EUTHANASIA

 

 

 

  OR  

                                                  (a) Death wish, News Nations                                            (b)Property of devian hospital

 

 

Can we end life ?

 

By : Elodie JACQUIER - Nina JONES - Précilia JOST - Aude KRETZ – Marion ZUZA

 

 

 

 

 

INTRODUCTION 

 

The question of euthanasia appeared in the Middle Ages but did not have the same significance as today. Today, we do not use the term “euthanasia” but most of the time we use “assisted suicide”. Assisted suicide provides possibilities for the patient to end their own life. So the question of assisted suicide arises for persons who are suffering from terminal illnesses. There are two forms of euthanasia :

 

•  Active euthanasia : taking deliberate action such as an injection to end a patient’s life

 

•   Passive euthanasia : stopping medical treatment with the deliberate goal to end life. (1)

 

We chose this subject because, first, we wanted to talk about neurodegenerative illnesses, but step by step we agreed on human euthanasia. In addition to that, nowadays euthanasia is a topical subject. There are different viewpoints

First, we will talk about legalizataion in the different countries and where it is legal or illegal. Then we will approach the question of dignity and religion in the sphere of ethics.

 

TERMINOLOGY

 

Euthanasia : when another party performs the actions that directly end someone's life, sometimes divided into active and passive.

Assisted suicide : when someone receives help in taking their own life.

Ø      Assisted dying : umbrella term for assisted suicide and active euthanasia

Doctor-assisted suicide : when a physician helps a person to take their own life, usually by supplying lethal drugs, although the patient must self-administrate them, or the act is classed.

 

Advance directive : a plan for what kind of medical care someone would like if they become incapacited, for example if they are in coma. This can relieve relatives of the responsibility of difficult decisions about treatment withdrawal. An advance directive that comes into effect only when someone is terminally ill is known as a living will. (2)

 

                                                  (c) Nisan, Haaretz

 

I. Legalization and particular cases                 

 

1. In Europe

 

1.1.  Countries where euthanasia is legal

 

Europe is split but most countries have rejected legalization, with a few exceptions

Not a lot of countries have legalized euthanasia. Only three in Europe authorize it: the Netherlands, Belgium and Switzerland.  People in suffering, wanting to end their lives take advantage of this law and go to countries where it is possible to end one's life.

 

The Netherlands (3) 

 

Euthanasia has been tolerated since the 1970, but in 2002 the law was voted for its legalization. The Netherlands was therefore the first country to authorize it.

 

However not everyone is allowed to end their life. The law is very strict and people have to be ill and in an irrecoverable way, that means without mental faculties, the human condition being degraded. Furthermore the medical staff have to agree. Then it has to be registered.

Consequently, the numbers are extremely high, around 2000 deaths a year.

 

 

Belgium (3)

 

Euthanasia has been legalized since 2002. Actually euthanasia has caused a lot of debates in Belgium, as in all the other countries. Doctors were against it, and a lot of people, such as Catholics, were against it too. In 2008, the prime minister put the law on the agenda and revised it.

Now the law does not simply legalize euthanasia, but the request has to be repeated, it has to be for an incurable condition, and with the consent of two doctors and experts.

 

A particular case : twin brothers Marc and Eddy Verberssem (4)

These two brothers have a degenerative illness. They are deaf and going blind. They asked Dr David Dufour to help them to end their lives, because they were suffering and it was difficult for their parents to have two disabled children.

It created a serious debate because some thought it was too soon to end life, and others thought it was not too early because they were due to die of this terminal illness, and as a result it was better to die in dignity.

 

 

Switzerland (3)(5)

 

Euthanasia was not illegal. In 1998, an association called “ Dignitas” was created to help people end their lives. In Switzerland, all forms of active euthanasia, like administering lethal injection, are prohibited. According to Swiss law, a person can be accused of a crime only if they help someone commit suicide out of self-interested motivation. But since the 1930s assisted suicide has been legal in Switzerland, where the activities of the “Dignitas Clinic” have made international news. Non-physicians can be involved.

 

 

Sweden (3)

 

Passive euthanasia is possible, according to the wishes of patients who are capable of making their own decisions. Swedish doctors are not generally in favour of helping a patient die, but euthanasia is legal.

