Palliative Care Doesn't Address Existential Suffering
Therefore, better care doesn't negate the desire for assisted death
In 2005, Pearlman et. al. published a qualitative study investigating the motivations for assisted death. They found 3 broad categories: illness-related experiences, changes in the person’s sense of self, and fears about the future. Under these categories were more specific reasons.
Illness-related experiences
Feeling weak, tired, and uncomfortable
Pain and/or unacceptable side effects of pain medication
Loss of function
Sense of self
Loss of sense of self
Desire for control
Fears about the future
Fears about future quality of life and dying
Negative past experiences with dying
The first and third categories are straightforward, so I won’t elaborate on them.
Loss of sense of self refers to patients losing their personality, source of identity, or essence. The authors state, “Without the ability to maintain aspects of their life that defined them as individuals, life lost its meaning and personal dignity was jeopardized” (p. 237).
Some also didn’t want to be remembered in their decrepit state. Others’ sense of self was tied to being independent, which was closely tied to the desire for control over their futures.
This study corroborates the data that we’ve collected from Oregon and Canada.
What does this tell us? It tells us that improved palliative care can only address some of the reasons that people have for seeking assisted death, namely, illness-related experiences. This means that even if we provided better care, some would still want to hasten their death.
It’s not palliative care versus assisted death, but rather palliative care and assisted death. They address different problems.