International Hospice and Palliate Care body statement - lessons for Victoria

In January this year, the International Association for Hospice and Palliative Care published their position statement on euthanasia and assisted suicide in the Journal of Palliative Medicine.

The association sought to explain the process they undertook to arrive at this statement and their reasoning in an expansive journal article.

Some key points:

Result: IAHPC believes that no country or state should consider the legalization of euthanasia or PAS until it ensures universal access to palliative care services and to appropriate medications, including opioids for pain and dyspnea.

This is a reflection on the problem of Unmet Need, discussed at length in the document:

"Throughout the world, many patients present to their healthcare system late, when their disease is advanced and therapies to control it are frequently ineffective. Tragically, although the knowledge and skills to control pain and diminish suffering exist, most of the world's population has no access to palliative care. The greatest need is in low- and middle-income countries, where 78% of adults in need of palliative care live and healthcare resources are the scarcest."

Comment: legal euthanasia & assisted suicide in places - even in Australia - where access to palliative care is non-existent or limited, should never be considered. There is no real choice when good care is not available. To enact euthanasia or assisted suicide in such circumstances is a form of discrimination.

Conclusion: In countries and states where euthanasia and/or PAS are legal, IAHPC agrees that palliative care units should not be responsible for overseeing or administering these practices. The law or policies should include provisions so that any health professional who objects must be allowed to deny participating.

Comment: Conscientious objection is discussed int he paper circulated recently by the Victorian Premier's advisory committee. It is far from clear whether practitioners will have the ability to opt out. Nor is it clear whether palliative care units and specialist centres will also be free to decline.

The IAHPC asserts the following:

- Withholding or withdrawing ineffective, futile, burdensome, and unnecessary life-prolonging procedures or treatments does not constitute euthanasia or PAS because it is not intended to hasten death, but rather indicate the acceptance of death as a natural consequence of the underlying disease progression.

– In some countries, voluntary euthanasia, nonvoluntary euthanasia (the patient is unable to consent), or involuntary euthanasia (against the person's will) are all recognized as forms of euthanasia. However, the IAHPC believes that nonvoluntary or involuntary forms of euthanasia should not be recognized and must never be permitted.

– Palliative sedation—sedation intended to relieve refractory distress of a dying patient and not to hasten death—is not euthanasia or PAS. Distinguishing palliative sedation from euthanasia and PAS is based on the ethical principles of beneficence (duty to alleviate suffering) and nonmaleficence (duty to prevent or avoid harm). It shoud never be used with the intention to shorten life.

Comment: This last statement destroys the false assertion by the likes of Andrew Denton that palliative sedation is a form of 'slow-euthanasia'.

You can download the full document HERE.

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