 

 

1.2.  Countries where euthanasia is illegal

 

Italy (3) 

 

In Italy euthanasia and assisted suicide are illegal  

 

A particular case : Piergiorgio Welby, 2006 (3)

He was a terminally-ill man with a severe form of muscular dystrophy. He died after a protracted legal dispute during which he described his life as a torture. A judge had ruled that he did not have the right to have his respirator removed, and when the anaesthetist, Marc Riccio, switched off the patient's life support he was investigated by a judge for “consensual homicide”.

 

(d) Piergiorgio Welby

 

Another example : Giovanni Nuvoli, 2007 (3)

In July 2007 came this case, a 53-year old former footballer with advanced muscular dystrophy, who died after going on hunger strike because he was not granted his request to die without suffering. Police prevented his doctor, Tommaso Ciacca, from switching off his respirator. Former Health Minister, Livia Turco, said that it's time of Italy have a law “which allows sick people to express their will”.

 

(e) Giovanni Nuvoli

 

 

But Eluana Englaro’s case shows that opinion is changing. (3)

In July 2008, a court in Milan awarded the father of Eluana, a 38-year old woman, who had been in a permanent vegetative state since a crash in 1992, the right to disconnect her feeding tubes. “There is a will to urgently agree on end-of-life legalization”, said Health Minister Maurizio Saconi.

 

(f) Eluana Englaro 

 

 

France (3)

Under the “end of life” law, doctors are advised to avoid taking external measures to keep dying or brain-dead patients alive. Active euthanasia, even at a patient’s request, remains illegal.

 

A particular case : Chantal Sebire, 2008 (3)

Her face horribly disfigured, she had fought in vain for the right to take a lethal dose of prescribed barbiturates, surrounded by her family at a time of her choosing. After she was refused to die under medical supervision by a court in Dijon, she was found dead at home. According to prosecutors, she had taken a “deadly dose” of barbiturates.

The minister Bernard Kouchner argued that it was wrong that Chantal Sebire should have to “commit suicide in a clandestine way, which would cause suffering to everyone, especially her loved ones”

 

(g) Chantal Sebire

 

Another particular case : Vincent Humbert, November 2003 (6)

He is the first case to appear in the media in France. He asked ex-President Jacques Chirac for the right to die and the question became a matter of debate.

He was mute, blind and paralyzed. Marie, his mother overdosed him with the help of Dr Frederic Chaussoy. Marie was briefly arrested then put in a psychiatric care. But a majority of the French people agreed with her and the doctor.

 

(h) Vincent Humbert and his mother Marie

 

Spain (3)

 

Political and religious opinions about euthanasia are much divided.

In 2007, the Socialists joined the opposition Popular Party in voting against the legalization of euthanasia as a way of guaranteeing the right to dignified death.

 

United Kingdom (3) 

 

An important distinction in English, Welsh and Scottish law exists between active euthanasia and passive euthanasia.

Several recent attempts to persuade the courts to change the law have failed. In 2007, the House of Lords rejected a proposal to give doctors the right to prescribe drugs that terminally ill patients in severe pain could use to end their own lives.

 

A particular case : Diane Pretty (3)

A bill was brought after Diana Pretty, a woman with terminal motor neurone disease, fought for the right to allow her husband to help her end her life. She lost her case in the European Court of Human Rights, in Strasbourg, before she died in a hospice in May 2002.

 

(i) Diane Pretty

 

Poland (3)

 

Poland is a predominantly Catholic country and has strongly condemned euthanasia.

 

 

2. In the rest of the world

 

2.1.  Legal in the rest of the world

 

 

SOUTH AMERICA

 

Colombia

 

Colombia is the only country in Latin America where it is not outlawed (since 1977). Constitutional Court created a law on euthanasia allowing people to choose to end their lives but there are no guidelines to regulate euthanasia. (7)

In 2007, Senator Armando Benedetti introduced a motion in Congress to regulate euthanasia, but he had been alerting the state to this problem since 1997. The motion was finally voted in 2012.

The law says that :

-          only medical professionals can carry out euthanasia or assisted suicide

-          only Colombians can benefit from euthanasia, to prevent euthanasia tourism

-          the correct procedure must include psychiatric assessment and councils from doctors, to ensure the best decision.

