STELLARTON – There’s no black and white answers euthanasia or physician-assisted suicide, Dr. José Pereira told the more than 200 people who attended a palliative care conference in Stellarton on Friday.
Instead, the hotly-debated topic is slippery slope, said Pereira, the head of the Palliative Care division at the University of Ottawa. And often, the safeguards society puts into place is nothing but an illusion.
While euthanasia and physician-assisted suicide is not legal in Canada, other parts of the world have allowed it, most notably in Belgium, Holland and Switzerland, while some U.S. states, including Oregon, have introduced dying with dignity legislation over the past decade.
“It’s a very emotional and divisive topic,” Pereira said. “The argument for is sometimes very compelling – they say it’s a way to alleviate suffering and preserve dignity.”
But there’s far more to it than that, said Pereira, who worked in Switzerland for several years.
In 1937, Switzerland made suicide illegal – to the point that if someone attempted suicide and survived, they would face jail time, while the families of those who succeeded could face legal sanctions.
Assisted suicide became a loophole. If someone had nothing to gain from assisting suicide – such as an inheritance – it was permitted in certain strict cases, such as terminal illness.
Belgium introduced similar legislation in 2002, and by 2006, 14 per cent of non-acute deaths in the country were the result of euthanasia. Statistics also show that 1.6 per cent of euthanasia deaths are done without the explicit consent of the patient, Periera said, and Belgium is now allowing the euthanasia of demented persons.
“They’re breaking the rules they established just two years previously,” Pereira said.
“One of the reasons they legalized it in Holland and Belgium is so we can regulate it. But regulating everything is an illusion. Physicians who haven’t done things by the rules aren’t going to report it.”
Allowing assisted suicide in palliative care conflicts with the principles of palliative care and sends a double message, Pereira added.
“There are many myths around palliative care,” he said. “Still, sometimes, we have to convince patients and families that medications are safe and will not shorten life.”
Many people are also confused about what euthanasia actually means. Withdrawing or withholding futile treatment isn’t euthanasia, he explained.
“A lot of Canadians think euthanasia is the only way to avoid futile life-prolonging measures and the prolonging of suffering,” he said, but that’s simply not the case. He says better education is required to ensure Canadians know the difference.
The problem was highlighted in a 2009 survey of Quebec doctors, which showed 75 per cent of the doctors who responded supported legalizing euthanasia. But the same survey showed that many of the doctors who responded equated appropriate opioid use and withdrawing care with euthanasia.
“We really need to educate people better prior to the debate,” he said.
A similar study of palliative care patients saw 62 per cent report they think euthanasia should be an option, but only five per cent of those patients say they would ask for it today if legal.
“I believe we need to focus on that five per cent and the care they receive,”
Pereira said.
