State of Palliative Care Development in European Countries with and without Legally Regulated Physician-Assisted Dying

Bernheim, Jan L.; Chambaere, Kenneth; Theuns, Peter; Deliëns, Luc

doi:10.12966/hc.02.02.2014

Cited by 12 publications

(8 citation statements)

References 33 publications

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“…En este trabajo se tomarán como referencia las definiciones consensuadas por la Asociación Europea de Cuidados Paliativos (EAPC, por sus siglas en inglés "European Association for Palliative Care") 26 , que se describen en la Tabla 1. Para efectos de este trabajo, el concepto de MMA incluye ambas prácticas, eutanasia y suicidio médicamente asistido (SMA), acorde a la terminología ampliamente utilizada en investigación relacionada 14,[27][28][29][30] . Si bien existen considerables diferencias conceptuales y éticas entre estas prácticas 31 , estas no son relevantes para el argumento central a discutir en este trabajo.…”

Section: Definicionesunclassified

Legalización de muerte médicamente asistida: discusión sobre el potencial impacto en el desarrollo de cuidados paliativos

Micolich²

2020

Rev. méd. Chile

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Legalization of medically assisted death: its potential impact on the development of palliative care In Chile, there are four bills to legalize euthanasia, an act which public surveys report as supported by most of the population. At the legislative, healthcare and social level, there is an active debate about euthanasia, the rights of terminally ill patients and the context of Palliative Care (PC) in the country. Chilean literature on euthanasia focuses mainly on the ethical analysis of the act itself but does not address the moral legitimacy of the legalization of this practice. This distinction is relevant since the probity of a particular action does not determine the moral legitimacy of its implementation at a public policy level. One aspect of this dimension is the potential negative impact of the legalization of physician-assisted death (PAD) on the development of PC services. This issue is particularly relevant in Chile, where PC provision is currently suboptimal and mostly restricted to cancer patients. This paper analyses available evidence on the potential impairment of PC development after PAD legalization. Although the analysis of evidence has some limitations, this concern is not supported by the available evidence. However, any project about PAD legalization must contemplate a factual commitment with the development of minimum PC provision, according to international recommendations.

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Section: Definicionesunclassified

Legalización de muerte médicamente asistida: discusión sobre el potencial impacto en el desarrollo de cuidados paliativos

Micolich²

2020

Rev. méd. Chile

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“…According to all seven available indicators of the state of development of PC, Belgium and the Netherlands are roughly on a par with the UK, the benchmark country where PC has the longest history 21. They are well ahead of Germany, France and Spain, countries where, as in the UK, euthanasia is illegal 22. Euthanasia was depenalised only after Belgium's level of development of PC had become high1 22 and figure 2 shows that PC's expansion, which is by law demand-driven, has since continued unabated at a rate of 10% per year 21.…”

Section: Characteristics Of the Belgian Modelmentioning

confidence: 99%

“…They are well ahead of Germany, France and Spain, countries where, as in the UK, euthanasia is illegal 22. Euthanasia was depenalised only after Belgium's level of development of PC had become high1 22 and figure 2 shows that PC's expansion, which is by law demand-driven, has since continued unabated at a rate of 10% per year 21. In sum, there may still be room for improvement, but none of the pragmatic fears of opponents has materialised.…”

Section: Characteristics Of the Belgian Modelmentioning

confidence: 99%

Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care

Bernheim

Raus

2017

J Med Ethics

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The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects. It is problematic that some critics disregard the empirical evidence as epistemologically irrelevant in a normative ethical debate. Next, rejecting euthanasia because its prevention was a founding principle of PC ignores historical developments. Further, critics' ethical positions depart from the PC tenet of patient centeredness by prioritising caregivers' values over patients' values. Also, many critics' canonical adherence to the WHO definition of PC, which has as the ethical criterion is objectionable. A rejection of the Belgian model on doctrinal grounds also has nefarious practical consequences such as the marginalisation of PC in euthanasia-permissive countries, the continuation of clandestine practices and problematic palliative sedation until death. In conclusion, major flaws of essentialistic arguments against the Belgian model include the disregard of empirical evidence, appeals to canonical and questionable definitions, prioritisation of caregiver perspectives over those of patients and rejection of a plurality of respectable views on decision making at the end of life.

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“…There are no indications that good medical care will prevent all requests, what is to be seen is that in spite of good care, a good share of the patients nevertheless will want to orchestrate the end of their life in order to remain in charge of accepting the level of their suffering. Lack of palliative care is not a reason in the Netherlands; in general in countries allowing PAD, the level of palliative care is as good or better as elsewhere [52]. Furthermore, it has become clear that people with serious but not terminal diseases have different opinions on the relationship between their suffering and the timing of their deaths.…”

Section: Clinical Pragmatic Argumentsmentioning

confidence: 99%

Ethical Issues of the Practice of ‘Medicide, Suicide and Laicide’ in the Netherlands after the Euthanasia Law of 2002

Gk¹

2015

J Clinic Res Bioeth

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In June 2015 a proposed framework has been published on developments in the way people die in the Netherlands after both regulations (since 1997) and a `Euthanasia Law' (since 2002) made it possible to help people die without repercussions for physicians. This framework with the central terms 'medicide, suicide and laicide' was intended as a descriptive model with a focus on the main actors (physicians, people themselves and non-medical/ family persons) and actions in the area of end-of-life decision-making. The following article elaborates on this descriptive model, described here in brief, with the aim to investigate ethical aspects of the current practice in the light of the past ethical arguments in favor or against physician-assisted dying (PAD) and reexamine their significance in the light of this practice and its empirical research over almost 20 years.

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State of Palliative Care Development in European Countries with and without Legally Regulated Physician-Assisted Dying

Cited by 12 publications

References 33 publications

Legalización de muerte médicamente asistida: discusión sobre el potencial impacto en el desarrollo de cuidados paliativos

Legalización de muerte médicamente asistida: discusión sobre el potencial impacto en el desarrollo de cuidados paliativos

Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care

Ethical Issues of the Practice of ‘Medicide, Suicide and Laicide’ in the Netherlands after the Euthanasia Law of 2002

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