How do you feel about euthanasia and assisted suicide?


Funeral lily

A QUT senior lecturer and pharmacist is seeking to map pharmacists’ attitudes towards euthanasia and assisted suicide

Tony Hall, from the School of Clinical Sciences, Queensland University of Technology, is conducting the study, commencing with a questionnaire which can be filled out here.

“I am looking for community pharmacists in Australia who would complete a 10-15 minute anonymous online questionnaire,” Mr Hall says.

“The questionnaire will collect information about basic demographics e.g. gender, years in practice as a pharmacist and experiences and opinions toward the provision of medications intended for physician assisted suicide and euthanasia.”

“As the Victorian and South Australian governments have recently initiated debate on legalising physician-assisted suicide and euthanasia it is clear that the pharmaceutical profession has not been involved in this debate,” he writes in the study proposal.

“This despite an overdose of pentobarbitone or secobarbitone being the mechanism of choice and the likelihood of the pharmacist as being involved at some stage in the supply of this medication.

“There is little research data on the attitudes of pharmacists to the use of medications in this arena.”

The study is being conducted under the auspices of QUT Human Research and Ethics Committee.

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15 Comments

  1. Notachemist
    26/05/2017

    Great to see this discussion happening. Doctors have been discussing this for some time and we should be as well. Great survey with lots of thought provoking questions.

    • Ronky
      21/06/2017

      Not so sure about that. The fact that this survey has been created might tend to make these things more thinkable as a real possibility to some people.

      • Jarrod McMaugh
        21/06/2017

        Do you mean that people would think they would have access to euthenasia?

        Or do you mean that people would be encouraged to consider euthanasia just from seeing that a survey exists?

        • Ronky
          21/06/2017

          Promoting discussion of it as a hypothetical possibility might lessen the outrage and resistance that people would put up when and if some politician (or worse, some unelected judge creatively “interpreting” the law) decides to foist it on us. People might shrug and say “oh well I knew this might be coming because we were talking about its possibility years ago. ” The cynic in me thinks this is exactly the intent of this survey.
          On the other hand, it’s possible that actively discussing it might encourage real thinking about the basic principles and activate rather than deaden our consciences, and better prepare us to resist it if we’re ever threatened with it in future.

  2. Jarrod McMaugh
    27/05/2017

    Very important discussion for pharmacists to be involved in. We will be the profession dispensing the medication, so it’s important that we understand the processes and the professional ramifications.

    • John Wilks
      27/05/2017

      Jarrod, You say that “We will be the profession dispensing the medication” which appears to presuppose that euthanasia is an inevitable social and medical decision. The use of the conditional “might” would be a more apt word, as in “We MIGHT be the profession dispensing the medication” and for two reasons. Pro-euthanasia moves in Tasmanian have recently failed by the humiliating margin of 16-8 just 1 week ago. Moreover it must not ever be forgotten that our guiding principle is Primum non nocere.

      • Jarrod McMaugh
        27/05/2017

        I’m making the comment with the supposition that assisted suicide and euthenasia are legalised.

        If this is the case, then pharmacists are the health professionals who would be dispensing the medication.

        My comment isn’t in support or opposition of either euthenasia or assisted suicide…. It is more a statement designed to overcome any opinion that “this isn’t out issue”

        The discussion within the profession needs to occur now while the wider community is also looking at it, otherwise we may find ourselves in a situation where changes are made, and we aren’t prepared for them.

  3. John Wilks
    31/05/2017

    This research succinctly shows that despite the best intentions that may underpin euthanasia, the darkness of the human heart finds ways to circumvent said “safety provisions.” Hence the only safeguard is to reject euthanasia – masquerading as it does under a variety of euphemisms such as ‘mercy killing’ or ‘death with dignity.’ – and adhere to the principled dictum ‘primum non nocere.’

    Abstract
    Euthanasia or assisted suicide—and sometimes both—have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures have included, among others, explicit consent by the person requesting euthanasia, mandatory reporting of all cases, administration only by physicians (with the exception of Switzerland), and consultation by a second physician.

    The present paper provides evidence that these laws and safeguards are regularly ignored and transgressed in all the jurisdictions and that transgressions are not prosecuted. For example, about 900 people annually are administered lethal substances without having given explicit consent, and in one jurisdiction, almost 50% of cases of euthanasia are not reported. Increased tolerance of transgressions in societies with such laws represents a social “slippery slope,” as do changes to the laws and criteria that followed legalization. Although the initial intent was to limit euthanasia and assisted suicide to a last-resort option for a very small number of terminally ill people, some jurisdictions now extend the practice to newborns, children, and people with dementia. A terminal illness is no longer a prerequisite. In the Netherlands, euthanasia for anyone over the age of 70 who is “tired of living” is now being considered. Legalizing euthanasia and assisted suicide therefore places many people at risk, affects the values of society over time, and does not provide controls and safeguards

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/

    • Andrew
      31/05/2017

      Hi John,

      From a response article to the famous Perieira article of 2011;

      “Conclusions;
      Pereira’s conclusions are not supported by the evidence he provided. His paper should not be given any credence in the public policy debate about the legal status of assisted suicide and euthanasia in Canada and around the world.”

