Rose-Marie Chaperon

Euthanasia



Posted: Friday, April 03, 2009

by Rose-Marie Chaperon
Chaperon Consulting, LLC

  Every person shall have the right to die with dignity; this right shall include the right to choose the time of one's death and to receive medical and pharmaceutical assistance to die painlessly. (BBC -Home, 2002) Euthanasia is the intentional premature termination of another person's life either by direct intervention also known as active euthanasia or passive euthanasia by withholding life-prolonging measures and resources, either at the express or implied request of that person, or in the absence of such approval where the individual wishes to go on living - is a euphemism for murder (Nead, 2009).  No physician, nurse or pharmacist shall not be held criminally or civilly liable for assisting a person in the free exercise of this right or should they?  Euthanasia is illegal almost everywhere, "although doctors in many countries admit that they have done it" (Lo, Physician assisted suicide in Oregon a-bold-experiment, 1995). The term euthanasia has virtually abolished the term assisted suicide. Different ethical issues are at play when discussing euthanasia. People who are pro euthanasia believe that a terminally ill person has the right to seek the help of another for the purpose of helping that person at the end of life. The question of euthanasia is a question of choice and empowering people to have control over their bodies. Today in the United States a terminal illness is a medical term popularized in the 20th century to describe an active and malignant disease. When that disease cannot be cured or adequately treated; and that is reasonably expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer or advanced heart disease than for trauma. In popular use, it indicates "a disease which will end the life of the sufferer" (Alimi, 2003).

Euthanasia and assisted suicide are subjects of great debate due to the opposing views taken by people on either side of the debate. In this research I will be discussing the ethical and legal issues surrounding euthanasia and Physician-Assisted Suicide in the United States with an emphasis on the state of Oregon, the only state in the United States with any form of legislation that recognizes a patient's "Right to Die," (Masci, 2007) , and I will also research the International Observatory on End of Life Care in Belgium and Australia. In addition, I will explore the work of writers and the legal and ethical issues of euthanasia in the United States where religion is concerned. 

On October 27, 1997 the state of Oregon enacted the Death with Dignity Act which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. The Oregon Death with Dignity Act (DWDA) requires the Oregon Department of Human Services to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report. Under the prevision, in 2007, 85 lethal medications prescriptions were written that is comparing to 65 prescriptions in 2006. Since the DWDA was passed in 1997, 341 patients have died under the terms of the law (Canetto, 2007).

In Europe, John Bodkin Adams (21st January 1899 – 4th July 1983) was an Irish-British general practitioner, convicted fraudster and suspected serial killer. (Lor, 1983) It was alleged that between the years 1946-1956, more than 160 of his patients died under suspicious circumstances. Of these 132 left him money or items in their will. He was tried and acquitted for the murder of one patient in 1957. Adams' trial had several important legal ramifications. It established the principle of double effect, whereby a doctor giving treatment with the aim of relieving pain, may as an unintentional result, shorten life. Due to the publicity surrounding Adams' committal hearing, the law was changed to allow defendants to ask for such hearings to be held in private. Finally, though a defendant had never been required to give evidence in his own defense, the judge underlined in his summing-up that no prejudice should be attached by the jury to Adams not doing so (Lor, 1983). Adams was found guilty in a subsequent trial of 13 offences of prescription fraud, lying on cremation forms, obstructing a police search and failing to keep a dangerous drug registered. Scotland Yard's files on the case were initially closed to the public for 75 years, until 2033. Special permission was granted in 2003 to reopen the files.  In 1957 in Britain, Judge Devlin ruled in the trial of Dr John Bodkin Adams that causing death through the administration of lethal drugs to a patient, if the intention is solely to alleviate pain, is not considered murder even if death is a potential or even likely outcome. In 1993, the Netherlands decriminalized doctor-assisted suicide, and in 2002, restrictions were loosened. During that year, physician-assisted suicide was approved in Belgium (Humphrey, 2005).

Australia, the Northern Territory consists of about 1/6 the land mass of Australia but only has a population of about 168,000 people. The law started as a private member's bill Rights of the Terminally Ill Bill 1995, sponsored by Marshall Perron. It was opposed by the Australian Medical Association and a variety of right-to-life groups. The law is called the Rights of the Terminally Ill Act. A survey conducted by Newspoll in Jul-1995 found 81% of Australian adults support voluntary euthanasia. A poll by the Roy Morgan Research Centre in June-1995 showed similar results: 78% in favor. A separate poll showed that 60% of doctors and 78% of nurses in Victoria favored voluntary euthanasia. Among older church attendees, support was higher (50% among those 60 and older) (Robinson, 2007).

