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Euthanasia - Types, Arguments For and Against

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Euthanasia, its types, ethical and moral dilemma, arguments for and against, religious views, philosophical arguments and legal validity in different countries.

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Euthanasia - Types, Arguments For and Against

  3. 3. WHAT IS EUTHANASIA?  EUTHANASIA comes from the Greek words: Eu (good) and Thanatos (death) and it means “Good Death”, “Gentle and Easy Death.”  Now it means “the act of inducing an easy death”, usually referring to acts which terminate or shorten life painlessly in order to end suffering where there is no prospect of recovery.  This word has come to be used for “mercy killing”.  It is the act or practice of ending a life of a person either by a lethal injection or suspension of medical treatment.
  4. 4. WHAT IS EUTHANASIA? (cont..)  The word "euthanasia" was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a “physician's responsibility to alleviate the 'physical sufferings' of the body”.  Euthanasia is the most active area of research in contemporary bioethics.
  5. 5. WHAT IS EUTHANASIA? (cont..)  According to the World Medical Association euthanasia means:  Deliberate and intentional action with a clear intention to end another person’s life under the following conditions:  The subject is a competent informed person with incurable illness  Who voluntarily asked for ending his life;  The person who is acting knows about the state of this person and about his wish to die and is doing this action with an intention to end life of this person;  The action is done with compassion and without any personal profit
  7. 7. THE DILEMMA  Arguments about euthanasia often hinge on the “right to life” and the “right to die”.  The first is a widely accepted basic human right and moral value, based on the fact that people generally want to live.  But what should we do when seriously ill people no longer want to live? Do they have a right to die?  Sufferers sometimes wish to commit suicide but do not have the physical strength or the means to do it painlessly.
  8. 8. THE DILEMMA (cont..)  Like many problems of medical ethics, this has become more pressing recently.  A century ago most people died quite quickly (and probably painfully) if they had serious injuries or illnesses.  Nowadays they can be treated, sometimes cured, and often kept alive.  Codes of conduct formulated centuries ago, for example those found in sacred texts, or the Hippocratic Oath, cannot necessarily help us with twentieth century problems of medical ethics.
  10. 10. WHAT ARE THE VARIOUS OCCASIONS?  The question of euthanasia arises on three occasions  At the beginning of life (at birth)  At the end of natural life (terminal stage) and  When a person is severely impaired as a result of brain damage (unforeseen mishap)
  11. 11. AT BIRTH  In case of severely physically and mentally handicapped infants  Decision rests on the parents or on the doctors aided by the law of the land  The decision should be based on :  quality of life the child can expect and its consequent impact on the parents, society and the resources of the State and also  care of the child after death of the parents
  12. 12. AT TERMINAL STAGE  The dying conscious patient can give his own consent or decision as to continue or not the ongoing treatment if he wishes to.  No moral obligation on doctors to preserve life at any cost.
  13. 13. UNFORESEEN MISHAP  When a person is severely impaired as a result of brain damage either due to violence, poisoning or natural causes where the brain suffers from hypoxic brain damage from which it cannot recover irrespective of the treatment given his/her life can be sustained by artificial means but only in a state of suspended animation.  This gives rise to the confusion whether the treatment is prolonging life or death !!  In such cases he may be allowed to die in comfort and with dignity (such a step would also save the resources of the State for more rational uses)
  15. 15. WHAT ARE THE TYPES OF EUTHANASIA? Active or Positive Passive or Negative Voluntary Involuntary Non-Voluntary
  16. 16. WHAT ARE THE TYPES OF EUTHANASIA? (cont..)  VOLUNTARY EUTHANASIA, sometimes called “assisted suicide”, is used in cases where the sufferer has made it clear that s/he wishes to die and has requested help to bring this about.  When the euthanasia is practiced with the expressed desire and consent of the person concerned.  INVOLUNTARY EUTHANASIA occurs when no consent or wish to die is expressed by the sufferer.  When the euthanasia is practiced against the will of the person.
