Education And Debate

Patients' voices are needed in debates on euthanasia

BMJ 2003; 327 doi: (Published 24 July 2003) Cite this as: BMJ 2003;327:213

This article has a correction. Please see:

  1. Yvonne Y W Mak, medical officer (,
  2. Glyn Elwyn, professor2,
  3. Ilora G Finlay, professor of palliative medicine3
  1. 1Bradbury Hospice, A Kung Kok Shan Road, Shatin, Hong Kong
  2. 2Primary Care Research Group, University of Wales Swansea Clinical School, Swansea, SA2 8PP
  3. 3School of Medicine, University of Wales College of Medicine, Cardiff CF14 7XL
  1. Correspondence to: Y Y W Mak
  • Accepted 3 July 2003

Medically assisted death is legal in a few countries, and discussion about legalisation is ongoing in many others. But legalisation may be premature when we still do not know why patients want euthanasia and whether better end of life care would change their views

Countless debates have been held on euthanasia, but little research has been done into the experiences of patients who request it. Proponents portray an undignified death and opponents fear the potential dangers of legalising euthanasia, but the fundamental question is why patients want euthanasia. Current debates have been based on perspectives of medical professionals, academics, lawyers, politicians, and the public. Qualitative, experiential, and patient based research is needed to help capture the complexity of patients' subjective experiences and elucidate the influences and meanings that underpin their desire for death.

The euthanasia debate

Justifications for legalisation of euthanasia have pivoted on unbearable suffering, respect for autonomy, and dignified death. Proponents argue, from the principles of compassion and self determination, that mentally competent patients with an incurable illness and intolerable suffering should be able to choose the manner and timing of their death. This view is gaining support within an increasingly secular society with an individualistic and utilitarian ethos.

Opponents highlight the potential dangers for patients, healthcare professionals, and society.1 Doctors should strive to relieve suffering, not end the life of the sufferer; the authority to terminate life would undermine their trustworthiness. Euthanasia is irreversible, yet the will to live often fluctuates widely over the course of a terminal illness.2

Some opponents fear patients might …

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