Legalised euthanasia debate puts palliative care in spotlight

As debates about laws for assisted dying intensify globally, Dr Monique Price, a South African general practitioner specialising in geriatrics and palliative care, emphasises that the role of palliative care is to improve the quality of life, not hasten death.

She says palliative care is about more than just end-of-life care, it’s a process that starts from the moment a life-threatening illness is diagnosed. “It’s a holistic approach that addresses physical, emotional, social, and spiritual needs, essential for enhancing the well-being of patients and their families.”

The United Kingdom (UK) is grappling with the ethical and societal implications of Labour MP Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill, which seeks to legalise assisted suicide for terminally ill adults. As the bill passes its second reading in Parliament, Chief Rabbi Ephraim Mirvis has raised concerns, calling it “a fundamental moral challenge to our society”.

Mirvis warns against a shift in values that could redefine assisted dying as “just another treatment option”. In his effort to drive home the ethical alternative that quality palliative care represents, he reminded UK legislators of Dame Cicely Saunders, the founder of modern hospice care, who said, “You don’t have to kill the patient to kill the pain.”

In South Africa, Price points out that though the country ranks low globally in providing care for its dying citizens – 72nd out of 81 countries, according to a 2021 Duke University survey – there have been efforts to improve care through the introduction of Advanced Illness Benefits by major medical aids. “These benefits provide access to palliative care, but services remain limited and often come too late in the illness trajectory,” she says.

Historically, palliative care in South Africa has been largely provided by hospices and nongovernmental organisations, which has led to a misconception that it’s synonymous with end-of-life care. Price clarifies that “palliative care starts from the moment of diagnosis of a life-threatening illness, and extends beyond just terminal care”. The misconception can delay crucial support, as many patients access palliative care only when curative treatments are no longer effective, missing the opportunity to benefit from its holistic approach earlier in their illness.

The South African government’s support of the World Health Assembly’s resolution on integrating palliative care reflects a commitment to improving access to these services for all citizens. However, implementation has been slow. Most hospitals still lack dedicated palliative care programmes, and training for healthcare providers remains inadequate. This gap emphasises the need for comprehensive healthcare reform to prioritise palliative care as part of the national health system.

A major challenge is overcoming the stigma that equates palliative care with imminent death. Price says patients and clinicians still tend to view palliative care as a last resort, available only when curative treatments have failed. In reality, palliative care is a proactive, holistic approach that, when introduced early, is concrete in managing symptoms and enhancing quality of life. “It’s a care model that integrates pain management, psychosocial support, and spiritual care, ensuring that patients experience dignity and comfort throughout their illness,” she says.

The World Health Organization stresses that palliative care focuses on normalising dying as a part of life, ensuring dignity and autonomy for patients.

In many countries, including the UK and Canada, terms like “supportive care” or “anticipatory care” are used to encourage earlier referrals to palliative services. Studies show that early access to palliative care leads to better patient outcomes, including enhanced quality of life, a more dignified death, and an improved bereavement experience for families. When integrated early on, palliative care offers relief from pain and distress while providing a sense of control and comfort for the patient.

Price emphasises the importance of a patient-centred approach, saying, “Effective palliative care requires open, honest communication between healthcare providers and patients, mutual agreement on goals, and respect for patient autonomy. While families play an essential role, their wishes should never override the patient’s choices.” In the past, palliative care was often seen as separate from curative treatments, with patients referred only after all other options had been exhausted. This “either-or” model left many feeling abandoned by their doctors. Today, the best approach combines disease-oriented care with palliative interventions, ensuring continuous, compassionate support.

Another common misconception is the association of palliative care with euthanasia. While euthanasia seeks to end life to alleviate suffering, palliative care is focused on improving the quality of life, no matter how long it lasts.

Says Price, “Palliative care doesn’t hasten death. It aims to manage symptoms, address concerns, and preserve dignity. A patient should never feel abandoned by their care team.” In fact, the lack of access to comprehensive palliative care is a significant factor that increases the likelihood of individuals to seek euthanasia as an option. Expanding these services and educating the public about their benefits is key to reducing the perceived need for assisted dying.

For South Africa, prioritising the integration of palliative care into the healthcare system is crucial. This requires not just investment in funding and infrastructure, but also in training healthcare professionals to provide holistic, patient-centred care. Fair and early access to palliative services can radically transform how society approaches illness, death, and dying.