Would Improving Palliative Care Decrease Patient Requests for Physician-Assisted Suicide?


General Reference (not clearly pro or con)
The World Health Organization (WHO) explained in its "WHO Definition of Palliative Care" section on its website (accessed Apr. 10, 2018):

"Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten or postpone death;
  • integrates the psychological and spiritual aspects of patient care;
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patients illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications."

Apr. 10, 2018 - World Health Organization (WHO) 

The British Broadcasting Corporation (BBC), in its Ethics Guide on "Anti-Euthanasia Arguments," (accessed Apr. 10, 2018) explained that:

"Palliative care is physical, emotional and spiritual care for a dying person when cure is not possible. It includes compassion and support for family and friends.

Competent palliative care may well be enough to prevent a person feeling any need to contemplate euthanasia."

Apr. 10, 2018 - BBC (British Broadcasting Corporation) 



PRO (yes)

Physicians for Compassionate Care wrote in the "Top 10 FAQs" section of their website (accessed on Aug. 14, 2006):

"Once a patient has the means to take their own life, there can be decreased incentive to care for the patient's symptoms and needs. The case of Michael Freeland is an example. Michael had been given a lethal prescription and when his doctors were planning for his discharge to his home from the hospital, one physician wrote that while he probably needed attendant care at home, providing additional care may be a 'moot point' because he had 'life-ending medication'. His assisted suicide doctor did nothing to care for his pain and palliative care needs. This seriously ill patient was receiving poor advice and medical care because he had lethal drugs."

Aug. 14, 2006 - Physicians for Compassionate Care Education Foundation (PCCEF) 



Gary Lee, MD, Medical Director of Hospice at Sacred Heart Medical Center, was quoted in Wesley Smith's 1997 book Forced Exit:

"Hospice commits to the patient and the family that we will take care of them, to nonabandonment... But if euthanasia becomes a standard of practice, too many times there would be a real incentive to do it. There are some patients whose proper care requires time and effort, professional services that aren't necessarily paid for by insurance companies. I might say, 'There has to be an easier way.' I could too easily find myself seeing euthanasia as the simple answer; one that is less time consuming and the least expensive. If accepted, euthanasia could very easily take the place of proper patient care."

1997 - Gary Lee, MD 



Kathleen Foley, MD, Professor in the Department of Neurology at Weill Medical College of Cornell University and Herbert Hendin, MD, Professor in the Department of Psychiatry and Behavioral Sciences at the New York Medical College, wrote in the introduction to their 2002 book, The Case Against Assisted Suicide: For the Right to End-of-Life Care:

"Opposition to legalization [of assisted suicide and euthanasia] is strongest among physicians who know most about caring for terminally ill patients (i.e., palliative care specialists...). They know that patients requesting a physician's assistance in suicide are usually telling us as strongly as they know how that they desperately need relief from their suffering and that without such relief they would rather die. They are making an anguished cry for help and a very ambivalent request to die. When they are treated by a physician who can hear their ambivalence, understand their desperation, and relieve their suffering, the wish to die usually disappears."

2002 - Kathleen Foley, MD 
Herbert Hendin, MD 



Edmund Pellegrino, MD, Professor Emeritus of Medicine and Medical Ethics at Georgetown University Medical Center, wrote in the chapter "The False Promise of Beneficent Killing," that appeared in his 1998 book Regulating How We Die:

"Most often, the request for euthanasia or assisted suicide is a plea for help in dealing with suffering as much as pain... The combined and integrated relief of pain and suffering shaped to suit the peculiarities of their manifestation in each person is the aim of comprehensive palliative care and the more sophisticated hospice regimens. Patients treated this way usually do not ask for termination of their lives; when they do ask for it, they tend to change their minds later. It is an injustice to offer these patients assisted suicide or euthanasia as options when so much more can be offered in the way of sophisticated treatment."

1998 - Edmund Pellegrino, MD 



The American Geriatrics Society wrote in their Position Statement, "Physician-Assisted Suicide and Voluntary Active Euthanasia," last updated in Nov. 2002:

"It is the general consensus of the AGS [American Geriatrics Society] that most individuals who consider PAS [physician-assisted suicide] or VAE [voluntary active euthanasia] do so out of fear of the dying process. The vast majority of patients can be comfortable (which might require sedation) and potentially could find meaning in the last phase of life and choose to forgo a life-sustaining treatment and accelerate dying. All of these options for care, are already legal. Most would choose to live if they had full confidence that the care system would serve them well. A thorough search for the underlying reason for the request for death may uncover several areas amenable to potential interventions (e.g., undertreated physical symptoms, psychosocial or spiritual crisis, clinical depression, etc.)."

Nov. 2002 - American Geriatrics Society 



Wesley Smith, JD, Anti-Euthanasia Activist, wrote in his 1997 book Forced Exit:

"If we want to create a truly humane health-care system that cares for people rather than killing them, pain control must be made universally available... For pain that average doctors cannot overcome, all H.M.O.s must be required to make referrals to board-certified pain-control experts readily available to plan members without arbitrary restriction, on an as-needed basis. In that way, suffering people such as Rebecca Badger, Jack Kevorkian's thirty-third victim, who stated in a presuicide television interview that she would prefer to life if she could escape the pain, would be able to obtain relief without resorting to death peddlers."

1997 - Wesley J. Smith, JD 



Kathleen Foley, MD, Professor in the Department of Neurology at Weill Medical College of Cornell University and Herbert Hendin, MD, Professor in the Department of Psychiatry and Behavioral Sciences at New York Medical College, wrote in the introduction to their 2002 book, The Case Against Assisted Suicide: For the Right to End-of-Life Care:

"Given legal sanction, euthanasia, intended originally for the exceptional case, has become an accepted way of dealing with serious or terminal illness in the Netherlands. In the process, palliative care has become one of the casualties, while hospice care has lagged behind that of other countries."

