Euthanasia

Euthanasia, as defined by the Netherlands State Commission on Euthanasia, is "the intentional termination of life by another at the explicit request of the person who dies" . Although this implies that euthanasia is always explicitly requested by the dying individual, in reality the term is used in a variety of ways, with varying degrees of patient involvement. The wide scope of the term is perhaps one of the reasons why the public is unable to come to a consensus on the issue. Here are four very different types of euthanasia: (1) passive euthanasia, (2) active euthanasia, (3) physician assisted suicide, and (4) involuntary euthanasia.

Euthanasia is probably almost as old as humanity itself. Voluntary euthanasia can be traced back to the ancient Greeks and Romans. Both of these societies accepted voluntary euthanasia. With the advent of Christianity and the other major modern religions between two thousand and one thousand years ago, religion came to play a greater role in government and everyday life. The newer religions preached about the sanctity of human life, and euthanasia was condemned as wrong . Euthanasia was seen as sinful throughout the civilized world, but it was still practiced quietly. This century has marked the return of the issue of euthanasia to the public consciousness. In 1935, The Voluntary Euthanasia Society was founded in London. This group of doctors was the first organization that supported the legalization of voluntary euthanasia. The next year, the House of Lords rejected a bill that would have legalized voluntary euthanasia in the United Kingdom. Also in 1936, King George V of England was secretly and voluntarily euthanized by his physician Lord Dawson. The suffering king requested and received a lethal injection of morphine and cocaine. The public was told that he had succumbed to his illness and the truth was buried for fifty years. The first American euthanasia society was the Hemlock Society. Today the group has 67,000 members and still seeks to change America’s euthanasia laws. It also offers support for those who are dying and wish to be euthanized. Euthanasia was legalized in the Netherlands in late 2000.

Related nodes:
Jack Kevorkian
Opinions on Euthanasia
mercy killing
Aktion T4

Also, the name given in Nazi Germany to the program that caused the murder of thousands of handicapped, retarded and mentally ill germans in the Dachau concentration camp near Munich from 1935 to 1939.

The plan worked like this: They told the family that the person who was meant to be killed that he was going to a government owned spa, to better his chances of getting better. Over at Dachau, those people (many of them children) were gassed. Then a letter would be sent to the family informing them that their relative has suffered an unfortunate accident. In time as these letters became more and more common, people started to understand what was going on and pressured the government to stop it.

As was noted above, Opperation Euthanasia ended in 1939. However by that time the Nazi government has already performed several researches as to what gas would affectively be used in mass killing, a knowledge that was well used in years to come.

On November 28, 2000, euthanasia was legalized in the Netherlands by the Dutch parliament - the first country to ever formally legalize the practice. They approved a bill that will allow euthanasia and physician-assisted suicide for patients undergoing irremediable and unbearable suffering. The patient's request must be voluntary and independant while they are of sound mind and, they must be aware of all other medical options and get a second professional opinion.

Is it possible for someone to experience a fate worse than death?

This clearly depends on your personal convictions concerning the afterlife. For example, if you consider suicide a mortal sin, it is never a favourable option. Personally, I believe that life ends with death; for me, the choice is between continuing life for an indefinite time, or going to permanent sleep. A very different proposition. Considering this, it is a very strong statement to say that it is not possible for a person to experience a fate worse than death.

Does a person have the right to consider their fate worse than death?

This is the moral side of the issue. If I'm feeling miserable, permanently, with little or no prospect of improvement, am I allowed to compare my situation to death and consider myself worse off? This is what consumagenerica appears to be saying when arguing that it cannot be true that rape is worse than death: regardless of what your situation looks like from an objective point of view, you are morally obliged not to view it in that way, you are not allowed to consider death better than life. Whether or not this correctly represents her feelings, it does summarize the conviction of many.

This is a very respectable point of view. She has a strong argument, too: telling someone their fate is worse than death can be taken as a verdict, a condemnation. Words are powerful.

Still, I would just like to stress that it is not the only view possible. In Japan, people commit suicide out of shame; in wartime, people are proud to sacrifice themselves for their country; in our society, people commit suicide as a way to end their own misery. If we are honest with ourselves and with our moral values, we have to face the fact that suicides are rarely impulsive acts of desperation committed by someone who didn't really know what they were doing; often, they are the carefully planned consequence of a perfectly rational choice. Some people honestly believe cannot turn their fate far enough to make living their life worthwhile.

