Rui Nunes | Bspreport

Who is Rui Nunes?

President of the Portuguese Bioethics Association and Research Department of the Unesco Chair of Bioethics. He was awarded with the Medal of the Physician's Order

To Rui Nunes the medicine “battle” is about the assurance of “quality care at the end of life and, naturally, to have the tools, so that people can make the choices in a lucid and informed way”. To die with dignity especially in its “social and organizational component” is the “fundamental right in cause”, since “death is the inevitability of life”.

In this context, the doctor highlights his opinion on the importance of palliative care as a way to provide good existencial conditions at the end of life: “empirical studies show that with good existential conditions at the end of life most people want to live, and want to live for as long as possible, because it is contrary to human nature to desire death. If we give them the conditions they need, they will want to live. What people do not want is to live with suffering, whether is physical, spiritual, or from any other nature”.

Another palliative care advantage referred is related to economic reasons since studies show that “palliative care saves resources to the national health service, because it is a much more humane and much less technological medicine”, claims Rui Nunes. The importance of spiritual assistence is also highlighted, but, as the bioethics expert emphasizes, this concept is not the same as religious assistence.

According to Rui Nunes, all of these measures have been researched at University of Porto and they are meant to “provide self accomplishment even at the end of life”.

When asked about the his view on how much weight has the factor “religion” on the creation of opinions towards euthanasia, Rui Nunes thinks that “altough Portugal is a country where sociologically the majority of the population is Catholic, the truth is that we live in a plural democracy, so people form their ethical conscience by very different influences”.

“The value of life is so intrinsic to the human person and nature” that opinions on these topics are shaped by “cultural and political influences, traditions, educational values” and even “lived experiences”, according to the expert.

Euthanasia and palliative care are contradictory practices?

Under what conditions does Rui Nunes thinks it would be ethically acceptable for a patient to require euthanasia?

When asked about his view on euthanasia application in countries where this practice is legal, such as the Netherlands or Belgium, Rui Nunes claims that he believes that they “have entered in a sliding ramp” which he “liked to be more controlled”.

The bioethics specialist distinguishes the belief that “an adult, rational and informed, who is not on the influence of a disease, drugs, or any psychological or psychiatric illness, like depression, can make decisions” from the particular situations of Belgium and the Netherlands, in which the speacilist considers that euthanasia is applied “to people with reduced competences”.

The specialist has been following this problem for more than 25 years, and to exemplify better his point of view he points out the euthanasia application on children of any age.

“The administration on children, who have their competences diminished by the simple force of biology, needs the parents consent, which is the proof that their competence is truly diminished. If it was not, it wouldn’t be necessary others authorization and the child or the teenager could make the decision by himself. In the jurisprudence there are also innumerable cases of people who were administered euthanasia at their request, but they were suffering from treatable affective diseases such as depression. These are patients who can be treated to regain their autonomy and to make informed choices and that opportunity is not given to them because euthanasia is immediately administered.”, points out Rui Nunes.

He adds that for him this is the main issue when it comes to the decriminalization of euthanasia. The expert considers that “in the countries where it has been decriminalized for the longest time, it hasn’t yet been set a red line from which it is established what is not admissible. It is the theory of the sliding ramp: it all began with severe constraints to the practice and then the mesh got larger and larger”.

Rui Nunes thinks that nowadays “we can say with all the truth and intelectual justice that, in some countries, euthanasia is almost an instrument of social engineering”. According to him this is a way to control social phenomena such as the ageing population, which concerns him.

“I believe that human life has always dignity. It can be an young person, it can be old, it can be sick, it can be healthy, it can be deficient, it can not be deficient, it can be a man, it can be a woman, but it always has a intrinsic, inherent and unsurpassed dignity that is not conditional”, emphasizes the doctor.

When it comes to Portugal, Rui Nunes alerts to the importance of being aware of the “slips” made by these countries and to the need of creating the required safeguards to not commit the same mistakes.

Is there a break in the Hipócrates oath in the practice of euthanasia?

What factors dictated the euthanasia lead in Portugal, according to Rui Nunes’ opinion?

What is Rui Nunes’ opinion on the euthanasia argument future in Portugal

Right now the portuguese future towards euthanasia is in stand-by with 2018 proposals loss in the parliament. Nevertheless, Rui Nunes believes that the decriminalization “is more likely to happen than not to happen”, someday in the future.

The doctor confesses that he doesn’t have yet a “completely crystallized conscience on this matter”, “not so much for the purity of the concept, that is, of the exercise of the ethical freedom of the person, but more for the consequences that unfortunately we can perceive in all the countries that have decriminalized euthanasia”.

In the particular case of Portugal, Rui Nunes has doubts that he would like to see clarified, such as if the National Health Service reunites the conditions that are necessary to euthanasia administration.

“One thing is to judge ethically, in the abstract, whether euthanasia in a particular person is legitimate or illegitimate. No one likes to see a human being suffer. A different thing is to turn this option into a public policy, which will have a series of contours and consequences that have to be properly evalueted.