Legalising Euthanasia and/or Physician Assisted Suicide: Implications for Palliative Care Providers

Abstract

This study researched the implications for and the views of palliative care providers should euthanasia and/or physician assisted suicide (PAS) be legalised. In order to contextualise this study global developments with regard to the legalisation of euthanasia and legislation were examined, followed by a review of the New Zealand history of significant cases and legislative attempts. A structured literature review of the opinions of palliative care nurses and doctors (internationally) revealed that the majority were not in favour of legalising life-shortening treatments. This response was also reflected in the literature review of general practitioner opinion in jurisdictions where these practices are not legal, (with the exception of Canada and the Netherlands). Studies of general practice involvement in the Netherlands and Belgium since legislation revealed more support, but also the stressful nature of such involvement. Data was gathered through interviews with New Zealand hospice nurses, physicians and general practitioners. New Zealand participants expressed concerns with regard to patients from vulnerable populations. Concern was also expressed regarding lost opportunities for emotional and spiritual growth and healing if patients’ lives were foreshortened. Participants anticipated personal and professional dilemmas should euthanasia be legalised – especially with respect to palliative care philosophy and patient autonomy. While a minority of participants were ambivalent about legislation, with one supportive, all were clear that euthanasia and PAS have no place as treatment options within palliative care. Participants felt that the symptom-management nature of hospice and palliative care was not widely understood by the public. These concerns were juxtaposed against the experiences of hospice nurses and physicians, working in hospices in Oregon and Washington States; both states legally allow PAS. The hospices, at which interviews took place, do not participate in the provisions of the Death with Dignity Acts. American data gathered revealed vital nature of ethics education and personal support for staff when patients chose both hospice care and PAS. This was particularly important when staff’s personal opinions, with regard to legislation, diverge from that of their employing facility. This research concludes that palliative care professionals have an important contribution to make to the current New Zealand legislation debate.