Euthanasia

 

Euthanasia is presently understood to mean ‘good’ ‘happy’ ‘easy’ ‘painless’ and ‘compassionate’ death. The word ‘euthanasia’ is derived from two Greek words, ‘eu’ which means ‘good’ or ‘well’ and ‘thanatos’ which means ‘death’. Euthanasia is now misleadingly being used to promote ‘mercy killing’ which denotes the painless killing of human beings. Euthanasia does NOT mean to take life even in a ‘good manner’ or in a ‘proper way’.

 

A request to be killed is usually a call for help – a call for more loving and caring treatment. Experience has shown that people asking to be killed are saying they are fearful of pain and neglect. We must oppose the active killing of any patient even when the patient has consented or has asked to be killed. If the State were to allow this type of action, the door would be open to widespread abuses which would threaten our society.

 

The right to life of an individual is threatened when that individual is considered to be a burden, or that person’s life is considered meaningless or worthless.

 

People should be entitled to die with dignity and with adequate relief of pain and suffering. Such adequate relief of pain should be provided even where this may unintentionally cause a shortening of the patient’s life. This is not ‘killing’ in any sense of the word.

 

Palliative care

 

Whilst no-one wants to see someone they love endure pain, euthanasia is not the answer to this. Instead, we should put far greater resources into high quality, easily accessible palliative care so that people’s last days can be made as comfortable as possible.

 

The World Health Organization (WHO) defines palliative care as "An approach that improves the quality of life of patients and their families facing the problems 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

  • provides relief from pain and other distressing symptoms

  • affirms life and regards dying as a normal process

  • intends neither to hasten or postpone death

  • integrates the psychological and spiritual aspects of patient care

  • offers a support system to help patients live as actively as possible until death

  • offers a support system to help the family cope during the patient’s illness and in their own bereavement

  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated

  • will enhance quality of life, and may also positively influence the course of illness

  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications

 

One goal of palliative care is for the patients and families to accept dying as a normal process. It seeks to provide relief from pain and uncomfortable symptoms while integrating psychological and spiritual features of patient care. Palliative care strives to offer a support system to help patients live their remaining time as actively as they can and to help families bereave and deal with the illness of a loved one. 

 

Since pain is the most visible sign of distress among patients receiving palliative care, affecting about 70% of cancer patients and 65% of patients dying from non-malignant diseases, opioids are a very common treatment option. These medicines form part of well-established treatment plans for managing pain as well as several other symptoms that patients encounter. Often, opioids are chosen during palliative care in spite of the side effects such as drowsiness, nausea, vomiting, and constipation. 

 

Some type of palliative care is given to about 60,000 patients in Australia per year. About 90% of these patients have cancer, while the remaining patients have heart disease, stroke, motor neuron disease, or multiple sclerosis. The providers of the palliative care include in-patient care, hospital support services, community care, day care and outpatient care.

 

There are two classifications of euthanasia

 

  • Passive euthanasia - this is when life-sustaining treatments are withheld. The definition of passive euthanasia is often not clear cut. For example, if a doctor prescribes increasing doses of opioid analgesia (strong painkilling medications) which may eventually be toxic for the patient, some may argue whether passive euthanasia is taking place - in most cases, the doctor's measure is seen as a passive one. Many claim that the term is wrong, because euthanasia has not taken place, because there is no intention to take life.

  • Active euthanasia - lethal substances or forces are used to end the patient's life. Active euthanasia includes life-ending actions conducted by the patient or somebody else.

 

Death is a process that takes place over a period of time. It involves several stages. The death process has reached an irreversible state when there is lack of brainwave activity over a specific period of time. Prior to this state, breathing, or the heart, or both, may stop but the death process may not be irreversible at this time. With the use of a respirator or heart stimulator some patients recover. Only the doctors at the bedside are competent to judge whether the patient would recover if revived. If recovery is possibly, then active resuscitation is called for.

 

If the death process has already reached an irreversible stage, then active resuscitation is not needed and should be withheld. Nevertheless, no person should be permitted to kill or hasten the death process in such a patient. Ordinary care such as warmth and nourishment and general nursing care should be provided until the patient is pronounced ‘dead’.

 

Reasons against voluntary euthanasia

 

  • The doctor's role - doctors and other health care professionals may have their professional roles compromised. The Hippocratic Oath, in its ancient form stated "To please no one will I prescribe a deadly drug nor give advice which may cause his death."

