Premature closure of the debate

Downar and colleagues¹ are premature in their assertion that the “Yes or No” debate about euthanasia and physician-assisted death is over.

As the authors note, last August the Canadian Medical Association (CMA) voted against a change in its policy, which opposes physician-assisted death. The CMA’s blog on this issue is running at least two to one against physician-assisted death; an even larger proportion of Downar’s palliative care colleagues are opposed.² Whatever the courts may decide, apparently, the majority of Canadian physicians are unwilling to participate in physician-assisted death or euthanasia.

Downar and colleagues¹ provide a comprehensive list of the controversies that may arise should physician-assisted death be legalized in Canada. I wish to respond to 2 of the 13 questions in the list:

“How can we protect the vulnerable?” We can’t. It’s too short a step from believing that one might choose physician-assisted death to believing that it should be chosen; the vulnerable will inevitably feel a sense of coercion.

“How can we ensure that physician-assisted death will not be considered a low-cost alternative to palliative care?” We can’t. Despite the experience in Oregon in this regard, the much larger experience in the Netherlands has been an untoward delay in the development of palliative care services.³ When faced with a difficult palliative case, it’s just too easy to say, “Why bother?”

This debate is not over. For the sake of our most vulnerable patients, and for the sake of our colleagues, especially our youngest colleagues, we must persevere.