Presented by: Jan L Bernheim
Background. The Belgian model of ‘integral end-of-life (EOL) care’ consists of legally ordained, demand–driven universal access to both PC and euthanasia and/or assisted suicide (EAS). It was in 2015 largely emulated in Québec. Several mainstream PC organisations consider EAS incompatible with the very foundations of PC. Yet, in ever more jurisdictions EAS is legal or on the legislative agenda. In EAS-permissive environments PC workers have three options: exclude EAS from PC, leave involvement in EAS to individual caregivers’ conscience, or, as in Flanders, Belgium, embed EAS in PC.
Aims. To inform this debate.
Methods. Review of 1) the essentialistic (epistemological, historical, doctrinal, conceptual, ethical) objections to EAS embedded in PC and 2) the empirical data from EAS-permissive jurisdictions.
Results. 1) The essentialistic objections to EAS embedded in PC are found logically difficult to sustain or contradict the PC tenets of patient-centeredness and ‘total care’. 2) In Oregon and Washington and in Flanders, over 70% of cases of EAS are preceded by professional PC. In Flanders, EAS occurs three times more after a professional PC trajectory than after non-specialised EOL care.
Discussion. Pragmatically, if in future EAS-permissive countries EAS is excluded from PC and carried out only in settings less competent for EOL care, patients who desire the possibility of EAS may shun professional PC and hence not receive optimal EOL care. Second, EAS will likely be less practiced in a spirit of ‘total care’. Thus, the quality of all EOL care stands to decline.
Conclusion: PC organisations need to confront these fundamental and practical issues lest they be marginalised by societal developments and consent to suboptimal care.