Days before, she had been all smiles while joking with her son and having a beer to celebrate what would have been her death by euthanasia.

Sepúlveda would have been the first patient without an immediate terminal prognosis — those expected to live for six months or less — to receive euthanasia in Colombia, a country considered a pioneer in the right to a dignified death, both in Latin America and globally.

But on Saturday, a committee from the center where she had planned to undergo euthanasia, the Instituto Colombiano del Dolor, reversed the decision, saying Sepúlveda does not meet the requirement for being terminal.

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The court and society have thrust assisted-death squarely into the laps of physicians and we are now left grappling with what this will look like.

My perspective as a palliative care physician on living and dying has been shaped by the thousands of patients and families I have had the privilege of walking alongside as they face suffering in the context of a life-threatening illness.

It is from this vantage point that I can say with resounding confidence that physician-assisted death is not palliative care and should have no home within a palliative care service.

And I am not alone in this perspective.

In a recent poll by the Canadian Society of Palliative Care Physicians, 74 per cent of members felt that euthanasia and physician-assisted suicide should not be provided by palliative care services or palliative care physicians.

The World Health Organization's definition of palliative care states:

"Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."

Palliative care also "… affirms life and regards dying as a normal process; and intends neither to hasten or postpone death."

By definition, palliative care does not hasten death, and while dying is a normal life process, killing is not. Let's not kid ourselves or cloak reality with soft words — physician-assisted death is killing.

Dying is hard work for everyone involved: the patient, family and care providers.

It is innately an existential matter and asks us what life is all about.

Dying is a normal process and final growth stage of life.

Like birth, it is an important developmental stage in the lives of humans, but unlike birth, one that we seldom talk about as a society.

Those of us privileged to work with and journey alongside the dying and their families will tell you that dying can be transformative — relationships can be healed and past hurts reconciled.

Requests for hastened death are predominately related to existential suffering and do not correlate with physical symptoms such as pain. These existential concerns are typically due to loss of control, loss of hope, loss of meaning in one's life, or a sense of burden to others.

Thanks to the great work of Canadian palliative care physicians such as Balfour Mount and Harvey Chochinov, we have developed holistic dignity-conserving palliative care interventions that aim to restore purpose, meaning and hope in the face of loss that accompanies a life-threatening illness.

These therapies help a person focus on living while dying.

The foundations of our work in palliative care are trust and relationship.

Trust between patient and physician, family and care providers and between members of the health-care team. Is trust really engendered when we reach out with one hand inviting patients to engage in the hard and intense work of addressing their suffering, while in the other hand, we hold the needle to end their lives?

Suffering is not limited only to the individual.

Individuals are inevitably part of a community - family, friends and care providers, to name a few.

Individual choices affect us all. Continue reading

• Leonie Herx is the Head of the Division of Palliative Medicine and Associate Professor in the Department of Medicine, Queen's University. She holds the W. Ford Connell Chair in Palliative Medicine.

On September 21, the Victorian Government unveiled legislation for an assisted-dying scheme, with debate on the bill to begin next month and a conscience vote expected before the end of the year. Read more

It's clear that New Zealand will one day vote in a voluntary euthanasia law.

But the ‘slippery slope' from voluntary euthanasia to non-voluntary euthanasia can't be avoided once the initial limited voluntary act is passed. Why so?

Voluntary euthanasia is presumed the ultimate act of self-determination. Current society is well primed to accept as an absolute good the right of individuals to do whatever they like with their own bodies.

Likewise individuals should decide for themselves the limits of their personal suffering and may select voluntary euthanasia to end their pain. But this promised autonomy is an illusion.

The individual who requests euthanasia is not realising autonomy but rather relinquishing it to medical experts.

He or she is exchanging the apparent tyranny of the natural lifespan for the power of the medical expert to permit or deny. He or she has relinquished personal subjectivity to science unto death.

The medical expert who legally practices euthanasia has already accepted that euthanasia is a merciful good for suffering patients. Therefore legal voluntary euthanasia which is undeniably a direct killing would be included within the medical principle of beneficence; a principle which once rejected direct killing as maleficence.

Medical beneficence can be defined as those actions and intentions of the medical profession to do that which is good for the sake of their patients.

There is now no reason why the principle of beneficence now inclusive of euthanasia as a direct killing could not be bestowed on the incapacitated patient as a good they would have consented to if they could. Active consent becomes presumed consent and we have a ‘slippery slope'.

Individuals seeking voluntary euthanasia empower the medical expert with the information as to why they request euthanasia. This information can be compared to the lives of incapacitated persons who are unable to give their own personal consent.

The various conditions, illnesses and psychiatric disorders which inflict the quality of individual lives of those seeking voluntary euthanasia can be used to mark out those persons who would if they could consent to euthanasia.

Consent then can be understood as a window of opportunity simply missed by these incapacitated patients. Within the new informed principle of beneficence no one need put up with suffering anymore.

To this end the experts focus is the measure of qualities lost and limitations born in suffering; the personal dignity of a human life is measured by changeable and extrinsic criteria. Like Alice Down the Rabbit Hole we could eventually find ourselves in a very strange sort of world.

The fact is non-voluntary euthanasia is embedded within the presenting concept of voluntary euthanasia as both swill from the same utilitarian trough.

Public opinion in New Zealand is empathetic toward euthanasia with support around 70%.

But Hospice New Zealand, who are specialists in palliative care of the dying oppose voluntary euthanasia.

The Catholic Church will always oppose it. As GK Chesterton said the Church "saves a man from the degrading slavery of being a child of his age."

• Lynda Stack graduated as a distance student with a BTh from Good Shepherd College. She is now studying for a Masters at the JPII Institute in Melbourne. Lynda is married. She and her husband have two adult children who are living overseas.