April 24, 2024

Physician assisted death versus palliative care

Why wait for the perfect public health system?

Arguments against physician assisted suicide and euthanasia often turn on a claim about the need prioritize the development of adequate palliative care. A new article in the Journal of Medical Ethics provides a sophisticated critique of this archetypal argument.

Joaquín Barutta (Ruhr University, Germany) and Jochen Vollmann (Italian Hospital University, Argentina) discuss a number of variants of the ‘argument from palliative care’ – the view that the existence (or, in some cases, the non-existence) of palliative care means that we should not allow physician assisted death (PAD). Barrutta and Vollmann claim that each variant of the position is flawed.

One formulation, sometimes put forward by more cautious pro-euthanasia advocates, is that a lack of available palliative care limits a patient’s autonomy. If a patient does not have all the options available to him, then how can he make a truly free decision? Barutta and Vollmann respond by arguing that ‘autonomy’, even in situations where palliative care is not available, is still present.

“Certainly, a lack of better options limits the choices a person has available. However, an autonomous decision is not the same as a decision after trying all other options… All we should require is that their choice is the result of correctly applying the skills needed to make a decision based on their own values and beliefs.”

Barutta and Vollmann continue from this claim to discuss the second variant of the position, ‘the argument from existing alternatives’. Some would argue that patients should try all existing alternatives first before opting for euthanasia. The authors respond:

“we interfere with the autonomous decision of these patients to request PAD that we have discussed previously. Since doing so results in more suffering, it is hard to see how this could be justified using this argument.”

The authors also discuss the claim that PAD will be used primarily by those from low socio-economic backgrounds, precisely those social classes lacking adequate palliative care. They put forward the following rejoinder:

“PAD derive from lack of economic resources to get better care, forbidding PAD does nothing to help these patients. On the contrary, as already noticed when analysing the previous argument, it reduces their options even more, condemning many of them to a worse death.”

It strikes this writer that the oft-made argument from ‘lack of autonomy’, though not without promise, needs to be revisited if it is to address Barutta and Vollmann’s critique.  

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