Altman explains how the body dies, death does not occur all at once, but in stages. Even after heartbeat, breathing, and brain activity stop some cells keep functioning for a time.  For example, people's hair and fingernails continue to grow. Linda Jacobs Altman offers some notes on the stages of dying. She explained that physical changes are that of the body is having a more difficult time maintaining itself. There are signs that the body may show during this time: The body temperature lowers by a degree or more. The blood pressure lowers. The pulse becomes irregular and may slow down or speeds up. There is increased perspiration. Skin color changes as circulation becomes diminished. This is often more noticeable in the lips and nail beds as they become pale and bluish.

This source made it somewhat clear, however; the writer failed to mentioned that during that stage breathing changes occur, often becoming more rapid and labored. Congestion may also occur causing a rattling sound and cough while speaking decreases and eventual stops altogether.  As the body's system weakens less oxygen is available to the muscles, the life force weakens, and more effort is needed to complete everyday tasks and one may become embarrassed, discouraged, ambivalent, depressed, irritable and/or just naturally become more interested in matters that seem more important: matters of the mind, heart and spirit. This is often a time of self-examination, of questioning, of looking for the meaning of life (Altman L. , 1943 - 2000, p. 97).

Arthur Rifkin stated that physician assisted suicide is a concrete fashion forces us to consider and act on what we consider ultimate. It not only makes us question whether someone should commit suicide but whether another person should help. The author speaks and explains that euthanasia is the legal term for a medically assisted mercy killing; however in most countries, euthanasia is illegal. This begs two fundamental questions. First, is euthanasia ethical or unethical? Second, depending on the first question, should euthanasia be legal or illegal?  The author should have mentioned that, the traditional view is that the intentional termination of human life is impermissible. Is the intention deadly? If so the act or omission is wrong. A physician's unwillingness to use extraordinary means may be prompted, not by a determination to bring about death, but by other motives, for instance, his realization that further treatment may offer little hope of reversing the dying process and/or be excruciating. As in the case when a massively necrotic bowel condition in a neonate is out of control, "the doctor who does what he can to comfort the infant but does not submit it to further treatment or surgery may foresee that the decision will hasten death, but it certainly doesn't follow from that fact that he intends to bring about death" (A. Rufkin).

 Bernard Lo speaks of the fact that there are several unresolved issues and potential problems surrounding the Oregon Death with Dignity Act. Under this law, terminally ill patients can ask physicians for a lethal prescription. Oregon physicians must determine their moral and ethical position on physician-assisted suicide so they can communicate the position to their patients. Physicians also must carefully judge a patient's prognosis to determine if death would likely occur within six months. Physicians must know lethal dosages of the medications they are prescribing, and which drugs are most effective to prevent the suicide from failing. Physicians should advise patients that lethal medications may not put the patient into a tranquil sleep ending in death. Options such as hospice and other pain-relieving care should be discussed with patients. Physician-assisted suicide should be the last resort.

The author failed to mention that physician-assisted suicide is illegal in every state except Oregon. In 1997, the U.S. Supreme Court issued rulings on physician-assisted suicide and sent the issue back to the states to decide. The Court decided that it could not identify a right to request a physician's help in dying. Therefore, the merits of state laws that bar physician-assisted suicide are appropriate for the states to decide. At the same time, the Court reaffirmed that Americans do have the right to refuse or end life-sustaining treatment, such as ventilators and feeding tubes. The Court pointed out that there is a difference between letting someone die and helping someone to die. Refusing treatment lets your disease run its natural course. Having someone's help in suicide, the court ruled, is different (Lo, Physician assisted suicide in Oregon a-bold-experiment, 1995).

Ethics is the scientific or philosophical treatment of morality. Ethics has merely to do with the order which relates to man as man, and which makes of him a good man. Ethics takes its origin from the empirical fact that certain general principles and concepts of the moral order are common to all people at all times. This fact has indeed been frequently disputed, but recent ethnological research has placed it beyond the possibility of doubt. All nations distinguish between what is good and what is bad, between good men and bad men, between virtue and vice; they all agreed in this: that the good is worth striving for, and that evil must be shunned, that the one deserves praise, the other, blame. When we are trying to explain the ethical issues relating to euthanasia we have to consider that opposition to euthanasia mainly comes from three different groups. Medical associations who are dedicated to saving and extending lives feel uncomfortable helping people to end their lives. Groups concerned with disabilities fear that euthanasia is the first step towards a society that will kill people against their own wishes.

Religious groups who oppose freedom of choice in abortion also oppose euthanasia. In the Catholic religion, the church teaches that euthanasia is a grave sin, Pope John Paul II wrote in his Mar. 25, 1995 Evangelium Vitae "To claim the right to abortion, infanticide and euthanasia, and to recognize that right in law, means to attribute to human freedom a perverse and evil significance: that of an absolute power over others and against others confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. Consequently, a civil law authorizing abortion or euthanasia ceases by that very fact to be a true, morally binding civil law. Abortion and euthanasia are thus crimes which no human law can claim to legitimize. (Jean Paul, 1995)

Mercy killing, the good death, being put down, put to sleep, put out of one's misery, going to sleep permanently, ending your life, murder are a few of the names euthanasia has been known by over the years. Only a fool would minimize the agony that many terminally ill patients endure.  And there's no question that by letting them die on request we shorten the period of suffering, but we also shorten their lives.  Can you seriously argue that the saving of pain is greater good than the saving of life?  Or that presence of pain is worse than the loss of life? Of course, nobody likes to see a creature suffer, especially when the creature has requested a halt to the suffering.  But we have to keep our priorities straight?