  17. 17. WHAT ARE THE TYPES OF EUTHANASIA? (cont..) To define this type further –  NON-VOLUNTARY EUTHANASIA – where patients cannot express a wish to die – patients in comas, infants, profound mentally retarded, severely brain damaged, cases of extreme senile dementia, those who cannot communicate for other reasons  INVOLUNTARY EUTHANASIA - where patients can express a wish to die but don't (this equates to murder).
  18. 18. WHAT ARE THE TYPES OF EUTHANASIA? (cont..) The way in which the euthanasia is carried out can also be defined –  ACTIVE, or DIRECT, EUTHANASIA involves specific actions (e.g. lethal drugs or injections) intended to bring about death.  It means a positive merciful act to end useless sufferings and a meaningless existence. It is an act of commission for example by giving large doses of a drug to hasten death.
  19. 19. WHAT ARE THE TYPES OF EUTHANASIA? (cont..)  PASSIVE EUTHANASIA is the practice, widely carried out and generally judged to be legal, where patients are allowed to die, by withdrawing treatment and/or nourishment. A common practice of this is a patient signing a ‘Do Not Resuscitate’ (DNR) document.  It implies discontinuing or not using extraordinary life sustaining measures to prolong life. Others include act of omission such as failure to resuscitate a terminally ill or incapacitated patient (e.g. a severely defective new-born infant).
  20. 20. WHAT ARE THE TYPES OF EUTHANASIA? (cont..)  Other methods include disconnecting a feeding tube, not carrying out a life-extending operation or not giving life-extending drugs etc.  ‘Letting die’ ... means to give way to an ongoing inner-organismic process of disintegration, without supporting or substituting vital functions.  Therefore the extubation [removal from a ventilator] of an incurably ill patient, though a physical action with subsequent death, is not killing in its proper meaning...
  21. 21. WHAT ARE THE TYPES OF EUTHANASIA? (cont..)  The extubation does not produce the effect of death; it only influences the time of its occurrence.  Calahan (1992) has aptly illustrated this difference of causality:  The lethal injection kills both the ill as well as the healthy person;  the discontinuation of life sustaining treatment, however, only causes the death of the mortally ill, whereas on the healthy it would have no effect at all."
  22. 22. WHAT ARE THE TYPES OF EUTHANASIA? (cont..)  WITHDRAWING TREATMENT: For example switching off a machine that keeps the person alive.  WITHHOLDING TREATMENT: For example not carrying out a surgery that will extend life of the patient for a short time.  INDIRECT EUTHANASIA (sometimes referred to as "the double effect") is the practice of providing treatment, normally pain relief, which has the side-effect of hastening death. This is also widely practised and generally considered legal if killing was not the intention.
  24. 24. ETHICAL CONTRADICTION  DOCTOR-ASSISTED SUICIDE: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose.  When it is a doctor who helps another person to kill themselves it is called “physician assisted suicide or doctor assisted suicide”.  In doctor assisted-suicide, the doctor provides the patient with medical know-how (i.e. discussing painless and effective medical means of committing suicide) enabling the patient to end his / her own life.
  25. 25. ETHICAL CONTRADICTION (cont..)  THE HIPPOCRATIC OATH and International code of medical ethics pose ethical contradiction for the doctors.  Hippocrates mentions euthanasia in the Hippocratic Oath, which was written between 400 and 300 B.C.  The original Oath states:  “To please no one will I prescribe a deadly drug nor give advice which may cause his death.”  According to him, a doctor is to relieve the pain of his patient on one hand and protect and prolong his life on the other.
  26. 26. ETHICAL CONTRADICTION (cont..)  The first can be used in favour of the doctrine of euthanasia but the second counters the doctrine.  American Medical Association hold it inconsistent with the ethics of advanced medical technology.  Legalization would cause loss of hope, fear of medical institutions, and involuntary euthanasia.
  28. 28. RELIGIOUS AND PHILOSOPHICAL BACKGROUND  SECULAR HUMANISTS think that in a lot of circumstances voluntary euthanasia is the morally right course of action to take.  But many religious people, however, think that euthanasia is always morally wrong, regardless of whether the suffering person really wants to die.  Most religions disapprove of euthanasia for a number of reasons: 1. God has forbidden it (that says 'you must not kill'). 2. Human life is sacred. 3. Human beings are made in God's image. 4. God gives people life, so only God has the right to take it away.
