GESTIÓN EN SALUD PÚBLICA: Is there any difference between euthanasia and palliated starvation?

domingo, 5 de noviembre de 2017

Is there any difference between euthanasia and palliated starvation?

Is there any difference between euthanasia and palliated starvation?

by Xavier Symons | 4 Nov 2017 | 1 comment

While euthanasia and assisted suicide are currently illegal in most countries, the practice of voluntarily stopping eating and drinking (VSED) is seen by some as an ethically and legally permissible alternative. VSED refers to seriously-ill patients refusing to eat and drink for a sustained period of time with the intention of bringing about their own death.

Yet a new paper published in BMC Medicine argues that VSED is ethically indistinguishable from assisted suicide, and should be subject to the same legal regulations as more salient cases of assistance in dying.

The paper, lead-authored by Ralf J. Jox of the Institute for Ethics, History and Theory of Medicine at the University of Munich, argues that “supporting patients who embark on VSED amounts to assistance in suicide, at least in some instances, depending on the kind of support and its relation to the patient’s intention”.

While VSED does not involve an invasive or aggressive act like many other means of suicide, the authors write that “VSED should [nevertheless] be considered as a form of suicide, as there is both an intention to bring about death and an omission that directly causes this effect”. Doctors who assist patients in VSED -- by encouraging them, or promising pain-relief if VSED is undertaken -- are potentially instrumental in the deaths of the patients, as the suicide would not occur without them, and they share the patient’s intention of inducing death.

The authors of the paper conclude that the same legal prescriptions or regulations that apply to physician assisted suicide should also apply to VSED.

“[We] maintain... that future ethical discussions on assisted suicide require consideration of medically supported VSED, and vice versa...Thus, the widely held position by palliative care societies, professional bodies of physicians, legal scholars, and ethicists to disapprove of assisted suicide but approve of and even promote medically supported VSED appears inconsistent”.

Sunday, November 5, 2017

Songs about loneliness are legion and range from the soppy and sentimental, like Ray Orbison’s “Only the Lonely” to the irony of the Beatles’ “Eleanor Rigby”. I’ve always been a sucker for Ralph McTell’s “The Streets of London”, with its piercing lyrics about homeless people in a big city.

Perhaps the reason loneliness is such a potent theme is that we instinctively realise how dangerous it is.

It turns out that loneliness is (a) a major social and health issue and (b) a widespread phenomenon. One US researcher has even estimated that it affects as many as 45% of retired Americans. This seems far too much, but the levels are certainly high. And since it increases the odds of an early death by 26%, I’d call it a challenge for bioethics. How can we heal the frayed and broken bonds of social cohesion?

A feature in this week’s JAMA examines the cost of loneliness – and the lack of solutions. We report on it below.