I wish to make several points in response:

Relief of suffering

My colleague claims that with ‘expert’ palliation ‘symptoms can be relieved, explanations can be given and suffering can be addressed and not felt to be too hard to deal with’. This is an idealised view that does not acknowledge the limitations of palliative care, and promotes the myth that suffering in terminal illness can be relieved to the extent there should be no desire nor need for voluntary euthanasia/physician assisted suicide (VE/PAS).

In reality, it is not possible to effectively relieve fatigue and dependency, or eliminate symptoms caused by failing organs, or change many patients’ minds. Evidence indicates that patients receiving specialist palliative care are only marginally better off in terms of symptoms, yet express the wish for a hastened demise more-so than other dying patients. [1]

Patient autonomy

My colleague highlights that patients’ requests for VE/PAS are due to  ‘overwhelming  emotional  distress’,  ‘total  pain’,  ‘hopelessness’, ’demoralisation’, ‘despair’,     ‘fear’,     ‘loneliness’,     ‘vulnerability’, ‘depression’ etc. The argument is that their decision-making capacity is lacking, so there is no need to respect their wishes.

Requests for a hastened demise, however, can be genuine, rational, and in accordance with long-held life values. A person’s autonomy is not invalidated because of their suffering.

It is inconsistent and perplexing when respect for patient autonomy is promoted as a core value of palliative care, including for the withholding and withdrawing of life-prolonging treatments, but not when it applies to VE/PAS.

Effect on clinicians

My colleague suggests that clinicians who become involved VE/PAS are ill-equipped and uneducated in palliative care, and they are adversely affected by ending life.

In Oregon, however, doctors who are actively interested in palliation at the end of life are more likely to be involved in PAS. [2]

Accompanying terminally ill patients with compassion, with respect for their autonomy (the opposite of abandonment), can lead some doctors to be involved in PAS/VE. To borrow the words of my colleague, this “can be hard work, and it is not something that everyone can or will want to do . . . it is one of the most challenging times  . . . yet paradoxically it can be one of the most rewarding.”

Voluntary euthanasia and palliative care

I agree that we should try to improve education and practice in the art  and  science  of  palliation. Evidence  indicates  that  communities that have sanctioned VE/PAS have also enhanced the enterprise of palliation. Palliative care and VE/PAS can be symbiotic rather than ‘antithetical’.

Conclusion

In the light of experience in overseas jurisdictions, it is likely that VE/PAS will be legally sanctioned in Australia during your career in medicine. This  will  empower  terminally  ill  patients  with  a  reassuring  choice for a quick exit if their suffering is too great to bear. I am confident the medical profession in Australia will be responsible, careful and considered in the care of patients who request such help to die.

References

[1] Seale C, Addington-Hall J.   Euthanasia: the role of good care. Soc Sci Med   1995;40(5):581-7

[2] Ganzini L, Nelson HD, Lee MA, Kraemer DF, Schmidt TA, Delorit MA. Oregon physicians’ attitudes about and experiences with end-of-life care since passage of the Oregon Death with Dignity Act. JAMA, 2001; 18; 2363-9.