At last some sensible research in the never-ending and subjective
debate into euthanasia and end of life care. I was pleased to see that
they have considered the idea of 'unbearable suffering' in some detail.
I think that as doctors we so often focus on 'sanctity of life' above
all other concepts and are sometimes keen to pursue treatements beyond all
hope of cure. It is not surprising, given our training and the pervasive
public view that the aim of medical treatment is to prolong life at all
cost. Recent articles have talked about how poor doctors are at discussing
'do not resuscitate' decisions; we are worse yet still at promoting 'good'
deaths- a comfortable end to life.
This research coming out of the Netherlands, which allows euthanasia
under strict regulations, shows us how difficult it is to make these
decisions appropriately. They focussed on 'unbearable suffering', probably
the most subjective decision the doctors have to make when deciding
whether to allow or refuse euthanasia. It was clear from their cases that
patients and physicians often have quite differing views on what
constituted 'unbearable suffering', with doctors quite naturally focussing
on physical issues including pain, whereas patients most often considered
loss of dignity, independence and 'not being needed any more' as more
important than physical issues.
Medical student curricula nowadays have a much heavier weighting
towards 'holistic' care and the psychosocial aspects of medicine than was
previously the case, however it is apparent that doctors remain poor at
actually applying many of these issues in practice.
In the UK, euthanasia remains illegal. We can however apply many of
the principles of this research to end of life care for our patients with
chronic illnesses, particularly those which lead to a marked loss of
independence such as stroke and Parkinson's disease; at least trying to
discuss these issues with them and see what can be done to alleviate any
distress they may have. When we are considering patients who are
'approaching death', although far from perfect, doctors are improving at
implementing end of life care pathways, which allow death free from pain.
Perhaps when we start to implement these pathways, we can begin to
consider issues other than pain which our patients might be experiencing
and what other problems our patients might consider to constitute
'unbearable suffering'.
Rapid Response:
The difficulties of subjective suffering
At last some sensible research in the never-ending and subjective
debate into euthanasia and end of life care. I was pleased to see that
they have considered the idea of 'unbearable suffering' in some detail.
I think that as doctors we so often focus on 'sanctity of life' above
all other concepts and are sometimes keen to pursue treatements beyond all
hope of cure. It is not surprising, given our training and the pervasive
public view that the aim of medical treatment is to prolong life at all
cost. Recent articles have talked about how poor doctors are at discussing
'do not resuscitate' decisions; we are worse yet still at promoting 'good'
deaths- a comfortable end to life.
This research coming out of the Netherlands, which allows euthanasia
under strict regulations, shows us how difficult it is to make these
decisions appropriately. They focussed on 'unbearable suffering', probably
the most subjective decision the doctors have to make when deciding
whether to allow or refuse euthanasia. It was clear from their cases that
patients and physicians often have quite differing views on what
constituted 'unbearable suffering', with doctors quite naturally focussing
on physical issues including pain, whereas patients most often considered
loss of dignity, independence and 'not being needed any more' as more
important than physical issues.
Medical student curricula nowadays have a much heavier weighting
towards 'holistic' care and the psychosocial aspects of medicine than was
previously the case, however it is apparent that doctors remain poor at
actually applying many of these issues in practice.
In the UK, euthanasia remains illegal. We can however apply many of
the principles of this research to end of life care for our patients with
chronic illnesses, particularly those which lead to a marked loss of
independence such as stroke and Parkinson's disease; at least trying to
discuss these issues with them and see what can be done to alleviate any
distress they may have. When we are considering patients who are
'approaching death', although far from perfect, doctors are improving at
implementing end of life care pathways, which allow death free from pain.
Perhaps when we start to implement these pathways, we can begin to
consider issues other than pain which our patients might be experiencing
and what other problems our patients might consider to constitute
'unbearable suffering'.
Competing interests:
None declared
Competing interests: No competing interests