 

NORTH AMERICA

 

United States of America 

Assisted suicide is only legal in four states in the USA : Washington, Oregon, Texas and Montana. (9)

-          Oregon : it was the first state of the USA (and one of the first in the world) to legalize assisted suicide, in 1994 (10)

-          Washington : in 2008, the electorate voted in favor of assisted suicide (10)

-      Texas : since 1999, hospitals and doctors can proceed to passive euthanasia for patients in terminal phase, when all the treatments seem pointless. For example, they can stop artificial respiration (10)

-          Montana : since 2009, the sick in terminal phase can inject lethal doses, supplied by doctors, but doctors cannot inject it themselves. (11)

 

ASIA

 

India (12)

 

Since March 2011, passive euthanasia is legal, but not active euthanasia. Doctors can end lives by removing supports for the preservation of life, for vegetative patients.

 

Japan (13)

 

There are no laws about euthanasia, just a legal framework for passive and active euthanasia. 

•  In the case of passive euthanasia, there are 3 conditions

 

-          the patient suffers from a incurable disease

-          the patient must give his consent, or his family has to give its consent with biological proof

-          only doctors can stop treatments.

  

•  In the case of active euthanasia, there are 4 conditions :

 

-          the patient must be suffering from unbearable physical pain

-          death must be close

-          the patient must give his consent (his family cannot give it)

-          no treatment has worked.

 

Saudi Arabia (14)

 

Euthanasia is legal in Saudi Arabia but constituted a serious debate between members of the religious and medical community, addressing tough questions about when to remove patients' life support systems in hospital. The doctor's decision to turn off life support should come only after brain death is diagnosed and the family agrees to turn off life support.

The act of prematurely ending the life of unconscious terminal patients could be considered murder, which is a capital crime for which doctors can be put to death.

According to a local daily newspaper (reporting the words of a Saudi resident), euthanasia is acceptable if it “prevents patients from suffering more pain”.

Physician-assisted suicide is illegal in Saudi Arabia.

 

2.2.  Illegal in the rest of the world

 

OCEANIA

 

Australia (15)

 

Euthanasia is illegal. It was once legal in the Northern Territory. But in 1997 the central government passed an anti-euthanasia bill which overturned the 1995 act. Nevertheless the majority of people would like euthanasia to be legalized.

 

(j) Sidney Morning Herald Photo

 

AFRICA 

 

South Africa (16)

 

South Africa is struggling with the debate over legalizing euthanasia. Owing to the under-developed health care system that pervades the majority of the country a member of the South African Law Commission stated that many South African doctors would be willing to perform acts of euthanasia when it became legalized in the country. He felt that because of the lack of doctors in the country “legalizing euthanasia in South Africa would be premature and difficult to put into practice”.

Medical practitioners in South Africa will be given the legal right to end the lives of terminally ill patients. This is the practice of active euthanasia, the procedure whereby a medical doctor or a professional nurse can end the life of a terminally ill patient at the patient’s request, by providing or administering a lethal dose of a drug.

Specifically, it provides that a medical practitioner may under certain conditions stop the treatment of a patient whose life functions are being maintained artificially.

 

Furthermore, a competent person may refuse life-sustaining treatment if he chooses to die. A medical practitioner may also give effect to a patient’s living will in which the patient has requested the cessation of treatment. The act also provides for the options of active voluntary euthanasia or physician-assisted suicide.

 

 

II.      Ethics in terms of dignity and religion                

 

1. The question of dignity

 

To die with dignity is the founding principle of death by euthanasia. First of all, to explain that, we have to give a general definition of dignity.

“Dignity : bearing, conduct or speech indicative of self-respect or appreciation of the formality or gravity of an occasion or situation.” (17)

 

From that, we wonder what is a good or a deserving death. We asked our circle of acquaintances, and their answers were : dying without pain, or dying before illness made them suffer. Many persons want to have the time to say goodbye to their close relations, and others want to go to sleep and never wake up in the morning (just die in their sleep).

Unfortunately, diseases and accidents still do not allow this. We do not necessarily die at once, and people suffer or are disabled and cannot live normally any more. This is when the question about euthanasia appears.

 

On the website of the BBC (18) : on the article “Ethic : Euthanasia”, we find some answers.

In the section entitled: “What is a good death”, we found a part of an article from the Journal of the America Medical Association (19) that explains that there is no good death, it depends on the individuals. So, it proposes nine general principles : “…”

-          freedom from pain

-          at peace with God

-          presence of family

-          mentally aware

-          treatment choices followed

-          finances in order

-          feel life was meaningful

-          resolve conflicts

-          die at home.

