IAHPC Special Issue on Assisted Dying Practices

Photo by IAHPC member Kim Adzich. Used with permission.
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Section I: The survey

Introduction
Lukas Radbruch, IAHPC Chair of the Board; Tania Pastrana, IAHPC Research and Academic Advisor; Liliana De Lima, IAHPC Executive Director

Methodology and Key Findings
Methodology / Definitions / Main findings / Open comments

Perspectives of major world religions on euthanasia and assisted dying
Katherine Pettus, IAHPC Senior Director of Partnerships & Advocacy

Human rights framework of the right to life and right to die
Katherine Pettus, IAHPC Senior Director of Partnerships & Advocacy

Section II: Opinions

Heads of global associations

How will these issues impact a country’s development of palliative care? Views of our colleagues are important, and should be heard.
Julia Downing, Executive Director, International Children’s Palliative Care Network (ICPCN)

We could do more to delve into the challenges that our colleagues face when forced to choose whether to participate in assisted dying, and better understand the longer-term impact of these decisions on family members.
Stephen Connor, Executive Director, Worldwide Hospice Palliative Care Alliance (WHPCA)

Heads of regional associations

In Africa, discussing euthanasia risks hindering or destroying nascent palliative care, and the practice goes against faith and culture.
Emmanuel B.K. Luyirika, Executive Director, African Palliative Care Association (APCA)

Assisted dying & euthanasia are not matters of great public debate in the Asia Pacific region. These options devalue the dying and undermine society’s responsibility to protect its most vulnerable members.
Ednin Hamzah, Chair, Asia Pacific Hospice Palliative Care Network (APHN)

Heterogeneity marks the European experience of assisted dying. For me, however, it remains clear that euthanasia is not a part of palliative care.
Christoph Ostgathe, President, European Association for Palliative Care (EAPC)

This discussion is increasingly necessary, as assisted dying and euthanasia are increasingly decriminalized. However, first we need universal access to quality palliative care.
Paola Marcel Ruíz Ospina, President, Latin American Palliative Care Association (ALCP)

The large majority of people in the Caribbean object to assisted dying on religious grounds, as it is considered a grave sin to actively choose your time of death.
Dingle Spence, President-Elect, Caribbean Palliative Care Association (CARIPALCA)

Africa

In 20 years, many newly referred patients have wished for death, but only 2 asked for help to die after receiving palliative care. Terminal sedation—a dignified death—is preferred.
Olaitan Soyannwo, Nigeria

A person-centered approach helps alleviate the suffering that causes patients to request euthanasia.
Eve Namisango, Uganda

IAHPC’s goal of quality palliative care for those in need is on point in an ideal world that few countries attain—leaving a vacuum on how to act.
Jennifer Hunt, Zimbabwe

See also: Emmanuel Luyirika

Asia Pacific/Australia/India

Though described as a choice of care, physician-assisted dying is no choice if basic social support, health care, and quality palliative care services are not provided for.
Maria Cigolini, Australia

It is the need of the hour to have a clear understanding and message for all.
Sushma Bhatnagar, India

See also: Ednin Hamzah

Europe

Belgium’s 20-year history of assisted dying is well accepted by the public and health care practitioners; ideally, it should be integrated into palliative care.
Luc Deliens, Belgium

In Italy, people are reluctant to talk about death and dying. Assisted dying carries a concrete risk of furthering a gap in care between rich and poor.
Simone Cernesi, Italy

The desire to die without suffering is a legitimate one that, fortunately, has an effective medical response in what we know as palliative care.
Carlos Centeno, Spain

Wherever assisted dying has been rolled out it rapidly expands, and access to early, quality palliative care dwindles. The fundamental question not asked: Is it part of clinical care or not?
Baroness of Llandaff Ilora Finlay, United Kingdom

Let us pay attention to cautionary experiences and not move rapidly toward new laws, which are blunt instruments that respond poorly to ethical complexities.
Robert Twycross, United Kingdom

See also: Christoph Ostgathe

North America

A pharmacist’s point of view on physician-assisted suicide.
Ebtesam Ahmed, United States

Euthanasia and palliative care: synonyms, antonyms, or a different language?
Eduardo Bruera, United States

A minority of people seek hastened death for pain relief; others are motivated by loss of dignity, or feeling like a burden. In our field, we believe it is a privilege to care, not a burden.
Ira Byock, United States

If palliative care is not a national priority, given the demographics and our underfunded health care system, I don’t know what is.
Monica Do Cuotti Monni, Canada

A cautionary tale from Canada: MAiD, intended as an exceptional event to relieve intolerable suffering, is now commonplace. How about medical aid in living?
Romayne Gallagher, Canada

The disengagement of formal palliative care and mainstream medicine from assisted dying has resulted in a lost opportunity in Canada and elsewhere for these groups to have a moderating influence on the practice.
Gary Rodin, Canada

An interdisciplinary perspective: to find common ground, personal biases and beliefs need to be respected yet kept out of the debate.
Gina Tarditi, Mexico

See also: Dingle Spence

South America

Framing the discussion as “all or nothing” or “for or against” does not allow us to advance in a mature, sincere, committed, and well-founded analysis of these alternatives.
María Susana Ciruzzi, Argentina

How a discussion of MAiD served as a catalyst for a Universal Palliative Care Law. Also, life as “sacred” is increasingly exposed to a qualitative evaluation.
María Alejandra Palma, Chile

When options are limited, such as poor access to essential pain relief medicines, are patients’ decisions truly acts of self-determination?
María Adelaida Córdoba, Colombia

A request for assistance in dying because of predominantly physical suffering should be treated as a medical emergency and addressed immediately. Seek clarity on motivation. Be honest about what you can offer.
Luisa Fernanda Rodríguez-Campos, Colombia

See also: Paola Marcela Ruíz Ospina

Closing statement