Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians

Dear editor

I read with interest Pasman et al paper published in BMJ of Wednesday
28.11.09

The paper addressed a very important issue not only in the Netherlands or
Europe but also for humanity (patients, carers, doctors and the whole
community). As we know in the Netherlands, assisted suicide is legally
allowed but there are strict rules for euthanasia. However under such
strict the rules, who and how can we define the concept of unbearable
suffering? [1]

The authors studied in depth 10 patients and this limited number
itself should be considered as one of the study limitations. Another
important limitation: religious belief, which was not considered in the
study of Pasman et al. As we all know religious belief influences
patients’ potential to tolerate or suffer (the concept of unbearable
suffering may vary here). Al-Razi (a recognised physician in the Islamic
Civilization) believed that successful face-to-face relief of actual
suffering continues to require the application of ordinary human feeling
and compassion, known in English as bedside manner [2]. This raises 2
important points: (1) Suffering can be bearable if managed with care,
compassion and respect to human dignity. (2) Emotional aspects of
suffering may be as equally important as the physical suffering or even
more. Are Are our terminally ill people deserve humane care or this would
be considered too expensive cost for our modern society to pay?

In this study, physicians defined unbearable suffering more often
than patients as physical suffering which the authors believed was
influenced by Cassell’s notion that, in medicine, suffering is generally
related to the body and not to the mind [1]. There was an interesting.
The authors believed that in the context of euthanasia, the difference
could also be influenced by the different interests of patients and
physicians (1). This could also be explained by differences in religious
beliefs.

For various reasons assisted suicide is currently a hot topic in the
developed countries but there will be soon a time in which this debate
will be more hot in the developing countries. Those countries may find
themselves facing a problem that has been addressed in the developed
countries within certain boundaries and concepts of western medical
ethics, financial costs and risks versus benefits. However in the
developing countries where religion plays an important role in the life of
people, the debate about euthanasia will definitely have to be influenced
by this strong factor i.e. religion.

The materialistic approach in many aspects was successful in taking
over. However, in the area of assisted suicide “euthanasia” would it be
different? Would the materialistic principles including: Do not
resuscitate, stop unbearable suffering, cost minimisation beat the human
values of care, compassion & patience that stem essentially from the
religious values. Which approach is more caring? If we do not agree on
the concept of unbearable suffering, how can we make a decision? Who
knows?

Mamdouh EL-Adl

MBBCh, MSc, MRCPsych

Consultant Psychiatrist

References:

1. Passman HR, Rurup ML, Willems DL & Onwuteaka-Philipsen B D:
Concept of unbearable suffering in context of ungranted requests for
euthanasia: qualitative interviews with patients & physicians.
Published 16 November 2009, doi:10.1136/bmj.b4362. Cite this as: BMJ
2009;339:b4362

2. Muhammad ibn Zakariya al-Razi. From Wikipedia, the free
encyclopedia. n.wikipedia.org/wiki/Muhammad_ibn_Zakariya_al-Razi.
Accessed on 07.12.09

Competing interests:
None declared