For students to know and understand arguments for
and against the legalisation of euthanasia and some of the ethical and
moral questions this raises.
| Euthanasia |
The deliberate ending of the life
of an individual either by act or omission, usually out of a motive
of misplaced compassion. |
| Voluntary Euthanasia |
The killing of an individual at their request. |
| Do we have the right to end our own life? |
Attempted suicide is not punishable under law
– recognises the need for treatment of depression or mental
illness, but there is also no legally established right to end your
own life. In fact the opposite is true; international charters of
human rights recognise an inalienable right to life; it cannot be
given up. |
| Do we have a right to die? |
Dying cannot be considered a legal right; it is
instead something that is inevitable for every human being. Legalised
euthanasia supposes a right to be killed at a time of your choosing,
even though this goes against the internationally recognised human
right, the right to life. |
| |
Every right implies a duty. The right to be
killed would imply a duty to kill – on the part of the doctor?
What consequences might there be for doctor-patient
trust and the morale of the medical profession and how it views
its role in society? |
| Suicidal able-bodied person Vs
Suicidal disabled person |
If someone attempts suicide or says that they
want to die we recognise that they have a need for treatment of
their depression or mental illness. If euthanasia was legalised
for people living with illness or disability, then when someone
with a disability says that they want to die we might agree to their
request rather than offering treatment for depression or mental
illness, or exploring the reasons why they want to die and what
can be done to change their situation. |
| Ethical Considerations |
In 2003 a British couple travelled to Switzerland
for assisted suicide. There was outrage because the couple were
not dying or suffering from any disabilities or terminal illnesses.
Does this show a difference between attitudes towards those who
are ill or disabled and those who are considered to be able-bodied?
No man is an island – all our actions have
consequences for others and for society? The voluntary euthanasia
of an individual has consequences for others in society? |
| Law on euthanasia would
outline criteria for those to be allowed the right to die |
If the law categorises particular individuals
in society e.g. people with particular disabilities, as having
the right to be killed does this involve the law and society passing
judgement on the value of the lives of people with such disabilities?
Might some who have such conditions feel that by giving them the
right to be killed the law is saying that they should want
to die?
Might such a law increase the fears and vulnerability of individuals
categorised by the law and make them feel a burden on society? |
| |
Any law to legalise euthanasia would be very
general. It would be based on particular medical conditions and
illnesses. Every person is an individual and so even if others
have a common medical condition, their own circumstances, e.g.
pain, fears, emotional needs etc, will be individual to them.
No law can consider the individual circumstances of each person.
On the other hand doctors, family and carers are in a position
to assess and attend to the individual needs of their patients/loved
ones.
If there was legalised euthanasia and a patient requested euthanasia
would the doctor be less likely to consider and address the patient
as an individual with his/her own needs and concerns, it being
easier to simply grant his/her wish for death? Would the doctor
look past the physical condition, for which the law permits euthanasia,
to the emotional needs of the individual? |
| Disability |
Attitudes: “I think if people with disabilities
or terminal illnesses want euthanasia then the law should allow
them their wish”. |
| |
Can we make such statements about disability and
still claim to respect people with disabling conditions? Does such
a statement consider the lives of those with disabilities or terminal
illnesses to be of lesser worth than the lives of the able-bodied? |
| Dignity |
Pro-euthanasia perception that disabling and terminal
conditions are undignified. This is a subjective quality of life
judgement. |
| Ethical Considerations |
"Dying with dignity" implies that
those who are ill or disabled can only find dignity in death.
What is dignity? How do we find dignity?
If we define dignity as self-respect can this be undermined by
the way others treat and consider us?
Dignity is found in the way others treat us? |
| Value |
To consider a life no longer worth living is to
consider all human beings on the basis of their abilities/usefulness.
This viewpoint considers our value to be found in what we can or
cannot do for ourselves, for others, and for society. On this measurement
our value increases from birth until maturity and then decreases
as we grow older until the point of near death. |
| Ethical Considerations |
If this is how society measures value and we
are perceived as a burden on those around us e.g. it may be expensive
to care for us, we might be seen as having surpassed the point
of usefulness and so our life no longer has any worth in the eyes
of society.
How else might we consider value? All human beings have an inherent
value derived from their humanity and therefore our perceived
"usefulness" is irrelevant as a measure of what we contribute
to society. All human beings and all human lives are valuable.
People who request euthanasia have lost sight of the value of
their lives. Everyone should be helped to rediscover and reaffirm
their value as human beings. |
| Palliative care |
"No one wants to die in pain". |
| |
Palliative care: hospice care and the work
of experts in pain relief to ensure that people do not die in
pain. Hospice doctors say they can relieve 95% of physical pain
and can help 100% of patients (cf Statement
by Dr Robert G Twycross, Macmillan Clinical Reader, Oxford
University, 23 July 1997). Hospice and palliative care
is about comforting and making comfortable those who are terminally
ill or who have entered the dying process. It is also about caring
for a person’s emotional as well as physical needs.
The World Health Organisation (WHO) describes palliative care
as:
- 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
patients 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.