2002 - Kathleen Foley, MD 
Herbert Hendin, MD 



CON (no)

Gerrit Kimsma, MD, Associate Professor in Medical Philosophy at the Center for Ethics and Philosophy at Vrije Universiteit, Amsterdam, and Evert van Leeuwen, PhD, Professor in Philosophy and Medical Ethics at the Center of Ethics and Philosophy at the Vrije Universiteit Medical Center, Amsterdam, wrote in the chapter "Assisted Death in the Netherlands: Physician at the Bedside When Help Is Requested," that appeared in their 2004 book Physician-Assisted Dying: The Case for Palliative Care & Patient Choice:

"Despite evidence that the number of euthanasia cases has stabilized over the past six years with improvements in palliative care, twelve years of research on issues of end-of-life care indicate no increase in the number of physicians who believe that 'adequate treatment of pain and counseling the dying' can eliminate the need or desire for euthanasia."

2004 - Gerrit Kimsma, MD, MPh 
Evert van Leeuwen, PhD 



Timothy Quill, MD, Professor of Medicine, Psychiatry, and Medical Humanities at the University of Rochester School of Medicine and Dentistry, wrote in the chapter "Death and Dignity--A Case of Individualized Decision Making" that appeared in his 1995 book Arguing Euthanasia:

"Although I know we have measures to help control pain and lessen suffering, to think that people do not suffer in the process of dying is an illusion. Prolonged dying can occasionally be peaceful, but more often the role of the physician and family is limited to lessening but not eliminating severe suffering.

I wonder how many families and physicians secretly help patients over the edge into death in the face of such severe suffering. I wonder how many severely ill or dying patients secretly take their lives, dying alone in despair. I wonder...whether the Hemlock Society's way of death by suicide is the most benign."

1995 - Timothy E. Quill, MD 



Erich Loewy, MD, Professor and Endowed Alumni Association Chair (emeritus) of the Bioethics Program at the University of California, Davis Medical Center, wrote in the chapter "Harming, Healing, and Euthanasia," that appeared in his 1998 book Regulating How We Die:

"The better our care of terminal patients, the less will be the need for euthanasia. Orchestrating death by giving as much content and meaning to the last stage of living as to every other stage, rather than focusing on dying, can do much to reduce the need for euthanasia. Nevertheless, the need for active euthanasia will not vanish. Inevitably, part of good 'orchestration' of a patient's last days may require euthanasia or assisted suicide."

1998 - Erich Loewy, MD 



Marcia Angell, MD, Senior Lecturer in the Department of Social Medicine at Harvard Medical School, wrote in "The Quality of Mercy," which appeared in the July 11, 2006 edition of The Willits News:

"Death is not fair and it is often cruel. Some die young, others in extreme old age. Some die quickly, others die slowly but peacefully. Some find personal or religious meaning in the process, as well as an opportunity for a final reconciliation with loved ones. Others, especially those with cancer, AIDS, or progressive neurological disorders, die by inches and in great anguish. Good palliative care usually can help in these cases, but not always, and often not enough...

There is no right way to die, and there should be no schism between advocates for better palliative care and advocates for making it possible to hasten death with a physician's help. Good palliative care and the right to make this choice are no more mutually exclusive than good cardiologic care and the availability of heart transplantation. To require dying patients to endure unrelievable suffering, regardless of their wishes is callous and unseemly. Death is hard enough without being bullied. Like the relief of pain, this too is a matter of mercy."

July 11, 2006 - Marcia Angell, MD 



Gerrit Kimsma, MD, MA, Associate Professor in Medical Philosophy and Evert van Leeuwen, PhD, Professor in Philosophy and Medical Ethics, wrote in their chapter "Assisted Death in the Netherlands: Physician at the Bedside When Help Is Requested," that appeared in the 2004 book Physician-Assisted Dying: The Case for Palliative Care & Patient Choice:

"Assisting death in no way precludes giving the best palliative care possible but rather integrates compassionate care and respect for the patient's autonomy and ultimately makes death with dignity a real option...

The evidence for the emotional impact of assisted dying on physicians shows that euthanasia and assisted suicide are a far cry from being 'easier options for the caregiver' than palliative care, as some critics of Dutch practice have suggested. We wish to take a strong stand against the separation and opposition between euthanasia and assisted suicide, on the one hand, and palliative care, on the other, that such critics have implied. There is no 'either-or' with respect to these options. Every appropriate palliative option available must be discussed with the patient and, if reasonable, tried before a request for assisted death can be accepted...

Opposing euthanasia to palliative care...neither reflects the Dutch reality that palliative medicine is incorporated within end-of-life care nor the place of the option of assisted death at the request of a patient within the overall spectrum of end-of-life care."

2004 - Gerrit Kimsma, MD, MPh 
Evert van Leeuwen, PhD 



Barbara Coombs Lee, JD, President of Compassion and Choices, said during a Nov. 26, 1997 interview on PBS Newshour, entitled "A Right to Die?":

"Palliative care has been the main beneficiary of the Oregon Death with Dignity Act [which legalized physician-assisted suicide] so far. Since its passage, we've seen a great resurgence of interest in the medical community in palliative care. Hospice referrals have increased by 20 percent, and now Oregon leads the nation in prescription of morphine. This has a salutary effect on end of life care."

Nov. 26, 1997 - Barbara Coombs Lee, JD