Thursday, 16 April 2009

Koelzer and Brittingham: The Ethics & standards of Euthanasia and Palliative Care

Viktor Koelzer and Sara Brittingham have presented an excellent overview of the ethics and standards of euthanasia and palliative care

This is an article recently published on The Lancet Student. The authors review research that shows that there is alot of insecurity and misinformation in the provision of end-of-life care amongst medical staff. As the authors are medical students themselves they speak with knowledge about the need to have more information about end-of-life issues in order to develop their skills and confidence on dealing with terminally ill patients. The authors then go on to review the historical, ethical and leval aspects of palliative care and voluntary euthanasia in Europe. They reiterate their emphasis on compassion and respect in the provision of end-of-life care whilest respecting and adhering to the law and the ethical principles of our society. Koelzer and Brittingham then proceed to compare and contrast palliative care approaches with voluntary euthanasia approaches. They authors present contrasting approaches to addressing issues such as pain management, patient autonomy, spiritual support and communication.

Both voluntary euthanasia and palliative care options currently co-exit in Europe. It is clear that each country within the EU is addressing this issue in relation to its cultural and ethical framework, however, what seems clear if that some elements such as the Hippocratic oath and a common Judeo-Christian perspective are prevalent within the palliative care approaches in Europe. The authors state their view as follows
..."In the early stages of medicine, hardly any disease could be cured; instead, the patients were accompanied and comforted, trying to palliate suffering (10). One of the earliest medical codices, the Hippocratic Oath (400 B.C.), stated that doctors must never “give deadly medicine to anyone if asked nor suggest any such counsel”. This definite statement leads us to assume that disagreements about medically assisted death were already a matter of debate during this time. With the rise of Christianity in Europe, arguments against VE were further based on religious beliefs. Thomas Aquinas(approx. 1225-1274), one of the most important Catholic scholars of the middle ages stated in his main work “Summa Theologiae” that not only killing but also suicide was a capital sin, and emphasized the Christian virtues of “caritas” (Lat. benevolence) and “misericordia” (Lat. mercy) in the care of patients. In our opinion these values are still central in palliatice care today, emphasizing the Christian roots of the palliative care movement.

This is thoughtful article for anyone interested in this debate.


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