 

On the same website, we found an article called “Is there a duty to die?”, based on the ideas of John Hardwig, an American philosopher. He re-opened the debate on conditions of euthanasia, in his article of 1997 : “Does a person ever have a duty to die?” (20). He explained that it is not so much a question of personal dignity but also concerns the family and the close relations of the patient.

He considers that we can help somebody to die, if he settled everything concerning him and his family and his family agrees with him. We can’t die for ourselves, but because we prevent our family from living normally, because the patient is a weight for his family.

John Hardwig said : “I can readily imagine that, through cowardice, rationalization or failure of resolve, I will fail in this obligation to protect my loved ones. If so, I think I would need to be excused or forgiven for what I did".

 

Finally, dying with dignity is a hard question and is not the only thing to take into account for euthanasia or assisted suicide.

 

2. The question of religion

 

Death is an important aspect of religion. Religions regard understanding death and dying as vital to finding meaning in human life. It is not surprising that all faiths have strong views on euthanasia. Most religions are against euthanasia. (21)

 

All religions state that those who become vulnerable through illness or disability deserve special care and protection, and that proper end of life care is a much better thing than euthanasia. They are opposed to euthanasia for a number of reasons

• God has forbidden it : A command from religions with a supreme God prescribes that people must not kill, interpreted as meaning ‘’you must not kill innocent human beings”. Euthanasia and suicide are against God’s orders and would be an attack on the sovereignty of God.
• Human life is sacred: God created humans so that their lives are special and should be protected and preserved.  Believers must use their bodies as God intended them to and not shorten their lives.

 

Religious points of views about euthanasia are often at the heart of debates for several countries.

 

For example, for Italy which is a country where the influence of the Roman Catholic Church remains strong, the debate is especially passionate and opposition to euthanasia remains strong.

 

 

IN CONCLUSION

 

As a conclusion, opinions are strongly divergent over euthanasia. This is seen in individual cases and also at a country-wide level: some countries are pro-euthanasia and others are anti-euthanasia.

The ones which are pro-euthanasia tend to think that everyone can decide on their own lives, that death is a private matter. Furthermore, as euthanasia is a moral right, it should be made universal. Moreover the European Convention on Human Rights gives a person the right to die. (22)

 

However most of the countries are against euthanasia. For them, euthanasia - taking away a life - means that some lives are worth less than others, and that euthanasia is not necessarily the best solution for an individual. Besides, allowing euthanasia can decrease the quality of care for the terminally ill. Another factor is that patients can be pressurise into ending their lives. In addition, religion is against euthanasia because it states that the only one who can decide on a person’s death is God. (23)

 

And if euthanasia is allowed, what happens if the person is not able to think? This raises other questions, like the question of dignity. To what extent should we cut down the life of a person who is reduced in his human capacities? Where is the suffering ? Is it from the patient or his surroundings ?

Finally, the question of euthanasia is so sensitive and yet so serious. We cannot conclude if it is a good or bad thing. It all depends on the case we are confronted with.

 

 

BIBLIOGRAPHY

 

(1) BBC website, 2014 : Ethic guide – “Forms of euthanasia”

http://www.bbc.co.uk/ethics/euthanasia/overview/forms.shtml

(2) New Scientist article of 23/04/05, page 46-47 : “Last rights” / Terminology

(3) BBC News website, February 2009, last update April 2014 : “Euthanasia : a continent divided”

http://news.bbc.co.uk/2/hi/europe/7322520.stm

(4)CBC news / world website – Karin Wells, 6 May 2013 : “Death of twin brothers fuels debate over Belgian euthanasia law”.

http://www.cbc.ca/news/world/death-of-twin-brothers-fuels-debate-over-belgian-euthanasia-law-1.1334860

(5) Dignities website, January 2014

http://www.dignitas.ch/index.php?lang=fr

(6) Sally-Anne Lewis, September 2011 – article : “I ask the right to die, by Vincent Hubert, Deceased”

https://suite.io/sally-anne-lewis/5p8s2fb

(7) NBC News, website – The associated press, 2013 : “Euthanasia regularly practices in Colombia”

http://www.nbcnews.com/id/8778072/ns/health-health_care/t/euthanasia-regularly-practiced-colombia/#.U0FFalfLKnd

