Pasterfield et al, looking at GPs' views on changing the law on physician-assisted suicide and euthanasia, end with a question.1 Why are most GPs opposed to changing the law whereas patients largely are seen to support such a measure? To this I would add a further question. Why are a larger percentage of palliative care doctors opposed to such a change than GPs?2,3 If one sees these two questions as being linked, an obvious hypothesis emerges. The hypothesis is that increasing experience of good palliative care is associated with the belief that legally allowing euthanasia is unnecessary and potentially dangerous.
Many of us will remember cases of appalling palliative care while in our house officer years. Hearing comments of families in the lead up to the Joffe Bill debate illustrates that many such bad stories are also in the public domain. As a GP, the benefits of good palliative care to my patients and their families rapidly became apparent. These good stories, however, are not media big sellers. As a result, a balanced view on end of life care is only available to a privileged few. We as GPs are able to experience this to a degree, often depending on how well resourced our local palliative care services are. Palliative care clinicians, on the other hand, live these stories with their patients on a daily basis.
As doctors we have a unique insight into the dangers of legalising euthanasia. Many of us will have been in a position where we have been directly or indirectly asked to end a patient's life. However, once the reason behind the request has been identified and addressed, the request is usually withdrawn. Palliative care clinicians, who meet these requests more frequently, tell me that their most common experience is the same. As GPs and palliative care clinicians we see errors in prognosis and diagnosis. We see the use of time as a therapeutic tool: patients who once wished themselves dead, are glad to be alive. We see how tired families can become caring for a loved relative, so that death can seem like a welcome release, not so much for the patient, but for the family.
Does exposure to good palliative care result in opposition to legalised euthanasia? Is it worth further research? I think so.
- © British Journal of General Practice, 2006.