The current issue of VN, a Dutch weekly, contains an article written by Frank van Ree, a well-known psychiatrist, detailing his 40-year experience with suicidal patients and the issue of euthanasia. He says it's impossible to generalize in this matter. Every case is different; every person is different. What matters to you may not matter to me. Patients have thanked him for saving their lives; other patients have thanked him for helping them end their lives. Some patients manage to find happiness in life after long periods of depression; some patients manage to end their lives after 40 years of continuous attempts. Van Ree describes the situation in the 60s, 70s and 80s, when it was completely taboo to even discuss suicide attempts, as pure horror, where patients and the medical staff would keep each other locked in a state of desperation with no prospect of improvement. He makes it clear that the right to choose, the option to discuss suicide openly, the right (in practice, even when it's still illegal) for doctors to assist patients with an open mind, is an immense relief to all concerned. Van Ree clearly feels that in this matter, strict principles, such as "life is always better than death", are unjust.

The Roman Catholic View of Euthanasia

Euthanasia, or the premature and unnatural ending of a human life, obviously raises many moral issues and questions. Is it moral to end ones life before they die naturally? From the standpoint of the Roman Catholic Church, Euthanasia can be both moral and immoral, depending on the circumstances of it’s use and the way it is performed. There are two types of euthanasia. There is active and there is passive. Active euthanasia is always immoral without question. One cannot induce death, with such aids as poison or anything else for that matter -- that is considered Active euthanasia. Therefore, assisted suicide also falls well within the realm of 'immoral.'

Passive euthanasia is basically removing life support or not performing extraordinary procedures to keep someone alive. But, in order for passive euthanasia to be considered moral, there are certain conditions which must be met. If any one of these conditions is not met, then the act is considered immoral and a grave sin by the Catholic church.

The first of these conditions is that the patient in question must be suffering from a terminal illness with no hope of recovery. The second is that there is an obligation to use all ordinary medical treatment to help save the patient, however the use of extraordinary medical treatment can be used, but is not obligatory. Another condition is that one may not stop treatment just to end the patient’s life. The intention must be to relieve pain and end suffering. Treatment whose purpose is to relieve undesirable pain and anxiety may be used, even if shortening the death process may be the outcome. One also may stop any treatment that is simply prolonging the death process. And last, whether treatment is stopped or not given can never be a matter of the patient’s utility or financial situation. If all of these factors and conditions are met or followed, then that passive euthanasia may be considered moral and acceptable.

This is not fiction.

How it works:

We make sure the curtains are closed, tissues available for the family and a clean blanket for the patient to lie down on. Sometimes the patient prefers to sit. It doesn’t really matter. The family are sad, sometimes crying. The patient is usually just ready to go. We each have our traditional last-minute questions, us asking are you sure you want to go through with this, do you want to watch, them asking will it hurt. (No, it won’t.) And then

I hold the patient, wrapped firmly around his body, holding one limb out. Hand goes around the elbow and twists, thumb pressing down on the vein. Holding off the vein while the doctor inserts the needle. Draws a little blood to make sure we’re in the vein. Blood swirls like octopus ink into the pink liquid. We’re ready. I let up on the vein and the doctor slowly depresses the plunger. The patient kicks a little while death runs up through his vein.

The doctor pulls the needle out, and I put my thumb over the puncture. A few seconds later the patient goes limp, and I ease him to the floor, still holding. Once in a great while, adrenaline overpowers the sedative, and the patient thrashes for a few seconds before letting go. Usually, it’s over in seconds. The last breath comes out in a quiet sigh, and the eyes glaze. If you look at the eyes you can see, if you want to, the exact second when whatever force animated the patient leaves the room. It’s a mystical and terrible moment that I no longer care to see.

I lay the head down, wait for the doctor to confirm that the heart has stopped, arrange the body discreetly so it doesn’t look like an HBC, pull part of the blanket over the body. Then I leave quietly. We let the family stay in the room as long as they want to. I have a plastic bag ready, but they don’t need to see it.

Sometimes they stay in the room for close to an hour, saying goodbye. Most people only take ten or fifteen minutes. There is almost always crying. Sometimes there isn’t. The people that don’t cry scare me.

