A Tale of Two Visions: Euthanasia and Palliative Care

Of 32 non-profit Palliative Care centres scattered around the province of Quebec, even under intense economic and political pressure, only 6 currently allow euthanasia within their walls.

Doctors who promote euthanasia consider this low participation rate as a barrier to the fulfillment of patients’ wishes. Many of them, despite self-identifying as Palliative Care physicians, see no problems with cohabitation: they claim to do both Palliative Care and euthanasia; they promise they will always continue Palliative Care as long as the patient obstinately maintains his or her will to live; and when that patient finally becomes reasonable they will – in perfect “continuity of care” — perform the euthanasia which they believed to be indicated all along.

Naturally there are many who would resent and dispute such a characterization of their methods and intent. However, in this case, truth is in the eye of the beholder; and in the view of a typical non-suicidal patient, any doctor or institution practising euthanasia becomes a threatening presence stimulating feelings of anxiety, which arguably nullify the whole benefit of Palliative Care.

At the best of times, non-suicidal patients (and their families) often harbour fears that doctors intend to do them harm. Only with the greatest effort do doctors gain the trust of patients, which is one of many reasons why, throughout the history of medicine, doctors have relied on an unambiguous promise that they would never harm patients.

Euthanasia proponents, of course, reverse this logic: How, they ask, might a (suicidal) patient trust a doctor who has promised that he would never be willing to end suffering by ending life?

Clearly, then, we are talking about two distinct services and two distinct clienteles, mutually exclusive to the point where a doctor associated with one will naturally be disqualified in the perception of a patient who desires the other.

But where will these services be offered? Euthanasia advocates have a simple answer to this question: everywhere. We will simply take our proposed service, they say, and install it in the homes of others, like a loudly sizzling hamburger stand, suddenly introduced in one corner of a contemplative vegetarian restaurant. The juxtaposition is absurd, of course, but the suggestion also betrays astounding arrogance, founded in a deep ignorance of past social evolution as it is reflected in existing infrastructure.

Palliative Care centres were not always there; Palliative Care only truly began in the 70’s. Nor did the picturesque pastoral “homes”, that we recognize today, spring out fully formed in the blink of an eye. They are the fruit of evolution, imagination, dedication, perseverance and experimentation. In the early days Dr. Balfour Mount and others succeeded in carving out little units in prestigious hospitals where pilot programs were initiated. At that time, there was no question of combining them with euthanasia, because that was still an unheard-of barbarism in the medical culture of the day. But the exclusivity of Palliative Care did not end there.

The whole idea of Palliative Care lay in its differentiation from contemporary models of medicine. And the self-selected staff who gravitated to this new practice were fierce in their loyalty to the ideal, and remain so, in many cases, to this day. Palliative Care is not a technique; it begins as a state of mind. To oblige the staff of existing Palliative Care facilities to offer care in any other mode – let alone that of euthanasia – is to erase, by stealth, from within, the very existence of Palliative Care.

But today, Palliative Care is not something insubstantial, to be cavalierly brushed aside or co-opted into new administrative improvisations. Each of the existing centres embodies the unpaid work of countless real individuals. The buildings were constructed through voluntary contributions of funds, and often of land. In the usual model, fifty to sixty percent of operating budgets are financed through charity. They typically depend on volunteers at every level, from kitchen help, through basic care, to administrative functions. Salaried workers, nurses and others, are working at the pay scales reserved for “private” facilities, which are significantly lower than those enjoyed by similarly qualified staff elsewhere. Key professionals actually migrate from other locations and specialties, in order to enable and share in the professional culture which is unique, not only to this form of practice, but to each individual institution. In short: over a forty-year period, within the confines of a public medical monopoly, certain imaginative individuals and groups have succeeded in creating something truly new and distinctive, financed by charitable donation and supported by armies of volunteers having deep roots in the surrounding communities. To suggest that the nature of care practised in such facilities should be open to legislative or bureaucratic intrusion, beyond minimal oversight, is an insult to the notion of selfless creativity in community service.

No, therefore, euthanasia proponents who would cleverly disguise themselves as Palliative Care specialists have no business whatsoever in such facilities. Crudely articulated: these new enthusiasts of the lethal mode have not yet paid their dues. Let them justify themselves. Let them search for freely given funds. Let them build their clinics stone by stone. Let them show a little respect for differences in medical thought and method; a little humility before the achievements of an authentic labour of love.

In no case should they be allowed, like the famous cuckoo bird, to lay their eggs in the nests of others, and to murder the offspring – in this case the medical brainchildren — of their hosts.

Make euthanasia unimaginable.


Catherine Ferrier



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