  29. 29. RELIGIOUS AND PHILOSOPHICAL BACKGROUND (cont..) ISLAM:  Muslims are against euthanasia.  They believe that all human life is sacred because it is given by Allah, and that Allah chooses how long each person will live.  IMANA (the Islamic Medical Association of America) says that turning off life support for deemed to be in a persistent vegetative state is permissible.  This is because they consider all mechanical life support procedures as temporary measures.
  30. 30. RELIGIOUS AND PHILOSOPHICAL BACKGROUND (cont..) CHRISTIANITY:  Christians are mostly against euthanasia.  The arguments are usually based on the beliefs that life is given by God, and that human beings are made in God's image.  Some churches also emphasize the importance of not interfering with the natural process of death.  Life is a gift from God, Christianity requires us to respect every human being.
  31. 31. RELIGIOUS AND PHILOSOPHICAL BACKGROUND (cont..) JUDAISM:  Jewish medical ethics have become divided, over euthanasia and end of life treatment since the 1970s.  Generally, Jewish thinkers oppose voluntary active euthanasia, often vigorously, though there is some backing for voluntary passive euthanasia in limited circumstances.
  32. 32. RELIGIOUS AND PHILOSOPHICAL BACKGROUND (cont..) SHINTO:  In Japan, where the dominant religion is Shinto, 69% of the religious organizations agree with the act of voluntary passive euthanasia.  In Shinto, the prolongation of life using artificial means is a disgraceful act against life.
  33. 33. RELIGIOUS AND PHILOSOPHICAL BACKGROUND (cont..) BUDDHISM:  An important value of Buddhism teaching is compassion.  Compassion is used by some Buddhists as a justification for euthanasia because the person suffering is relieved of pain.  However, it is still immoral "to embark on any course of action whose aim is to destroy human life, irrespective of the quality of the individual's motive."
  35. 35. THE HUMANIST VIEW  HUMANISTS are non-religious people who live by moral principles based on reason and respect for others, not obedience to dogmatic rules.  They promote happiness and fulfilment in this life because they believe it is the only one we have.  Humanist concern for quality of life and respect for personal autonomy lead to the view that in many circumstances voluntary euthanasia is the morally right course.
  36. 36. THE HUMANIST VIEW (cont..)  People should have the right to choose a painless and dignified end, either at the time or beforehand, perhaps in a "living will".  The right circumstances might include:  extreme pain and suffering;  helplessness and loss of personal dignity;  permanent loss of those things which make life worth living for this individual.  To postpone the inevitable with no intervening benefit is not a moral act.
  37. 37. THE HUMANIST VIEW (cont..)  Individuals should be allowed to decide on such personal matters for themselves;  If someone in possession of full information and sound judgement decides that her continued life has no value, her wishes should be respected.  While humanists generally support voluntary euthanasia, they also uphold the need for certain safeguards.  These may include counselling,  the prevention of pressure on patients,  clear witnessed instructions from the patient,  the involvement of several doctors,  no reasonable hope of recovery–measures.
  38. 38. THE HUMANIST VIEW (cont..)  There is no rational moral distinction between allowing someone to die and actively assisting them to die in these circumstances:  The intention and the outcome (the death of the patient) are the same in both cases,  But the more active means is probably the more compassionate one.
  40. 40. ARGUMENTS FOR  Euthanasia provides a way to relieve extreme pain.  Euthanasia provides a way of relief when a person’s quality of life is low.  Euthanasia frees up medical funds to help other people.  It is another case of freedom of choice – the right to commit suicide.  People should not be forced to stay alive.  Speedy termination of physical and emotional suffering.  Organs can be put to good use.  Relieve mental suffering for the patient and his relatives.
  41. 41. ARGUMENTS AGAINST  Euthanasia demeans and devalues the sanctity of human life.  Euthanasia can become a means of health care cost containment.  Euthanasia will become non-voluntary.  Euthanasia would not only be for people who are terminally ill.  It amounts to murder and it is only God who can take away human life.  It destroys life, which has potential that could be yet unknown to the patient, doctor or the family members.  It discourages scientists who are looking for a cure for incurable ailments.  An irreversible damage.
