DEATH WISH

Medical and scientific professionals believe that the time is right for Jamaica to frontally discuss the ethical dilemma surrounding the right to die amid a growing global lobby for euthanasia to be legalised.

With November 2 recognised as World Right to Die Day, supporters of physician-assisted suicide will be rallying for legislative change on the steps of global parliaments on Tuesday to press for greater acceptance of “the inherent right to choose how we die”.

But that appeal to countries like Jamaica is likely to trigger reflexive pushback because conservative Christianity holds powerful sway over families and political parties even though its society is largely secular. Some physicians also consider it a betrayal of the Hippocratic Oath.

Jamaican bioethicist Dr Derrick Aarons said that debate on the right to die is long overdue.

“Everywhere, every day, patients are dying in severe pain that just is not being released. I know Jamaica does not have a strong palliative care service for this,” said Aarons.

“If we were to start from Jamaica’s perspective, which has a strong religious-based society, then there is the prevailing belief that God gives life and only God should be able to take life. So the perspectives that Jamaicans would have in general on the matter are different from the Canadians, who are guided more by secular considerations and are concerned more by suffering,” he added.

In euthanasia, a doctor is permitted by law to end a person’s life by a painless means with family consent, while assisted suicide involves a doctor’s help in a patient committing suicide on request.

Euthanasia and physician-assisted suicide are legal in Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland, and five states of Australia.

Dr Rob Jonquière, executive director of the World Federation of the Right to Die Societies, believes that euthanasia is a matter of self-determination as it reduces suffering of both the ailing patient with a painful terminal disease and family members looking on.

“Life is something that is personal for an individual, and it is silly if you can make all kinds of choices in your life and the most important issue is that the end of your life, you are not allowed to make a choice about how and when you are going to die,” he said Sunday in an interview with The Gleaner.

Noting that most opposition is fuelled by politicians and religious groups, Jonquière said that although many doctors are afraid to practise euthanasia, he is certain that physicians in most countries administer drugs secretly to end the pain of their patients.

Dr Brian James, president of the Medical Association of Jamaica, described euthanasia as a “thorny ethical issue” but believes that the time is right for vigorous debate of the subject.

“What needs to happen if it becomes an issue that people are concerned about, then a national conversation should happen … . The discussion should happen and we should see where people are. We should examine the merits of either side,” the MAJ president said Saturday evening.

But Professor Denise Eldemire-Shearer, director of the Mona Ageing and Wellness Centre, was unequivocal in her resistance to euthanasia, arguing that patients may make those decisions out of depression in moments of acute pain, “as if nothing can be done”.

“I don’t think as a doctor that I have the right even to help someone take their life. I am very definite on this,” she said on Sunday.

Eldemire-Shearer, one of the country’s foremost experts on ageing in Jamaica, said that she has seen people contemplating dying have their hopes revived after learning of the availability of new medical treatments.

Eldemire-Shearer believes that there must be greater emphasis on palliative and hospice care and more support given to families.

Palliative care is an approach to healthcare that improves the quality of life of patients who are facing life-threatening illnesses.

The professor explained that as more Jamaicans cross the threshold of old age, that type of intervention will be needed.

“There are many families that don’t want to see someone suffer not necessarily practise euthanasia but want comfort … . I would like to see more doctors comfortable about the issue discussing palliative care around end of life and developing the training to support people through end-of-life issues,” the ageing expert said.

Outgoing president of the Jamaica Council of Churches, the Rev Newton Dixon, said that while he was against “any form of the taking of life”, he acknowledged the ethical dilemma of having to deal with patients who were gravely ill and in pain.

“The question of a person’s choice is the real crux of the matter and that question is I think an ethical question that I don’t know if we have yet resolved it.

“.... It feels like an un-Christian thing but we still struggle with the person’s right to choose so I think the question is still up in the air although I would come down against it as a matter of principle. Whether or not, that is a practical measure for practice is quite another matter,” said the pastor.

Dr Winston Dawes argues that the controversial topic should be discussed, even though he is aware that euthanasia ran counter to orthodoxy medical teachings.

“Whenever this comes up, it reminds me of when I was a medical student and Dr [name redacted] was saying that he had to treat Roger Mais, who was a writer, a heavy smoker who had lung cancer in his last few days.

“What he did was to give him enough morphine to keep him pain free and that morphine suppressed his breathing and he died, but he didn’t suffer. But he did not actively kill him,” said Dawes.

That’s another angle of the ethical dilemma for commentators like bioethicist Aarons, who described such double-edged intervention as a “grey area”.

david.salmon@gleanerjm.com