“Growing old isn’t so bad when you consider the alternative,” used to be a joke. But for supporters of legalised euthanasia, the alternative looks better than growing old. Some recent research shows that there is some confusion about the aims of the movement.
In the July 5 issue of JAMA, Ezekiel Emmanuel and colleagues compiled an overview of euthanasia and assisted suicide in the United States, Europe and Canada. They painted a fairly optimistic picture: euthanasia and assisted suicide are relatively rare, involve mainly patients with cancer, and involve very little abuse. However, one of their main conclusion was that more research was needed on some key issues.
What was clear, however, was that unmanageable pain was not the main issue for people who wanted to die. “Pain is not the main motivation for [physician-assisted suicide]. Typically, less than 33% of patients experience inadequate pain control. The dominant motives are loss of autonomy and dignity and being less able to enjoy life’s activities.”
So the problem faced by supporters of legalization is how to sell euthanasia to the public if pain is no longer a major problem. The Economist, an avowed supporter, this week highlights a possible answer in JAMA Internal Medicine. Four doctors from the University of Pennsylvania investigate a “new metric” which they call “States Worse Than Death”. It found that around half of the 180 patients in their study thought that bowel and bladder incontinence, relying on a respirator, inability to get out of bed, and being confused all the time were states worse than death.
The authors conclude that providing more medical care may actually make matters worse by prolonging a life that has become worse than death. They have essentially recucled the “loss of autonomy and dignity and being less able to enjoy life’s activities”argument, but now it sounds far closer to the argument about uncontrolled pain.
The death of Ivo Pitanguy in Rio this week was the intersection of bioethics and the Olympics. The world’s best-known cosmetic surgeon and a celebrity in his native Brazil, he carried the Olympic flame on the day before he died of a heart attack at the age of 93.
A member of the Brazilian Academy of Letters, Pitanguy thought deeply about his specialty. “My operations are not just for my patients’ bodies. They are for their souls,” he wrote. He regarded beauty as a human right and he made cosmetic surgery as popular among the poor as among glittering celebrities.
However, his poetic vision of his specialty clashes with the scepticism of some bioethicists. The Nuffield Council on Bioethics, in the UK, is currently conducting an inquiry into cosmetic procedures, in response to concerns that patients are being victimized and that the industry is sustained by sexist stereotypes. Its discussion paper is particularly interesting. We hope to cover this area in more depth in the future.
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