Relief from pain, not from life
CMAJ 1997;157:638
See response from: J.V. Lavery, P.A. Singer
At first sight the article "Bioethics for clinicians: 11. Euthanasia and assisted suicide," by James V. Lavery and associates (CMAJ 1997;156:1405-8 [full text / résumé]), impresses one as a well-researched and scientifically and logically sound paper.
On closer scrutiny, however, it raises more questions than it answers. A lapse in logic appears immediately with the use of "assisted suicide" in the headline. If suicide is the consequence of an act of self-destruction -- something carried out by the person -- then any persons rendering assistance in this act of destruction automatically become murderers, regardless of whether the "assisted" victim had agreed or not. The heading alone reflects strongly the ambivalence pervading the article. It is, of course, our society's ambivalence that is being shared by the authors.
Perhaps the rather loosely applied term "self-determination" should have been replaced by the more straightforward designation "self-termination." I can only determine with certainty that I have travelled from A to B if I know everything I have to know about both points. Do we know -- scientifically -- where we are going after death? Of course not. How then can I determine where I am going by ending my life?
Someone suffering extreme pain does not wish to go into possible oblivion. These people scream to be relieved from pain and not from life. Have you ever witnessed patients who first "demanded euthanasia" and then changed their mind? I did in my younger years. How many patients had changed or may have changed their minds but may have been unable to say so and were accidentally put to death because of their inability to communicate?
Pain-relieving medication may as a side effect shorten a patient's life span, but this has nothing to do with euthanasia. The intent is to relieve the pain, not terminate a life. In my younger years as a general practitioner I used to visit terminally ill patients as often as necessary to soothe at least their pain. A bond would develop between patient and physician and nobody ever thought of "assisted suicide." Obviously there was no need for it then, so why should there be a need for it today? Let's be honest and use common sense.
Wilhelm Kreyes, MD (retired)
Winnipeg, Man.
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