INTRODUCTIONIn the past few decades, the consideration of euthanasia has become amore public debate in developed nations. Euthanasia had prevalence since thetimes of the ancient Greeks, where it was practiced by doctors and the subject appearedin multiple plays and philosophical texts. (13) Euthanasia, also known asmercy-killing, is defined as “painlesskilling of a patient suffering from an incurable and painful disease”. (5)It is planned cessation of life and is carried out by administering a patient alethal dose of a drug by a physician to achieve a peaceful and painless death.Contrary to this, physician- assisted suicide is where the doctor in chargewill provide the lethal dose to the patient and they will administer themedication themselves. (5) Intoday’s world some countries,such as the Netherlands have legalized euthanasia whereas in the United Kingdom (UK) this debate has been ongoing since the 1870’s.
(Kemp 2002, 3) Currently, healthcare professionals in the UKcannot euthanize nor counsel and advise someone of euthanasia; if this occursit is considered manslaughter or murder and the physician responsible can faceup to 14 years in jail (1)Understandably, the opposing views and the threat of legislation abusealong with opposition from the church makes it difficult for the passing ofeuthanasia in England;therefore it has become an off-limits subject. Looking at the ethicalstandpoint, there are many arguments that support euthanasia. From autilitarian standpoint, giving people the right to choose how they die willmake their last few days happier and will ease their anticipation of a painfuldeath. In support to their argument, the libertarians will argue that as longas no one else’s rights are hindered thenpeople interfering with someone’s choice of euthanasia is unjustified. (1) Themanifestation of a terminal disease is out of a patient’s control and thus sentencing them into a life ofsuffering would be cruel. When terminally ill patients ask for euthanasia manyof the reasons they use are: the pain, loss of dignity, and the inability tolook after themselves therefore becoming a burden on family. Additionally,those that seek death through the healthcare system have most likely alreadycontemplated other modes of death, such as suicide.
(3) Euthanasia may be themost beneficial treatment a patient can receive. For certain, withinvulnerability lies a spark of courage. A person that develops a terminalillness, with time, turns into a vulnerable and dependent patient.
This patientwill move in and out of hospital till one day they stop responding totreatment. Knowing that the end is not going to be easy and definitely ridiculedwith pain, they are forced to put on a brave face till nature takes it course.Not many people can understand the strength it takes for a patient to quietlysuffer till they take their last breath, and therefore it can be seen as unfairto have healthy lawmakers decide the fate of those that this legislation willprimarily affect. For instance, Tony Nicklinson suffered a stroke which causedthe onset of “locked-in” syndrome, condemning him to be unable tomove a single muscle, therefore, a fully functioning mind was trapped in amotionless, broken body.
Tony had requested euthanasia and on two accounts was refusedby the British High Court, therefore when he was diagnosed with pneumonia hetook this chance and refused to take the antibiotics he was prescribed which ultimatelylead to his demise; an undignified and painful way to die. (9) An articlewritten by Tony Nicklinson’s daughter revealed the painful process of herfather’s battle with trying to getaccess to euthanasia. She exclaimed that her father had shown great courage andpersistence while battling his fate. (10) As human beings when we see an animalsuffering and there are no methods of treatment available, to end their sufferingwe pose to put them down; doing this is seen as humane. However, when a humanbeing is suffering and no treatment is available we deny them any access todeath; this is inhumane. However, many proactive thinkers argue, when lookingback a 100 years diseases that were seen as incurable and killed our ancestorsnow have treatment options or are no longer present in today’s world.
(6) If euthanasia was an option the abilityto understand these illnesses will die with the patient. Nevertheless, there isno justification to prolong a patient’ssuffering, as a healthcare professional it is their duty to provide treatmentfor the patient and not have pharmaceutical business in mind. Looking at individuals whomhave accidently harmed themselves, the pain provokes them to say, “if only I would die”. Though this statement disappears after some painkillersor a period of treatment, patients that are always in pain with no option oftreatment can have this constantly running through their minds; this pain canbecome as bad as to immobilize them and steal the essence of living. On theflipside, to define insufferable pain there is no method or scale that allowsconsultants to measure pain. (6) The pain threshold of one patient will not beidentical to another’s, therefore, one can arguethat creating a set criteria will be difficult. Yet, in Accident and Emergencywe manage to get patients to scale their pain from one to ten; dealing witheach patient individually.
