Development of palliative care and legalisation of euthanasia: antagonism or synergy?

Dear Editor

We are writing in response to the article by Bernheim et al. (1) The authors suggest that palliative care and euthanasia are not ‘antagonistic’ but in fact compatible and 'if Belgium’s experience applies elsewhere . . . .palliative care need not oppose the legalisation of euthanasia'. However, their model ‘grew up side by side’ and is unlikely to be transferable to the UK.

The Association for Palliative Medicine in the UK surveyed its members (doctors who work in hospices and specialist palliative care) in 2007 to ask if “they believed that with improvements in palliative care, good clinical care can be provided within existing legislation and that patients can die with dignity” – 94 % agreed. (2) Furthermore, when asked whether, if legislation allowed, would they personally be prepared to participate actively in a process to enable a patient to terminate his or her life, only 3% were prepared to do so. Thus, UK palliative care doctors who are likely to be seeing some patients with extreme distress, view euthanasia very differently to those working in Belguim. Whilst Bernheim et al found “indicators of reciprocity” in the development of palliative care and the legalisation of euthanasia in Belgium, these results suggest that doctors working in palliative care within the UK are unlikely to work “synergistically” with those potentially practising euthanasia.

The authors argue that legalising euthanasia does not impede the development of palliative care, yet a recent publication in the BMJ about terminal sedation at the end of life in the Netherlands revealed that only 9% of these patients were reviewed by a palliative care team.(3) Although palliative care services may be ‘developed’ in countries that have legalised euthanasia, this study suggests they are not being appropriately used.

Lastly, the history of palliative care in the UK is different from that in Belgium. The hospice movement originated outside the National Health Service and many parts of the service are funded by charitable donations. The effect of euthanasia and palliative care being ‘developed’ together could be detrimental to patient care; would donations be given to institutions that actively terminate lives of patients?

Whilst we hope this article will increase societal debate and increase the provision for palliative care in the UK to improve end of life care for patients, the Belgian model is unlikely to be a transferable to the UK.

1. Bernheim JL, Deschepper R, Distelmans W, Mullie A, Bilsen J, Deliens L. Development of palliative care and legalisation of euthanasia: antagonism or synergy? British Medical Journal 2008; 336: 864-867

2.www.apm.co.uk (accessed 19.04.08)

3. Rieriens J, van Delden J, Onwuteaka-Philipsen B, Buiting H, van der Maas P, van der Heide A. Continuous deep sedation for patients nearing death in the Netherlands: a descriptive study. British Medical Journal 2008; 336: 810-813

Competing interests: None declared