Last Updated: Friday - 09/24/2010

Intractable pain not top reason for assisted suicide

Sr. Nuala Kenny

OTTAWA - Contrary to the prevailing view, most people seeking assisted suicide or euthanasia are not experiencing unmanageable physical pain or other medical symptoms such as seizures.

"The general public perception is that people are requesting assisted death because they are in physical pain that is just unacceptable," said Sister Nuala Kenny, professor emeritus of bioethics at Dalhousie University.

"There is no significant association between the desire for hastened death and either the presence of pain or pain intensity," she said.

Kenny, who now serves as the ethics and health policy advisor to the Catholic Health Alliance of Canada, recently concluded a review of the medical literature.

Most requests for assisted death spring from fear: of future pain rather than actual perceived pain, of loss of control, of loss of autonomy, of being a burden and of loss of dignity, Kenny said.

ANGUISH OF THE SOUL

Depression and hopelessness have been found to be significant contributors to desires for hastened death, she said. In general, when a patient is treated for the depression, the request for an assisted death is withdrawn.

Kenny said if a patient is asking to end his or her life because of physical pain, usually the doctors address the symptoms and manage the pain. "When it comes to hopelessness, or existential suffering, there is nothing medical they know how to do, so they comply with the request," she said.

Where assisted death is illegal, doctors are more likely to look for the reasons for the request and try to remove the pain symptoms. "If it is legal, they don't go to the reasons for the request," she said. "The attention is shifted from the 'Why?' to 'Have we fulfilled every judicial requirement?'"

Kenny noted most reports of those who assist the suicide of a loved one are painted in a heroic light. "The heroism of those who accompany the dying to natural death is rarely applauded."

In the Netherlands, there is a debate over whether "life fatigue" is a legitimate justification for assisted death.

"There are people giving up on life for a wide variety of reasons," Kenny said, noting some people argue, "Who are we to say that life fatigue isn't just as intolerable as serious symptoms of metastasizing bone cancer?"

DEFINE SUFFERING

If people attempt to justify assisted suicide in order to relieve suffering, rather than physical pain, then they are abandoning the need for an objective medical assessment, she said. They have, in effect, turned suffering into a medical condition.

Kenny said Bloc Quebecois MP Francine Lalonde's assisted suicide and euthanasia Bill C-384 permits this kind of subjective assessment of suffering unrelated to end of life care. Kenny said Catholics should contemplate the meaning of suffering in light of the paschal mystery. She noted God the Father did rescue Jesus from the suffering he endured in the Garden of Gethsemane.

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