Active euthanasia - a slippery slope

I AM a nurse working in a local hospice. I refer to the reports in the South China Morning Post, on July 11 and 15, regarding the drafting of a government position paper on euthanasia.

When terminally ill patients are dying it is our duty to relieve their suffering. Since using extraordinary or artificial means to prolong life (or the process of dying) will not benefit them, they are allowed to die naturally and peacefully. In hospice care, morphine relieves pain, but it is given solely with the intention to relieve pain, not to shorten life. In hospice care, withdrawing or withholding some treatment when a patient is at a terminal stage is a common practice, but active euthanasia is not practised.

Fear is often the basis for suicide and requests for active euthanasia. This fear relates to actual or anticipated physical pain, loss, isolation and abandonment. When the patient seeks release from an intolerable situation, examining sources of distress and trying to relieve them in a concrete way, may be enough to make the patient willing to postpone and eventually discard, consideration of hastening death. This caring approach to patients who request active euthanasia is widely adopted in hospice care. A number of patients have requested euthanasia when they have come to us. But when we managed to control their pain and provide appropriate emotional support, many patients changed their mind. The low incidence of suicide reported by many palliative care and hospice units supports this argument. The availability of euthanasia in the Netherlands is believed to be one reason why there has been such a limited development of hospice care in that country.

We care for the terminally ill with one fundamental belief - that no human life should be seen as less valuable because of physical or mental impairment. It is the respect for the inherent and intrinsic worth of the patient which enables us to persist in trying to help, even under adverse circumstances. Very often, a request for active euthanasia carries the underlying question: 'Am I a worthwhile person to society?' A health care professional who felt that a given patient still had a worthwhile life to live could not accede to a request for euthanasia. Active euthanasia might encourage the health professional to view the lives of some patients as worthless. With this view, we would not be able to help patients to value their lives.

The existence of a trusting relationship between the patient and the professional carer is essential in terminal care. If the health care professionals who have the duty to care and to heal took on the additional role of ending life, it might be very difficult to maintain this trust. In the hospital, the patients should not need to have to wonder whether the professional carers coming into their hospital rooms are there to relieve pain and restore health, or to perform the act of executioner. Trust between patient and the professional carer is too important and too fragile to be subjected to such strain.

There is a lot of public support for active euthanasia for people who are competent to make such a choice. However, once the legal barrier to the active termination of life was removed, it would be harder to define the grounds for excluding other patients from such treatment, that is, the elderly, the handicapped, chronically ill patients - anyone labelled by the system as having a poor quality of life. The alteration in the law could, in some circumstances, lead to a climate of opinion where euthanasia became not just permissible but desirable. The danger of a 'slippery slope' might arise making it difficult to create appropriate safeguards to prevent abuse.