This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but (...) together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. (shrink)

Dr Gillian Craig (1) has argued that palliative medicine services have tended to adopt a policy of sedation without hydration, which under certain circumstances may be medically inappropriate, causative of death and distressing to family and friends. We welcome this opportunity to defend, with an important modification, the approach we proposed without substantive background argument in our original article (2). We maintain that slowing and eventual cessation of oral intake is a normal part of a natural dying process, that artificial (...) hydration and alimentation (AHA) are not justified unless thirst or hunger are present and cannot be relieved by other means, but food and fluids for (natural) oral consumption should never be 'withdrawn'. The intention of this practice is not to alter the timing of an inevitable death, and sedation is not used, as has been alleged, to mask the effects of dehydration or starvation. The artificial provision of hydration and alimentation is now widely accepted as medical treatment. We believe that arguments that it is not have led to confusion as to whether or not non-provision or withdrawal of AHA constitutes a cause of death in law. Arguments that it is such a cause appear to be tenuously based on an extraordinary/ordinary categorisation of treatments by Kelly (3) which has subsequently been interpreted as prescriptive in a way quite inconsistent with the Catholic moral theological tradition from which the distinction is derived. The focus of ethical discourse on decisions at the end of life should be shifted to an analysis of care, needs, proportionality of medical interventions, and processes of communication. (shrink)

A Tip of the Hat to Our Peer Reviewers Content Type Journal Article Category Editorial Pages 319-322 DOI 10.1007/s11673-011-9328-9 Authors Michael A. Ashby, Palliative Care and Persistent Pain Services, Royal Hobart Hospital, Southern Tasmania Area Health Service and School of Medicine, Faculty of Health Sciences, University of Tasmania, 1st Floor, Peacock Building, Repatriation Centre, 90 Davey St, Hobart, TAS 7000, Australia Leigh E. Rich, Department of Health Sciences (Public Health), Armstrong Atlantic State University, 11935 Abercorn Street, Savannah, GA 31419, USA (...) Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 4. (shrink)

Discussing Difference and Dealing With Desolation and Despair Content Type Journal Article Category Editorial Pages 315-317 DOI 10.1007/s11673-011-9331-1 Authors Michael A. Ashby, Palliative Care and Persistent Pain Services, Royal Hobart, Hospital, Southern Tasmania Area Health Service, and School of Medicine, Faculty of Health Sciences, University of Tasmania, 1st Floor, Peacock Building, Repatriation Centre, 90 Davey Street, Hobart, TAS 7000 Australia Leigh E. Rich, Department of Health Sciences (Public Health), Armstrong Atlantic State University, 11935 Abercorn Street, Savannah, GA 31419, USA Journal (...) Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 4. (shrink)