(8) Colombia Reports – Joey O’Gorman, August 2009 : “Colombia senate approves regulation of euthanasia”

http://colombiareports.co/colombian-senate-approves-regulation-of-euthanasia/

(9) Wikipedia website, last update 6 March 2014 : “Euthanasia in United States”

http://en.wikipedia.org/wiki/Euthanasia_in_the_United_States

(10) Wikipedia website (March 2014) – Euthanasia in US by Oregon Blue Book website 2014 : “Initiative, Referendum and Recall: 1988-1995 »

http://bluebook.state.or.us/state/elections/elections21.html

(11) Wikipedia website (Marche 2014) – Euthanasia in US by NBC News website, last update December 2008 : “Montana, third state to legalize assisted suicide”

http://www.nbcnews.com/id/28085809/#.U0FI9FfLKnc

(12) Wikipedia website, last update 29 March 2014 : “Legality of euthanasia” by The Hindu website, March 2011 : “Supreme Court disallows friend's plea for mercy killing of vegetative Aruna”

http://www.thehindu.com/news/national/article1516644.ece

(13) Wikipedia website (29 March 2014) : “Legality of euthanasia” by Mac Dougal & Gorman, 2008

(14) World right to die news website, April 2009 : “The degrees of euthanasia being debated in Saudi Arabia”

http://lists.opn.org/pipermail/right-to-die_lists.opn.org/2009-April/003324.html

(15) Wikipedia website (29 March 2014), by Inquiry into the Rights of the Terminally Bill 2008 – Law Council of Australia, April 2011

http://www.lawcouncil.asn.au/shadomx/apps/fms/fmsdownload.cfm?file_uuid=6807213F-1C23-CACD-2205-729F871CF170&siteName=lca

(16) NCBI Website March 2003: "Doctors can kill active-euthanasia in South Africa"

http://www.ncbi.nlm.nih.gov/pubmed/14626887

(17) Dictionary.com, 2014 : first definition of dignity

http://www.bbc.co.uk/ethics/euthanasia/overview/gooddeath.shtml

(18) Ethic guide, BBC 2014 : Euthanasia and assisted suicide

http://www.bbc.co.uk/ethics/euthanasia/

(19) Ethic guide, BBC 2014 : Euthanasia and assisted suicide, part : “Wath a good death”

http://www.bbc.co.uk/ethics/euthanasia/overview/gooddeath.shtml

(20) Hastings Center Report, March – April 1997 (page 34 – 42)

http://www-personal.umich.edu/~elias/Courses/442/slides/hardwig.pdf

(21) BBC News Website, 2014 "Religion and Euthanasia"

http://www.bbc.co.uk/ethics/euthanasia/religion/religion.shtml

(22) BBC News website, 2014 : Ethic guide, part : Pro-euthanasia arguments

http://www.bbc.co.uk/ethics/euthanasia/infavour/infavour_1.shtml

(23) BBC News website, 2014 : Ethic guide, part : anti-euthanasia arguments

http://www.bbc.co.uk/ethics/euthanasia/against/against_1.shtml

 

 

 

IMAGE SOURCES

 

(a)    Common sense website, January 2009 : “Death wish”

http://omgitsjez.wordpress.com/2012/01/02/euthanasia-a-utilitarian-perspective/

(b)   Secrets of the fed : “Property of Devian Hospital”

http://www.secretsofthefed.com/belgium-looks-at-euthanasia-for-minors/

(c)    Haaretz website by Nisan, April 2014

http://www.haaretz.com/news/features/in-israel-assisted-suicide-is-not-painless.premium-1.481982

(d) (f) (g) BBC News website, February 2009, last update April 2014 : “Euthanasia : a continent divided”

http://news.bbc.co.uk/2/hi/europe/7322520.stm

(e)    La Republica website, last update Januray 2011

http://www.repubblica.it/2007/07/sezioni/cronaca/welby-medico/nuvoli-morto-di-inedia/nuvoli-morto-di-inedia.html

(h) Arte website, unknown date

http://boutique.arte.tv/f1065-morthorslaloivincenthumbert

(i)     BBC News website, April 2002 : “British woman denied right to die”

http://news.bbc.co.uk/2/hi/health/1957396.stm

(j)     The Sidney Morning Herald, October 2010

http://www.smh.com.au/nsw/message-goes-out-on-right-to-choose-death-20101018-16qxn.html