Two Sides of the Issue Euthanasia - Essay Example

Euthanasia Euthanasia is an issue that is surrounded by a wide range of opinions-medically, legally and ethically. All of these must be taken into consideration whilst still bearing in mind that the people who request or may be in need of euthanasia are in a very vulnerable position. Arguments both for and against euthanasia are very compelling and it is difficult to find a balance at times. Very few countries have legalised euthanasia to date and the ones that do allow euthanasia have very strict laws regarding it. While guidelines have been set, each case has to be considered on a case-by-case basis and as right to die cases are unique in each case. This paper attempts differentiate between the different types of euthanasia, provide a discussion of the countries that have legalised euthanasia and give a few examples. In addition, the arguments both for an against euthanasia are considered in detail, the different factors affecting euthanasia-mainly religion and also the laws governing euthanasia in countries that have already legalised it are also discussed. While a brief mention is made of animal euthanasia, the main focus is to deal with euthanasia in humans. Euthanasia in its literal sense implies a good and peaceful death (Brazier, 1996 ; Jeffrey, 1994). Nowadays, euthanasia has a second meaning and can be defined as ‘an act or omission designed to hasten death and thus relieve the suffering of a dying or incurably sick patient’ (Brazier, 1996). Euthanasia can be divided into active euthanasia and passive euthanasia where the former is killing the patient and the latter is defined as an act to not prolonging the patient’s life (Rachels, 1975 from Garrard and Wilkinson, 2005). In the few places where euthanasia has been legalised, laws sometimes differ between the two forms. Active euthanasia is also referred to as physician-assisted suicide. The line between active euthanasia and passive euthanasia is key to the debate surrounding euthanasia (Rachels, 1975 from Garrard and Wilkinson, 2005). In addition, to active and passive, euthanasia can be further subdivided into voluntary, non-voluntary and involuntary euthanasia. These divisions are based solely on whether a patient can request their own death of their own free will, are competent but have their views disregarded or are unable to give consent based on their medical condition (Garrard and Wilkinson, 2005). To date, only a handful of countries have laws that legalise physician assisted euthanasia. Netherlands was the first country to legalise it in 2000, followed by Belgium in 2002 and the state of Oregon in the United States of America (USA) in 1997 (Marcoux et al, 2007). In Switzerland, euthanasia is approved with or without a physician’s involvement. Australia briefly approved euthanasia in 1995 but this was overturned by parliament in 1997 (Chapple et al, 2006). It must be noted that in all these places, any form of euthanasia must be reported to the authorities (Chaloner and Sanders, 2007). To fully appreciate the nature of the debate on euthanasia and the complex issues surrounding it, two examples will first be briefly described. The first is the case of a former television reporter who was injured in a car accident. While he was alive due to surgery, he was in a near-vegetative state. The courts in Oregon gave the order that the patient’s wife could remove the feeding tube. The rest of the patient’s family objected to this, however, on the basis that advanced medical science may someday cure him and that as a staunch catholic, that would not have been his wish. The issue had to be resolved by the court and the feeding tube was finally removed (Masters, 1998 from Abeles and Barlev, 1999). The second example is in the case of Dr Anne Turner who flew to Switzerland from the UK. In countries where euthanasia is still illegal, there have been reports of people flying to countries where it has been legalised in order to die. Dr Turner was suffering from supranuclearpalsy and chose to fly to Switzerland with the assistance of Swiss charity ‘Dignitas’ to receive and lethal dose of barbiturates. She said before her death ‘I think it’s dreadful somebody like myself has to go to Switzerland to do this’ (Boseley and Dyer 2006 from Chaloner and Sanders, 2007). While euthanasia is only legal in very few countries, results from polls indicate that people in several other countries feel it should be legalised. This is true of Canada, Australia, UK, USA (Marcoux et al, 2007). The law in the UK implies that anyone who assists in active euthanasia can be charged with murder (Wainwright, 1999 from Chaloner and Sanders, 2007). Someone who assists another person with their death can be charged under the Suicide Act and can be imprisoned for up to 14 years (Chaloner and Sanders, 2007). The