May 26, 2024

Is unbearable pain still a reason for euthanasia?

If not, what reasons will be advanced next?

“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.
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