Last Updated: Friday - 09/24/2010
May 18, 2009
Do not mix palliative care and euthanasia
It would erode trust, distress patients, says Ottawa physician
CCN PHOTO | DEBORAH GYAPONG
Dr. Jose Pereira warned Catholic physicians about euthanasia's slippery slope
CANADIAN CATHOLIC NEWS
OTTAWA — If euthanasia or assisted suicide is legalized, do not allow it to be practised by palliative care units, said Ottawa’s palliative care director Dr. Jose Pereira.
Otherwise, people will think physician assisted suicide (PAS) is part of palliative care and a gateway to it, he warned.
Pereira told a conference of Catholic physicians in Ottawa May 8-10 the separation must be “crystal clear,” based on his experience working in Switzerland where assisted suicide (AS) is legal.
He also said AS or euthanasia must not be called “death with dignity” in any upcoming debate in Parliament, because “it implies there is no other form of dignified death.”
GHETTOS OF DYING
Mixing AS or PAS with palliative care is a source of considerable tension among hospital staff; it causes distress for patients and families; it erodes trust and creates “ghettos of dying,” he said.
At first, Swiss hospitals refused to participate in AS, but shortly before he arrived in Switzerland, hospitals began opening their doors to it, he said.
The Netherlands allows euthanasia and PAS; Belgium allows euthanasia; the United States allows PAS in some states; Luxembourg allows euthanasia and PAS; and Switzerland allows AS, he said. In Austria, however, euthanasia and PAS are illegal.
Switzerland’s AS law has attracted “suicide tourism,” he said.
“A slippery slope exists,” he said. Between 700 and 800 patients in the Netherlands have been euthanized without their consent, he said. Euthanasia of seriously malformed infants also occurs.
Though euthanasia is illegal in Switzerland, “people turn a blind eye to it.”
Also, AS is supposed to be limited to those with terminal illness and in intractable pain, but a recent study showed that more than 21 per cent of those who die of AS in the German cantons did not have a fatal illness, he said.
Legalization of AS and PAS reduces palliative care services, he said.
Sometimes time is needed to get to the bottom of emotional, psychological and spiritual pain that palliative care can address, he said.
He spoke of nursing homes in the United States and Japan where a large proportion of patients are hooked up to feeding tubes solely because no one on staff has the time to feed them by hand.
CHANGE OF HEART
One of his patients, who had pelvic cancer, grabbed his shirt after he treated him for an infection causing delirium and asked him why he had brought him back. Animals are treated better than this, he said.
This was a difficult patient, who saw no meaning in his life and wanted to end it. Pereira asked him to remember a time when he felt his life was worthwhile. The patient recalled service in the armed forces in Angola during the civil war there. He got separated from his unit for a week and managed to survive in hostile conditions.
“I guess I’m a survivor,” he thought.
He eventually was baptized into the Catholic Church before his death. Near the end, he told Pereira, “I’m glad you didn’t sedate me. These have been the best three months of my life.”