law in Canada offers more leeway than the one in the UK. As in the UK, active euthanasia is considered murder but passive euthanasia such as the refusal of treatment or providing drugs to reduce pain which may result in death is legal. A mention must be made of the fact that in Canada at least, a high percentage of the population could not tell the difference between euthanasia and other end of life decisions and this has to be taken into account when considering the results of any study (Marcoux et al, 2009). Legalising euthanasia is not a simple task as there are strong opinions both for and against it. Some of the main arguments against legalising euthanasia include that -the elderly population may feel an increasing burden to volunteer for euthanasia (Allmark, 1993). -people may be convinced by others that they are a burden to society and mainly to their families and may volunteer for euthanasia (Allmark, 1993). -there might be misuse of both voluntary and involuntary euthanasia in people who suffer from dementia for example, the handicapped or people in comas for long periods of time (Allmark, 1993). With regards to issue that the elderly or vulnerable may become more susceptible to euthanasia, research has been done in the Netherlands to examine if this is indeed the case. It was reported however, that the elderly did not have a higher incidence of euthanasia than the general population (Muller et al, 1998). The argument for legalising euthanasia is very complex. Several aspects need to be taken into consideration. The bottom line is that compassion for other people’s suffering is a virtue and it is unjust and cruel to prolong the suffering of certain people suffering from illnesses or conditions deemed incurable (Boonin, 2000). Common sense dictates this reasoning is correct yet when dealing with a human life, it is not easy to make such a decision. Advocates for euthanasia have suggested that if it is acceptable to euthanize and animal to put it out of its misery, the same standard must hold true for humans too (Bachelard, 2002). In fact, Bob Dent’s death was the first legal euthanasia case in the world in Australia, in 1996, and he wrote just before his death about the pain and suffering he was in. One statement that stands out is ‘If I were to keep a pet animal in the same condition I am in, I would be prosecuted’ (Dent, 1996 from Bachelard, 2002). An important consideration when considering euthanasia is the wishes of the people who might wish to die as a result as a result of euthanasia. Voluntary euthanasia does not infringe upon an individual’s right to life so it also seems a contradiction that the law does not legalise it (Brazier, 1996). Several reasons have been given by people as to why they should be allowed to die including the pain they were in or the anticipated pain they would experience, the indignities they would suffer, a loss of control or cognitive functions or being a burden to others. People who had witnessed the death of other people were particularly likely to state such reasons (Chapple et al, 2006). People who wished to end their life could be grouped into three distinct categories each with its own characteristics: the first category saw euthanasia as an exit plan, the second was that people were extremely desperate to end it all and the third was that the patients just wanted to let go (Nissim et al, 2009). When terminally ill patients were asked for their opinions on euthanasia, 60.2% said they would support it. However, only 10.6% actually contemplated it for themselves (Emmanuel et al, 2000b). A disease in which euthanasia is practised widely is in the case of AIDS patients. 1 in 3 AIDS patients die as a result of euthanasia, a much higher proportion than the rest of the population. It is seen as being acceptable as AIDs is an incurable disease, (Onwuteaka-Philipsen and Van der Wal, 1998) By examining individual cases where patients expressed a desire to die, conclusions were drawn that indicated depression and hopelessness were a primary factors in wanting to die. Discussing alternate options with the patients was seen to help them (Cole,1993). Over time, over half of people who were suffering from depression during a terminal illness were seen to change their minds about wanting to die (Emmanuel et al, 2000b). In fact, research with oncologists and cancer patients has suggested that as physicians become more informed about end of life options, they are less likely to need to need to use euthanasia-active or passive (Emmanuelet al, 2000a) It must be mentioned that requests for euthanasia are not only made by people suffering from terminal illnesses but also people who are defined as being ‘healthy. Thirty percent of physicians in the Netherlands reported having being asked by a person with no disease for physician assisted suicide. Only 