Belgium's experience applies elsewhere, advocates of the legalisation of euthanasia have every reason to promote palliative care, and activists for palliative care need not oppose the legalisation of euthanasia."
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BMJ

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