EAPC ethics task force on palliative care and euthanasia

Background: In recognition of the ongoing discussion on euthanasia and physician-assisted suicide, the Board of Directors of the European Association for Palliative Care commissioned this white paper from the palliative care perspective.
Aim: This white paper aims to provide an ethical framework for palliative care professionals on euthanasia and physician-assisted suicide. It also aims to provide an overview on the available evidence as well as a discourse of ethical principles related to these issues.Design: Starting from a 2003 European Association for Palliative Care position paper, 21 statements were drafted and submitted to a five-round Delphi process
Participants: A panel with 17 experts commented on the paper in round 1. Board members of national palliative care or hospice associations that are collective members of European Association for Palliative Care were invited to an online survey in rounds 2 and 3. The expert panel and the European Association for Palliative Care board members participated in rounds 4 and 5. This final version was adopted as an official position paper of the European Association for Palliative Care in April 2015.
Results: Main topics of the white paper are concepts and definitions of palliative care, its values and philosophy, euthanasia and physician-assisted suicide, key issues on the patient and the organizational level. The consensus process confirmed the 2003 European Association for Palliative Care white paper and its position on the relationship between palliative care and euthanasia and physician- assisted suicide.
Conclusion: The European Association for Palliative Care feels that it is important to contribute to informed public debates on these issues. Complete consensus seems to be unachievable due to incompatible normative frameworks that clash.



Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force

Palliative Medicine 2003 17(2):97-101

In 1991 a debate at the European Parliament on euthanasia stimulated discussion at all levels in Europe. Subsequently, the Board of Directors of the European Association for Palliative Care (EAPC) organized a working session together with two experts to help them clarify the position the organization should adopt towards euthanasia.

The experts collaborated with the Board of Directors on a document and in 1994 the EAPC produced a first statement, Regarding Euthanasia, published in the official journal of the EAPC / the European Journal of Palliative Care.1 In February 2001, the EAPC Board asked an expert group to form an Ethics Task Force to review the subject and advice the organization accordingly.
In the intervening years there have been major developments and achievements in the field of palliative care, as well as much discussion, some of it controversial, of euthanasia and physician-assisted suicide. There has also been new legislation in some countries. It is important that the EAPC contributes to informed public debates on these issues, especially as European policy and law are becoming an increasing feature of modern life. To do so requires careful and continuing discussion.
This is no straight forward task, as euthanasia and physician-assisted suicide are two of the most complex and challenging ethical issues in the field of healthcare today. This paper builds on current debates and develops a viewpoint from the palliative care perspective. It may be noted that most patients receiving palliative care suffer from cancer. Across Europe, unfortunately only a small minority of terminally ill cancer patients has access to palliative care expertise. At the same time, some 86% of patients who die from euthanasia or physician assisted suicide in the Netherlands also suffer from cancer

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Professor Lukas Radbruch
Palliative Care Physician
University Hospital, Bonn, Germany


Carlo Leget, University of Humanistic Studies, Utrecht, The Netherlands

Patrick Bahr, Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany

Christof Müller-Busch, Gemeinschaftskrankenhaus Havelhöhe, Berlin & Witten/Herdecke University, Witten, Germany

John Ellershaw, Marie Curie Palliative Care Institute Liverpool (MCPCIL), University of Liverpool, Liverpool, UK

Franco de Conno, European Association for Palliative Care, Milan, Italy

Paul Vanden Berghe, Federation Palliative Care Flanders, Vilvoorde, Belgium