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abstract
Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care -- Journal of Medical Ethics
The Belgian model of
‘integral’ end-of-life care consists of universal access to palliative
care (PC) and legally regulated
euthanasia. As a first worldwide, the
Flemish PC organisation has embedded euthanasia in its practice.
However, some critics
have declared the Belgian-model
concepts of ‘integral PC’ and ‘palliative futility’ to fundamentally
contradict the essence
of PC. This article analyses the
various essentialistic arguments for the incompatibility of euthanasia
and PC. The empirical
evidence from the euthanasia-permissive
Benelux countries shows that since legalisation, carefulness (of
decision making)
at the end of life has improved and
there have been no significant adverse ‘slippery slope’ effects. It is
problematic that
some critics disregard the empirical
evidence as epistemologically irrelevant in a normative ethical debate.
Next, rejecting
euthanasia because its prevention was a
founding principle of PC ignores historical developments. Further,
critics' ethical
positions depart from the PC tenet of
patient centeredness by prioritising caregivers' values over patients'
values. Also,
many critics' canonical (clergy) adherence to
the WHO definition of PC, which has intention as the ethical
criterion is objectionable. A rejection of the Belgian model on
doctrinal grounds also has nefarious practical
consequences such as the
marginalisation of PC in euthanasia-permissive countries, the
continuation of clandestine practices
and problematic palliative sedation
until death. In conclusion, major flaws of essentialistic arguments
against the Belgian
model include the disregard of
empirical evidence, appeals to canonical and questionable definitions,
prioritisation of caregiver
perspectives over those of patients and
rejection of a plurality of respectable views on decision making at the
end of life.
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