Euthanasia - Assisted Suicide

Fatalistic Suicide, Altruistic Suicide, Egoistic Suicide, Anomic Suicide

Euthanasia refers to the practice of ending a life in a painless manner. The term Euthanasia is from the Greek, meaning "good death": eu- (well or good) + thanatos (death). In 1937, doctor-assisted euthanasia was declared legal in Switzerland as long as the doctor ending the life had nothing to gain.

Extreme suffering may make an individual feel that the only way to find escape is suicide. It would be similar to fatalistic suicide because the individual considers himself condemned by fate or doomed. A fatalistic situation calling for suicide as a solution or escape.

The euthanasia discourse takes account of the meaning we construct for our lives and the lives of others.

Euthanasia and physician-assisted suicide have been the focus of debate and controversy for a long time now. Leading figures like Clarence Darrow and Jack London advocated for the legalization of euthanasia.

We have voluntary euthanasia and involuntary euthanasia. Involuntary euthanasia occurs where an individual makes a decision for another person incapable of doing so. Here it is similar to coup de grâce or a "death blow" given to end the misery of a dying enemy or friend. There is also euthanasia machines available for voluntary euthanasia.

Euthanasia may be passive, non-active, and active. Passive euthanasia occurs where common treatments are avoided or withheld knowing that it may also result in death. Passive euthanasia is a common practice in most hospitals. Non-active euthanasia occurs life support is withdrawn and is very controversial. Active euthanasia occurs with the use of lethal substances or forces to kill and is highly controversial.

The term "assisted suicide" is contrasted with "active euthanasia" when the difference between providing the means and actively administering lethal medicine is considered important.

In Germany Nazis conducted a euphemistically named "euthanasia program" code-named Action T4 based on eugenics and grounded in the view that the state is responsible for providing racial hygiene.Even though this program was referred to as an "euthanasia program", the Nazi German use of the term euthanasia differs from the current use of the term.

The term "right to die" refers to the idea that a person with a terminal illness and in serious condition should be allowed to commit suicide and is often referred to as dying with dignity. The question of who should be empowered to make these decisions is still being debated.

Assisted Suicide, Suffering and the Meaning of a Life
Miles Little, Department of Surgery, University of Sydney, Sydney, 2006, NSW, Australia E-mail
Journal, Theoretical Medicine and Bioethics, Volume 20, Number 3 / June, 1999
Abstract The ethical problems surrounding voluntary assisted suicide remain formidable, and are unlikely to be resolved in pluralist societies. An examination of historical attitudes to suicide suggests that modernity has inherited a formidable complex of religious and moral attitudes to suicide, whether assisted or not. Advocates usually invoke the ending of intolerable suffering as one justification for euthanasia of this kind. This does not provide an adequate justification by itself, because there are (at least theoretically) methods which would relieve suffering without causing the physical death of the suffering person. Carried to extremes, these methods would finish the life worth living, but leave a being which was technically alive. Such acts, however, would provide no moral escape, since they would create beings without meaning. Arguments seeking to justify ending the lives of others need some grounding in concepts of the meaning of a life. The euthanasia discourse therefore needs to take at least some account of the meaning we construct for our lives and the lives of others.

