For some, euthanasia is not an option, but for others it is a way to end their suffering and have a peaceful death. Although some view euthanasia to be morally wrong, voluntary euthanasia should be legalized in the United States to end the suffering of others, help patients who have the ability to live a longer life, and decrease the cost of health care.
Euthanasia is an act of killing an incurable patient who is suffering or in pain. Euthanasia is the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma Oxford dictionaries, It can be either passive or active however this essay will focus specifically on active euthanasia.
Euthanasia is currently illegal in Australia, although it was briefly legal in the northern territory. It is usually seen in light of inducing death to patients who are terminally ill or may not be terminally ill but are suffering from unbearable pain. The focus of this paper is on voluntary euthanasia, namely, euthanasia carried out upon the request of a patient deemed competent enough to make such decisions. Looking into the stances, arguments and opinions surrounding the issue of legalizing Euthanasia.
It goes into detail about why citizens are requesting legalization and also reviews who are the people specifically that chose to be euthanized. Many people ask, what is Euthanasia? Any argument on this subject usually evolves into a series of complex, abstract questions about freedom of choice, morality and so on. Only by Physicians The involvement of nurses gives cause for concern because all the jurisdictions, with the exception of Switzerland, require that the acts be performed only by physicians.
In a recent study in Flanders, nurses reported having cared for a patient who received life-ending drugs without explicit request In many instances, the physicians were absent. Factors significantly associated with a nurse administering the life-ending drugs included the nurse being a male working in a hospital and the patient being over 80 years of age. Second Opinion and Consultation All jurisdictions except for Switzerland require a consultation by a second physician to ensure that all criteria have been met before proceeding with euthanasia or pas.
The consultant must be independent not connected with the care of the patient or with the care provider and must provide an objective assessment. However, there is evidence from Belgium, the Netherlands, and Oregon that this process is not universally applied 10 , Moreover, non-reporting seems to be associated with a lack of consultation by a second doctor In Oregon, a physician member of a pro-assisted-suicide lobby group provided the consultation in 58 of 61 consecutive cases of patients receiving pas in Oregon This raises concerns about the objectivity of the process and the safety of the patients, and raises questions about the influence of bias on the part of these physicians on the process.
Networks of physicians trained to provide the consultation role when euthanasia is sought have been established in the Netherlands Support and Consultation on Euthanasia in the Netherlands and Belgium [Life End Information Forum leif ] Their role includes ensuring that the person is informed of all options, including palliative care. However, most leif physicians have simply followed a hour theoretical course, of which only 3 hours are related to palliative care, hardly sufficient to enable a leif member to provide adequate advice on complex palliative care needs The development of expertise in palliative care, as in any other specialty, requires a considerable amount of time.
In the United Kingdom, it involves a 4-year residency program, and in Australia and the United States, 3 years. In , none of the people who died by lethal ingestion in Oregon had been evaluated by a psychiatrist or a psychologist 20 , despite considerable evidence that, compared with non-depressed patients, patients who are depressed are more likely to request euthanasia and that treatment for depression will often result in the patient rescinding the request 21 — Despite that finding, many health professionals and family members of patients in Oregon who pursue pas generally do not believe that depression influences the choice for hastened death A recent Oregon-based study demonstrated that some depressed patients are slipping through the cracks Among terminally ill patients who received a prescription for a lethal drug, 1 in 6 had clinical depression.
Of the 18 patients in the study who received a prescription for the lethal drug, 3 had major depression, and all of them went on to die by lethal ingestion, but had been assessed by a mental health specialist. There is evidence, therefore, that safeguards are ineffective and that many people who should not be euthanized or receive pas are dying by those means.
Of concern, too, is the fact that transgressions of the laws are not prosecuted and that the tolerance level for transgressions of the laws has increased. The interpretations proposed by Keown in 27 appear very relevant, however.
The first interpretation postulates that acceptance of one sort of euthanasia will lead to other, even less acceptable, forms of euthanasia. The second contends that euthanasia and pas, which originally would be regulated as a last-resort option in only very select situations, could, over time, become less of a last resort and be sought more quickly, even becoming a first choice in some cases.
The circumvention of safeguards and laws, with little if any prosecution, provides some evidence of the social slippery slope phenomenon described by Keown 5 , Till now, no cases of euthanasia have been sent to the judicial authorities for further investigation in Belgium. In the Netherlands, 16 cases 0. In one case, a counsellor who provided advice to a non-terminally ill person on how to commit suicide was acquitted There has therefore been an increasing tolerance toward transgressions of the law, indicating a change in societal values after legalization of euthanasia and assisted suicide.
However, basing a request on an advance directive or living will may be ethically problematic because the request is not contemporaneous with the act and may not be evidence of the will of the patient at the time euthanasia is carried out. Initially, in the s and s, euthanasia and pas advocates in the Netherlands made the case that these acts would be limited to a small number of terminally ill patients experiencing intolerable suffering and that the practices would be considered last-resort options only.
