A study published on bmj suggests that it is possible for proponents of euthanasia legalization and advocates of better palliative care services to work together for a common good.

Researcher Jan Berheim (End-of Life Care Researcher Group of the Vrije Universiteit Brussel) and colleagues write that the two prevailing schools of antagonistic and differing attitudes regarding palliative care and euthanasia fail to recognize that they are, "Both based on medical and ethical values of patient autonomy and caregiver beneficence and non-maleficence."

Euthanasia is the practice of using medicine to assist death, and palliative care is an approach to treatment designed to reduce the severity of disease symptoms instead of curing the disease or delaying its progression.

The researchers conducted a historical review of regulatory and epidemiology evidence from Belgium - the second country to decriminalize the practice of euthanasia (in 2002). Belgium also places third, after Iceland and the UK, in rankings of the best palliative care systems.

Berheim and colleagues point out that in Belgium, euthanasia and palliative care practices have actually helped each other. In one direction, the political and social movement to legalize euthanasia prompted the development of palliative care. In the other direction, the fact that sufficient palliative care was obtainable led to ethical and political acceptance that enabled then legalization of euthanasia.

The development of these two movements, according to the authors, developed coincidentally with shared workers, and this is one reason that the debate in Belgium was not caustic. The debate about euthanasia grew side-by-side with provisions for palliative care.

The researchers failed to find evidence of increased harm to vulnerable patients or disabled people due to the legalization of euthanasia. In addition, although The European Association for Palliative Care expressed concern, legalization did not stop the development of palliative care in Belgium. As the law became closer to being enacted, reports of secret physician-assisted dying and other ethically disputable practices actually declined.

The view among advocates of euthanasia in Belgium was that palliative care complements euthanasia instead of competing with it. Euthanasia is seen as an option at the end of the palliative care pathway, focusing on the preferences of the patient.

Support for palliative care is seen in the euthanasia law that was passed in Belgium. The law mandates that patients who are interested in euthanasia must be informed about potential palliative care, and at the same time the law was passes, a second Act was passed that doubled public funding for palliative care and guaranteed the right to palliative care in every hospital, nursing home, and even at home.

The researchers argue that, "The process of legalisation of euthanasia was ethically, professionally, politically, and financially linked to the development of palliative care."

"The societal debates made clear that most values of palliative care workers and advocates of euthanasia are shared. If Belgium's experience applies elsewhere, advocates of the legalisation of euthanasia have every reason to promote palliative care, and activists for palliative care need not oppose the legalisation of euthanasia," conclude the authors.

Development of Palliative Care and Legalisation of Euthanasia: antagonism or synergy?
Jan L Bernheim, Reginald Deschepper, Wim Distelmans, Arsène Mullie, Johan Bilsen health scientist
BMJ. Vol 336. pp 864. (April 2008)
Click Here to See Article Online

: Peter M Crosta