Euthanasia: Issues Implied Within - D. Gupta, S. Bhatnagar & S. Mishra : Euthanasia: Issues Implied Within . Internet Journal of Pain, Symptom Control and Palliative Care. 2006 Vol 4 Num 2
Abstract: Euthanasia is defined as “a deliberate act undertaken by one person with the intention of ending life of another person to relieve that person's suffering and where the act is the cause of death”. Assisted suicide is defined as “the act of intentionally killing oneself with the assistance of another who deliberately provides the knowledge, means, or both”. In ‘physician-assisted suicide' (PAS) a physician provides the assistance. The present literature –based review article is prepared with the aims (1) to understand the genesis of the idea of euthanasia (2) to peek into the historical chronology related to this idea (3) to learn the arguments and counter arguments given for this idea (4) to look into the patient's perspective related to his request for death (5) to know the global scenario regarding euthanasia, and (6) to generate an awareness about the concept behind euthanasia – more than ‘legal medical death'. In ancient Greece and Rome, euthanasia was an everyday reality. The proposals for euthanasia revived in the 19th century with the revolution in the use of anesthesia. It has been claimed that advances in life-sustaining medical technology have renewed interest in euthanasia again. Fear of being kept alive by technology along with the extrapolation of anesthetics to make death easier have been the facilitators for this renewal of debates on euthanasia. The arguments and justifications advanced both for and against euthanasia have hardly changed in over a century, that is, human right born of self-determination versus fear of ‘slippery slope'. Looking from patient's perspective, the patient asks for death when his psychological purview changes from ‘why me' to ‘what next'. Physical symptoms rarely serve as primary or sole motivation for death request. Instead individual values appear to have primary role to play. An avoidance or immediate refusal runs the risk of adversely affecting the patient's care. The motivation behind patient's request should be explored and a deeper understanding should be reached. Globally, Netherlands in 2001 and Belgium in 2002 have legalized euthanasia. Oregon, USA has legalized only PAS in 1997. Northern territory of Australia was the first to legalize euthanasia in 1995 and first to repeal the act in 1997. According to Swiss penal code, suicide is not a crime and assisting suicide is a crime if and only if the motive is selfish. It condones assisting suicide for altruistic reasons. In conclusion, the people practicing medicine should have an analytical viewpoint while having a debate on euthanasia. There is a need to understand the arguments and counter arguments given for euthanasia so that formal guidelines can be worked out regarding this vital issue, for the primary goal of all the medical practitioners is to infuse control in all patients to live gracefully and to die peacefully.
Introduction
Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. Euthanasia is defined as “a deliberate act undertaken by one person with the intention of ending life of another person to relieve that person's suffering and where the act is the cause of death”. Euthanasia may be ‘voluntary', ‘non-voluntary' or ‘involuntary'. Euthanasia is voluntary when the suffering person has requested and consented for ending life. It is non-voluntary when the suffering person has neither requested nor consented for ending life. And it is involuntary when the suffering person has requested contrary to ending life. Assisted suicide is defined as “the act of intentionally killing oneself with the assistance of another who deliberately provides the knowledge, means, or both”. In ‘physician-assisted suicide' (PAS) a physician provides the assistance.

Euthanasia - a critique - Siegler, Mark, Singer, Peter A., Massachusetts Medical Society, The New England Journal of Medicine
Abstract: Euthanasia (literally, a 'good death') refers to the assisted death of terminally ill patients at the hands of another person. Three recent developments indicate that public awareness is focusing on this issue: a recently published first-person account of euthanasia, an attempted legislative initiative to permit euthanasia in California, and permission for doctors in the Netherlands to aid suffering patients in this manner if certain stringent criteria are met. Physicians in this country, however, are urged to reject arguments favoring euthanasia, which is defined as the "deliberate action by a physician to terminate the life of a patient". This is distinguished from several other kinds of situations a physician may face, including withholding life-supporting treatment; administration of analgesics for pain relief; 'assisted suicide', in which a doctor prescribes lethal drugs, but does not administer them; and 'mercy killing' by a patient's family or friends. Supporters of euthanasia believe doctors should terminate the lives of willing patients who are in extreme pain. People should not have to end their lives hooked up to modern life-sustaining equipment. According to this view, the individual has the right to determine his or her own medical care, including physician-administered death. However, such individual interests must be weighed against the public good. Arguments against euthanasia are based on its dangers if made part of public policy, and its violation of the ethical norms of medicine. If euthanasia became part of public policy, it could be performed on people against their wishes. The ways this could happen are described, some of which are unique to the United States and not applicable to a country such as Holland. Euthanasia is a profound violation of medical norms and undermines the basic definition of the term 'physician'. To resist pressure toward euthanasia, physicians need to respond more to dying patients' needs and to offer them the pain management they need. In the ultimate case, if euthanasia were to be legalized, physicians should refuse to practice it. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dealing with requests for euthanasia: a qualitative study investigating the experience of general practitioners
Journal of Medical Ethics 2008;34:150-155; BMJ Publishing Group Ltd & Institute of Medical Ethics. VU Medical Center, Department of Public and Occupational Health, Institute for Research in Extramural Medicine, The Netherlands
ABSTRACT: Background: Caring for terminally ill patients is a meaningful task, however the patient’s suffering can be a considerable burden and cause of frustration.
Objectives: The aim of this study is to describe the experiences of general practitioners (GPs) in The Netherlands in dealing with a request for euthanasia from a terminally ill patient.
Methods: The data, collected through in-depth interviews, were analysed according to the constant comparative method.
Results: Having to face a request for euthanasia when attempting to relieve a patient’s suffering was described as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs (14/30) strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient’s suffering without "intentionally hastening a patient’s death on his request". The other GPs (16/30) explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient’s request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient’s suffering through euthanasia and their personal values.
Conclusion: Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient’s suffering and to promote a peaceful death.

