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A study published in the journal BMJ Supportive & Palliative Care in May 2024 looked at the impact of euthanasia on palliative care in Victoria, where the practice has been decriminalised in 2017. The study was conducted across three care centres between 2019 and 2021 and analysed data from 141 patients who had expressed a wish to die by euthanasia (which was the case for 51 of them).
This study highlights new challenges with the emergence of euthanasia which, operating alongside medical and palliative care, tends to call into question the approach to end-of-life care.
Palliative care in the context of euthanasia: what impact?
Palliative care aims to relieve pain, alleviate mental, psychological, existential or spiritual suffering, safeguard the dignity of the sick person until their natural death and support those around them. The study began by analysing the impact of requests for euthanasia on overall patient care, noting that requests for information about euthanasia could sometimes divert patients and carers from the usual discussions about how to improve quality of life. However, when the patient's motivations for euthanasia were listened to and analysed, patients were more open to the idea of considering therapeutic options.
The study also analysed the impact of euthanasia on family relationships, noting that requests for euthanasia could give rise to conflict and significant stress for families and healthcare staff. In addition, some patients expressed the fear of being abandoned by healthcare professionals or family members in the event of a request for euthanasia.
Attention is drawn to possible moral distress among carers faced with refusals of palliative care and requests for euthanasia, leading to a problematic ambiguity between these two practices.
Palliative care effective in responding to real suffering
The study concludes with a nuanced reflection on the impact of euthanasia on the quality of palliative care, noting in particular that requests for euthanasia could lead to better listening to and understanding of patients' suffering. The study also found that, among people who died as a result of euthanasia, fear of future suffering (49%) was mentioned more often than current suffering (45.1%). In contrast, among those who did not ultimately die by euthanasia, the main reason for requesting euthanasia in the first place was actual suffering (66.7%) more than autonomy (65.3%). The people who actually died by euthanasia suffered more from mental health problems fuelling a fear of suffering.
When patients are suffering real pain, palliative care has a positive impact on this pain and reduces requests for euthanasia, underlines the study. It remains to be seen to what extent it will be possible in future to continue to provide quality palliative care in a context where the widespread adoption of euthanasia is leading society to consider it as the only solution for putting an end to suffering.