{"id":7746,"date":"2020-11-29T14:11:52","date_gmt":"2020-11-29T05:41:52","guid":{"rendered":"https:\/\/exitinternational.net\/?p=7746"},"modified":"2020-11-29T21:44:34","modified_gmt":"2020-11-29T13:14:34","slug":"demedicalisation-radically-reframing-the-assisted-dying-debate-an-essay-by-lucy-thomas","status":"publish","type":"post","link":"https:\/\/www.euthanasia.net\/exit\/demedicalisation-radically-reframing-the-assisted-dying-debate-an-essay-by-lucy-thomas\/","title":{"rendered":"Demedicalisation: radically reframing the assisted dying debate &#8211; Lucy Thomas"},"content":{"rendered":"<p><strong>Lucy Thomas questions why assisted dying is framed as a medical solution to a medical problem <\/strong><strong>and proposes demedicalising the debate<\/strong><\/p>\n<p><em>Lucy Thomas, consultant in public health and specialty doctor in palliative care<\/em><\/p>\n<p>Medically assisted dying currently exists as a legal medical procedure for patients meeting defined eligibility criteria in six countries, one Australian state, and nine US states, and pressure is mounting to extend the practice to other countries.<\/p>\n<p>The current eligibility criteria vary considerably, from unbearable physical or mental suffering in the presence of an incurable (but not necessarily terminal) illness, disorder, or disability to the presence of a terminal illness (variously defined) without any judgment of suffering (box 1). But what they all have in common is an assumption that the desire to end life in the presence of an eligible medical condition is a medical problem requiring a medical solution\u2014and fundamentally different from the desire to end life in all other circumstances.<\/p>\n<p>Medical eligibility criteria for assisted dying in different jurisdictions<\/p>\n<p><strong>US States, Colombia, Victoria (state, Australia)<\/strong><\/p>\n<p>Terminal illness<\/p>\n<ul>\n<li>Death expected within six months &#8211; US states where the practice is legal; Colombia; and Victoria, Australia<\/li>\n<li>Death expected within 12 months\u2014Victoria, in the case of a neurodegenerative condition<\/li>\n<li>Prognosis not defined<\/li>\n<\/ul>\n<p><strong>Luxembourg; Switzerland*<\/strong><\/p>\n<p>Serious and incurable illness, disease, or disability (does not have to be terminal)<\/p>\n<p><strong>Belgium, Netherlands, Canada**<\/strong><\/p>\n<p>Unbearable physical or mental suffering\u2014Netherlands, Belgium, Luxembourg, Colombia, Canada<\/p>\n<p>\u2022In Switzerland assisted dying has not been legalised, but assisted suicide is not a crime. However, only doctors are permitted to prescribe the lethal drug, and they must<br \/>\nwork within professional guidelines, which require that a patient be \u201capproaching end of life.\u201d<\/p>\n<p>**In Canada an initial requirement that even though an illness need not be terminal natural death must be \u201creasonably foreseeable\u201d was ruled unconstitutional by<br \/>\nthe Supreme Court in Quebec in 2019.<\/p>\n<p><a href=\"https:\/\/exitinternational.net\/demedicalisation-radically-reframing-the-assisted-dying-debate-an-essay-by-lucy-thomas\/screen-shot-2020-10-21-at-4-48-40-pm\/\" rel=\"attachment wp-att-7749\"><img loading=\"lazy\" class=\"aligncenter wp-image-7749 size-large\" src=\"https:\/\/exitinternational.net\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm-620x509.jpeg\" alt=\"\" width=\"620\" height=\"509\" srcset=\"https:\/\/www.euthanasia.net\/exit\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm-620x509.jpeg 620w, https:\/\/www.euthanasia.net\/exit\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm-300x246.jpeg 300w, https:\/\/www.euthanasia.net\/exit\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm-768x630.jpeg 768w, https:\/\/www.euthanasia.net\/exit\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm-600x492.jpeg 600w, https:\/\/www.euthanasia.net\/exit\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm-220x180.jpeg 220w, https:\/\/www.euthanasia.net\/exit\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm-130x107.jpeg 130w, https:\/\/www.euthanasia.net\/exit\/wp-content\/uploads\/2020\/10\/Screen-Shot-2020-10-21-at-4.48.40-pm.jpeg 1203w\" sizes=\"(max-width: 620px) 100vw, 620px\" \/><\/a><\/p>\n<p><strong>Why medical eligibility criteria?