Similarly, when dealing with euthanasia each case ofpain due to terminal illness must be treated individually and taken intoconsideration; this will allow for a justified result. When treating a patient,their will is of utmost importance and that the patient has the full right tocontrol what happens to their body. (7) Voluntaryeuthanasia allows patients that are bedridden and feel as if a burden onfamily, to die a peaceful and dignified death. On the other hand, when a patient is unable to give consent and furthertreatment is not an option, a trusted, assigned next of kin can make thejudgement; it is upon the attending physician to provide the necessaryinformation for the individual to make an informed decision. One of theunderlying problems is that the government is unable to pass legislation thatcan predict and prevent the misuse of a euthanasia law. As the chairman of thehouse of Lords, Lord Walton exclaimed “it is virtually impossible to ensure that all acts ofeuthanasia are truly voluntary”.
(7) This can be arguedthat no law passed can be perfect, with use, amendments will be made to any fillloop holes. Furthermore, a law does not prevent crimes from occurring; murder,rape and theft occur repeatedly in the UK regardless of laws. Likewise, makingeuthanasia illegal will not stop it from happening. Legalization of euthanasiawill allow a wider spread of knowledge of ‘what it is’ and otheralternatives that can be used instead.
Additionally,people argue that decisions can be influenced and the rate of euthanasia willsky rocket. However, a study conducted in the Netherlands by the New EnglandJournal of Medicine presented that a decade before the legalization ofeuthanasia 0.4% cases of euthanasia were acted on, whereas ten years prior tothe legalization of euthanasia 0.8% of cases were carried out; therefore, bylegalizing euthanasia we can save more lives.
Furthermore, in the UK roughly57,000 patients are removed from life support and put on pain management tilltheir demise; (9) therefore doctors already practice euthanasia without itslabel. Therefore, the legalization of euthanasia can protect doctors from legalaction that may ensue and ensure that a synthetic death is also the patient’s will. Nevertheless,human beings are known to be indecisive and therefore it is understood thatpeople change their minds frequently and that it is possible for it to occurafter deciding to end one’s life. As a medical practitioner, when administering thelethal dose, they should confirm that this is what the patient wants; if thereis any uncertainty then to immediately stop the procedure. If euthanasia islegalized then it would be ideal to train specialists in the procedure of euthanasiathat can read physical, emotional and verbal cues of uncertainty; havingtrained professionals will also be beneficial in educating the patient andfamily about what it really means to end one’s life and the followingimplications.
It is important to assure that the patient has the right supportand information when making the decision. COURAGE IN EUTHANASIAIt is considered that a doctor’s job is to preserve life as the Hippocratic oath statesthat as a doctor one shall do no harm. (11) Additionally, it is also believedthat a doctor’s job is torelieve the patient of pain. As aphysician, it can be difficult to justify your moral standpoint of ending alife. Many people believe that the right to end someone’s life is not in theirhands, this can be controversial due to the fact that religion and culture areinfluencing a doctor’s ability inproviding maximum care.
Depending on the strength of their beliefs, they canrefuse to administer such lethal doses; however, they should refer the patientto a doctor that is more willing to participate in the action. Having couragein a health care setting can be defined as acting despite of fear and havingthe confidence in one’s actionsand thoughts. This can be challenging especially when one’s ideas of euthanasia does not matchthose of their colleagues.
Looking at the Dutch government as guidance, theyhave set out extensive criteria in which multiple elements must match foreuthanasia to take place. As one of their clauses, any doctor has the right torefuse to carry out euthanasia. (16) This clause allows physicians that do notwant to participate in the act, to wilfully decline. Furthermore, due to the fact that it is illegal to advise apatient about euthanasia in the UK, it takes a large amount of courage and persistencein not helping them with their query; as it is in a doctor’s nature to provide the maximumamount of information and help with patient questions.
