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Assisted Suicide Editing

Assisted Suicide Editing


Regarding Boudreau JD, can you imagine teaching medical students how to end the lives of their patients through physician-assisted suicide and euthanasia? Perm J Fall 2011;15(4):79-84.

Since physician-assisted suicide and euthanasia are sensitive and contentious issues, the reductionism and lack of objectivity in the question and discussion are intriguing. The author and advisers desired only their response. It is unusual for academics to be hesitant to debate their ideas with others.
Surprisingly, none of those with the most experience in the field, namely those from the Netherlands, Belgium, and the state of Oregon, were consulted. Their comments would have broadened the readership’s horizons and corrected some lexical errors. Killing and murder are commonly understood to be acts committed on non-consenting victims. As a result, the absolute moral value of “not killing” does not apply to requested euthanasia, and the term “self-murder” is an oxymoron.

Experts from other countries would have insisted that euthanasia cannot be reduced to the “teaching of an act intended to hasten death” and that what can be role-modeled is a humanism paving the way toward the “presence and accompaniment” lauded by Dr. Boudreau, which is the essence of Belgian Integral Palliative Care: high-quality palliative care, open to the “act” of advancing death when suffering cannot be relieved and proves

1 Similarly, from the Netherlands, one would appreciate how the “euthanasia talk” can be taught over weeks and months, along with excellent palliation and end-of-life care. Nine of ten formal requests sublimate into a natural death in this humanistic, reassuring process. 2 According to Eric Cassell, MD, only one in ten people will want their request to be honored: “Assisting a patient in dying is not an easy way out. When terminally ill patients request aid in dying due to their suffering and meet widely accepted safeguards, their request should be honored.” 3

In that light, bright and sensitive medical students learn to cultivate a rich “autonomie-en-lien” (bonds in autonomy), an unavoidable tandem between patient and physician, in which both remain free while being bound by the bonds of humanity (Marc Desmets, MD; personal communication; 2012).

According to philosopher Tom Beauchamp, MD4, the morality of an act is based on its justification and benevolence; benevolence, as an answer to suffering, is affirmed solely by the patient. “Only the patients understand how terrible their suffering is,” Cassell wrote. 3

To entertain nightmares of “Modules of euthanasia” taught by certified “euthanatricians” teaching evidence-based medicine, which may or may not be relevant when “The One and Only Mrs. Jones” faces death, five all belong to fiction.

Curricula, textbooks, research, and thus journals on end-of-life and palliative care abound and are on the rise, especially in areas where regulated physician-assisted suicide has been legalized. Palliative care, including medically assisted suicide, is already taught by qualified medical educators in the Netherlands and Belgium. “Palliative care education fits very well with the goals and agenda of general medical education, contributing to the correction of knowledge, skills, and attitudes.” 6 The Flemish Palliative Care Federation stated in 2007 that “no dual track in end-of-life care would develop in separation, with palliative care practice and teaching on the one hand and euthanasia on the other”… “The choice of each patient must be respected.” 1

What is required is a continued expansion of those activities by mentors who respect patients’ autonomy and whose agenda is aligned with and subordinated to the patients. Paternalism is no longer a virtue but a form of oppressive tyranny (vide infra). “The first duty of the physician is no longer to save life at any cost, but to respect his patient’s choices,” Hon Baudouin stated. 7 “Whatever our beliefs, we should never impose them on another person, least of all on any individual dependent on us,” Dr. Cicely Saunders reminded everyone. 8

If a ludicrous specialty of “euthanatrists” is ever deemed necessary, one for “terminals” or “sedationists” is then urgently required to administer terminal sedation because both euthanasia and terminal sedation result in death. The alleged shortcomings in “death talk,” diagnosing depression, and pain management is still being raised. Terminal sedation can last more than ten days (in 10% of cases) and even more than 20 days (in 3.4% of cases), even in reputable palliative care units. 9 The longer it goes, the more knowledge, skills, and humanism are required to deal with the wide range of physical, psychosocial, and spiritual issues that arise for staff and families. Not infrequently, experienced palliatives perform poorly in such situations, as I witnessed firsthand during workshops on “prolonged terminal sedation.”

Visit Humanism and Values.
Such “deep-seated personal convictions about one’s obligation to others—especially those in need” (humanism as defined in the commentary) have made Dutch physicians the most trustworthy physicians in the seven countries studied by the British Medical Journal, which included the United Kingdom (UK) and the United States (US), ten. At the same time, Belgium is second only to the UK in terms of palliative care activities. And, contrary to unfounded fears, there is no evidence of a slippery slope,7,11 no evidence that “vulnerable” people have been abused12, and requests for death are not less frequent among patients receiving palliative care rather than standard care.13
Assisted Suicide Editing
Dr. Boudreau is correct; this question is neither “exclusively axiologic” nor “exclusively humanistic,” but it is nearly so for both terms. “One’s opinion (about euthanasia) and personal sentiments depend, above all, on one’s own moral and religious convictions,”7 said Hon Baudouin (emphasis added; translation by author). “A tyranny sincerely exercised for the good of its victims may be the most oppressive…” wrote CS Lewis: “… those who torment us for our own good will torment us without end because they do so with the approval of their conscience.”

Humanism is also displayed unevenly by physicians. It has also been displaced by science and technology, with premedical marks becoming increasingly important at the admissions stage. Everyone understands that knowledge and skills are far easier to teach than personal values or attitudes. Students quickly learn to appreciate—and rate—great and lesser-known humanists who are all doing their best. Some cases will defy even the best end-of-life care. Humility does not humiliate. Finally, students will understand that euthanasia is not a choice between life and death but rather a personal decision about a personal death that should be respected.

William Osler would be perplexed about what “Whole Person Medicine” entails. Was there ever another goal for the faculty? Similarly, euthanasia modules and euthanatricians can only result from a misguided hyper-compartmentalization that suited Descartes but not Spinoza. 15

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