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The Medical Ethics of Euthanasia

Law of Euthanasia legalizing  suicide-assistance / Photo by Shutterstock

 

Euthanasia and physician-assisted suicide as defined by the Medical News Today, refer to deliberate action taken with the intention of ending a life by whatever means usually painlessly, in order to relieve persistent suffering. Other places consider this illegal and could often lead to a jail sentence while some deliberately leave this issue off the hook.

Doctor-assisted suicide increases overall suicide rates among the non-terminally ill where it’s made legal. Such laws have a measurable effect on those who aren’t dying, but who are suffering from depression.

A study conducted between 1990 and 2013 and published by the Southern Medical Journal found the correlation unmistakable: “Controlling for various socioeconomic factors, unobservable state, and year effects, and state-specific linear trends, we found that legalizing [physician-assisted suicide] was associated with a 6.3% increase in total suicides.”

A study of New York cancer patients suggested that a high percentage of those terminally ill patients who expressed a “high desire for hastened death” found themselves suffering from depression.

Yet for some reason, assisted suicide for psychiatric patients is not prohibited, but increasingly accepted. An alarm-sounding March issue in the New England Journal of Medicine said, “Physicians in the Netherlands and Belgium have helped a small but growing number of patients with mental illness but no terminal condition to end their lives. In some U.S. states, attempts to extend physician-assisted death to psychiatric patients appear inevitable.’’

Earlier this year, an NPR report on the assisted suicide of a 104-year-old Australian scientist, David Goodall, circulated the news.

“Goodall, on the other hand, was not terminally ill,” the piece said. “But he was ‘losing his faculties of sight and sound’ and ‘his quality of life [was] fast diminishing’.

Just this year, California reinstated doctor-assisted suicide, which is already legal in other states in America like Colorado, Vermont, Washington, Oregon, and Hawaii as reported by the Kansas City Star.

 

Legalized Assisted Suicide

This year, medical professionals in the Netherlands performed euthanasia on a 29-year-old woman suffering from depression and other mental ailments, after the country liberalized its euthanasia laws – some of the most permissive in the world – to include allowing it for those with mental illnesses.

Various incidents with regards to doctor-assisted suicide have been happening and it certainly involves most patients who have mental health problems that tend to request for alternative treatment methods resulting in euthanasia.

“We wanted to highlight the way that physician-assisted suicide is also a mental health issue and that the norms of suicide prevention should also apply to people to are seeking to end their lives by assisted suicide,” said David Albert Jones, the director of the Anscombe Bioethics Center.

Jones told Crux that all instances of assisted suicide - including for the elderly and disabled - raise the mental health issue of undiagnosed depression, but he said it is “even more problematic” when mental health issues are used as a justification for performing euthanasia or assisted suicide (the difference being that the doctor performs the action which causes death in euthanasia, while in physician-assisted suicide, the actual action is performed by the patient.)

Aside from this, allowing euthanasia to become an option for often-suicidal patients is a “profound” change in the culture, Professor Willem Lemmens said in a psychiatric symposium in England.

“Also, psychiatrists are often put under pressure to ‘grant’ euthanasia, sometimes even by the family of a patient,” Dr. Mark Komrad said.

“Human suffering is our core focus, and we have a skill set to accompany a patient in their suffering, no matter what the diagnosis,” he wrote in the Psychiatric Times. “Our approach is to address that suffering in various ways, but not by snuffing out the life of the sufferer. We prevent suicide, not provide it.”

In addition to this, with after almost a year after passing the assisted suicide law in Washington, not a single patient had used it and only two physicians have signed up in favor of the law. Religious groups and advocates wanted to scrap this “Death with Dignity”  bill signed by Mayor Muriel E. Bowser allows patients with less than six months to live to receive a fatal dose of drugs after making two requests at least 15 days apart. Two witnesses must attest that the requesting patient was of sound mind, and patients must take the medication without assistance.

“They don’t want to be known as the doctor who gives out death prescriptions,” said Omega Silva, a retired physician in the District and a Compassion and Choices volunteer.

In an article from the Washington Post, it stated that no local practicing physician testified in favor of the measure, and even several opposed it, during a debate before the D.C. Council.

“The physician community was not out there advocating for it, so I don’t think there should have been an assumption that there would have been a lot of physicians signing up,” said Pia Duryea, a spokeswoman for the Medical Society of the District of Columbia.

70-year-old former journalist and ovarian cancer survivor, Klein instigated city officials to launch an education campaign regarding the law and ease barriers for its access. As a known advocate for the law which allows doctors to prescribe fatal medication to patients, she also remarked, “if I’m not able to access this medication in time, then my deep hope is other terminally ill patients who want it will be able to access it.”

“Every doctor wants their patient to survive forever, even though they know that’s not possible forever,” Klein said. “It isn’t a situation where I’m going to pressure doctors to do this compassionate option. What I’m trying to do is find doctors I can have a real conversation with, who are open to considering this.”