On the contrary, thereis enormous amount of courage when a physician goes against their moral code tocarry out the last wishes of their patient; to know when to stop treating apatient and therefore following through with it. Moreover, a doctor can assessa patient and acknowledge that that no treatment is available to restore theirquality of life. Though the physician sees the situation in this way, it is wrong of a him or her to suggestto a patient that euthanasia is an option left for them. If a patient were tomake such a choice, it should be an uninfluenced decision to request such anextreme form of treatment Physicians will face a dilemma eachtime they encounter a patient requesting euthanasia, however, it is importantto recognize the courage of the patient. Death is feared by many people aroundthe globe, many fear that a painful and undignified death is what is held forthem. (9) Much like anyone else, this is also the driving force with manypatients that request death from their healthcare team. Death not only meansthe end of pain, it also means leaving loved ones behind, things they haveworked hard to achieve and perhaps unattained hopes and dreams; allowing us toconclude that it takes a great amount of courage not only to come to a decisionto end one’s life butalso acting on it.
VULNERABILITYIN EUTHANASIAMany people assume that ifeuthanasia is legalized those that are vulnerable will be put at a higher risk.People that are included in this are the elderly, children, those that cannotcommunicate their wishes, such as comatose patients. Looking at the countriesthat have legalized euthanasia, it is only accessible to those that areterminally ill. In the Dutch clauses,for a patient to access euthanasia, a patient’s suffering must be prolonged and have no possibility incure, additionally a second physician unrelated to the case must give asecondary opinion on the patient’seligibility. (12) This eliminates the possibility of having euthanasia incidentsthat are unnecessary, however, it is necessary for safeguards to be put inplace. Furthermore, assuring that only patients that are terminally ill haveaccess to such medical measures can assure that those that are elderly and notin need of pain relieving death are at risk. Furthermore, the process ofacquiring legal consent for euthanasia would be lengthy, which may preventpeople from going through the process. Furthermore, many argue that the elderlymay feel pressure undergo euthanasia.
Conversely, the message that should besent to those deemed vulnerable in society is that they have ample support anddo not need to feel pressured into seeking euthanasia. (12) Looking at patients that are comatose and onlife support, if no treatment is available and according to a doctor’s judgement euthanasia is the humane thing todo, a family member should be involved in making the decision alongside thecourts. This would prevent doctor’sfrom acting out their own will when they have no family to contact, because asa doctor it would seem unjust to make that decision without knowing the choicesof the family.
If legalized, this as a clause can prevent family members fromtaking legal action against doctors that were acting “in the best interest of the patient”. Oursociety runs on strict rules that must be followed, and having some rules abouteuthanasia are better than having nothing in place.Vulnerability can also bean emotional state. When a loved one is asking for death but is being deniedand the patient asks a family member to assist them, though completely healthythey are put into a fragile position.
In 1996, Paul Brady was being chargedwith murder of his brother whom had been suffering from Huntingdon’s disease: aneurodegenerative disorder. However, it was found that his brother hadrequested that his brother assist him in his suicide. (15) When a family memberor a patient wants to find comfort in death, this can cause destructive, emotionalconsequences on those that are forced to standby. While the political debate oneuthanasia is stretched by religious and ethical arguments, a major focus ofthe public is death with dignity. (2) A vast number of people are worried aboutthe abuse towards the vulnerable, is one of the major reasons as to why it hasn’tbeen legalized in many countries. However, some people argue that this aloneshould not take away someone’s right of dignity in death and that legislationthat is passed should have effective methods of safeguarding those are seen tobe at high risk.
(12) CONCLUSIONEuthanasia has been acontroversial issue for decades. People that want to leave this planet earlierthan their set time, always have an influencing factor that significantlyimpacts their quality of life. These can vary from neurodegenerative diseases tobeing fully immobilised.
Doctors, patients and loved ones display a vast amountof courage when faced with such a contentious subject. However, this ongoingdebate seems to resolve nothing and therefore continues to make patients withthe poorest quality of life suffer longer; making them more vulnerable thanthey already are. In the UK, where even thediscussion of euthanasia is prohibited for healthcare professionals makes itdifficult when a patient demands for it.
Additionally, knowing that a patient wantssuch action, if capable, they will try at commit suicide within their homes. Homesuicide attempts, if they fail, can result in more damage done. Having a trustedplace to go to for information and advice can ensure that patients have apainless death or can even deter from wanting it. Not only can this benefitterminally ill patients but it can bring forward people that simply want tocommit suicide for mental health reasons.
The ability to advise patients abouteuthanasia gives medical professionals the room to identify whether it is a cryfor help or if it is someone’s painful struggle with untreatable illness thatdrives them.