Voluntary Euthanasia And Palliative Care – Dr. Ruth Nicholls

During my time of working with thousands of terminally ill patients, serious requests for euthanasia have been extremely rare. Most often any thoughts of euthanasia vanished once they realised the amount of support that can be offered, the availability of effective symptom control, reassurance given that life prolonging measures would not be pursued unless desired and that everything possible will be done to alleviate pain and suffering.
Families have consistently voiced their appreciation and have been helped in their grieving by the knowledge that they have been able to help care for their loved one until the end.
Often, when visiting people in their homes, their comments have included “I had no idea this amount of support was available, it is marvelous”.

Could voluntary euthanasia be a “logical follow-on from palliative care, as a complimentary medical procedure”? Could killing someone be truly called a medical procedure? 

In some instances symptom control can be very difficult to achieve and all stops have to be pulled out including consulting with specialists, looking up the latest research and searching the palliative care web sites from other nations, plus involving counselling and pastoral services to explore psycho-social issues.
How easy it would be, when symptoms become difficult, to say “it is now time to move on to the last “medical procedure”. All problems solved! 

Knowledge of symptom control has vastly improved over the last 24 years, thanks to medical research and the development of new drugs. At times patients in difficult situations have declared that they have “had enough”. However, with much effort on behalf of the palliative care teams, symptoms have been controlled and the patient has been able to continue living comfortably, accomplishing more of his/her goals and eventually dying a peaceful death in the presence of their loved ones. 

I wonder, if euthanasia was a legal option, whether this scenario would give way to an easier option, and whether advances in symptom control would have come so far. 

Gone are the days of having to tolerate all the side effects of morphine or put up with the pain, as there are now a wide range of drugs available. It is comparatively rare not to be able to find a medication that provides good pain control and is well tolerated. 

Symptoms due to dehydration can be managed using subcutaneous or intravenous fluids as appropriate. However, in the terminal stages of the dying process, the body itself compensates for lack of fluids, and thirst and other symptoms of dehydration are not a problem.

In palliative care no attempt is made to disguise the fact that the patient is dying. However we do come across people who do not want to discuss this or admit that their disease is terminal. At all times we would endeavour to consider the person’s wishes, not focusing on death and dying unless asked, and helping them to make the most of their remaining time.
If no more active or life prolonging measures are wanted they are supported in this. 
Over the years we have cared for an increasing number of terminally ill patients suffering from diseases other than cancer. These have included Motor Neurone Disease and other neurological disorders, end stage respiratory, heart and renal disease, AIDS and dementia.
Much research is being carried out into the palliative management of these diseases and ways of expanding the services to be able to care for more people with non-malignant disease.
Indeed to force unwanted treatment on a person is a criminal offence.
I can understand a person’s fear of futile medical treatment once quality of life has become intolerable. Every person has a right to refuse treatment and this should be taken into account within the legal framework. I also acknowledge that not everyone has a peaceful, symptom-free death. 
However, I believe that legalising euthanasia would be a disservice to society as a whole and many people would be disadvantaged, or even have their life shortened, when this would not have been their preferred option.


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