      It’s well known as an ideological almost-rant.

      There’s strong evidence that the *availability* of euthanasia is of great comfort to patients and very effective at reducing anxiety at what is obviously a very stressful time.

      I agree that the scenarios you present are worth consideration but in jurisdictions where euthanasia is legalised I’m not sure if they’ve identified any systemic abuses like you mention.

      • John Wilks
        31/05/2017

        Thanks for this Andrew. I note that the article had been moved to the ‘Opinions’ section of the Journal. Has it been removed by the editor on the basis of putative errors and misstatements?

        • Andrew
          01/06/2017

          Dunno. The only reason I’m familiar with the article is that it’s the article most often presented by opponents.

          • Jarrod McMaugh
            01/06/2017

            P

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  4. John Wilks
    31/05/2017

    And from the American Medical Association Journal of Ethics 2013

    Opinion 2.211 – Physician-Assisted Suicide
    Physician-assisted suicide occurs when a physician facilitates a patient’s death by
    providing the necessary means and/or information to enable the patient to perform
    the life-ending act (e.g., the physician provides sleeping pills and information about
    the lethal dose, while aware that the patient may commit suicide).
    It is understandable, though tragic, that some patients in extreme duress–such as
    those suffering from a terminal, painful, debilitating illness–may come to decide that
    death is preferable to life. However, allowing physicians to participate in assisted
    suicide would cause more harm than good. Physician-assisted suicide is
    fundamentally incompatible with the physician’s role as healer, would be difficult or
    impossible to control, and would pose serious societal risks.
    Instead of participating in assisted suicide, physicians must aggressively respond to
    the needs of patients at the end of life. Patients should not be abandoned once it is
    determined that cure is impossible. Multidisciplinary interventions should be sought
    including specialty consultation, hospice care, pastoral support, family counseling,
    and other modalities. Patients near the end of life must continue to receive emotional
    support, comfort care, adequate pain control, respect for patient autonomy, and good
    communication.
    Issued June 1994 based on the reports “Decisions Near the End of Life,” adopted
    June 1991 and “Physician-Assisted Suicide,” adopted December 1993; updated June
    1996.
    http://journalofethics.ama-assn.org/2013/03/pdf/coet1-1303.pdf

  5. John Wilks
    31/05/2017

    Andrew has indicated that the original Pereira paper which I cited was defective.The key criticism of Pereira came from Downie et al and can be found here:

    https://www.ncbi.nlm.nih.gov/pubmed/22670091

    For those interested I have found the follow-up paper by Pereira wherein he acknowledges some regrettable references errors in his original paper.

    “Downie et al. identified some errors in my article challenging the safeguards that are in place in jurisdictions that have legalized euthanasia and assisted suicide. I humbly accept that there are some errors in the references and subtleties that are regrettable. However, most of what they report to be erroneous and false I would argue is indeed correct, and other issues they raise are meant to cast aspersions and distract readers from the primary issues. The facts and my position remain unscathed; there are too few effective safeguards in place to prevent abuses in the practice of euthanasia and assisted suicide.”
    See:
    http://www.current-oncology.com/index.php/oncology/article/view/1088/914

  6. John Wilks
    21/06/2017

    Following is an opinion article about the current state of euthanasia in The Netherlands. In essence it is a lamentation of regret by the ‘founder’ of euthanasia in that that country. One clear conclusion? The ‘moral slippery slope’, so often decried as a religious right ‘scary monster’ concept, has been shown to be true. Why? Because of the ‘Heart of Darkness’ that lies within us all. The original article is at:

    https://www.nrc.nl/nieuws/2017/06/16/de-euthanasiegeest-is-uit-de-fles-11123806-a1563406

    Paste it into Google and translate from Dutch.

    “If there is anyone who could be called a patron saint of Dutch euthanasia, it is the psychiatrist Boudewijn Chabot. In 1991 he gave one of his patients, Mrs B, a lethal dose of medication. After accompanying her until she died he reported himself to the police and was subsequently tried. In 1993, the Supreme Court declare that he was guilty of assisting a suicide, but did not punish him and allowed him to keep practicing medicine.

