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All patients should be treated with respect, courtesy and compassion simply because they are of immense value and worth as human beings. Serious illness does not rob someone of their inherent human dignity. Dignity is intrinsic to who we are as human beings and cannot be lost. Accordingly, it is the very presence of that inherent human dignity, that intrinsic value and worth of human beings that restrains us from taking human life.
The UN declaration of Human Rights states in its preamble,
‘recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.
Dependence need not be undignified but is at the heart of human relationships. Responsibility to and for each other is the very stuff of friendship and family, of the doctor-patient relationship, of society itself.
DAME Cicely Saunders, the founder of the modern hospice movement said:
“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”
The test for our society is how we value those who are dying and look after those who need care.
We must listen to those who have had difficult experiences of family members’ deaths or have poor symptom control at present. Modern specialist palliative care can address many of the difficulties that patients experience at the end of life. There are many pain medications that can be used in different ways and different combinations. If patients’ pain, nausea or breathlessness is not well controlled, we should ensure that there is access to expert palliative care provision to help make them more comfortable:
‘many complex patients with a serious, life-threatening illness benefit from consultation with palliative care specialists, who are trained and experienced in complex symptom management and challenging communication interactions, including medical decision making and aligning goals of care.
Strand JJ, Kamdar MM, Carey EC. Top 10 things palliative care clinicians wished everyone knew about palliative care. Mayo Clin Proc. 2013 Aug;88(8):859-65. doi: 10.1016/j.mayocp.2013.05.020. PMID: 23910412.
It is important to note that pain is not the main reason why people seek assisted suicide. Not all suffering is physical, but often has psychological, social and spiritual aspects.
‘Inadequate pain control, or concern about it’ was reported by 32.7% and this does not break down how many felt in actual pain, or were concerned about potentially experiencing pain in the future.
Where pain is an issue therefore, this is likely due to a lack of access to that specialist palliative care, which is an argument for extension of that access, not euthanasia. For difficult pain management, although there is much that can be done, we should be campaigning for greater research in palliative care for better painkillers and other drugs to support comfort care.