<\/strong><\/p>\n<p>Advocates of medically assisted dying rarely explain why, if the key values at stake are compassion and autonomy, the right to an assisted death should be restricted to people with medical conditions. Instead, they tend to assert that eligible patients are not suicidal and focus on the prospect of intolerable physical symptoms, especially pain, if the practice is not legalised.<\/p>\n<p>However, a large body of research demonstrates that the reasons why patients with advanced and terminal illnesses seek to hasten death are as complex and varied as they are among other people considering ending their lives prematurely, and they are heavily influenced by psychosocial and existential issues\u2014such as feelings of being a burden, hopelessness and loss of meaning, a lack of social support, depression, and loss of autonomy and a social role. (1 -3)<\/p>\n<p>Patients with advanced illness can certainly suffer from a high symptom burden, especially in the absence of good quality palliative care. However, studies have found that the presence and severity of physical symptoms are either not predictive or only weakly predictive of the desire to hasten death, whereas the strongest predictors are depression, hopelessness, and the perception of being a burden. (4 -6)<\/p>\n<p>Experience from implementing the US state of Oregon\u2019s Death with Dignity Act reflects these findings. In a study of patients who requested a medically assisted death all current physical symptoms, including pain, had an average rating of \u201cnot at all important,\u201d in contrast with higher ratings for psychosocial issues and worries about future symptoms. (7)<\/p>\n<p>One in four participants who requested a medically assisted death, and one in six of those who received one, had diagnosable clinical depression. (8)<\/p>\n<p>The most common officially reported concerns of patients who received a medically assisted death in 2019 were \u201closs of autonomy\u201d (90.4%), \u201cdecreasing ability to participate in activities that made life enjoyable\u201d (86.7%), \u201closs of dignity\u201d (72.3%), and \u201cbeing a burden on family, friends\/caregivers\u201d (59.0%)\u2014whereas only a third reported \u201cinadequate pain control\u2014or concern about it.\u201d (9)<\/p>\n<p>The desire to hasten death is highly unstable in patients with advanced and terminal illness, who are often adjusting to rapidly changing and\/or vulnerable circumstances. Studies have found that as many as half change their mind during follow-up, (10) including those with \u201ca long-lasting and apparently consolidated wish to hasten death,\u201d(11) and important changes are seen even in the last weeks of life. (12)<\/p>\n<p>Although palliative care interventions, including management of depression, significantly reduce the proportion of patients who proceed to an assisted death, (13, 14) no consistent factors distinguish those who change their minds from those who do not. (12)<\/p>\n<p><strong>Why medical assistance?<\/strong><\/p>\n<p>When it comes to understanding why doctors are required to do the assisting, again proponents seldom justify their involvement explicitly.<\/p>\n<p>The medical profession is certainly not necessary to achieve the right to die: detailed technical guidance on how to end life is available over the internet, as is access to the drugs to do so. Moreover, if society decides that there are circumstances in which people should be helped to end their lives, provision of a standard dose of a lethal drug for self-administration does not require any medical knowledge or skills.<\/p>\n<p>Research on why people seek a specifically medically assisted death sheds light on the desire for medical participation, as patients describe how involving a doctor provides validation and legitimacy to the decision to end life. (15, 16)<\/p>\n<p>Some advocates suggest that the medical profession has an even more determining role, with doctors required to provide a \u201ccompetent judgement that death would be of benefit to the patient.\u201d (17) Others acknowledge concerns about this major extension of medical authority but still support the involvement of the medical profession on purely strategic grounds, stating that \u201ceven if there is no logical basis for a predominantly medicalised model it is arguably better to advocate the model that is most likely to be acceptable to legislature and the public.\u201d (18)<\/p>\n<p><strong>What are the consequences?