Palliative care and PAD - The Benelux experience

Xavier Symons
7 February 2015
Reproduced with Permission
BioEdge

In debates about end of life care, there are many who express concern at the potential impact of physician-assisted death on palliative care. Are there grounds for this worry?

A recent paper in the Journal of Medical Ethics says 'no'. The paper - published by a team of researchers from Belgium's End of Life Care Research Group - compares the development of palliative care (PC) in countries where euthanasia is legal to countries where it is not.

The team considered changes in structural service indicators in EU countries, as well as examining increases in government spending on palliative care in Belgium over the period 2002-2011.

The results, they said, were surprising. The rate of increase in the number of structural PC provisions was highest in the Netherlands and Luxembourg. Belgium stayed on par with the UK in its development of palliative care availability. Furthermore, Belgian government expenditure for PC doubled between 2002 and 2011.

The authors tentatively suggest that concerns about effects on palliative care are unfounded:

"Does adding the 'antibiotic' of PAD to the Petri dish of society inhibit growth of PC resources and services? The Benelux data do not verify this concern."

But while these findings are significant, the authors still note that only one in four of the top countries for palliative care provision in the EU is a country that allows euthanasia (Belgium). In the other three top countries, Iceland, the UK and Sweden, the procedure remains illegal.

The authors of the study also acknowledge that it will be important to examine the long term effects of euthanasia legalization: "A final comment is that the effects of legal PAD may still manifest on the longer term or in other ways."

Time will tell what other effects euthanasia has on end-of-life care.

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