Why are Downar and colleagues1 so coy? Why not write in plain English? They come down squarely in favour of physician-assisted death, but don’t most physicians already assist in death? The authors,1 presumably, are promoting physician-administered death. The authors have moved “beyond Yes or No” to advocate euthanasia, but they do not want to admit this. They tell us to forget our well-rehearsed debate: sanctity of life versus patient autonomy, and yet they say they have no clear answer to their question of how to protect the vulnerable or incapable from receiving physician-administered death against their will. Psychiatric indications for physician-administered death by lethal injection could be equally contraindications.
The authors1 ask, “How can we ensure that physician-assisted death is available equitably to all patients?” Very simply, if amyotrophic lateral sclerosis or metastatic cancer are potential indications for physician-assisted death, then it will have to be offered to all patients with such diseases. A few will accept, many will be frightened and a few will feel obliged. Obviously, there would be a trade-off. The supposed benefit to a few would threaten many more: this is why most doctors oppose euthanasia. Do the authors1 have any new figures to contradict this? In my 29 years of experience, the vast majority of the frail and ill want to live — and without a medically administered threat hanging over them.
The authors1 ask, “How can we ensure that physician-assisted death will not be considered a low-cost alternative to palliative care?” There is only one way: do not make killing the patient an alternative. Indeed, the authors do suggest the answer: improve the availability of palliative care and keep physician administered-death illegal.