 

 

“Curse of living a long life”

With the advent of his permission to end his life through euthanasia, the renowned scientist, Dr. David Goodall, has fulfilled his final wish and had taken his life through assisted suicide in a Swiss clinic, leaving a powerful statement in favor of voluntary euthanasia.

"If one chooses to kill oneself then that's fair enough. I don't think anyone else should interfere."

On his 104th birthday last April, Dr. Goodall used the media attention to declare there was nothing to celebrate in getting older and instead used the occasion to speak out for voluntary euthanasia.

The following month, he traveled to Switzerland where it is legal to get help to suicide. He used his final days to call for legislative changes that would allow the practice in Australia.

'It's my own choice'

Dr. Goodall met with two Swiss doctors in the days leading up to his death, who confirmed his intention to end his life and that he was of sound mind, measures that are both required under Swiss law.

The fatal procedure, a lethal injection of the barbiturate Nembutal, was then carried out about 12:30 pm local time on May 10 at the Life Circle/Eternal Spirit Foundation clinic in Basel.

Dr. Nitschke, the founder of euthanasia advocacy group Exit International, said Dr. Goodall's case was one of the firsts of its kind because, despite being frail, he does not have a terminal illness and is generally healthy.

He was then commemorated at a Perth memorial with his family, scientific colleagues and public guests who had followed his journey The memorial ended with guests singing Beethoven's Ode to Joy — the same song Dr. Goodall had listened to as he died.

While the issue subsided a bit in honor to mourn Dr. Goodall, Australian Medical Association expressed grave concerns about the precedent incident. Laws allowing euthanasia is ‘dangerous’ although it helps us aspire to make palliative care better especially for those who want to subject ending their life, AMA president Dr. Michael Gannon said.  

 

Compassionate or Mercy-killing?

Most people think unbearable pain is the main reason people seek euthanasia, but some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of severe pain.

According to BBC, psychological factors that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or dislike of being dependent.

Many patients who are terminally ill resort to euthanasia because of the desire to end their intense pain and suffering. This makes them unbearable to handle severe afflictions caused by their conditions and makes this an issue of whether or not this option is acceptable or not.

Issues involving ethics especially in the field of medicine cause countless debates stirring moral obligations to authority abuse - including religious views aside.

An example would be the rule “Do Not Resuscitate”. Although DNRs can be regarded as a form of passive euthanasia, they are not controversial unless they are abused.

In an article by Phillip Berry on Euthanasia, a conversation between a physician-patient scenario was dissected to fully disclose philosophical arguments between principles involving judgment and life.  An excerpt from the dialogue is as follows, “The pain is more than can be alleviated with drugs; it is a pain of thought and regret and some little guilt too. The patient asserts his right to die, and establishes that he is of sound mind.”  

A study published by the Journal of Medical Ethics, two most controversial end of life decisions are those in which physicians actively help patients to die, by means of either physician-assisted suicide or euthanasia. In physician-assisted suicide, the physician provides the patient with the means to end his or her own life. In euthanasia, the physician deliberately and directly intervenes to end the patient’s life; this is sometimes called “active euthanasia” to distinguish it from withholding or withdrawing treatment needed to sustain life.

 

As a result, the older the patient, the more acceptable it is for the physician to assist in suicide or euthanasia. Responses are separated, however, with the physician-assisted suicide scale higher than to the euthanasia scale. People’s judgment of the acceptability of physician-assisted suicide or euthanasia appeared to depend mainly on four of the five factors examined: the level of a patient suffering in spite of treatment; the extent to which the patient requested the life-ending procedure; the age of the patient, and the degree of curability of the illness.

In an interview with Dr. Bernard Lo in the Bioethics conservatory, 19% of patients with cancer reported that they would change physicians if their doctor had participated in assisted suicide or euthanasia. Patients who oppose PAD (physician-aid in dying) might fear that a physician who supports it would encourage them to consider it. Conversely, patients who are open to PAD might want to choose a supportive physician early in their illness. In all cases, doctors should elicit and address patients’ specific concerns and emphasize their ongoing commitment to relieving suffering.”

It was also stated in the interview that physicians who explore patients’ needs and concerns, try to alleviate pain and distress, and clearly state their opposition to assisted suicide aren’t complicit in PAD. Even continuing to care for a patient who has obtained a prescription from another physician need not make a physician complicit. On the contrary, by discussing their patient’s concerns and trying to address the reasons behind a request for PAD, the physician might help the patient find reasons to continue living.

As it expands further, amid truly frightening spikes in suicide, especially among military veterans and prominent personalities, let’s not be afraid to look at the uncomfortable, unattended and the unintended consequences. Let’s at least consider what the science says, instead of talking only about how compassionate these laws are.

 

Unplugging the life support of a patient / Photo by Shutterstock

 

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