Euthanasia

Rebecca Yeung 楊美雲

Dear Editor

In the editorial titled "To die a dignified death" in the June 2007 issue of this journal, Dr Stephen Chen advocates voluntary euthanasia as the way to achieve a dignified death.¹

There is no doubt that a dignified death is of paramount importance for patients. Nevertheless euthanasia is not the solution.

The request for euthanasia is often a manifestation of various underlying problems, including suboptimal symptom control (especially pain control), undiagnosed depression, psychosocial issues (e.g. hopelessness, fear of being a burden) etc. Terminating the life of the patient by euthanasia is not the way to solve these underlying problems.

Dr Chen has quoted an article from BMJ to illustrate how a dignified death can be achieved. This is the story of a terminal patient who suffered from poor medical care and futile intervention given at an acute hospital, but subsequently had a peaceful and dignified death after transferring to another hospital which offered him good palliative care. This is a good example to illustrate that dignified death can be achieved through high quality palliative care instead of euthanasia.²

Good palliative care would be a more genuine and practical solution to achieve dignified death. More effort should be devoted for the development of palliative care instead of promoting euthanasia.

Legalization of euthanasia is not just a matter of personal choice. It involves complex ethical, social and medico-legal issues.

The legalization of euthanasia may lead to a negative impact on the chronically ill and the vulnerable, e.g. imposing pressure on them to choose euthanasia. It will also have a negative implication on resource allocation for their service provision.

Legalization of euthanasia will also result in the problem of slippery slope. Nowadays euthanasia in Netherland and Belgium has already moved from voluntary euthanasia to non-voluntary euthanasia. Disabled babies who cannot express their wishes have already become a target.^3,4

In conclusion, euthanasia is not the answer for achieving a dignified death. Palliative care should have priority over euthanasia. High quality palliative care should be developed and the access to palliative care should be ensured before discussion on legislation of euthanasia.

Author's reply
Stephen Chen 陳紹德

Dear Editor

In response to Dr Yeung's letter concerning an invited editorial I wrote for the June issue of The Hong Kong Practitioner, I gladly note that Dr Yeung also agrees with my view that the topic involves multidisciplinary complexities, encompassing not only ethical, medicolegal and religious issues, but also human rights concern. That is exactly why my plea is for "open uninhibited and well-informed discussions."¹

Neutrality with a touch of provocativeness is the name of the game and nowhere in the said editorial have I specifically pleaded for or against euthanasia whilst presenting different angles of the subject matter. The aim is to arouse multidisciplinary interest in an important topic that may touch us all, thereby providing a platform for discussions. Meaningful discussions demand that we start from neutrality.

The two papers^3,4 quoted by Dr Yeung to support her claim that legalization of euthanasia has led to "non-voluntary" ending of life of "disabled babies"² do not, on close scrutiny, contain such incriminating statistics. The patients were "critically ill neonates and infants",³ and there is a distinct gulf between the meaning of "critically ill" as reported in this paper and the term "disabled" as alleged by Dr Yeung. Moreover, the Dutch study⁴, which in 2001 (post-legalization of euthanasia) replicated a questionnaire study done in 1995 (pre-legalization of euthanasia), showed no significant increase in the use of euthanasia. The verbatim summary is that "decisions to actively end the lives of infants not dependent on life-sustaining treatment remained stable at 1%. The practice of end-of-life decision-making in neonatology of 2001 has changed little since 1995."⁴ These findings would strenghthen Professor Peter Singer's report that legalization of euthanasia has not harmed medical care in the Netherlands,⁵ rather than lend support to Dr Yeung's allegation of its indiscriminate use on "disabled babies who cannot express their wishes".²

Terminal illnesses embrace not only patients dying of metastatic carcinoma, but also bedridden and/or mechanically ventilated patients suffering from progressive muscular dystrophy, massive cerebrovascular accidents, post-traumatic tetraplegia, and so forth. For those latter patients, quality of life rather than pain relief may be of their over-riding concern. I fully concur with Dr Yeung that the development of readily accessible high quality palliative care is of paramount importance, but not to the extent of excluding other alternatives or obstructing their independent evolution. In a civilized and pluralistic society, the availability of choices should not lead to "negative.... resource allocation"² for certain existing services. Given the way whereby oriental officialdom grinds along, it will probably be decades (analogy can be seen in the legalization of homosexuality and abortion as well as the current debate on universal suffrage) before euthanasia is legalized locally, even if officials and legislators were to commence discussions now. By then, Dr Yeung will probably be in contented retirement and I shall have joined the hall of the departed. The gist of the matter is that no good government with a social conscience would use legalization of euthanasia as a tool to manipulate budget cuts in selective healthcare sectors, as feared by Dr Yeung.

I should like to thank Dr Yeung for her valuable comments, which hopefully will encourage more readers to take up the editorial bait, thereby sprinkling some much-needed spices into the cauldron of our College Journal.

Dr Stephen Chen
Honorary Clinical Assistant Professor in Family Medicine
The University of Hong Kong