<\/strong><\/p>\n<p><strong>Institutionalising unconscious discrimination<\/strong><\/p>\n<p>Medically assisted dying creates a differential healthcare response to patients who express a desire to end their lives, depending on the presence or absence of an eligible medical condition. In the absence of such a condition, doctors are expected to address issues amenable to intervention; to support patients in their struggle to rediscover meaning, value, and purpose; and to do everything possible to prevent suicide. By contrast, for eligible patients with a chronic or terminal illness or disability doctors are expected to assist them in ending their lives, thus formally validating the patients\u2019 assessment that their lives are no longer worth living.<\/p>\n<p>Advocates for disability rights have highlighted how this distinction institutionalises deeply discriminatory attitudes about the relative value of different lives\u2014in a context that equates dependence with burden and indignity and too often disempowers rather than enables people living with severe illness and disability.19<\/p>\n<p>It would be unthinkable to base eligibility for assisted dying on another protected characteristic such as sex or race, illustrating the depth of unconscious prejudice associated with advanced illness and disability.<\/p>\n<p>The consequences are starting to be seen. In 2019, the United Nations special rapporteur on the rights of persons with disabilities reported serious concerns about people with disabilities in Canada being pressured to seek medical assistance in dying instead of receiving viable care options. (20)<\/p>\n<p>And in Oregon, official data have shown progressive increases in both the number and proportion of patients who receive a medically assisted death because of concerns about being a burden on others and loss of dignity and autonomy. (9)<\/p>\n<p><strong>Crossing the red line<\/strong><\/p>\n<p>In countries where trends in end of life practices have been monitored over time, wider changes in medical care have been documented after lifting the absolute prohibition on doctors deliberately ending patients\u2019 lives.<\/p>\n<p>In addition to the progressive rise in legal medically assisted deaths, Belgium, the Netherlands, and Switzerland have seen substantial increases in the use of deep continuous sedation until death, up from 5.7% of all deaths in the Netherlands in 2001 to 18.3% in 2015. (21)<\/p>\n<p>In Belgium and the Netherlands this practice involves the intentional inducement of deep unconsciousness up to two weeks before anticipated death (22)\u2014a very different practice from the titration of medicines with potentially sedating side effects to treat specific symptoms in the last days of life, as typically practised elsewhere. (23, 24)<\/p>\n<p>Although it\u2019s not legal to do so, doctors describe how they sometimes use deep continuous sedation with life shortening intent in these countries\u2014as a more \u201cnatural\u201d or less administratively burdensome alternative to euthanasia23 -25 but also in response to pressure from family members,23 or even because of the doctors\u2019 own discomfort at witnessing the dying process. (25)<\/p>\n<p><strong>Technocratic reductionism<\/strong><\/p>\n<p>When assisted dying is framed as a medical treatment it increasingly becomes normalised as just another technical healthcare procedure, devoid of any social or ethical implications.<\/p>\n<p>Certain jurisdictions in Canada have incorporated medical assistance in dying into the job descriptions of palliative care nurses26 and are now obliging hospices to provide it as part of their end of life provision. (27)<\/p>\n<p>Health economists in the US and Canada have quantified how much money the healthcare budget saves by ending lives prematurely through medically assisted dying. (28, 29)<\/p>\n<p>Others are starting to conceptualise the outcomes in health utility terms, formulating reallocation of resources saved, a predicted increase in organ donations, and avoidance of \u201ctime in [a] state worse than death\u201d into \u201cpositive quality adjusted life years\u201d (QALYs) generated from medically assisted deaths\u2014enabling them to conclude that \u201cthe benefits to the individual patients who choose assisted dying may in fact be outweighed by the broader benefits to society.\u201d (30)<\/p>\n<p><strong>Demedicalisation &#8211; <\/strong><strong>What happens if we challenge this profoundly medicalised <\/strong><strong>perspective?