Euthanasia debate reignited

It is notable that after all those years of discussions which followed the Sue Rodriguez case, we are still insinuating that « pain so intense » (which painkillers do not alleviate) leads near-death patients to ask that their life be ended.

Thanks to Palliative Care (and others), pain management has made so much progress in the last 40 years that most studies have shown that pain is NOT the primary reason to request euthanasia. Often, pain ranks 4th, 5th or lower (1). Reflecting on “modern dying”, bio-ethicist Hubert Doucet wrote : “With good pain management, we thought we had rendered dying more humane. We now discover that a dying person’s life does not necessarily regain sense because he has been relieved of his pains. …Now looms the real question about the meaning of life : why live if only to await death”(2). The commonest motives are existential, a much less relievable type of suffering: profound deterioration, progressive loss of autonomy, inacceptable dependency, all leading to meaninglessness, even in spite of excellent palliative care. In a recent Canadian study, 6% of 379 Palliative Care cancer patients wanted euthanasia “now” (3). Autonomy has undergone a paradigm shift in the last few decades. As mentioned in the Philosophers’ Brief presented to the USA Supreme Court : “Most of us see death –whatever we think will follow it- as the final act of life’s drama, and we want the last act to reflect our own convictions, those we have tried to live by, not the convictions of others forced on us in our most vulnerable moment” (4). Modern dying, for a few, has become unacceptable. That explains the 80% support of Canadians, and that of 75% of Quebec’s specialists recently reported.

Yes, when appropriate and so wished by a near-death patient, euthanasia should be the “ultimate palliation”.

Marcel Boisvert md Retired palliative care physician.

1. Heyland, KD. et al. What Matters Most in End of Life Care CMAJ Feb. 28th 2006.

2. Doucet, H. La quête d’une bonne mort. Info-Kara Dec. 1993.(my translation)

3. Wilson, KG et al. Desire for Euthanasia or Physician-Assisted Suicide in Palliative Cancer

Care. Health Psychol. 26(3), 314-323, 2007.

4. The Philosophers Brief. The New York Review of Books. Vol.44(5), 1997.

Conflict of Interest:

None declared