Relief from pain, not from life
CMAJ 1997;157:638
Re: "Bioethics for clinicians: 11. Euthanasia and assisted suicide," by James V. Lavery and associates (CMAJ 1997;156:1405-8 [full text / résumé])
In response to: W. Kreyes
Dr. Kreyes' comments reveal his strong personal views regarding euthanasia and assisted suicide. We applaud him for contributing to the public debate by sharing these views.
Contrary to his assertion that our paper reflects our ambivalence toward euthanasia and assisted suicide, we were asked to collaborate in the writing of the article precisely because we all share a strong professional interest in these issues. The article was meant to outline key concepts associated with euthanasia and assisted suicide and to help clinicians integrate these concepts into daily practice. The paper was not intended as a forum for us to expound our own views.
Kreyes offers 2 specific criticisms, both objections to our choice of language. First, far from revealing a "lapse in logic," we used the term "assisted suicide" to be consistent with the vast majority of commentators around the world, including the report of the Special Senate Committee on Euthanasia and Assisted Suicide.1 As well, the term accurately conveys the spirit and substance of Section 241(b) of the Criminal Code of Canada, which prohibits aiding or abetting a person to commit suicide.
Second, Kreyes objects to our use of the term "self-determination," suggesting instead a "more straightforward" term, "self-termination." We used "self-determination" in our summary of the arguments in favour of euthanasia and assisted suicide because it is this concept, more than any other, that has underpinned this set
of arguments. "Self-termination," though precise with respect to the specific act of suicide, does not convey anything of the broader social, legal and political context that frames these arguments and gives them force.
Kreyes suggests that appropriate pain control and compassionate, attentive care would obviate the need for euthanasia and assisted suicide. Based on our clinical experience, we agree with him that better palliative care would reduce the need for euthanasia and assisted suicide; in fact, we think improving end-of-life care, including palliative care, should be a major national priority. However, we doubt that even the best palliative care would eliminate all requests for euthanasia or assisted suicide.
Kreyes' appeal to "common sense," no matter how attractive, is unlikely to provide a solution to the complex and pressing social problems of euthanasia and assisted suicide. This is an issue on which people of common sense disagree.
James V. Lavery, MSc
PhD Candidate
University of Toronto Joint Centre for Bioethics
University of Toronto
Coordinator
HIV Ontario Observational Database
Sunnybrook Health Science Centre
North York, Ont.
Peter A. Singer, MD, MPH
Sun Life Chair in Bioethics
Director
University of Toronto Joint Centre for Bioethics
Toronto, Ont.
Reference
- Special Senate Committee on Euthanasia and Assisted Suicide. Of life and death. Report of the Ottawa: Supply and Services Canada; 1995:A80-3. Cat no YC2-351/1-OIE.
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