<\/strong><\/p>\n<p>Firstly, with no reason why a standard dose of a lethal chemical should be viewed as a therapeutic drug requiring medical prescription, it becomes clear that giving people access to the means to end their life is not, in itself, a medical procedure, and there is no practical need to involve a medical professional. More fundamentally, it becomes difficult to reduce something as profoundly complex as the desire to end life to a medical problem.<\/p>\n<p>All of us experience suffering in our lives, and at times we all ponder the meaning of our existence in the context of our personal histories, social relationships, and wider circumstances. Many of us have occasions when we question whether our lives are worth living, and some go as far as to consider ending life, either in a moment of desperation or after lengthy, considered deliberation. The underlying existential struggle is not fundamentally different in the presence or absence of illness or disability; nor is it determined by how long or short a remaining life is predicted to be.<\/p>\n<p>Once we acknowledge this, it becomes evident that decisions about whether people should ever be assisted to end their life should not be based on societal judgments about the conditions that make a life no longer worth living. Instead, we need to start asking broader questions about how society should respond to anyone with mental capacity and a consistent desire to end their life prematurely.<\/p>\n<p>These include fundamental philosophical issues, such as:<\/p>\n<ul>\n<li>What constitutes a rational decision to end one\u2019s life, and is there any way that this could be objectively assessed without relying on an external evaluation of the quality or value of the life at stake? (19)<\/li>\n<li>Is the decision to end life, as libertarians argue, so profoundly private and individual that, to truly respect autonomy, the state should never intervene, either to prevent or to assist? (31)<\/li>\n<li>Or is autonomy relational, making it impossible to detach an individual\u2019s decision to end life from the influence of people around them? (32)<\/li>\n<\/ul>\n<p>Then we have more practical questions, such as:<\/p>\n<ul>\n<li>How should we judge whether an individual\u2019s desire to end life is a response to circumstances that should be challenged rather than accepted, including addressing the physical, social, and economic factors that contribute tohumansuffering and despair?<\/li>\n<li>Is it ever possible to predict that a desire to end life is so firmly established that it could never be reversed?<\/li>\n<li>How would the way society responds to the expressed desire to end life in turn influence how people feel about the value of theirown lives and the lives of others?<\/li>\n<li>And, if society were to legalise assistance in ending life, who would be best placed to provide it: an existing professional group, lay volunteers, the courts, or a new profession specialising in the highly complex assessment and support of people who ask for help to die?<\/li>\n<li>With such questions at the forefront we can start to seriously discuss the wide range of potential societal responses\u2014from trying to prevent people from deliberately ending their life in all circumstances, to, under certain conditions, decriminalising assisted suicide, legalising access to the means for people to end their own life safely or giving society the legal power to end their life for them.<\/li>\n<li>What would the individual and societal level consequences be for each of these options, and what ethical and practical trade-offs would society be willing to accept?<\/li>\n<\/ul>\n<p><strong>Conclusion<\/strong><\/p>\n<p>Medically assisted dying frames assisted death as a straightforward medical solution to a medical problem, a solution that promotes compassion and autonomy and has no ill effects for individual patients or society. However, with medical criteria for what constitutes an acceptable reason for ending life, and with doctors as the arbiters and administrators, it extends medical authority rather than enhancing patient autonomy, with deeply damaging unintended consequences. Moving outside the medical frame brings the fundamental ethical and practical dilemmas into focus, facilitating serious discussion about how society should respond to people with mental capacity and a consistent desire to end their life prematurely.