GESTIÓN EN SALUD PÚBLICA: What are the five best arguments against euthanasia?

domingo, 10 de junio de 2018

What are the five best arguments against euthanasia?

What are the five best arguments against euthanasia?

Bioedge

What are the five best arguments against euthanasia?

by Xavier Symons | 9 Jun 2018 | 1 comment

As medical societies around the world consider changes to their position on euthanasia, several influential doctors and ethicists have co-published a commentary in the Journal of Palliative Care opposing any policy change.

Among the authors of the article, entitled “Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective”, are Georgetown University’s Daniel Sulmasy, who served on President Obama’s Commission for the Study of Bioethical Issues, Margaret Somerville, a legal scholar and one of the most vocal opponents of the legalisation of euthanasia in Canada, and influential palliative care specialist Lukas Radbruch.

The authors summarise what they take to be the five strongest reasons to oppose euthanasia. They include:

1) “slippery slopes”: The authors assert that “despite safeguards for euthanasia in the Netherlands and Belgium, there are data that safeguards are ineffective and violated...Allowing voluntary euthanasia has led to nonvoluntary euthanasia”.

2) “lack of self-determination”: The authors note that many expressions of a desire for death do not mean that a patient wants to euthanasia or assisted suicide; “As individual requests for PAS-E are often labile, complex in origin, and subject to the individual’s changing priorities, such requests require careful and repetitive attention”.

3) “inadequate palliative care”: “Holistic knowledge of palliative care”, they state, “is the most urgent ethical obligation of jurisdictions worldwide rather than legalizing PAS-E

4) “medical professionalism”: doctors assisting in PAS-E, the authors argue, threaten the moral integrity of the medical profession.

5) “difference between means and ends”: the push for PAS-E confuses the problem of suffering with the life of the person: “we must kill the pain and suffering, not the person with the pain and suffering”.

Coincidentally, a completely different vision of euthanasia emerges from a recent article in the Belgian Tijdschrift voor Geneeskunde (Journal of Medicine). J.L. Bernheim, a researcher at the End-of-life Care Research Group,  flatly denies that critics of Belgian euthanasia know what they are talking about. He divides criticisms into pragmatic (factual) and essentialist (moral and legal).

On the first score, Bernheim denies that there was or is a “slippery slope” or that vulnerable patients are not protected adequately. On the second, he argues that euthanasia is a genuinely compassionate supplement to end-of-life care. It’s an interesting to see how different euthanasia looks inside the borders of Belgium. Unfortunately, the article is available only in Dutch at the moment.

Sunday, June 10, 2018

The deaths this week of fashion designer Kate Spade and celebrity chef Anthony Bourdain (see below) focused the media once again on explanations for America’s rising suicide rates. The short answer is: nobody knows. The more nuanced long answer is: nobody knows for sure. But something is driving it. Here are a few paragraphs from the New York Times which suggest that suicide is becoming culturally more acceptable:

The rise of suicide turns a dark mirror on modern American society: its racing, fractured culture; its flimsy mental health system; and the desperation of so many individual souls, hidden behind the waves of smiling social media photos and cute emoticons.

Some experts fear that suicide is simply becoming more acceptable. “It’s a hard idea to test, but it’s possible that a cultural script may be developing among some segments of our population,” said Julie Phillips, a sociologist at Rutgers.

Prohibitions are apparently loosening in some quarters, she said. Particularly among younger people, Dr. Phillips said, “We are seeing somewhat more tolerant attitudes toward suicide.”

In surveys, younger respondents are more likely than older ones “to believe we have the right to die under certain circumstances, like incurable disease, bankruptcy, or being tired of living,” she said.

If this is the case, why, O why, is there a movement for assisted suicide? Yes, it’s hard to prove, but it makes sense: if assisted suicide is a triumph of compassion and autonomy, how can unassisted suicide possibly be a tragedy?