GESTIÓN EN SALUD PÚBLICA: BioEdge: Is there a human right to anaesthesia?

martes, 2 de abril de 2019

BioEdge: Is there a human right to anaesthesia?

BioEdge: Is there a human right to anaesthesia?

Bioedge

Is there a human right to anaesthesia?

by Michael Cook | 31 Mar 2019 | 2 comments

It is widely agreed that pain relief is a basic human right. The non-binding Declaration of Montreal asserted in 2011 that because of “the inherent dignity of all persons ... the withholding of pain treatment is profoundly wrong, leading to unnecessary suffering that is harmful.”

A controversial editorial in the journal Anaesthesia takes this consensus further and contends that anaesthesia must also be a human right. Two bioethicists, Julian Savulescu and Janet Radcliffe‐Richards, argue that people who are dying deserve to have general anaesthesia (lack of all sensation), not just analgesia(lack of pain). Professor Savulescu draws upon his own experience as he watched his mother suffer needlessly as she died last year.

This would require a major cultural shift amongst anaesthetists. Traditionally anaesthesia has accompanied surgery. What Savulescu and Radcliffe-Richards propose is adding a new dimension to anaesthesia – helping people to die painlessly rather than just relieving pain of surgery so that they can be restored to health and normal functioning.

Through anaesthesia we have the means to eliminate suffering by bringing about unconsciousness, not just for surgery but also in particular at that time so close to death. Anaesthesia has been one of the greatest benefits to humankind. If we are to withhold it from people who are dying, we need to have strong reasons to justify that. The presumption must always be in favour of relieving suffering when we can.

In other words, anaesthetic techniques could be used to administer terminal sedation.

If a right to unconsciousness – and not just analgesia and sedation – at the point of death was established, it might take some of the heat out of the current debate about voluntary euthanasia. Many people who are against deliberate killing should have no objection to what is known as terminal sedation – bringing about unconsciousness until natural death. Conversely, for many people who want to retain the option of euthanasia, terminal sedation alone might be acceptable, even if it is less than ideal from their perspective.

Michael Cook is editor of BioEdge.

With hate crimes like the recent murders of 50 Muslims in Christchurch, New Zealand, by a white nationalist, some bioethicists are asking whether bigotry is a disease. And, if so, whether it can be prevented (or cured) with the tools in the armoury of public health professionals. In an article below, public health experts suggest four ways that doctors can push back against hatred.

It's an interesting line of thought. Clearly some forms of bigotry and hatred lead to deadly crimes. But defining hatred is often deeply political. The members of the KKK and ISIS are clearly dangerous "haters". But how about foes of Muslim immigration or same-sex marriage? Are they "haters" or just political opponents? I must confess that I feel that the bioethics of hatred is off to a shaky start, conceptually. But I believe that it will become more prominent as time goes on. The Christchurch gunman let a genie out of the bottle.