<\/p>\n<p>As with any issue as complex as this, there are no easy answers or simple solutions. Acknowledging this profound complexity may be the first step towards a more constructive debate.<\/p>\n<p><strong>Biography<\/strong><\/p>\n<p>Lucy Thomas is a consultant in public health with experience in the UK and internationally. For the past five years she has been working clinically in palliative care alongside her public health role. Working closely with patients with life limiting illnesses and their families has led her to question an initially uncritical attitude towards medically assisted dying.<\/p>\n<p>This article is informed by personal and clinical experiences; in-depth conversations with patients, including over prolonged periods; her broader public health perspective; discussions with clinical and public health colleagues, including some who have provided medically assisted dying in Canada and the Netherlands; and an extensive review of the literature.<\/p>\n<p>The opinions expressed in this article are solely her own, and they do not reflect the views or opinions of the organisations she works for.<\/p>\n<p>Competing interests: I have read and understood BMJ policy on declaration of interests and have no interests to declare.<\/p>\n<p>Provenance and peer review: Commissioned; not externally peer reviewed.<\/p>\n<p><strong>References<\/strong><\/p>\n<h6>1 Monforte-Royo C, Villavicencio-Ch\u00e1vez C, Tom\u00e1s-S\u00e1bado J, Balaguer A. The wish to hasten death: a review of clinical studies. <em>Psychooncology<\/em> 2011;20:795-804.<br \/>\ndoi: 10.1002\/pon.1839. pmid: 20821377<br \/>\n2 Hendry M, Pasterfield D, Lewis R, Carter B, Hodgson D, Wilkinson C. Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. <em>Palliat Med<\/em> 2013;27:13-26. doi: 10.1177\/0269216312463623.<br \/>\n3 Monforte-Royo C, Villavicencio-Ch\u00e1vez C, Tom\u00e1s-S\u00e1bado J, Mahtani-Chugani V, Balaguer A. What lies behind the wish to hasten death? A systematic review and meta-ethnography from the perspective of patients. <em>PLoS One<\/em> 2012;7. doi: 10.1371\/journal.pone.0037117.<br \/>\n4 Breitbart W, Rosenfeld B, Pessin H, etal. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. <em>JAMA<\/em> 2000;284:2907-11. doi: 10.1001\/jama.284.22.2907. pmid: 11147988<br \/>\n5 Kelly B, Burnett P, Pelusi D, Badger S, Varghese F, Robertson M. Factors associated with the wish to hasten death: a study of patients with terminal illness. <em>Psychol Med<\/em> 2003;33:75-81. doi: 10.1017\/S0033291702006827. pmid: 12537038<br \/>\n6 Smith KA, Harvath TA, Goy ER, Ganzini L. Predictors of pursuit of physician-assisted death. <em>J <\/em><em>Pain Symptom Manage<\/em> 2015;49:555-61. doi: 10.1016\/j.jpainsymman.2014.06.010.<br \/>\n7 Ganzini L, Goy ER, Dobscha SK. Oregonians\u2019 reasons for requesting physician aid in dying. <em>Arch Intern Med<\/em> 2009;169:489-92. doi: 10.1001\/archinternmed.2008.579. pmid: 19273779<br \/>\n8 Ganzini L, Goy ER, Dobscha SK. Prevalence of depression and anxiety in patients requesting physicians\u2019 aid in dying: cross sectional survey. <em>BMJ<\/em> 2008;337:a1682. doi: 10.1136\/bmj.a1682. pmid: 18842645<br \/>\n9 Oregon Health Authority. Death with Dignity Act annual reports. https:\/\/www.oregon. gov\/oha\/PH\/PROVIDERPARTNERRESOURCES\/EVALUATIONRESEARCH \/DEATHWITHDIGNITYACT\/Pages\/ar-index.aspx.<br \/>\n10 Emanuel EJ, Fairclough DL, Emanuel LL. Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. <em>JAMA <\/em>2000;284:2460-8. doi: 10.1001\/jama.284.19.2460. pmid: 11074775<br \/>\n11 Ohnsorge K, Gudat H, Rehmann-Sutter C. Intentions in wishes to die: analysis and a typology&#8211;a report of 30 qualitative case studies of terminally ill cancer patients in palliative care. <em>Psychooncology<\/em> 2014;23:1021-6. doi: 10.1002\/pon.3524. pmid: 24706488<br \/>\n12 Rosenfeld B, Pessin H, Marziliano A, etal. Does desire for hastened death change in terminally ill cancer patients? <em>Soc Sci Med<\/em> 2014;111:35-40. doi: 10.1016\/j.socscimed.2014.03.027. pmid: 24747154<br \/>\n13 Ganzini L, Nelson HD, Schmidt TA, Kraemer DF, Delorit MA, Lee MA. Physicians\u2019 experiences with the Oregon Death with Dignity Act. <em>N Engl J Med<\/em> 2000;342:557-63.<br \/>\ndoi: 10.1056\/NEJM200002243420806. pmid: 10684915<br \/>\n14 Breitbart W, Rosenfeld B, Gibson C, etal. Impact of treatment for depression on desire for hastened death in patients with advanced AIDS. <em>Psychosomatics <\/em>2010;51:98-105. doi: 10.1176\/appi.psy.51.2.98.