  43. 43. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES  Laws around the world vary greatly with regard to euthanasia, and are constantly subject to change as cultural values shift and better palliative care, or treatments become available.  It is legal in some nations, while in others it may be criminalized.  In some countries there is a divisive public controversy over the moral, ethical, and legal issues of euthanasia.  Those who are against euthanasia may argue for the sanctity of life, while proponents of euthanasia rights emphasize alleviating suffering, and preserving bodily integrity, self-determination, and personal autonomy.
  44. 44. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.)  Countries which have legitimized euthanasia:  The Netherlands  Belgium  Oregon and Washington in the USA  Switzerland (only assisted suicide)  India (only passive euthanasia)
  45. 45. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) THE NETHERLANDS  Amidst the ongoing debates, the Netherlands became the first testing ground for the world since it legalized euthanasia on 28th November 2000.  Passed by a vote of 104 to 40, the law provides for the addition of a special “criminal liability exclusion” clause to Article 293 and 294 of the Dutch Penal Code that deals with the offence of homicide.
  46. 46. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) THE NETHERLANDS (cont..)  Allowed for children aged between 12 and 16 years of age, with the consent of their parents/guardians and for individuals aged 16 years and over..  Certain conditions and criteria of practising euthanasia:  the patient has to be competent and the request voluntary and intentional,  the patient has to suffer unbearably,  euthanasia has to be the last choice,  euthanasia can be done only by a doctor.
  47. 47. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) BELGIUM  The euthanasia law was adopted in 2001.  Allowed only if the patient is an adult.  This law defines conditions for doctors to avoid penal punishment.
  48. 48. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) SWITZERLAND  Assisted suicide is legitimized, not euthanasia done directly by patient’s doctor.  The patient himself commits suicide at special clinics.  The doctor prescribes a poison which causes death – the patient himself has to drink the poison, otherwise it is a murder, considered as a crime.  “Suicide tourism” – foreigners can come to Switzerland and commit assisted suicide.
  49. 49. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) UNITED STATES OF AMERICA  In USA the practice of euthanasia is a clear offence too theoretically, but in real practice the judgements of different courts during trial of euthanasia cases seem to be liberal.  Supporters advances arguments of civil rights of terminally ills.  Opposers say it is to eradicate inconveniently ill elders, ‘the baby boomers’.
  50. 50. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) UNITED STATES OF AMERICA (cont..)  Moreover, some states in the USA including Washington D.C. have laws that recognise the ‘living wills’ (law to say in advance that one does not want to be kept alive with artificial means when there is no hope).  Impunity of euthanasia has been guaranteed in two states – Ohio and Iowa.  With certain conditions e.g.: the patient must be considered competent and aware of their situation.
  51. 51. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) UNITED KINGDOM  Currently in the UK, any person found to be assisting suicide is breaking the law and can be convicted of assisting suicide or attempting to do so (i.e. if a doctor gives a patient, in great pain, a bottle of morphine to take (to commit suicide) when the pain gets unbearable).  Although two-thirds of Britons think it should be legal, a recent ‘Assisted Dying for the Terminally-Ill’ Bill was turned down in the lower political chamber, the House of Commons, by a 4-1 margin.
  52. 52. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) CZECH REPUBLIC  The discussion about euthanasia was completely forbidden in the past by the communist party – it could be only made after the year 1990.  Legal norms do not include the term “euthanasia”, but it is indirectly regulated by numbers of norms, particularly by penal (criminal) code and civil code.  The penal code: “If the culprit kills another person out of compassion to accelerate his unavoidable near death and thereby liberates this person from cruel pain caused by incurable illness, the court can exceptionally mitigate the sentence or can refrain from punishment”.
  53. 53. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) OTHER COUNTRIES  In Japan : Only “passive” euthanasia is permitted for patients who have been in a Coma for more than 3 months.  While in Egypt, or in Islamic countries in general, the popular Egyptians’ Scholar Sheikh, recently issued a fatwa, equating euthanasia with murder but allowing the with-holding of treatment that is deemed useless.