Should euthanasia be legal? An international survey of neonatal intensive care units staff
M Cuttini, V Casotto, M Kaminski, I de Beaufort, I Berbik, G Hansen, L Kollée, A Kucinskas, S Lenoir, A Levin, M Orzalesi, J Persson, M Rebagliato, M Reid, R Saracci and other members of the EURONIC Study Group
Objective: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation.
Design: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hungary, and the Baltic countries) or random sampling (in France, Germany, Italy, Spain, and the United Kingdom); 1391 doctors and 3410 nurses completed an anonymous questionnaire (response rates 89% and 86% respectively).
Main outcome measure: The staff opinion that the law in their country should be changed to allow active euthanasia "more than now".
Results: Active euthanasia appeared to be both acceptable and practiced in the Netherlands, France, and to a lesser extent Lithuania, and less acceptable in Sweden, Hungary, Italy, and Spain. More then half (53%) of the doctors in the Netherlands, but only a quarter (24%) in France felt that the law should be changed to allow active euthanasia "more than now". For 40% of French doctors, end of life issues should not be regulated by law. Being male, regular involvement in research, less than six years professional experience, and having ever participated in a decision of active euthanasia were positively associated with an opinion favouring relaxation of legal constraints. Having had children, religiousness, and believing in the absolute value of human life showed a negative association. Nurses were slightly more likely to consider active euthanasia acceptable in selected circumstances, and to feel that the law should be changed to allow it more than now.
Conclusions: Opinions of health professionals vary widely between countries, and, even where neonatal euthanasia is already practiced, do not uniformly support its legalisation.

Voluntary Active Euthanasia and the Nurse: a comparison of Japanese and Australian nurses - Noritoshi Tanida, Atsushi Asai, Motoki Ohnishi, Shizuko K Nagata, Tsuguya Fukui, Yasuji Yamazaki, Helga Kuhse
Nursing Ethics, Vol. 9, No. 3, 313-322 (2002)
Although euthanasia has been a pressing ethical and public issue, empirical data are lacking in Japan. We aimed to explore Japanese nurses’ attitudes to patients’ requests for euthanasia and to estimate the proportion of nurses who have taken active steps to hasten death. A postal survey was conducted between October and December 1999 among all nurse members of the Japanese Association of Palliative Medicine, using a self-administered questionnaire based on the one used in a previous survey with Australian nurses in 1991. The response rate was 68%. A total of 53% of the respondents had been asked by patients to hasten their death, but none had taken active steps to bring about death. Only 23% regarded voluntary active euthanasia as something ethically right and 14% would practice it if it were legal. A comparison with empirical data from the previous Australian study suggests a significantly more conservative attitude among Japanese nurses.

Trends in acceptance of euthanasia among the general public in 12 European countries (1981–1999)
Joachim Cohen, Isabelle Marcoux, Johan Bilsen, Patrick Deboosere, Gerrit van der Wal and Luc Deliens - The European Journal of Public Health Advance Access published online on Apr 26, 2006
Background: We wanted to examine how the acceptance of euthanasia among the general public in Western Europe has changed in the last decades, and we wanted to look for possible explanations. Methods: We analysed data from the European Values Surveys, held in 1981, 1990, and 1999–2000 in 12 West European countries. In each country, representative samples of the general public were interviewed using the same structured questionnaire in all countries. Euthanasia was explained in the questionnaires as ‘terminating the life of the incurably sick’. Results: A total of 46 199 respondents participated in the surveys. A significant increase in acceptance of euthanasia could be observed in all countries except (West) Germany. While the average increase in euthanasia acceptance was 22%, the increase was particularly obvious in Belgium, Italy, Spain, and Sweden. Although changes in several characteristics of respondents, such as decrease in religious beliefs, rising belief in the right to self-determination, and (to a lesser extent) rise in levels of education, were associated with growing acceptance of euthanasia, they could only partly explain the increase of euthanasia acceptance over the years. Conclusions: An increase of euthanasia acceptance among the general public took place over the last two decades in almost all West European countries, possibly indicating a growing support for personal autonomy regarding medical end-of-life decisions. If this trend continues, it is likely to increase the public and political debate about the (legal) regulation of euthanasia under certain conditions of careful medical practice in several West European countries.

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