Palliative Care (PC) and Medically Assisted Death (MAD), specifically assisted suicide and euthanasia, are distinct practices characterized by differing objectives, methods, implementation and outcomes. Representatives of PC, including scientific societies or physicians, may, in certain cases, adopt a critical stance towards MAD.
Objectives
The study aims to explore the underlying reasons for such opposition.
Methods
To this end, the philosophical underpinnings and legal conditions of PC and MAD will be analyzed.
Results
The ethical and philosophical landscape of PC and MAD leads us to identify, on one hand, the Hippocratic paradigm and, on the other hand, what we call Socratic medicine. From a legal analysis perspective, the presence of intolerable suffering serves as a common ground between the two practices, albeit risking being the subject of misunderstandings and instrumental objections.
Conclusion
Preventing an instrumental use of PC in relation to MAD is crucial to enable the respect and the coexistence of the two practices.
SepúlvedaCMarlinAYoshidaTUllrichA. Palliative care: the World Health Organization’s global perspective. J Pain Sympt Manage. 2002;24:91-96.
2.
World Health Organization: National Cancer Control Programs. Policies and Managerial Guidelines. 2nd ed.Geneva: WHO; 2002.
3.
CasonatoC. Il Principio di autodeterminazione. Una modellistica per inizio e fine vita. Osservatorio Costituzionale; 2022.
4.
CostituzionaleCStudiSDiritto ComparatoAdi, Decisioni di fine vita ed ausilio al suicidio, a cura di P. Passaglia, settembre; 2019.
5.
D’AndreaR. Alcune osservazioni sullo stato di avanzamento degli ordinamenti giuridici europei che prevedono l’eutanasia e/o il suicidio assistito. BioLaw Journal. 2022;4:301-319.
6.
LewisPBlackI. Reporting and scrutiny of reported cases in four jurisdictions where assisted dying is lawful: a review of the evidence in The Netherlands, Belgium, Oregon and Switzerland (july 8, 2013). Med Law Int. Online ahead of print.
7.
GriffithsJWeyersHAdamsM, eds. Euthanasia and Law in Europe. Oxford; 2008.
8.
Belgian Act on Euthanasia of May, 28th 2002, article 3 §1 (Loi du 28 mai 2002 relative à l’euthanasie: «le patient se trouve dans une situation médicale sans issue et fait état d’une souffrance physique ou psychique constante et insupportable qui ne peut être apaisée et qui résulte d’une affection accidentelle ou pathologique grave et incurable»). AccessedAugust 11, 2023. https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/loi20020528mb_frnl.pdf
LuxembourgishEuthanasia and assisted suicide Act. article 2 §1.3 (Loi du 16 mars 2009 sur l'euthanasie et l'assistance au suicide: «Le patient se trouve dans une situation médicale sans issue et fait état d'une souffrance physique ou psychique constante et insupportable sans perspective d'amélioration, résultant d'une affection accidentelle ou pathologique»); 2009. AccessedAugust 11, 2023. https://legilux.public.lu/eli/etat/leg/loi/2009/03/16/n2/jo
Canadian Society of Palliative Care Physicians (CSPCP), Position on Euthanasia and Assisted Suicide; 2015. https://www.chpca.ca/
15.
RadbruchLLegetCBahrP, et al.Euthanasia and physician-assisted suicide: A white paper from the european association for palliative care. Pall Med. 2015:1-13. doi:10.1177/0269216315616524.
16.
BernheimJLDeschepperRDistelmansW, et al.Development of palliative care and legalization of euthanasia: Antagonism or synergy?BMJ. 2008;336:864-867.
17.
Vanden BerghePMullieADesmetM, et al.Assisted dying - the current situation in Flanders: Euthanasia embedded in palliative care. Eur J Palliat Care. 2013;20:266-272.
18.
DierickxSDeliensLCohenJChambaereK. Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study. Palliat Med. 2018;32(1):114-122.
19.
DerekDHanksGWCMacDonaldN. Oxford Textbook of Palliative Medicine. Edition Oxford University Press; 1998, 97-138.
20.
TurrizianiZaninettaAG. Il mondo delle cure palliative. Manuale per giovani medici; 2019, 336-347.
21.
OrsiL. Differenze e rapporti fra Cure Palliative e Morte Medicalmente Assistita. Per favore, non facciamo confusione! In Responsabilità medica, Gennaio-Marzo; 2022:49-52.
22.
Platone. Fedone, traduzione italiana di M. Valgimigli, Laterza; 1971:116-118.
23.
PatuzzoS. Storia del Codice italiano di deontologia medica. Dalle Origini Ai Giorni Nostri. Torino: Minerva Medica; 2014:21-22.
ParkSo-JAhnHKAhnHYHanK-TKwangIC. Association between continuous deep sedation and survival time in terminally ill cancer patients. Support Care Cancer. 2021;29:525-531.
26.
MercadanteSIntravaiaGVillariPFerreraPDavidFCasuccioA. Controlled sedation for refractory symptoms in dying patients. J Pain Symptom Manage. 2009;37:771-779. doi:10.1016/j.jpainsymman.2008.04.020.
27.
PradoBLGomesDBDUsón JúniorPLS, et al.Continuous palliative sedation for patients with advanced cancer at a tertiary care cancer center. BMC Palliat Care. 2018;17(1):13. doi:10.1186/s12904-017-0264-2.
28.
OrsiLIl punto di vista di un medico rispetto alla sentenza n. 242/2019 della Corte costituzionale, 2/2020. La Nuova Giurisprudenza Civile Commentata, 424-430.
29.
DaviesHM. Suffering difficult to define, difficult to identify and difficult to relieve. Eur J Palliat Care, 2012;19(2):438.
30.
RoyDJ. We all die unfinished: a meditation on existential suffering. J Palliat Care. 2015;31(1):3-4. doi:10.1177/082585971503100101.
31.
FerrandEDreyfusJFChastrusseM, et al.Evolution of requests to hasten death among patients managed by palliative care teams in France: a multicentre cross-sectional survey (DemandE). Eur J Cancer. 2012;48:368-376.
32.
OhnsorgeKGudatHRehmann-SutterC. Intentions in wishes to die: Analysis and a typology – a report of 30 qualitative case studies of terminally ill cancer patients in palliative care. Psycho Oncol. 2014;23:1021-1026.
33.
GuirimandFDuboisELaporteL, et al.Death wishes and explicit requests for euthanasia in a palliative care hospital: an analysis of patients files. BMC Palliat Care. 2014;13:53.
34.
RadbruchLLegetCBahrP, et al.Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliat Med. 2016;30(2):104-116. doi:10.1177/0269216315616524.
35.
SaundersC. Selected Writings 1958-2004. Oxford: Oxford University Press; 2006.
36.
ClarkD, ed. Cicely Saunders Founder of the Hospice Movement. Selected Letters. Oxford: Oxford University Press; 2002:21-22.
