Doctor explains reservations about euthanasia

Wednesday 20 May, 2015

While palliative care specialist Dr Frank Formby says he does not have a black-and-white attitude to euthanasia, he sees many problems with the practice.

A Senior Conjoint Lecturer at the UNSW School of Public Health and Community Medicine,  Dr Formby outlined his views when he visited Warrane as special guest at Warrane’s formal dinner on Wednesday 20 May 2015.

After pointing out that palliative care is a multidisciplinary effort to "maximise a patient's welfare and quality of life", he was asked for his views on euthanasia.

He began by noting that the issue is often misrepresented by people who are in favour of the practice because their agenda is to promote it for the purpose of political change.

“[This] may not necessarily involve a sober examination of the ethics and the consequences of a change in policy which I think are really important questions,” he said. “I wouldn’t say it is black-and-white [nor] that I think it is totally unacceptable. But that isn’t to say I approve of it."

He said one of the misrepresentations is that euthanasia provides a "good death".

"I don’t think that it is necessarily a good death," he said. "Giving someone, for arguments sake, a lethal injection - well some people would regard that as murder, which is quite a common response and most people would say that murder is unacceptable.”

Dr Formby emphasised that the broader question was about whether or not people who ask for euthanasia really did want it.

“Even when people are asking for it, it is not necessarily what they want,” he said. “They want help. They don’t want to suffer. But to go to euthanasia doesn’t necessarily help - it shortens their life.

“I mean that is the point of it. It’s not the aim, but that is inevitable and that can take away potential life that people can enjoy.”

Dr Formby said often a request for euthanasia was due to fear.

“People are afraid of what may happen to them,” he said.  “It’s a general belief that cancer is very painful [and] that pain is inevitable and that pain cannot be controlled, or it is difficult to control or you need so many drugs that you don’t know what you are talking about.

“Most of those things are myths.”

Dr Formby said he regarded euthanasia as a form of assisted suicide, but the complexity came in because it was the patient’s wish: “Should we be encouraging suicide? We spend a lot of money and resources preventing suicide."

Other points Dr Formby made about palliative care included:

  • That it is primarily about symptom control and there are many ways of treating symptoms: “The best way is treating the cause of the symptoms, so if someone has a painful cancer in their bones, radiation is probably the best way of treating that symptom and then you don’t have to take drugs that have potential side effects and the radiation doesn’t have many side effects in that area. Basically what palliative care does is to come in after that and give people medications to control the symptoms.
  • Palliative care specialists generally try to deal with the whole person which involves spiritual and pastoral care: “They are very important and the more I do palliative care the more that I understand that is a big part of palliative care ... I think that people want to be treated as human beings. They want people to listen to them. They want their spiritual concerns addressed. They want their questions answered. They want their family supported and they want practical help with things like equipment, social services and finances and all sorts of things like that.”
  • The interface between geriatrics and palliative care isn’t quite clear: “In the past palliative care was what you got when other doctors were finished with you. Now increasingly it is realised there is a transition and people can have active treatment - in other words trying to fix the cause of their problems - as well as having palliative care, which is symptom control.
  • Many people find it very difficult to come to terms with the fact that they are going to die, no matter what their age. “Most people don’t want to die, especially if they are young. As they get older they [dying becomes more immediate but it doesn’t mean that it is welcomed].”
  • Family and friends of someone who is dying often do not want to tell the person the full truth about their condition, but this is often a mistake. “People want to keep bad news from people who are sick because they don’t want to distress [the] person they love with bad news, but it puts a barrier between members of the family. They can’t talk to someone genuinely, and there can be less of an opportunity to talk about things that are important. The vast majority of people who are dying actually know they are dying unless they are confused and even then quite often they know. So trying to keep this information secret by trying to hold on to control of information might help you cope but often makes things worse.”
  • Doctors need to take into account cultural attitudes when dealing with both the patient and the wider family, particularly on the question of informing a patient about death.
  • Often, even when a patient is very old - in their 80s or 90s and have had a full and productive life, they can get very upset when they find out they have got an illness that is very serious and that they are probably going to die: “It’s just a natural human reaction and I don’t think there is any way around that. I mean, people don’t have to accept it and quite often they don’t accept it. You can’t really fix it. You can’t make death be a good thing, if people don’t want to see it like that.”

Dr Formby said that these days doctors do not tend to wear formal dress, like suits, in palliative care because they want to be more approachable. He said he did not introduce himself using the title of doctor, but instead used his name in order to help develop a relationship with the patient and the family.

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