Euthanasia In Palliative Care

In the context of palliative care, euthanasia, or intentionally ending someone's life to alleviate their suffering, is often talked about. However, palliative care itself is different from euthanasia. Rather than hastening or stopping death, the goal of palliative care is to improve the well-being and life experience of patients with serious illness, regardless of prognosis, by management of their symptoms and pain and meeting their psychological and spiritual needs (Yilmaz & zbek Gven, 2022). 

Euthanasia, especially voluntary euthanasia and physician-assisted suicide (PAS), raises many questions about patient autonomy, the function of healthcare providers, and the ethical consequences of end-of-life decisions (Akdeniz et al., 2021). Euthanasia can be seen as a potential extension of palliative care, where patients seek to end their suffering after an illness or unrelieved pain. In countries such as Belgium and the Netherlands, euthanasia is legal and can be provided simultaneously with palliative care. Studies show that patients who request euthanasia more often receive palliative care before making the decision, which suggests that effective palliative interventions can influence patients' decisions about euthanasia (Carvajal et al., 2021). 

The ethical debate on euthanasia is multifaceted. Opponents of euthanasia argue that euthanasia removes people who are considered incurable and debilitating, which goes against the principles of palliative care that aims to provide help and support (Ewan C. Goligher, E. Wesley Ely et al., 2017). On the other hand, proponents of euthanasia argue that euthanasia respects the patient's autonomy and right to die with dignity, especially in cases where suffering is unbearable and curative treatments are no longer effective (ener, ., & Dikmen, Y. 2023). The ethical debate surrounding euthanasia in palliative care revolves around several key principles: 

• Autonomy: Respecting patient autonomy means recognizing the right of individuals to make their own decisions about their health and medical care. Proponents argue that patients should have the right to choose euthanasia if they are experiencing unbearable suffering (Velasco Bernal & Trejo-Gabriel-Galan, 2022). 
• Benefit and No Harm: These principles emphasize the obligation of healthcare providers to act in the best interest of the patient while avoiding harm. Critics argue that euthanasia goes against the basic goal of palliative care, which is to alleviate suffering without hastening death. 
• Fairness: This principle ensures that all people have equal access to medical care. The legalization of euthanasia raises concerns about the potential pressure on vulnerable populations to choose death over continuing treatment.

The intersection of these ethical principles creates a complex landscape where healthcare providers must navigate their responsibilities to patients while considering broader societal implications. 

In recent research, the complex relationship between assisted dying and palliative care has been described. Research shows that although some patients choose to be assisted to die, many also receive palliative care services. A survey conducted by the International Association for Hospice and Palliative Care (IAHPC) found that approximately 80% of palliative care professionals are opposed to incorporating euthanasia into their work. The oversight emphasized the importance of maintaining a distinct role for palliative care in end-of-life care (Zenz et al., 2015). A survey conducted among palliative care professionals in Germany revealed that only 5.3% were willing to perform euthanasia on terminally ill patients if requested. Most respondents preferred to focus on symptom management before considering life-ending measures (Kremeike et al., 2021). According to research conducted in Belgium, those who requested euthanasia were more likely to have received palliative care than those who died for non-sudden reasons. This suggests that a patient's decision to pursue euthanasia may be influenced by effective palliative care (Dierickx et al., 2018). A qualitative analysis of professional journals discussing palliative care found that a growing body of literature addresses moral issues related to euthanasia. According to the results, many practitioners continue to maintain a clear distinction between assisted dying and palliative care (Fontalis et al., 2018). These studies underscore the importance of an ongoing dialog among healthcare professionals regarding the ethical implications and practicalities of integrating euthanasia into palliative care. 

Data shows that palliative care professionals are strongly opposed to the implementation of euthanasia in their practice. This opposition stems from the belief that palliative care should concentrate on improving patients' quality of life without hastening or delaying death. The IAHPC survey also shows that there are problems with transparency and accountability in assisted dying practices. This suggests that more research and discussion is needed between the palliative care team and those involved in death assistance (De Nonneville et al., 2018). Based on the data that has been studied, I believe that although euthanasia can help patients who are experiencing unbearable suffering, it should be done carefully within the palliative care process. Rather than hastening death, the main goal of palliative care is to improve quality of life through comprehensive care. 

However, it is important to respect individual freedom and understand that when patients face intolerable pain or loss of dignity, some may see euthanasia as a legitimate option. The challenge is to ensure that such decisions are made freely and without coercion while maintaining access to high-quality palliative care services (BernalCarceln, 2020). It is crucial for healthcare providers to talk to patients thoroughly about their wishes and the potential consequences of a euthanasia decision. This method makes the patient feel supported when making the decision and ensures their rights are protected (Pesut et al., 2020). 

In conclusion, euthanasia in palliative care is still a contentious issue. Some argue that it violates the principles of palliative care, while others argue that it respects patient autonomy and dignity. Recent research underscores the need for more transparency and accountability in assisted dying practices. Ultimately, incorporating euthanasia into palliative care should be done with caution, ensuring that improving the patient's quality of life remains the primary focus (Bellon et al., 2022). Euthanasia remains a contentious issue in the realm of palliative care, raising important ethical questions regarding autonomy, beneficence, impartiality and justice. Recent research suggests a complex relationship between the practice of euthanasia and palliative care services, highlighting a range of attitudes among health professionals (Leboul et al., 2022). 

As society continues to grapple with this issue, it is imperative for healthcare providers to engage in open discussions about end-of-life choices while prioritizing patient well-being. Ultimately, any approach to integrating euthanasia into palliative care should prioritize compassionate care that respects individual choice while upholding ethical standards. 

References 

• Akdeniz, M., Yardmc, B., & Kavukcu, E. (2021). Ethical considerations at the end-oflife care. SAGE Open Medicine, 9. https://doi.org/10.1177/20503121211000918 
• Bellon, F., Mateos, J. T., Pastells-Peir, R., Espigares-Trib, G., Gea-Snchez, M., & Rubinat-Arnaldo, E. (2022). The role of nurses in euthanasia: A scoping review. International Journal of Nursing Studies, 134. https://doi.org/10.1016/j.ijnurstu.2022.104286 
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