    Physically, there was nothing wrong with Mrs B. Nor did she have depression. But her personal life was tragic and Dr Chabot felt that she in a state of existential distress that she should be allowed to die. It was a landmark case in the steady advance towards legalisation in 2002.

    That was 25 years ago. Now Dr Chabot looks back and is horrified. Writing in one of the leading Dutch newspapers, NRC Handelsblad, he says that legal safeguards for euthanasia are slowly eroding away and that the law no longer protects people with psychiatric condition and dementia.

    The Dutch are complacent about their famous law, he says. But there is no room for complacency.

    Under current legislation, euthanasia is only legal if a doctor believes that three conditions have been met: (1) the request must be voluntary and deliberate; (2) there must be unbearable suffering with no hope of improvement; and (3) there must no reasonable alternative to euthanasia.

    However, as euthanasia has sunk its roots deeper and deeper into Dutch medicine, the second and third conditions have shrivelled up. Patients define what is unbearable and they define what is a reasonable alternative. Unhappiness can be unbearable and a nursing home may not be a reasonable alternative. So, as one ethicist has observed, requirements (1) and (2) “add little to the requirement of a voluntary and thoughtful request”. Autonomy has trumped medicine. As a result, the number of euthanasia cases roughly tripled between 2007 and 2016, from 2000 to 6000.

    In itself, this does not bother Dr Chabot. After all, he is the Grand Old Man of Dutch euthanasia. He says that he is prepared to accept tens of thousands of euthanasia cases. But he is aghast at the rapid rise in the number of people with psychiatric illness or dementia who have been euthanised:

    What does worry me is the increase in the number of times euthanasia was performed on dementia patients, from 12 in 2009 to 141 in 2016, and on chronic psychiatric patients, from 0 to 60. That number is small, one might object. But note the rapid increase of brain diseases such as dementia and chronic psychiatric diseases. More than one hundred thousand patients suffer from these diseases, and their disease can almost never be completely cured.

    One sign of the changing times is the rapid expansion of the services of the End of Life Clinic Foundation (Stichting Levenseindekliniek). This organisation offers euthanasia to patients whose own doctors have refused. They never offer to treat the underlying illness, whether it is physical or mental.

    By 2015, a quarter of euthanasia cases on demented patients were performed by these doctors; in 2016 it had risen to one third. By 2015, doctors of the End of Life Clinic performed 60 percent of euthanasia cases in chronic psychiatric patients, by 2016 that had increased to 75 percent (46 out of 60 people).

    Last year, Dr Chabot points out, doctors from the End of Life Clinic each performed about one euthanasia every month. “What happens to doctors for whom a deadly injection becomes a monthly routine?” he asks.

    Now the End of Life Clinic is recruiting psychiatrists to service the mentally ill and demented. One obvious problem is that there is a shortage of good psychiatric help in the Netherland – which tends to take a long time have an effect, in any case – because of budget cuts.

    Without a therapeutic relationship, by far most psychiatrists cannot reliably determine whether a death wish is a serious, enduring desire. Even within a therapeutic relationship, it remains difficult. But a psychiatrist of the clinic can do so without a therapeutic relationship, with less than ten ‘in-depth’ conversations? Well …

    Dr Chabot is deeply sceptical about euthanasia for the demented: “we are dealing with a morally problematic act: how do you kill someone who does not understand that he will be killed?”.

    How? It turns out that sometimes a relative or doctor secretly laces their food or drink with a sedative to make it easier to give them a lethal injection. In one notorious case last year, the sedative didn’t work and relatives pinned the terrified woman to the bed while the doctor gave the lethal injection. Dr Chabot was astonished to discover that “surreptitious administration of medication has previously occurred, but has never been mentioned in an annual report.”

    Isn’t anyone paying attention to these developments, Dr Chabot asks.

    The euthanasia practice is running amok because the legal requirements which doctors can reasonably apply in the context of physically ill people, are being declared equally applicable without limitation in the context of vulnerable patients with incurable brain diseases. In psychiatry, an essential limitation disappeared when the existence of a treatment relationship was no longer required. In the case of dementia, such a restriction disappeared by making the written advance request equivalent to an actual oral request. And lastly, it really went off the tracks when the review committee concealed that incapacitated people were surreptitiously killed.

    After surveying the wreckage of the euthanasia law, Dr Chabot concludes bitterly,

    I don’t see how we can get the genie back in the bottle. It would already mean a lot if we’d acknowledge he’s out.”

    https://www.mercatornet.com/careful/view/a-dutch-euthanasia-pioneer-surveys-the-wreckage-and-despairs/19992

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