  54. 54. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) OTHER COUNTRIES (cont..)  The Canadian law allows a person to refuse medical treatment and the medical profession accepts the ‘living will’, but the law does not allow the doctor to actively help someone to kill himself.  In Australia, a computerized injection system is in use to accomplice euthanasia.  Though not approved, the legal position in Germany, Switzerland, Poland etc. are comparatively liberal.
  56. 56. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) INDIA  Passive euthanasia is legal in India.  On 7 March 2011 the Supreme Court of India legalised passive euthanasia by means of the withdrawal of life support to patients in a permanent vegetative state.  The decision was made as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent Vegetative State (PVS) for 42 years until her death in 2015.
  57. 57. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) INDIA (cont..)  The Supreme Court specified two irreversible conditions to permit Passive Euthanasia:  The Brain-Dead for whom the ventilator can be switched off  Those in a Persistent Vegetative State (PVS) for whom the feed can be tapered out and pain-managing palliatives be added, according to laid-down international specifications
  58. 58. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) INDIA (cont..) The following guidelines were laid down:  A decision has to be taken to discontinue life support  either by the parents or the spouse or other close relatives, or  in the absence of any of them, such a decision can be taken even by a person or a body of persons acting as a next friend.  It can also be taken by the doctors attending the patient.  However, the decision should be taken bona fide in the best interest of the patient.
  59. 59. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) INDIA (cont..)  Even if a decision is taken by the near relatives or doctors or next friend to withdraw life support, such a decision requires approval from the High Court concerned.  When such an application is filled the Chief Justice of the High Court should forthwith constitute a Bench of at least two Judges who should decide to grant approval or not.
  60. 60. TRENDS OF EUTHANASIA IN DIFFERENT COUNTRIES (cont.) INDIA (cont..)  A committee of three reputed doctors to be nominated by the Bench, who will give report regarding the condition of the patient.  Before giving the verdict a notice regarding the report should be given to the close relatives and the State.  After hearing the parties, the High Court can give its verdict.
  61. 61. SUMMARY 11PART
  62. 62. SUMMARY  Euthanasia refers to acts which terminate or shorten life painlessly in order to end suffering where there is no prospect of recovery.  Euthanasia is the most active area of research in contemporary bioethics.  Secular humanists advocate in a lot of circumstances voluntary euthanasia is the morally right course of action.
  63. 63. SUMMARY (cont..)  But many religious people, however, think that euthanasia is always morally wrong, regardless of whether the suffering person really wants to die.  Euthanasia can be active or passive, voluntary or involuntary.  Passive euthanasia remains legal in many nations, whereas, active euthanasia remains legal in some and while in others it may be criminalized.  Passive euthanasia is legal in India.
  64. 64. ANY QUESTIONS?
  65. 65. REFERENCES  Euthanasia.com. Euthanasia Pros and Cons. Web. 10 December 2011. <http://www.euthanasia.com/prosoncs.html>.  Kliment, O. Legalizace eutanázie v České republice. Bakalářská práce. Brno: Právnická fakulta MU, 2008. 36 p.  Marker, R. L., Hamlon, K. Euthanasia and Assisted Suicide: Frequently Asked Questions. 2010. Web. 10 December 2011. <http://www.patientsrightscouncil.org/site/frequently-asked-questions->.  Munzarová, M. Eutanazie, nebo paliativní péče? Praha: Grada Publishing, 2005. 108 p.  Munzarová, M. a kol. Proč NE eutanazii aneb Být, či nebýt? Kostelní Vydří: Karmelitánské nakladatelství, 2008. 87 p.  Náhlíková, J. Eutanázie – správná volba? Bakalářská práce. Brno: Fakulta pedagogická MU, 2008. 49 p.  Špinková, M., Špinka, Š. Euthanasie. Víme, o čem mluvíme? Praha: Hospicové občanské sdružení Cesta domů, 2006. 42 p.  P.N.Murkey & Konsam Suken Singh, J Indian Acad Forensic Med, 30(2) Euthanasia [Mercy Killing]
  66. 66. THANK YOU