Modern-day palliative care approaches and hospices have made it such that uncontrolled symptoms at the time of death are rare, writes Chris Garrett
Caesar Augustus died peacefully at the age of 75 in the arms of his third wife Livia; unusual for that time given the bloody and traumatic deaths of some other Roman emperors. His passing was described using a Greek work: eu-thanos, a ‘good death’.
The original meaning of ‘eu-thanos’ or euthanasia changed in the late 1800s from its initial meaning of a peaceful and pleasant death to deliberately bringing death about in order to ostensibly reduce suffering.
This direct inducing of death medically by health professionals to this day has a strongly negative connotation with people. So much so that only five countries (Switzerland, the Netherlands, Luxembourg, Belgium and Colombia) have legalised euthanasia, i.e. doctors administering lethal doses of medicine in order to end a person’s life. Three additional countries, or some territories within those countries, have legalised physician-assisted suicide (PAS) (United States, Canada, and Australia). This is deemed to be more palatable to some people as it puts the final control in the hands of the patient. Unfortunately, it coopts the medical system by lending a patina of respectability to suicide; something for centuries has been discouraged for the societal good.
Code of ethics
So how did it come about that some physicians have gone against their ancient code of ethics, the Hippocratic Oath, specifically “I will abstain from all intentional wrong-doing and harm”, which inducing death clearly is? Legalising euthanasia and PAS has been aggressively advocated by over 50 well-funded national and international organisations.
These organisations have appealed to the sympathy of the public by purporting to relieve suffering and pain of patients who were terminally ill, even using titles in the legislation such as ‘Death with Dignity’ and ‘Compassion and Choices’. These advocacy groups have suggested that all of us risk a painful death unless the option of suicide is made legally available to us. Popular media such as film and literature have painted euthanasia and PAS in a romantic and positive light.
People should advocate for adequate palliative care and hospice resources be made available”
The truth is completely different. Modern day palliative care approaches and hospice infrastructure have made it such that uncontrolled symptoms at the time of death are rare and are usually related to inadequate provision of medical services.
Emerging data from countries regarding their experience with euthanasia and PAS is now showing increasing numbers of patients with non-terminal illnesses, particularly psychiatric conditions, are availing of suicide or euthanasia as an alternative to standard medical care.
Research studies have shown that physicians who are the least confident in palliative care and managing end-of-life symptoms are the most likely to support physician-assisted suicide.
Unfortunately, with the aging population, due to the post World War II baby boom generation, there will be fiscal pressures favouring putting patients and the elderly under duress to terminate their own lives for financial expediency. Advocacy groups for euthanasia and PAS will not admit it but their goals have little to do with alleviating suffering but are more to do with allocation of limited resources and population control. Suicide is not ‘death with dignity’ but death with neglect and without love.
Is legalisation of suicide, physician-assisted suicide, inevitable in Ireland? With the significant progress in Ireland in suicide awareness and prevention by state agencies and organisations, the legalisation of suicide, in whatever form or manner, would be a terribly regressive step for our society.
Although no such legislation has been proposed in Ireland to date, the worldwide trend towards legalisation of some forms of suicide means that it is almost inevitable that it will occur in the future.
Physicians and the public must push back against any such attempts. People should advocate for adequate palliative care and hospice resources be made available to the public for the ethical and proper care of those who need it. Patient education and our popular culture should reflect the truth that medicine does have the means to care for people and control symptoms at the end of life.
Any abandonment of patients by means of laws encouraging a medicalised pharmaceutical death should remain illegal and countered by Irish pro-life organisations. Physician conscience laws should be enacted to prevent interference with the doctor-patient relationship and making physicians actions controlled by state policies; patients need to advocate for these with their legislators.
High priority goal
Large, well-funded, extranational agencies have made world-wide legalisation of suicide, coopting the medical profession in the process, a high priority goal, and will no doubt eventually advocate in Ireland.
As a society, we have to make it clear that we support and care for our citizens and that we remain committed to continued suicide prevention in all situations. In that way we can truly have death with dignity.
Dr Chris Garrett was born and raised in San Francisco; he is a dual national and completed his secondary school studies at St Andrews College, Booterstown) and his university education at University College Dublin (Medicine, 1988). After three year’s Haematology and Oncology house officer training in Dublin, he completed his subspecialty training at the Mayo Clinic (Rochester, Minnesota). He practiced academic medical oncology and clinical research for 28 years in the US, most recently as Professor of Oncology at the University of Texas MD Anderson Cancer Centre (Houston, Texas).
In 2012 he received a licentiate in bioethics from the Pontifical Athenaeum Regina Apostolorum (Rome) and has previously served on the MD Anderson Clinical Bioethics Consultation Committee.
Presently he is discerning a vocation to the priesthood through the diocese of Elphin and has completed a propaedeutic year at the Royal Scots College (Salamanca). He is currently in his second-year of studies at St Patrick’s National Seminary (Maynooth).
His clinical research interests included the study of investigational monoclonal antibodies and small molecule receptor tyrosine kinase inhibitors, natriceuticals and the role diabetes plays in colorectal cancer outcomes, in addition to ethical issues associated with prenatal screening, chemotherapy in pregnancy, and end-of-life care.
He is one of the speakers at the Irish Catholic Doctors Learning Network Conference on October 5. Visit www.icdln.ie for more information.