<br \/>\n15 Richards N. Assisted suicide as a remedy for suffering? The end-of-life preferences of British \u201csuicide tourists\u201d. <em>Med Anthropol<\/em> 2017;36:348-62. doi: 10.1080\/01459740.2016.1255610. pmid: 27845576<br \/>\n16 Hagens M, Onwuteaka-Philipsen BD, Pasman HRW. 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End of Mission Statement by the United Nations Special Rapporteur on the rights of persons with disabilities, Ms. Catalina Devandas-Aguilar, on her visit to Canada. 12 Apr 2019. https:\/\/www.ohchr.org\/en\/NewsEvents\/Pages\/DisplayNews.aspx?NewsID=24481&amp;LangID=E.<br \/>\n21 Heijltjes M, van Thiel G, Rietjens J, van der Heide A, de Graeff A, van Delden J. Changing practices in the use of continuous sedation at the end of life. A systematic review of the literature. <em>J Pain Symptom Manage<\/em> 2020:S0885-3924(20)30560-1. doi: 10.1016\/j.jpainsymman.2020.06.019. pmid: 32599152<br \/>\n22 Verkerk MA, de Graeff A, Baar FPM, etal. <em>Guideline for Palliative Sedation Royal Dutch Medical Association. KNMG<\/em>. 2009: 1-78. Available from https:\/\/palliativedrugs.com\/download\/091110_KNMG_Guideline_for_Palliative_sedation_2009__2_%5B1%5D.pdf.<br \/>\n23 Seale C, Raus K, Bruinsma S, etalUNBIASED consortium. The language of sedation in end-of-life care: The ethical reasoning of care providers in three countries. <em>Health<\/em> (London) 2015;19:339-54. doi: 10.1177\/1363459314555377. pmid: 25389235<br \/>\n24 Seymour J, Rietjens J, Bruinsma S, etalUNBIASED consortium. Using continuous sedation until death for cancer patients: a qualitative interview study of physicians\u2019 and nurses\u2019 practice in three European countries. <em>Palliat Med<\/em> 2015;29:48-59. doi: 10.1177\/0269216314543319. pmid: 25062816<br \/>\n25 Sercu M, Pype P, Christiaens T, Derese A, Deveugele M. Belgian general practitioners\u2019 perspectives on the use of palliative sedation in end-of-life home care: a qualitative study. <em>J Pain Symptom Manage<\/em> 2014;47:1054-63. doi: 10.1016\/j.jpainsymman.2013.06.016. pmid: 24095283<br \/>\n26 Schiller CJ, Pesut B, Roussel J, Greig M. But it\u2019s legal, isn\u2019t it? Law and ethics in nursing practice related to medical assistance in dying. <em>Nurs Philos<\/em> 2019;20:e12277.<br \/>\ndoi: 10.1111\/nup.12277. pmid: 31429213<br \/>\n27 Brown J, Little S. A hospice must provide a medically-assisted death if a patient asks: <em>Fraser Health. Global News<\/em> 2018 Feb 7. https:\/\/globalnews.ca\/news\/4012677\/hospices-medically-assisted-death-fraser-health\/.<br \/>\n28 Emanuel EJ, Battin MP. What are the potential cost savings from legalizing physician-assisted suicide? <em>N Engl J Med<\/em> 1998;339:167-72. doi: 10.1056\/NEJM199807163390306. pmid: 9664094<br \/>\n29 Trachtenberg AJ, Manns B. Cost analysis of medical assistance in dying in Canada. <em>CMAJ<\/em> 2017;189:E101-5. doi: 10.1503\/cmaj.160650. pmid: 28246154<br \/>\n30 Shaw D, Morton A. Counting the cost of denying assisted dying. <em>Clin Ethics<\/em> 2020.<br \/>\ndoi: 10.1177\/1477750920907996.<br \/>\n31 Yuill K. The unfreedom of assisted suicide: How the right to die undermines autonomy. <em>Ethics Med Public Health<\/em> 2015;1:494-502. doi: 10.1016\/j.jemep.2015.10.003.<br \/>\n32 G\u00f3mez-V\u00edrseda C, De Maeseneer Y, Gastmans C. Relational autonomy in end-of-life care ethics:<br \/>\na contextualized approach to real-life complexities. <em>BMC Med Ethics<\/em> 2020. doi: https:\/\/doi.org\/10.1186\/s12910-020-00495-1.<\/h6>\n","protected":false},"excerpt":{"rendered":"<p>Lucy Thomas questions why assisted dying is framed as a medical solution to a medical problem and proposes demedicalising the debate Lucy Thomas, consultant in public health and specialty doctor in palliative care Medically assisted dying currently exists as a legal medical procedure for patients meeting defined eligibility criteria in six countries, one Australian state, [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0},"categories":[1],"tags":[32,174,25,175],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v15.9.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<link rel=\"canonical\" href=\"https:\/\/www.euthanasia.net\/exit\/demedicalisation-radically-reframing-the-assisted-dying-debate-an-essay-by-lucy-thomas\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Demedicalisation: radically reframing the assisted dying debate - 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