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. 2001 Oct 6;323(7316):809.

Euthanasia

Euthanasia already exists

Jeremy Dearling 1
PMCID: PMC1121350  PMID: 11669082

Editor—Emanuel misses the point in his editorial about euthanasia.1 The question is not “Should we debate whether to legalise euthanasia?” Euthanasia already happens, and is widely supported.2–5 The question is “Should we regulate existing practice using the Netherlands model?”

References

  • 1.Emanuel EJ. Euthanasia: where the Netherlands leads will the world follow? BMJ. 2001;322:1376–1377. doi: 10.1136/bmj.322.7299.1376. . (9 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Grassi L, Agostini M, Magnani K. Attitudes of Italian doctors to euthanasia and assisted suicide for terminally ill patients. Lancet. 1999;354:1876–1877. doi: 10.1016/s0140-6736(99)04194-x. [DOI] [PubMed] [Google Scholar]
  • 3.Shah N, Warner J, Blizard B, King M. National survey of UK psychiatrists' attitudes to euthanasia. Lancet. 1998;352,9137:1360. doi: 10.1016/S0140-6736(05)60751-9. [DOI] [PubMed] [Google Scholar]
  • 4.Tijmstra TJ, Kempen GI, Ormel J. [End of life and termination of life: opinions of elderly persons with health problems.] Ned Tijdschr Geneeskd. 1997;141:2444–2448. . (In Dutch.) [PubMed] [Google Scholar]
  • 5.Ward BJ, Tate PA. Attitudes among NHS doctors to requests for euthanasia. BMJ. 1994;308:1332–1334. doi: 10.1136/bmj.308.6940.1332. [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2001 Oct 6;323(7316):809.

Figures for “slow euthanasia” should be included in data on physician assisted suicide

Michael H K Irwin 1

Editor—Emanuel is mistaken in stating that “if the objective is to improve the quality of care at the end of life then the battle over legalising euthanasia is an emotionally charged irrelevance.”1-1 In my view, physician assisted suicide and voluntary euthanasia are a matter of personal choice and human rights. Having these options is extremely important for many individuals (including, I suspect, many BMJ readers) and should not be lightly disregarded as a minority issue. Legalising them would make the prospect of palliative care more acceptable to many terminally ill patients.

It is essential, when considering physician assisted suicide and voluntary euthanasia, to discuss the practice of “terminal sedation” or “slow euthanasia,” which is knowingly performed in hospitals, nursing homes, hospices, and private homes throughout the world. This is carried out under the doctrine loosely described as double effect, by which a doctor may lawfully give increasing doses of regular analgesic and sedative drugs that can hasten someone's death as long as the declared intention is to ease pain and suffering.

Of course, the key word here is “intention.” Doctors may, without publicly declaring the true purpose of their action, respond to a terminally ill patient's request and speed up the dying process in this way. From surveys in the Netherlands, Australia, and Belgium we know that “the alleviation of pain and symptoms with opioids in doses with a potential life-shortening effect” caused 19%, 31%, and 19% of all deaths in these countries respectively.1-2

If we acknowledge the existence of voluntary slow euthanasia then at least some of these deaths (perhaps at least a quarter, according to the Belgian figures) should have been added to the comparatively low figures for physician assisted suicide and voluntary euthanasia that Emanuel quotes.

References

  • 1-1.Emanuel EJ. Euthanasia: where the Netherlands leads will the world follow? BMJ. 2001;322:1376–1377. doi: 10.1136/bmj.322.7299.1376. . (9 June.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Deliens L, Mortier F, Bilsen J, Cosyns M, Vander Stichele R, Vanoverloop J, et al. End-of-life decisions in medical practice in Flanders, Belgium: a nationwide survey. Lancet. 2000;356:1806–1811. doi: 10.1016/s0140-6736(00)03233-5. [DOI] [PubMed] [Google Scholar]

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