Founder President, CanSupport
In the wake of the Supreme Court's judgment in the Aruna Shanbaug case, the arguments have moved from the "potential to be misused" argument to that of "I-have-the-right-to-choose-when-and-how-I-wish-to-die". So it's no surprise that euthanasia is being viewed as a pre-emptive strike that it will prevent the "loss-of-control" or becoming a "burden" on care-givers.
The World Health Organization (WHO) maintains that "governments should not consider the legalization of physician-assisted suicide and euthanasia until they have demonstrated the full availability and practice of palliative care for all citizens" (WHO Recommendations, Cancer Pain Relief and Palliative Care, 1990). This is a position that has been reiterated by practitioners of palliative medicine worldwide. They have argued that countries which have legalized (or have sought to legalize) euthanasia and/or physician-assisted suicide have inferior palliative care services. The inference is that because of inadequate care, the suffering of the terminally ill is not relieved and hence, the demand for assisted dying.
Published data also seems to support this position. A US Study of physician-assisted-suicides in Oregon suggests that 46% of patients who have received substantive palliative care changed their minds as compared to the 15% who weren't offered palliative care (New England Journal of Medicine, 2000). This was also supported by the evidence presented by the other palliative care physicians from Britain, the Netherlands and Australia.
On the other side, economic factors such as the cost of treatment, the subtle cocercion from carers--were recognized as parameters that can tip the balance in favour of opting for an assisted death. But there are basic questions that beg to be answered:
* Would offering euthanasia or physician-assisted suicide as a therapeutic option further add to the burden on patients as well as signify a deleterious shift in clinical practice currently focussed on saving lives?
* Who has the right to decide if and when a life-prolonging treatment be started or stopped or when suffering has become unbearable? The patient, the family, the physician, the lawmaker or the society at large?
* Is it justified in a situation where there is limited access to palliative care to deny a person the right to end his suffering by euthanasia or physician-assisted-suicide?
* With people living longer and with diseases such as cancer, Alzheimer's and dementia on the rise and with reduced family and community support, is it realistic to expect people to continue to live with dignity when no outside support is available?
* Is it not better to legalize euthanasia and thus bring it under closer control and scrutiny rather than allow it to operate clandestinely?
* Do laws regulating living wills or advance directives that exist in only a few countries now have any place in this debate?
* Does moral responsibility and personal beliefs count in a discussion on euthanasia and palliative care?
The debate should not be seen in an either/or paradigm but as a step-by-step approach with euthanasia, offered only in the rarest of cases where it can be proved beyond any doubt that there is unrelieved suffering.