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Volume 12, Number 2

Editorial
Physicians and Euthanasia

John R. Williams, PhD

In their report on Alberta physicians' attitudes toward active euthanasia (AE), Verhoef, Kinsella, and Page note that "physicians on both sides showed considerable confusion about the defining characteristics of AE, which made it difficult for the observer to draw clear conclusions." That paper ends with a call for further education and deliberation before any changes to the laws against euthanasia are introduced.

Five years have passed since this survey was conducted. During that time, physicians in Canada and elsewhere have had ample opportunity for further education and deliberation about euthanasia. Reports on the practice of euthanasia in the Netherlands appear regularly in medical publications and the media.1 The Northern Territory of Australia2 and the state of Oregon in the U.S.A. have adopted widely publicized laws permitting some forms of euthanasia and/or assisted suicide. At least 11 other surveys of physicians' views on the morality and legality of physician-assisted death have been published.4 In Canada, Sue Rodriguez received extensive publicity as she took her quest for legalized assistance in dying to the Supreme Court; despite being turned down (by a five-to-four margin),5 she allegedly found a physician to euthanize her in the presence of a member of Parliament. The Canadian Medical Association published a book on physician-assisted death6 and debated the issue at two General Councils (1993 and 1994), culminating in a policy that opposes physician participation in euthanasia or assisted suicide.7 Finally, a committee of the Canadian Senate conducted an extensive investigation into the legal, social, and ethical issues related to euthanasia and assisted suicide, involving numerous physicians and their organizations in the process; the Committee's report, released in June 1995, recommended that these practices should not be legalized at the present time.8

Have these events, and the abundant analytic and rhetorical literature accompanying them, lessened the confusion of physicians about euthanasia reported by Verhoef, Kinsella, and Page? Have physicians changed their opinions since 1991 as a result of these activities and information? Kinsella and Verhoef conducted a Canada-wide survey of physicians in 1995 to answer these questions. The results of this survey are not yet available. When they are, they will require careful interpretation.

Five years may seem a long time in an era of rapid social change and technologic development. However, it is a short time in human history. Despite our infatuation with change, which we often confuse with progress, human nature is quite stable. Morality in particular seems to resist evolution. There is little, if any, evidence that people make better moral decisions or behave better toward one another than they did 20, 50, 500, or 5000 years ago; therefore, we need to be careful when ascribing any significance to changes in attitudes over a 5-year period. Instead, we should examine a much longer length of history to see whether or not the reasons put forth to change the long-standing prohibition of physician-assisted death are likely to stand the test of time.

In 1994, an American physicianethicist9 published a study of this nature. He notes that the arguments for and against euthanasia used in the 19th century are identical to those we hear now. He concludes: "Public interest in euthanasia (1) is not linked with advances in biomedical technology; (2) it flourishes in times of economic recession, in which individualism and social Darwinism are invoked to justify public policy; (3) it arises when physician authority over medical decision making is challenged; and (4) it occurs when terminating life-sustaining medical interventions becomes standard medical practice and interest develops in extending such practices to include euthanasia."9 Interest in euthanasia wanes when these conditions change.

Is the current attention to euthanasia any more stable than previous manifestations? Only time will tell. However, it would be unwise to make sweeping changes to public policy on this issue on the basis of soft data such as physicians' attitudes or public opinion that can change quickly and decisively. It may turn out that the momentum for change in the laws concerning euthanasia will disappear. In the absence of enduring reasons in favour of legalization, the longstanding prohibition of this practice should be maintained.

References

  1. Ministry of Health, Welfare and Sport, the Netherlands: Euthanasia and physician-assisted suicide in the Netherlands: Bibliography 1984-1995. Rijswijk, 1995
  2. Australia passes first euthanasia law. BMJ 1995; 310: 1427-1428
  3. Alpers A, Lo B: Physician-assisted suicide in Oregon: a bold experiment. J Am Med Assoc 1995; 274: 483-487
  4. Chochinov HM, Wilson KG: The euthanasia debate: attitudes, practices and psychiatric onsiderations. Can J Psychiatry 1995; 40: 593-602
  5. Huang FY, Emanuel LL: Physician aid in dying and the relief of patients' suffering: physicians' attitudes regarding patients' suffering and end-of-life decisions. J Clin Ethics 1995; 6: 62-67
  6. Pancratz HRC: The Sue Rodriguez decision: concerns of a primary care physician. Humane Med 1995; 11: 16-22
  7. Lowy FH, Sawyer DM, Williams JR: Canadian physicians and euthanasia. Canadian Medical Association, Ottawa, 1993
  8. Canadian Medical Association: Physician-assisted death. Can Med Assoc J 1995; 152: 248A-248B
  9. Senate of Canada: Of Life and Death: Report of the Special Senate Committee on Euthanasia and Assisted Suicide. Minister of Supply and Services Canada, Ottawa, 1995
  10. Emanuel EJ: The history of euthanasia debates in the United States and Britain. Ann Intern Med 1994; 121: 793-802
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