When they leave, I come in with the bag and carry the body to the freezer. You want to get the body packaged before the sphincter loosens. The body is so floppy it seems boneless, and can be hard to carry. It always amazes me how much of our bodies’ rigidity is actually due to our muscles.

We log the drugs used, lock up the bottle, and clean the room. Another day done.

The statistic quoted in the industry is that veterinarians see five times as much patient death as human doctors. I tend to doubt the neatness of that figure (are they talking about oncologists or pediatricians?) But I can tell you we do this several times in an average week. This is a significant factor in what they call “compassion fatigue”, which can wreck veterinary personnel. You see a lot of people burn out from this fatigue. They develop all kinds of problems. There’s one in most vets’ offices. A lot of it has to do with the fact that so much of the death we see is totally preventable.

Miss Kitty’s Near Death Experience:

The owners are not clients of ours. Normally we don’t do walk-in euthanasias, for reasons which will soon be made clear. Normally we require that they come in for an examination. For some reason our office manager decided we would take this one. The cat, they say, is fifteen years old. Vomiting nonstop. Scratches everyone. Won’t eat. No shelter will take her because of her age, no friend will adopt her because of the vomiting. They’re at wits’ end.

We shouldn’t take it, but we do. The owners drop off the cat. An hour later, the doctor and I are in the room. Since this is supposedly a “caution cat”, I’ve got the gloves, but I hate the gloves because you can’t get a good grip with them. So I reach into the carrier gently, whispering to Miss Kitty. Touch her gently, pet her. Pull her out of the carrier. She hisses, but she comes. I weigh her and put her back on the table, doing the “careful snuggle”. Miss Kitty is doing fine.

The doctor looks at her. “This cat is fifteen?” He looks at the teeth, brushes the coat. Her teeth are atrocious, but her coat is healthy, she’s outdoor-cat-dirty but grooming herself, her weight is good, her eyes are bright.

He looks at me. “Did she try to bite you?” I shake my head, knowing already that we and Miss Kitty have been screwed. This is exactly why we don’t take walk-in euthanasias.

“I’m not doing this.”

We put the needle away and take her temperature. She has a mild fever. The doctor examines her a little more, gives her something for the fever. Then I brush her out and put her in a cage in the back room. On lunch break, we take her down to the hospital and remove the teeth that are beyond salvation. We put her on an IV drip overnight.

A day passes, and another, and Miss Kitty hasn’t vomited once or made any attempt to bite or scratch me. She’s eating and drinking normally. Bowel movements and urination are normal. We check for FELV and FIV. Negative. We run bloodwork. Normal. Miss Kitty is a perfectly good cat.

We are looking for a home for her now. She will live. She’ll be just fine.

The owners, meanwhile, have been on the phone with us every single day. They don’t understand it. She was terrible. She couldn’t hold down a bite. She bit everyone. When they have the nerve to tell us they don’t want her living in a cage, our entire staff totally loses it. The next time they call, we tell them we found a home for her. Really, it’s only a matter of days before one of our cat rescue ladies will take Miss Kitty.

Some people care.

Euthanasia is an area in which the Scottish legal system has managed to send one message, whilst behaving in a different way entirely. Despite this, legal authorities have remained clear on the issue; to wilfully take the life of a person, at their request, is to be guilty of murder. Euthanasia, given its literal definition, means a gentle or easy death, however it has come to refer to deliberate steps taken by a doctor to end the life of a patient. It can further be qualified into three distinct categories: that of voluntary, involuntary and non-voluntary, referring to the degree of patient involvement in the decision-making process. The Scottish legal system remains, as far as voluntary and involuntary euthanasia are concerned, unrelenting. In the latter, however, doctors can be assured of a degree of protection, both from prosecution, by the Lord Advocate, and from civil proceedings, following a ruling by the Court of Session. This differs from the approach of the Netherlands where a defence of necessity is provided, considerably a more effective technique than the confusing approach taken by the Scottish legal system.