 

 References:



Alimi, D. (2003, July 26). A systematic review of physicians' survival predictions in terminally ill cancer patients . Retrieved 01 17, 2009, from BMJ: http://www.bmj.com/cgi/content/full/327/7408/195

Altman, L. J. (1943, 2000). How the body dies. In L. J. Altman, Death and Introduction to Medical Ethical Dillema (p. 09). Berkeley Heights: Enslow Publishers, Inc.

BBC -Home. (2002, 03). Retrieved 03 02, 2009, from Religion and Ethics - Ethical Issues: http://www.bbc.co.uk/ethics/euthanasia/infavour/infavour_2.shtml

Canetto, S. S. (2007, 08 06). End of life care issue. Retrieved 01 24, 2009, from American Psychological Association: http://www.apa.org/pi/eol/arguments.html

Humphrey, D. (2005, 03 01). tread carefully when you help to die. Retrieved 01 30, 2009, from assisted suicide: http://www.assistedsuicide.org/suicide_laws.html

Jean Paul, P. (1995, 03 25). Euthanasia. What are Catholic perspectives on euthanasia and physician-assisted suicide? , pp. 121-122.

Lo, B. (1995, 07 26). Physician-assisted suicide in Oregon: a bold experiment. Retrieved 01 31, 2009, from JAMA, the medical association: http://www.faqs.org/abstracts/Health/Physician-assisted-suicide-in-Oregon-a-bold-experiment-Detention-of-persistently-nonadherent-patient.html

Lor, P. (1983, 07 09). John Bodkin Adams by Prathna Lor. Retrieved 02 2009, 2009, from Every Day Yeah: http://www.everydayyeah.com/content/john-bodkin-adams-prathna-lor

Masci, D. (2007, 10 10). The Right-to-Die Debate and the Tenth Anniversary of Oregon's Death with Dignity Act. Retrieved 01 19, 2009, from Pwe Trust: http://www.pewtrusts.org/news_room_detail.aspx?id=30709

Nead, N. (2009, 01 22). Euthanasia the right to die. Retrieved 02 23, 2009, from Knolt Today: http://www.knoltoday.com/health/2009/01/22/euthanasia-the-right-to-die/

Office of Public Affair. (2008, 10 06). CMS Never Event. Retrieved 10 06, 2008, from CMS: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1863

Rifkin, A. (1997). Euthanasia can be ethical. In D. A. Leone, The ethics of euthanasia (pp. 09-88). San Diego: David Bender.

Robinson, B. (2007, 06 08). Physician assisted suicide, outside the U.S., Canada. Retrieved 01 17, 2009, from Religious tolerance: http://www.religioustolerance.org/euth_wld.htm

Small Business Bible. (2001, 12 11). Small Business Bible. Retrieved 01 07, 2009, from smallbusinessbilbe.org: http://www.smallbusinessbible.org/types_terminalillnesses.html

The Islamic Medical Association . (1996). Euthanasia and Physician-Assisted Suicide. TheInstitute of Medicine Committee on Care at the End of Life , 25-27.

 

Rose-Marie Chaperon also works as a Director of Revenue Cycle for healthcare operations. Rose-Marie's experience is process improvement and redesigning patient access and patient financial services areas. Rose Marie is an exceptional A/R guru and has held many Business Office and Patient Financial Services positions throughout her twenty-year tenure in revenue cycle. She is a very proactive leader and the kind of person who can direct a group of people towards their goals. Rose Marie has experience with a variety of software systems and led three hospitals through a system conversion during her assignments there. Rose-Marie is a Certified Healthcare Access Manager (CHAM). Rose-Marie can be reached via e-mail: rosechaperon@hotmail.com or rchaperon@shenahaiti.org

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Top-level comments on this article: (2 total)
» left by Ben Morrish
 3 years 35 days ago.
48 fans.
"Of course, nobody likes to see a creature suffer, especially when the creature has requested a halt to the suffering. But we have to keep our priorities straight?"
 
So if you see an ill or injured creature than is clearly in agony, it is better to make every effort to keep that creature alive as long as possible, knowing full well that this extra period of being alive will be nothing more than further agony?
 
Life is primarily about quality rather than length. Would you rather live to 150 but spend all your waking hours suffering than live only to 75 but enjoying every waking moment?
» left by Jille Mcantire
 2 years 332 days ago.
I needed an article for my school project, I think I will use this one. Thank you for posting it.
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