President Marcelo Rebelo de Sousa had opposed this legislation, but he could no longer veto this bill. His office said in a statement the president had enacted the legislation "as he is obliged" to do so under the constitution.

Portugal becomes the sixth European Union country allowing the procedure. It’s probably reasonable to say that this is where the problems start. The new law will specify that people would be allowed to request assistance in dying in cases when they are "in a situation of intense suffering, with definitive injury of extreme gravity or serious and incurable disease".


The Hippocratic Oath


The first challenge will be to doctors, who, we assume will be ultimately responsible to administer a suitable drug. In the medical profession, the Hippocratic Oath is one of the most respected documents. The Oath states the professional conduct and obligations of doctors; it is an oath of ethics that emphasises is the importance of professional standards. Its name is derived from a Greek physician, Hippocrates, who was widely regarded as the “father of western medicine”.

The critical issue, in this case, is “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.” The Hippocratic oath has been undertaken by over 6 million doctors worldwide. There has been extensive debate in the medical profession about the oath and some amendments have been made, but the basic undertaking made by doctors is to ‘do no harm’. If the law says a doctor can administer drugs to end a patient’s life, and the patient requests it, what will a doctor do when faced with such a situation?


What does the Bible say?


Christians have debated this for years, and there is no clear answer. There are passages and events which can be interpreted either way, depending on your own position. Most Rev Dr. George Carey, formerly Archbishop of Canterbury, writing in the Daily Mail in 2014, said he supported a change in the UK law to permit assisted suicide. Openly acknowledging that he'd changed his mind, he wrote that ‘The old philosophical certainties have collapsed in the face of the reality of needless suffering'.

The Catholic Church is firmly against suicide or euthanasia. In Catholic medical ethics, official pronouncements strongly oppose active euthanasia, (or physician-assisted suicide) whether voluntary or not. No one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly. As many Portuguese doctors will be Catholics, this will be a dramatic challenge. I believe it is reasonable to say that no doctor wants to see his, or her, patient suffering extreme pain. They will use all their expertise and training to relieve pain, but would they be willing to administer lethal drugs? This seems to go against everything they believe in.

The Catechism of the Catholic Church clearly states what the Church teaches: Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible. Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons.

Portugal is a predominately Catholic country. How will doctors and nurses deal with this conflict between the law and their medical ethics and religious beliefs? Politicians can pass laws, but real people must deal with the consequences, and that will bring many moral and professional conflicts. Taking a life goes against everything physicians believe in.


Withdrawal of treatment


The withdrawal of treatment is known as ‘Passive euthanasia’ it’s when life-sustaining treatments are withheld. The definitions are not precise. If a doctor prescribes increasing doses of strong pain-management medications, such as opioids, this may eventually be toxic for the individual. Sometimes this is referred to as passive euthanasia. This is a very difficult subject, if treatment is withdrawn, is this euthanasia by a different name? The doctor or doctors can decide that by stopping treatment, they are not assisting the patient to die, but the reality is that this course of action will result in the death of the patient.

Others, however, would say this is not euthanasia, because there is no intention to take life. Active euthanasia is when someone uses lethal substances or forces to end the person’s life, whether by the individual or somebody else.


Who decides?


Voluntary euthanasia is currently legal in Australia, Belgium, Canada, Colombia, Luxembourg, The Netherlands, Spain, Switzerland, and New Zealand. Safeguards vary in each country, and now Portugal has to decide what to put in place. According to World Population Review Switzerland's laws regarding euthanasia are among the most lenient in the world. While active euthanasia is prohibited, physicians can legally supply lethal medications for the patient to self-administer. This permission extends to international patients as well, which has led to a cottage industry of "suicide tourism" in which individuals travel to Switzerland to end their lives.

What nobody can judge, except the patient, is if the pain is so bad, they would rather end their life. Nobody would like to be in that position, but who else can assess someone else’s pain and distress? Modern medicine should be able to control this, palliative care has advanced considerably. It has to be considered, is there another agenda, does the patient feel they are a ‘burden’, do relatives have a hidden plan?

There are no simple answers, but there are enormous dangers. Are any safeguards, however rigorous, good enough to protect someone from taking their own life?

Author

Resident in Portugal for 50 years, publishing and writing about Portugal since 1977. Privileged to have seen, firsthand, Portugal progress from a dictatorship (1974) into a stable democracy. 

Paul Luckman