Paula Span

“No. 1, when you ask who’s interested in this, the usual answer is, terminally ill people with excruciating pain. False. Factually not true. It tends to be a preoccupation of people who are depressed or hopeless for other reasons. No surprise, actually, if you look at what leads to suicide: hopelessness and depression. You have to look at euthanasia or assisted suicide as more like suicide than like a good death. Second, this notion that there’s no slippery slope, as advocates have long claimed? Totally wrong. Look at Belgium and the Netherlands: First, it’s accepted for adults who are competent and give consent. Then, it’s “We’re going to extend it to neonates with genetic defects, and adolescents.” Any time we do anything in medicine, it’s the same way: We develop an intervention for a narrow group of people, and once it’s well accepted, it gets expanded. I think it’s false to say, “We can hold the line here.” It doesn’t work that way. Third, people say this is a quick, reliable, painless intervention. No medical intervention in history is quick, reliable, painless and has no flaws. In the Netherlands, there’s about a 17 to 20 percent rate of problems, something screwing up. Initially, when the Oregon people published — “We have no problems. Every case went flawlessly!” — you knew the data was wrong. It had to be wrong. Either you’re not getting every case, so the denominator was wrong, or people are lying. There’s nobody who does a procedure, not even blood draws, and it’s perfect every time. So this idea that this is quick, reliable and painless is nonsense. And the last and most important point is: You want to legalize these interventions to improve end-of-life care in this country? That’s your motivation and this is your method? PS: I don’t think people argue that–— ZE: [interrupting] Oh, people do argue that! That is the justification for these procedures: It’s going to improve end-of-life care and give people control. The problem is, even in countries that have legalized it for a long time, at best 3 percent of people die this way in the Netherlands and Belgium. At best, 10 percent express interest in it. That is not a way to improve end-of-life care. You don’t focus lots of attention and effort on 3 percent. It’s the 97 percent, if you want to improve care. The typical response is, we can do both. Hmmm. Every system I’ve ever seen has a bandwidth problem: You can only do so much. We ought to focus our attention on the vast, vast majority, 97 percent of people, for whom this is not the right intervention and get that right — and we are far from that. I don’t think legalizing euthanasia and assisted suicide are the way to go. It’s a big, big distraction.”
― Paula Span, Ezekiel Emanuel: The Kindle Singles Interview