EUTHANASIA : GOOD DEATH

Most people in North America die what may be called a bad death. One study found that "More often than not, patients died in pain, their desires concerning treatment neglected, after spending 10 days or more in an intensive care unit.

The word Euthanasia originated from the Greek language: eu means "good" and thanatos means "death". One meaning given to the word is "the intentional termination of life by another at the explicit request of the person who dies." 2 That is, the term euthanasia normally implies that the act must be initiated by the person who wishes to commit suicide. However, some people define euthanasia to include both voluntary and involuntary termination of life. Like so many moral/ethical/religious terms, "euthanasia" has many meanings. The result is mass confusion.

It is important to differentiate among a number of vaguely related terms: Passive Euthanasia: Hastening the death of a person by altering some form of support and letting nature take its course. For example: Removing life support equipment (e.g. turning off a respirator) or Stopping medical procedures, medications etc., or Stopping food and water and allowing the person to dehydrate or starve to death. Not delivering CPR (cardio-pulmonary resuscitation) and allowing a person, whose heart has stopped, to die.

Perhaps the most common form of passive euthanasia is to give a patient large doses of morphine to control pain, in spite of the likelihood that the pain-killer will suppress respiration and cause death earlier than it would otherwise have happened. Such doses of pain killers have a dual effect of relieving pain and hastening death. Administering such medication is regarded as ethical in most political jurisdictions and by most medical societies.

These procedures are performed on terminally ill, suffering persons so that natural death will occur sooner. It is also done on persons in a Persistent Vegetative State - individuals with massive brain damage who are in a coma from which they cannot possibly regain consciousness. Active Euthanasia: This involves causing the death of a person through a direct action, in response to a request from that person. A well known example was the mercy killing in 1998 of a patient with ALS (Lou Gehrig's Disease) by Dr. Jack Kevorkian, a Michigan physician. His patient was frightened that the advancing disease would cause him to die a horrible death in the near future; he wanted a quick, painless exit from life. Dr. Kevorkian injected controlled substances into the patient, thus causing his death. Charged with 1st degree murder, the jury found him guilty of 2nd degree murder in 1999-MAR.

Physician Assisted Suicide: A physician supplies information and/or the means of committing suicide (e.g. a prescription for lethal dose of sleeping pills, or a supply of carbon monoxide gas) to a person, so that they can easily terminate their own life. The term "voluntary passive euthanasia" (VPE) is becoming commonly used. One writer 3 suggests the use of the verb "to kevork". This is derived from the name of Dr. Kevorkian, who has promoted VPE and assisted at the deaths of hundreds of patients. Originally he hooked his patients up to a machine that delivered measured doses of medications, but only after the patient pushed a button to initiate the sequence. More recently, he provided carbon monoxide and a face mask so that his patient could initiate the flow of gas.

Involuntary Euthanasia: This term is used by some to describe the killing of a person who has not explicitly requested aid in dying. This is most often done to patients who are in a Persistent Vegetative State and will probably never recover consciousness.

Why is it an issue?

People have many different reasons for wanting to end their life by committing suicide:

Some are severely depressed over a long interval. To them, suicide may be a "permanent solution to a temporary problem." There is a consensus that a better solution for most clinically depressed people is treatment, using counseling and/or medication. Such treatment can give to the person decades of enjoyable life which would have been lost if they committed suicide.

They live in excessive, chronic pain. Some, due to poverty or lack of health-care coverage cannot afford pain killing medication. Others are denied adequate pain killers because of their physician's lack of knowledge, inadequate training, or specific beliefs. Most physicians feel that suicide in such cases is not a preferred solution either; a better approach is proper management of pain through medication. There appears to be a lack of collective will to make this happen. Many, perhaps most, people die in excessive, though treatable, pain.

They have a terminal illness and do not want to diminish their assets by incurring large medical costs as their death approaches. As an act of generosity, they would rather die sooner, and pass on their assets to their beneficiaries.

A serious disorder or disease has adversely effected their quality of life to the point where they no longer wish to continue living.

They have been diagnosed with a degenerative, progressive illness like ALS, Huntington's Disease, Multiple Sclerosis, AIDS, Alzheimer's etc. They fear a gradual loss of the quality of life in the future as the disease or disorder progresses.

They have lost their independence and must be cared for continually. Some feel that this causes an unacceptable loss of personal dignity. They realize that they will be dying in the near future and simply want to have total control over the process.

Some are concerned about the future and want to have suicide available as an option.

Some people who decide that they wish to commit suicide are unable to accomplish the act. They need assistance from their physician. Physician assisted suicide helps them die under conditions and at the time that they wish. PAS is currently legal, under severe restrictions, only in the American state of Oregon and in the Netherlands. In other jurisdictions, they are forced to continue living against their wish, until their body eventually collapses, or until a family member or friend commits a criminal act by helping them commit suicide.

An analysis of the first full year of the availability of assisted suicide in Oregon showed that relatively few people requested help in dying. Some were probably deterred by the resistance of their physician. Only 23 actually obtained medication to induce their death. At least six of the 23 never used the pills, but died a natural death.

Physician-assisted suicide (PAS) generally refers to a practice in which the physician provides a patient with a lethal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life.

Is physician-assisted suicide the same as euthanasia?

No. Physician-assisted suicide refers to the physician providing the means for death, most often with a prescription. The patient, not the physician, will ultimately administer the lethal medication. Euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life. Some other practices that should be distinguished from PAS are: • Terminal sedation: This refers to the practice of sedating a terminally ill competent patient to the point of unconsciousness, then allowing the patient to die of her disease, starvation, or dehydration.

• Withholding/withdrawing life-sustaining treatments: When a competent patient makes an informed decision to refuse life-sustaining treatment, there is virtual unanimity in state law and in the medical profession that this wish should be respected.

• Pain medication that may hasten death: Often a terminally ill, suffering patient may require dosages of pain medication that impair respiration or have other effects that may hasten death. It is generally held by most professional societies, and supported in court decisions, that this is justifiable so long as the primary intent is to relieve suffering.

Is physician-assisted suicide ethical?

The ethics of PAS continue to be debated. Some argue that PAS is ethical (see arguments in favor). Often this is argued on the grounds that PAS may be a rational choice for a person who is choosing to die to escape unbearable suffering. Furthermore, the physician's duty to alleviate suffering may, at times, justify the act of providing assistance with suicide. These arguments rely a great deal on the notion of individual autonomy, recognizing the right of competent people to chose for themselves the course of their life, including how it will end. Others have argued that PAS is unethical (see arguments against). Often these opponents argue that PAS runs directly counter to the traditional duty of the physician to preserve life. Furthermore, many argue if PAS were legal, abuses would take place. For instance, the poor or elderly might be covertly pressured to chose PAS over more complex and expensive palliative care options.

TO BE CONT.

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