3% had complied with this request. A large proportion of these requests were made by people who were single and over 80 and most of the issues that lead to this request were of a social nature (Rurup et al, 2005). Another important consideration when discussing euthanasia is religion. People who gave reasons as to why the law should not be changed to allow euthanasia gave religious reasons as a main factor (Chapple et al, 2006). While religion may be divisive in other aspects of life, several religions seem unified in their belief that euthanasia if wrong and should not be legalised. Both the Buddhist and the Christian viewpoint are very similar in the belief in the ‘sanctity of life’ (Keown and Keown, 1995; Lecso, 1986). In Buddhism, while euthanasia has not been specifically mentioned , the destruction of life can warrant the severest penalty which is excommunication from the religion (Keown and Keown, 1995). In Christianity, the belief is that life is the biggest gift from God which should be cherished. Both Catholic and Anglican bishops came together in the House of Lords Select Committee on Medical Ethics in the UK to give the statement that 'All human beings are to be valued, irrespective of age, sex, race, religion, social status or their potential for achievement' and 'the deliberate taking of human life is prohibited except in self-defence or the legitimate defence of others' (Keown and Keown, 1995). Another religion where euthanasia is considered a sin is in Islam (Gielen et al, 2009) and Judaism as well (Mackler,2003 from Gielen et al, 2009). In an intensive study that was done in Japan, it was seen that religion greatly influenced the attitudes of people. 388 Japanese religious groups were looked in to and people were asked to answer questions euthanasia .approximately 70% of respondents indicated that passive or indirect euthanasia was acceptable to them while active euthanasia was favoured by less than 20% of the people. The religions that were looked into were mainly Shinto, Buddhism, Christians and a few others. Overall, Christians seemed the least supportive of euthanasia in general (Tanida, 2000). Also, amongst doctors in Canada, there was seen to be a strong correlation between how religious a doctor is and whether or not they supported legalising euthanasia with people who were very religious opposing it (Verhoef and Kinsella, 1996). Interestingly, in the USA, when the effect of time on the attitudes towards euthanasia was investigated, it appeared the opposition by five of the major denominations-: conservative Protestants, Catholics, moderate Protestants, liberal Protestants and non-affiliates- have become less opposed to euthanasia since 1977 (Moulton et al, 2006). Even more interesting was the fact that when there was a referendum in November 1991 in the USA regarding Initiative 119 which referred to the legalisation of euthanasia, some of the supporters for this initiative came from religious organisations such as Unitarian Universalist Association, the Pacific Northwest Council of the United Methodist Church, and the Interfaith Clergy Council. The referendum was defeated 54% to 46% (Campbell, 1992). In addition to religion, an important point that must be mentioned when discussing euthanasia is the attitudes of different ethnic groups. Differences were observed in different ethnicities and were likely due to differences in cultural values, demography, level of acculturation and their knowledge of options that were available (Kwak and Haley,2005). African-Americans were seen to prefer life support, the entire family generally contributed to decisions in Hispanics and Asians and whites were more likely to go with advance directives (Kwak and Haley,2005). Another issue to take in to consideration is a doctor’s attitude or opinions towards euthanasia. When a patient requests euthanasia, doctors are challenged morally. Even if the patient is dying and considering the situation from a secular viewpoint, it must be exceedingly difficult for a doctor to assist in a person’s death as medical training received conditions doctors to try their hardest to preserve life (Jeffrey, 1994). A fact that indicates exactly how difficult it is for some physicians to accept the practice of euthanasia is illustrated by the Assembly of the Norwegian Medical Association agreeing unanimously that they needed to include a paragraph in their ethical guidelines stating that any involvement in euthanasia and physician assisted suicide was unethical (Forde et al, 1997). While the population in Norway largely believes euthanasia should be legalised, a much more conservative proportion of physicians hold this view (Forde et al, 1997). A study in which physicians in Alberta, Canada answered questions twice over the course of four years found that there was a considerable decrease in the number