That change is most concerning in light of evidence of elder abuse in many societies, including Canada 33 , and evidence that a large number of frail elderly people and terminally ill patients already feel a sense of being burden on their families and society, and a sense of isolation. The concern that these people may feel obliged to access euthanasia or pas if it were to become available is therefore not unreasonable, although evidence to verify that concern is not currently available.
This definition enables physicians to assist in suicide without inquiring into the source of the medical, psychological, social, and existential concerns that usually underlie requests for assisted suicide. Physicians are required to indicate that palliative care is a feasible alternative, but are not required to be knowledgeable about how to relieve physical or emotional suffering.
Until , the Netherlands allowed only adults access to euthanasia or pas. However, the law allowed for children aged 12—16 years to be euthanized if consent is provided by their parents, even though this age group is generally not considered capable of making such decisions 5. The law even allows physicians to proceed with euthanasia if there is disagreement between the parents.
In , legislators in Belgium announced their intention to change the euthanasia law to include infants, teenagers, and people with dementia or Alzheimer disease In Belgium, some critical care specialists have opted to ignore the requirement that, in the case of non-terminally-ill patients, an interval of 1 month is required from the time of a first request until the time that euthanasia is performed.
Beneficence, this specialist argued, was the overriding principle. Initially, euthanasia in the Netherlands was to be a last-resort option in the absence of other treatment options. Surprisingly, however, palliative care consultations are not mandatory in the jurisdictions that allow euthanasia or assisted suicide, even though uncontrolled pain and symptoms remain among the reasons for requesting euthanasia or pas Moreover, the rates of palliative care involvement have been decreasing.
That finding contradicts claims that in Belgium, legalization has been accompanied by significant improvements in palliative care in the country Other studies have reported even lower palliative care involvement 8 , It must be noted that legalization of euthanasia or pas has not been required in other countries such as the United Kingdom, Australia, Ireland, France, and Spain, in which palliative care has developed more than it has in Belgium and the Netherlands.
The usefulness of a single palliative care assessment has been challenged—even when it is an obligatory requirement, as is the case at the University Hospital of the Canton of Vaud, Lausanne, Switzerland the first hospital to allow, in , assisted suicide in Switzerland 40 Among U.
A similar number of U. Originally, it was the view of the Supreme Court of the Netherlands, the Royal Dutch Medical Association, and the ministers of Justice and Health that euthanasia would not be an option in situations in which alternative treatments were available but the patient had refused them. When this view conflicted with the accepted ethical principle that patients are allowed to refuse a treatment option, the law was altered to allow access to euthanasia even if the person refused another available option such as palliative or psychiatric care.
One consequence of the change is that, the appropriateness of suicide prevention programs may begin to be questioned, because people wanting to commit suicide should, on the basis of autonomy and choice, have the same rights as those requesting euthanasia. In Switzerland in , the university hospital in Geneva reduced its already limited palliative care staff to 1. Unpublished data. There is evidence that attracting doctors to train in and provide palliative care was made more difficult because of access to euthanasia and pas, perceived by some to present easier solutions, because providing palliative care requires competencies and emotional and time commitments on the part of the clinician 47 , Compared with euthanasia cases, cases without an explicit request were more likely to have a shorter length of treatment of the terminal illness However, there is evidence that challenges those assertion.
The number of deaths by euthanasia in Flanders has doubled since Of the total deaths in this Flemish-speaking part of Belgium population 6 million , 1.
The requirement of the law to report euthanasia cases aided by laxity in prosecuting cases that fall outside the requirement may explain some, but not all, of the increase Chambaere et al.
But a closer review of the original study shows that the rate had declined to 1. In Holland, the overall rate of euthanasia was 1. Given the increasing numbers, interest in developing facilities that provide euthanasia similar to those of the Swiss pro—assisted suicide group Dignitas has recently been increasing. In Oregon, although the number of cases of pas remain very small relative to the population, the rate has been increasing: 24 prescriptions were written in 16 of which led to deaths by pas , 67 prescriptions in 43 of which led to deaths by pas , and 89 in In Belgium, the rates of involuntary and non-voluntary euthanasia have decreased; together they accounted for 3.
In the Netherlands, the rate decreased from 0. The actual rate is probably higher, given the large number of unreported cases. Notwithstanding the decrease, the rates are perturbing. Battin et al. Finlay and George challenged the study on the basis that vulnerability to pas or euthanasia cannot be categorized simply by reference to race, sex, or other socioeconomic status. Other characteristics, such as emotional state, reaction to loss, personality type, and the sense of being a burden are also important Patients are also vulnerable to the level of training and experience that their physicians have in palliative care and to the personal views of their physicians about the topic.
