The first-prize Logie essay by Daniel Gorman [1] very nicely outlined some of the ethical and management dilemmas facing modern medicine, especially the issue of palliative care in the ICU setting. However, Gorman has placed great emphasis on the difference between active and passive euthanasia, a difference that can be considered simply semantic or even irrelevant when palliative care is practised properly.
I am a surgeon and intensive care physician. I have been in the difficult situation of withholding or withdrawing care to allow death on numerous occasions. This is an extremely difficult process for everyone, but when curative or supportive medical care fails, becomes futile or contravenes the individual's autonomy, then good medical care mandates consideration to withhold or withdraw care that merely prolongs the dying process.
This does not relinquish the duty of care but, rather, changes it to provide a peaceful, pain-free and dignified death.
Such palliative care requires the health care team to support and prepare the individual for the impending death. Properly administered medications and other therapies can be used to relieve suffering, even if such therapies may shorten life. This satisfies society's laws and morality and is consistent with ethical medical care.
This is in stark contrast to euthanasia, which is a deliberate act to end life. Relief of suffering does not enter into the definition and may or may not be a goal. The distinction between good palliative care and euthanasia (active or passive) or physician-assisted suicide is clear and important, not just semantics. Considerate palliative care respects the guiding philosophies of patient care and medical ethics, above all by protecting individual autonomy and dignity while doing no harm. The aim is to allow the inevitable. Most important, good palliative care makes euthanasia and assisted suicide unnecessary.
Palliative care is hard to do well. Society has allowed a mechanism to evolve that works extremely well when applied correctly. The cases mentioned by Gorman do not cry out for euthanasia or legislative and medical change, but they do demonstrate what can happen when people do not do their jobs properly. These cases show the importance of continued medical education, awareness and proper training. As Gorman suggests, euthanasia can have "adverse social consequences" and would put the profession and society on a slippery slope.
Peter Lovrics, MD
Hamilton, Ont.
References
- 1.↵