Feature Article

Posted: November 27th, 2013

Rom Houben of the UK was in a coma for 23 years before he woke up to tell doctors and family that he was conscious all along. Kate Adamson recovered from a 70-day vegetative state during which doctors pulled her feeding tube. Were it not for her husband’s efforts to reverse this, Kate would have not have been alive today to tell her story (Euthanasia.com). Both cases indicate that ending of a terminally ill patient’s life is rarely a definite solution to ending their suffering.

Euthanasia is defined by Bartels & Otlowski as the intentional ending of a terminally ill person’s life in order to end their suffering (2010). Euthanasia is also known as mercy killings. However, is there really any mercy in killing someone else? Despite the fact that euthanasia is taken from the Greek words meaning ‘good death’, the act remains wrong for numerous reasons. In order to understand the controversy surrounding euthanasia, we need to understand first the different terms used to describe the different types of euthanasia there are.

First, there is what is known as voluntary euthanasia. This refers to that kind of mercy killing where the euthanized person has requested his or her own death. Non-voluntary euthanasia on the other hand occurs when the person euthanized has made no request or given any consent for euthanasia. This often occurs when family members or doctors decide to euthanize the patient without their wish or consent. Another term used is involuntary euthanasia, which refers to an incidence where the euthanized person has expressed a wish to the contrary (Euthanasia.com).

Also included in euthanasia terminology are passive and active euthanasia. Passive euthanasia is when the no action is taken to prolong the patient’s life while active euthanasia refers to the direct and deliberate cause of a patient’s death (Euthanasia.com). Sometimes the terms euthanasia and assisted suicide are used interchangeably even though they differ slightly in meaning. Assisted suicide in fact refers to the facilitation of euthanasia through provision of guidance, information and means to a patient. If the facilitation is done by a physician, the euthanasia is known as physician-assisted suicide or doctor-assisted suicide.

Different states and countries treat the subject of euthanasia differently. In the Netherlands for instance, doctors are not liable to prosecution if they medically assist suicide, even though the act continues to be a criminal offence (Rietjens, van der Mass, Onwuteaka-Philipsen, & van der Heide, 2009). Under certain conditions, direct euthanasia and physician-assisted suicide are not treated as criminal offences. Under these conditions, the doctor should believe that the patient’s request is voluntary, should believe that the patient’s suffering is unbearable and long lasting, and should have consulted with another independent physician. In addition, the physician is required to notify the authorities once the act of euthanasia or assisted suicide is done.

In the U.S on the other hand, only one state allows physician-assisted suicide: Oregon. Here, a doctor may give medication to a patient over the age of 18 so that he may end his or her life. Even here, there are certain conditions to be adhered to. These include informing the patient of the diagnosis and prognosis, as well as the potential risk stemming from taking the medication. In addition, the physician should refer the patient to another physician and should request that the next of kin be notified. In other U.S states however, physician-assisted suicide considered as criminal homicide.

In Australia, the laws affecting euthanasia are different from state to state even though euthanasia is generally illegal. However, the prosecutions resulting from acts of euthanasia are few (Bartels & Otlowski, 2010). For a brief moment between 1995 and 1997 however, the Northern Territory Rights of the Terminally Ill Act allowed euthanasia under certain conditions. These were a request by the patient to die, involvement of a first doctor, second doctor, and a psychiatrist in the process leading to euthanasia, and passing of seven days after the patient’s request to die. The act was however overturned in 1997, before which there had been four acts of euthanasia under the law.

A study carried out in the U.S in 2000 indicated that patients with advanced cancer favored enactment of policies that would allow euthanasia. Most (58%) indicated that they would consider euthanasia were it legal and were their situation to worsen, with 12% of them stating that they would have asked for euthanasia at the time of the interview had it been legalized (Wilson, et al., 2000).

This study shows that while majority of terminally ill patients would like to be presented with the option of euthanasia, only a minority would actually go ahead with the act. In addition, the patients who would have chosen euthanasia in the study were found to differ from the others in that they had a higher prevalence of various depressive disorders, a situation that can be corrected through other means.

An analysis of data from studies of physician-assisted suicide and euthanasia in Netherlands also indicates that euthanasia may not be the perfect solution it is thought to be. The analysis found that in 16% of the 649 cases of euthanasia studied, there were problems with completion, defined as longer-than-expected intervals before death (Groenewoud, et al., 2000). The study also found that in 21 of the cases of physician-assisted suicide, the patient had problems with completion, which required the physician to administer the lethal injection himself, making the case an act of euthanasia. The analysis concluded that “there may be clinical problems with the performance of euthanasia and physician-assisted suicide” (Groenewoud, et al., 2000).

These studies show that legalizing euthanasia may not in fact be the best solution to alleviating the suffering of terminally ill patients. In addition, complications may result from euthanasia that may even aggravate the situation. However, perhaps the major reason why euthanasia should not be allowed is the fact that once this happens, it is practically downhill thereon. Edmund D. Pelligrino, Professor Emeritus of Medicine and Medical Ethics at Georgetown University puts it best when he says, “In a society as obsessed with the costs of health care and the principle of utility, the dangers of the slippery slope are far from fantasy…” (Pelligrino, 1998). The moment euthanasia and assisted suicide are legalized, hospitals and individuals not willing to spend large amounts of money may abuse the law. Euthanasia and assisted suicide may have their benefits but we should be willing to ask the difficult questions: Are the dire consequences that will surely result from the legalization of this practice necessary to the human condition? I think not.

Reference:

Bartels, L., & Otlowski, M. (2010) A right to die? Euthanasia and the law in Australia. Journal of Law and Medicine 17(4), 532-555.

Euthanasia. Euthanasia.com. Retrieved from http://www.euthanasia.com/index.html

Groenewoud, J., van der Heide, A., Onwuteaka-Philipsen, B., … van der Wal, G. (2000). Clinical problems with the performance of euthanasia and physician-assisted suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556.

Wilson, K., Scott, J., Graham, I., Kozak, J., Chater, S., … Curran, D. (2000). Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide. Archives of Internal Medicine, 160(16), 2454-2460.

Pelligrino, E. D. (1998). The false promise of beneficent killing. Regulating how we die: The ethical, medical, and legal issues surrounding physician-assisted suicide.

Rietjens, J., van der Mass, P., Onwuteaka-Philipsen, B., & van der Heide, A. (2009). Two decades of research on euthanasia from the Netherlands. What have we learn and what questions remain? Journal of Bioethical Inquiry, 6(3), 271-283.