For example, one study showed that the more physicians know about palliative care, the less they favour euthanasia and pas Two recent studies further contradict the findings by Battin and colleagues. Zylicz, a palliative care specialist who has worked extensively in the Netherlands with people requesting euthanasia and pas, provides a taxonomy to understand the reasons underlying the requests and provides stepping stones for addressing the requests.
The requests can be classified into five categories summarized by the abbreviation abcde 54 : Being afraid of what the future may hold Experiencing burnout from unrelenting disease Having the wish and need for control Experiencing depression Experiencing extremes of suffering, including refractory pain and other symptoms Strategies are available to begin to address severe refractory symptoms, to treat depression, and to deal with the fear that some people have of what the future with a terminal disease may hold.
For these symptoms, there is the option of palliative sedation. Its intent is not to hasten death, which differentiates it from euthanasia. The goal is to achieve comfort at the lowest dose of sedative possible usually with midazolam infusion, not with opioids and at the lightest level of sedation.
Some patients therefore achieve comfort at light levels of sedation, allowing them to continue interacting with family; in others, comfort is achieved only at deep levels of sedation. Studies have shown that losing a sense of dignity and hope and taking on a sense of burden prompt some people to seek euthanasia and pas 21 — 23 , Strategies to improve the sense of dignity, based on empirical studies that have explored the concept of dignity within palliative care, have been shown to work Similar strategies need to be developed in the areas of hope and burden.
Non-voluntary euthanasia is now being justified by appealing to the social duty of citizens and the ethical pillar of beneficence. In the Netherlands, euthanasia has moved from being a measure of last resort to being one of early intervention.
Belgium has followed suit 37 , and troubling evidence is emerging from Oregon specifically with respect to the protection of people with depression and the objectivity of the process. The UN has also expressed concern that the system may fail to detect and to prevent situations in which people could be subjected to undue pressure to access or to provide euthanasia and could circumvent the safeguards that are in place.
Autonomy and choice are important values in any society, but they are not without limits. Our democratic societies have many laws that limit individual autonomy and choice so as to protect the larger community.
These include, among many others, limits on excessive driving speeds and the obligation to contribute by way of personal and corporate income taxes.
Why then should different standards on autonomy and choice apply in the case of euthanasia and pas? Legislators in several countries and jurisdictions have, in just the last year, voted against legalizing euthanasia and pas in part because of the concerns and evidence described in this paper.
They have opted to improve palliative care services and to educate health professionals and the public. Footnotes 6. Deliens L, van der Wal G. The euthanasia law in Belgium and the Netherlands.
In Oregon, although the number of cases of pas remain very small relative to the population, the rate has been increasing: 24 prescriptions were written in 16 of which led to deaths by pas , 67 prescriptions in 43 of which led to deaths by pas , and 89 in Euthanasia is also known as the practice of intentionally ending a life of person who is either suffering from an incurable disease or is in immense pain. BMC Public Health. Dutch GP found guilty of murder faces no penalty. On average one in four nurse have receive requests from their patients to help end their suffering by assisting in euthanasia Ersek ,
The concern that these people may feel obliged to access euthanasia or pas if it were to become available is therefore not unreasonable, although evidence to verify that concern is not currently available. They must be pushed in a wheelchair because they are too sick to walk and spend the rest of their few months in pain, knowing they will die but not sure when.
This can occur in various different ways such as lethal injection or suspension of medical treatment. They seek the help of a doctor to fulfill this wish. That finding contradicts claims that in Belgium, legalization has been accompanied by significant improvements in palliative care in the country Euthanasia should be a legal option I found a proposal given by members of the Vess organization.
Although passive euthanasia has been legalised keeping it subject to a specific set of regulations Various fascinating facts, Australia has already approved this act and many people from other countries have also committed Euthanasia. Two recent studies further contradict the findings by Battin and colleagues. When it comes to terminal illness, euthanasia should definitely be allowed in the United States and be protected be law as a personal right Portland, OR: dhs;
Mich Law Rev. The law that prohibits active euthanasia restricts many people from doing what they feel morally justified to do It is the hastening of death of a patient to prevent further sufferings Euthanasia Revisited. The starting point has to be in the law, which at present is failing, as shown by the recurrence of cases in the courts that often place relatives, already dealing with the painful loss of a loved-one, in the middle of distressing legal battles. The counterargument is that the legal requirement of explicit written consent is important if abuse and misuse are to be avoided. In America, we have the freedom to choose, but do we have the freedom to choose life over death, or even death over life?
As the illness begins to take over your body and brings only pain and suffering, death, what most of us fear, sometimes looks a lot more peaceful than life. There are different classification of euthanasia; involuntary and voluntary, non-voluntary, passive and active euthanasia. Looking into the stances, arguments and opinions surrounding the issue of legalizing Euthanasia.