Euthanasia debate reignited
===========================

* Marcel Boisvert

It is notable that after all the years of discussions that followed the Sue Rodriguez case, we are still insinuating that “pain so intense” (which painkillers do not alleviate) leads near-death patients to ask that their life be ended. 1 Thanks to palliative care (and others), pain management has made so much progress in the past 40 years that most studies have shown that pain is NOT the primary reason to request euthanasia. Often, pain ranks 4th, 5th or lower. 2 

The most common motives are existential, a much less relievable type of suffering: profound deterioration, progressive loss of autonomy, unacceptable dependency, all leading to meaninglessness, even in spite of excellent palliative care. In a recent Canadian study, 6% of 379 palliative care cancer patients wanted euthanasia “now.” 3 Modern dying, for a few, has become unacceptable. That explains the 80% support of Canadians, and that of 75% of Quebec’s specialists recently reported. Yes, when appropriate and so wished by a near-death patient, euthanasia should be the “ultimate palliation.”

## Footnotes

*   **For the full letter, go to:** [www.cmaj.ca/cgi/eletters/181/8/463#220766](http://www.cmaj.ca/cgi/eletters/181/8/463#220766)

## REFERENCES

1.  1. Collier R. Euthanasia debate reignited. CMAJ 2009;181:463–4.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxODEvOC80NjMiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTgxLzExLzgyNS40LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2. Heyland, DK, Dodek, P, Rocker G, et al. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ 2006;174:627–33.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNzQvNS82MjciO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTgxLzExLzgyNS40LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  3. Wilson KG, Chochinov HM, McPherson CJ, et al. Desire for euthanasia or physician-assisted suicide in palliative cancer care. Health Psychol 2007;26: 314–23.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1037/0278-6133.26.3.314&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=17500618&link_type=MED&atom=%2Fcmaj%2F181%2F11%2F825.4.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000246569100009&link_type=ISI)