of physicians who were for legalising euthanasia. Whilst the reason for this are unclear, it appears that as the debate on euthanasia rages on, increased education and knowledge on the issue has changed opinions (Verhoef and Kinsella, 1996). As previously indicated, very few places legalise euthanasia to date. A look will be taken at the laws in these places that govern euthanasia. The Netherlands has about 400 cases a year where people request euthanasia (Rurup et al, 2005). Almost 25% of people who are admitted into hospices talk about euthanasia with their doctors (Zylicz, 1998 from Zylicz, 2000). Netherlands does not have much of a distinction between physician assisted suicide and euthanasia in its legislature (Cohen-Almagor and Phil, 2003). The laws of that country state that there are three main criteria that need to be met when making the request for euthanasia. 1) The request must be made by the patient and it must be a voluntary request (de Haan, 2002; Cohen-Almagor and Phil, 2003). 2) The request must be well thought out by the patient and remain consistent (de Haan, 2002; Cohen-Almagor, 2003). 3) Euthanasia must be employed as the last action that can be resorted to. To fulfill these requirements, in particular requirement 2, the patient must be terminally ill. A terminal illness is defined ‘as one that leads to death within six months’. It is an extremely difficult clinical prognosis to make however (Abeles and Barlev, 1999) In addition, there are several other rules by which a doctor must abide by. These include that the doctor should assist the patient in ending their life but must whenever possible, have the patient administer the fatal dosage of drugs themselves. A second independent doctor with no links to the case must be consulted and in the case of psychiatric condition, at least two other doctors must be consulted. A detailed record must be made of each case and the case must be reported to the necessary authorities. If the doctor has any moral or religious objections to assisting the patient end their life, they have the obligation to refer the patient to a doctor who will help them carry put their wishes (Cohen-Almagor and Phil, 2003). A recent study done in Belgium, indicated that most of the legal requirements for euthanasia were being followed by doctors however, consultation with another doctor and the reporting of such cases to the authorities was not always followed through with as required (Smets et al, 2010). To conclude, it can be said that the debate on euthanasia is as strong as ever nowadays. There are a handful of places that have legalised euthanasia and the governments of other countries face increasing pressure to deal with it too. A high proportion of people are in favour of euthanasia in several countries but the ethics and legal ramifications of legalising it are complex. Firstly, there has to be made a distinction between active and passive euthanasia. The most compelling argument not to legalise euthanasia is because of the misuse of the law that may occur. in contrast, there is a school of thought that believes that if we can euthanatize an animal to put it out of its suffering, the same standard must be had for humans too In addition to moral reasons, religious beliefs of people do come into play when discussing euthanasia. Several religions reject it because of the belief in the sanctity of life. However, there are some religions that actively do promote it though these are definitely in the minority. In addition to religion, ethnicity, too, determines a person’s beliefs on certain things and euthanasia seems to be one of these. Netherlands if one of the few countries to have legalised euthanasia and it has strict laws governing it. The patient must make the request themselves, be terminally ill and be consistent in their request. Guidelines exist for how doctors should carry out euthanasia too, and a detailed report has to be submitted to the authorities in each case. While it is mainly terminally ill patients who make requests to end their life, there have been instances of healthy individuals doing the same, mainly for social reasons. This is a worrying trend as if this continues to increase; the issue of the law being misused will definitely come into play. Euthanasia is widely debated topic and it appears that this debate is unlikely to stop any time in the near future. Following the statistics and the results of what has been happening in the Netherlands, Belgium, Oregon and Switzerland will definitely provide more information for other governments as to whether this model could be introduced by other countries. Works Cited Abeles, N & Barlev, A. End of Life Decisions and Assisted Suicide. Professional Psychology : Research and Practice 30.3 (1999):229-234.Print. Allmark, P. 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