Does the lack of hospices and pain clinics in Holland demonstrate
that legalised euthanasia undermines the development of good palliative
care as an alternative to euthanasia or dying in pain? (Mark
Kennedy "Canada must help dying to go with dignity"
at the Second Joint Clinical Conference and Exposition on Hospice
and Palliative Care, "Palliation and Passion in the End of
LIfe", held in Orlando, Florida, 23-26 March 2001).
Only 5% of patients in Holland requesting euthanasia cite physical
pain as the reason (Van de Wal G, van Eijk
J Thm, Leenen HJJ, Spreeuwenberg L "Euthanasia and other
medical decisions concerning the end of life", Health
Policy, 1992; 22 [suppl 1 & 2] in British Medical Journal,
21 May 1994).
It was reported in The Lancet medical journal in 2001 that
“Although the traditional idea is that such deaths are wished
for as a means to avoid pain and suffering, studies suggest that
this explanation is insufficient. In fact, depression, hopelessness,
psychological distress, and need for social support are all factors.”
(Origins of the desire for euthanasia and
assisted suicide in people with HIV-1 or AIDS: a qualitative study
The Lancet 2001; 358:362-367). The authors reported that
although this study was confined to HIV/AIDS patients, it nonetheless
reflected the research on patients with other types of illness.
The WHO also recognize that “Palliative care has promoted
wider application of the principles of pain and symptom control.
However, more work is needed to train all professionals in assessing,
monitoring and treating pain and distressing symptoms in all settings.”
(WHO Palliative Care – The Solid
Facts, Elizabeth Davies and Irene J. Higginson Eds., 2004).
Part of the answer to helping those seeking euthanasia is better
training of health professionals in providing appropriate end-of-life
care.
Does this raise the question of health authorities failing to
treat psychological illness such as depression with euthanasia
being seen as an easier option? In the Netherlands a woman with
no physical illness who was suffering from depression was given
euthanasia ("Killing the Psychic Pain",
Time, 4 July 1994). The doctor
involved was cleared of any wrongdoing and so this legitimised
the killing of depressed patients. Those who are living with a
disability and who, as a result of depression, ask for euthanasia
may also have their request granted rather than being offered
treatment for their depression.
|
| Striving to keep patients
alive |
Opposing euthanasia means recognising that life
has a natural end point. It does not mean keeping dying people alive
as long as possible using every technological means available. It
does mean making every effort to ensure that the person is well
cared for and kept as pain-free and comfortable as possible. |
| |
All patients have the legal right to refuse
treatment that is excessively burdensome.
The best interests of a patient include not causing harm to the
patient.
Doctors can advise patients on the withdrawal or withholding
of treatment that is a burden to a dying patient or where it has
become futile. Doctors recognise that there is a point where their
role changes from curing to caring, usually when the patient has
entered the dying process. |
| Assisted
food and fluids |
Assisted food and fluids is when a person receives
food and fluids by feeding tube most likely through the nose by
naso-gastric tube or directly into the stomach through an opening
in the wall of the abdomen called a gastrostomy or PEG tube. |
| |
In 1993 a court ruled that food and fluids
delivered through a feeding tube could be withdrawn from a person
in a persistent vegetative state (PVS) [This is better described
as a persistent non-responsive state]. This case resulted in assisted
food and fluids for the first time being considered medical treatment
rather than basic care.
This judgement was a part of case law in England and Wales and
meant that the precedent was set for any such case to be awarded
a similar court ruling for the withdrawal of assisted food and
fluids. Another judgement in Scotland, in January 1996, for the
withdrawal of assisted food and fluids from a PVS patient again
set this precedent in Scottish case law.
The Mental Capacity Act (2005), which applies to England and
Wales means that these previous judgements regarding the withdrawal
of assisted food and fluids have now been enshrined in statute
law and can also be extended to incapacitated patients.
The Adults with Incapacity (Scotland) Act 2000 however does not
enshrine in statute law assisted food and fluids as medical treatment
that may be withdrawn.
People in a PVS are not dying, do not require life-support machines,
their bodies and organs still function normally and they can derive
nutrition and hydration from food and fluids. However, people
in a PVS do have difficulty swallowing and so need to receive
food and fluids through a tube. Withdrawing food and fluids from
people in a PVS results in their death through starvation and
dehydration.
People in a PVS can neither request nor consent to withdrawal
of assisted food and fluids. Where this is withdrawn these are
cases of non-voluntary euthanasia.
The above court case resulted in assisted food and fluids for
the first time being considered medical treatment rather than
basic care. |
| Ethical Considerations |
Patients do not have the right to demand medical
treatment, it is the doctors decision what treatment a patient
receives. If assisted food and fluids are considered medical treatment
then they can no longer be considered part of our right to basic
care.
Should food and fluids administered through a feeding tube be
considered medical treatment rather than basic care to prevent
starvation and dehydration?
To argue that people in a PVS have no benefit in receiving food
and fluids is to argue that they have no benefit in being alive?
Food and fluids given through a feeding tube is just a way of
assisting the receipt of food and fluids and is no different from
helping an incapacitated person to eat by spoon-feeding him or
her. |
