Examining assisted suicide and euthanasia through the lens of healthcare quality

Abstract

Many people on both sides of the debate to legalise physician-hastened death are motivated by compassion and a desire to provide better end of life care for others. Assisted dying may include euthanasia and/or assisted suicide (EAS). It is legal in some jurisdictions and under debate in others including Ireland. EAS is a complex, sensitive and can be an emotive issue; detailed and nuanced examination of the subject is needed. To enhance this discussion, we examine EAS through the lens of quality. In examining EAS from this stance, we consider the action, along with the outcomes, the impact of the outcomes from other jurisdictions with legalised EAS, alongside the risks and the balancing measures used, in addition to considering the intervention itself. Progressive expansion of eligibility for EAS has occurred over time in the Netherlands, Belgium and Canada. Given the complexity of assessing coercion, the risks to persons in vulnerable groups (including older persons, persons with mental health conditions and persons with disabilities), the progressive expansion of eligibility for EAS, the lack of safety and the undermining of suicide prevention strategies, the current law is most protective of persons in vulnerable groups in the interest of social justice. Person-centred and compassionate care needs be prioritised with greater access and equitable access to primary and specialist palliative care and mental health care for persons with incurable and terminal illnesses and support for caregivers allowing patients to die naturally with optimised symptom control.

Keywords: Assisted suicide; Ethics; Euthanasia; Palliative care; Palliative medicine; Quality of healthcare.