  • Moral religious argument - several religions see euthanasia as a form of murder and morally unacceptable. At best, some see voluntary euthanasia as a form of suicide, which goes against the teachings of many religions. Euthanasia weakens society's respect for the sanctity of life.

  • Competence - euthanasia is only voluntary if the patient is mentally competent - has a lucid understanding of available options and consequences. Determining or defining competence is not straightforward.

  • Guilt - there is a risk patients may feel they are a burden on resources and are psychologically pressured into consenting. They may feel that the burden - financially, emotionally, mentally - on their family is overwhelming. Even if the costs of treatment are provided by the state, there is a risk hospital personnel may have an economic incentive to encourage euthanasia consent.

  • Slippery slope - there is a risk things will start with those who are terminally ill and wish to die because of intractable suffering, and eventally begin to include other patients.

  • The patient might recover - the patient might recover against all odds. The diagnosis might be wrong.

  • Palliative care - good palliative care makes euthanasia unnecessary.

  • How can you regulate it? Euthanasia cannot be properly regulated

 

The AMA (Australian Medical Association) position

The AMA absolutely recognises that for most patients in the terminal stage of illness, pain and suffering can be alleviated by therapeutic and comfort care; however, there are still currently instances where the satisfactory relief of suffering cannot be achieved. We must, therefore, ensure that all patients have access to appropriate palliative care and advocate that greater research must go into palliative care so that no patient endures such suffering. No one should feel that their only option for satisfactory relief of pain and suffering is to end their own life.

 

Disability Rights Movement position

The disability rights movement is opposing legislative reform in a number of areas: legalization of euthanasia, mercy killing or assisted suicide and amendment of the Criminal Code to include compassionate homicide.

  • We believe that every safeguard put forward at the beginning of the debate has already been broken beyond repair.

  • We believe that as long as disabled people are viewed as a suffering entity, as an object of charity, as a life not worth living, we cannot accept the broadening of our access to death. It is not without a reason that studies show that the support for euthanasia is greatest among the healthy and young and lowest among the elderly and frail and the ones with the least control over their lives.

  • We believe that the legalization of euthanasia will force people to be euthanized in a misbegotten effort to do the right thing: save their loved ones from financial ruin, remove family members from the care taker role, cease to be a burden on the state. In a time where the percentage of elderly people is increasing and governments are reducing health care budgets and more and more people are without a circle of friends to support them, people find themselves facing the societal reality that There is a decreased willingness to provide social and economic support. The British Medical Journal reported on 29 October 1994 that, "People in Britain are more likely to request euthanasia to avoid being a burden on their relatives than because they are in pain."

  • We believe that the majority of death wishes are based on a lack of support and understanding for the individual by society.

  • We believe that euthanasia is another technique to free society of unwanted members of society among them disabled people and another expression of the ableism in western societies.

 

Is there at present anywhere in the world legislation which allows voluntary euthanasia?

The horrors of the mass-destruction in the Third Reich of Jews, of people who were senile or psychotic and of children who were severely handicapped, arose directly from a policy of restrictive voluntary euthanasia in the first instance. These atrocities led international medical organisations to ‘Condemn the practice of euthanasia under any circumstance’ (Resolution adopted by the General Assembly of the World Medical Association in 1950).

 

In the majority of countries euthanasia or assisted suicide is against the law.

 

Dutch euthanasia experiment

An article reproduced in an edition of the Journal of Medical Ethics states: The authors reviewed the findings of a large 1995 survey into end-of-life decisions by Dutch doctors. This survey involved interviews with 405 doctors and questionnaires mailed to physicians who had attended more than 6000 deaths.

 

In the Netherlands, physician-assisted death is subject to criminal law, but is widely practised according to safeguards established by the courts and the Royal Dutch Medical Association.

 

However, the authors said the 1995 study indicated these safeguards were not being adhered to. For example, almost 60% of cases went unreported and unchecked.

In 17% of the 3600 cases of euthanasia and assisted suicide, there had been treatment alternatives available, attending physicians reported. This breached the guideline that doctors should not hasten death when the alternative of palliative treatment was available, the paper said.

 

The intentional shortening of patients’ lives without their explicit request was also not uncommon. One in five cases in which the doctor said they intentionally ended a life involved no explicit request from the patient.

 

The main reason for not discussing the issue was reported to be patient incompetence, for example due to dementia. But in some cases, the doctor could have addressed the issue but did not because they felt euthanasia was in the patient’s best interests.

 

“Dutch claims of effective regulation ring hollow”, the authors said. Journal of Medical Ethics 1999:25:16-21.

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