The judicial stance on euthanasia in Scotland is this. Whilst taking ones own life is not regarded as a crime, deliberate intervention, with the express intention of ending the life of another individual, at the persons own request, or out of merciful motive, is to be guilty of murder. However, prosecutorial discretion is exercised on the part of the Lord Advocate, in refusing to authorise the prosecution of doctors who have acted under specific circumstances, to bring about the death of a patient suffering from a persistent, vegetative state, through the withdrawal of treatment. This would include withholding food and hydration. This approach vaguely echoes the approach of the Court of Session, where it was decided that to withhold treatment which had previously been the duty of a doctor, no longer violated the principle of the sanctity of life where no advanced directives existed to indicate the wishes of the patient and they had been in a persistent vegetative state for three years.

In practical terms, “it would be a most perilous doctrine to introduce into the law of Scotland, or of any civilised country, that any person was entitled to kill any other person at his or her request”. While sound in reasoning, in practice this argument can be questioned when looking at the approach of the Netherlands, where tens of thousands of people have had their lives shortened at their own request by medical professionals. There, the Penal Code provides a defence of necessity, typically only available to those who seek to save lives, to doctors who bring about an end to the lives of patients suffering to a sufficient extent (this is similar to the approach of Scottish courts to abortion prior to legislation). This would circumvent the issue of legalising homicide, while at the same time confronting the issue by adopting a clear message and approach, as opposed to the head-in-sand approach taken today. The ineffectiveness of this approach is highlighted by the approach of doctors, many of whom are now unwilling to perform euthanasia, or else have had to resort to less effective techniques such as suffocation for fear of prosecution, part of the reasoning behind the legislation of the area in Oregon. Failing to either condemn or condone euthanasia, the law would appear to have neglected its role as a deterrent, in not seeking to prevent a practice which it apparently prohibits.

As the decision not to prosecute is essentially an executive decision (the Lord Advocate being a member of the Scottish Executive), and given the unwillingness of the High Court to intervene on the issue, it can be conceived that the courts view the area very much as an area for legislation rather than decisions taken by judges. Therefore, given the opposition to euthanasia of medical bodies, it would appear that the law is unlikely to change its stance in the foreseeable future.

C.H.W. Gane and C.N. Stoddart, A Casebook on Scottish Criminal Law, 3rd Edition, W. Green & Maxwell, Edinburgh 10 at 42
T.H. Jones and M.G.A. Christie, Criminal Law 3rd Edition, Published 2003 by w. Green & Son Limited, Edinburgh
Somerville, Margaret A. Death Talk : The Case Against Euthanasia and Physician-Assisted Suicide. Montreal, PQ, CAN: McGill-Queen's University Press, 2002 accessed 23 February 2007
Keown, John. Euthanasia, Ethics and Public Policy : An Argument Against Legalisation. Port Chester, NY, USA: Cambridge University Press, 2002. accessed 23 February 2007
A.M. Johnston, J.D.D Hope, R.N.M MacLean, A.C.M. Johnston, Gloag and Henderson’s Introduction to the Law of Scotland, 7th Edition, 1969
British Medical Association Staff. Medical Ethics Today : The BMA’s Handbook of Ethics and Law (2nd Edition). London, , GBR: BMJ Publishing Group, 2003. accessed 23 February 2007
Hillyard, Daniel. Dying Right : The Death with Dignity Movement. London, UK: Routledge, 2001 at 4 accessed 23 February 2007
HMA v Rutherford, 1947 JC1
Law Hospitals NHS Trust v Lord Advocate, 1996 SLT 848
Acts, Legislation and Penal Codes
Abortion Act 1967
Death With Dignity Act 2004 (Ore
gon)
Article 293 of the Penal Code (Netherlands)
Journal Articles
Lord Advocate’s Statement, 1996 SLT 867
Jeremy Purvis, A Right To End One's Own Life? SCOTLAND 2006 349. 233-234 accessed 23 February 2007
Websites
Department of Constitutional Affairs: “Definition of Terms” http://www.dca.gov.uk/menincap/annex3.html
Scottish Executive, “Role of the Lord Advocate” http://www.scotland.gov.uk/about/departments/LPS/roleoflordadvocate

Eu`tha*na"si*a (?) n. [NL., fr. Gr. ; well + death, , , to die: cf. F. euthanasie.]

An easy death; a mode of dying to be desired.

"An euthanasia of all thought."

Hazlitt.

The kindest wish of my friends is euthanasia. Arbuthnot.

<-- 2. A putting to death for humane purposes. Used to refer to the killing of animals to relieve or avoid pain. -->

 

© Webster 1913.