Euthanasia

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Euthanasia (Greek: ευθανασία - ευ "good", θανατος death") is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end their suffering. This article discusses euthanasia in humans; a separate article covers animal euthanasia.

Euthanasia in the strict sense involves actively causing death (active euthanasia). This is in some cases legal in the Netherlands and Belgium, but in no other countries (as of 2005). Euthanasia in a wider sense includes assisting sufferers to commit suicide, in particular physician-assisted suicide; this is legal in a small number of jurisdictions.

Allowing death—e.g. by not providing life support or vital medication—is not considered euthanasia if it is the patient's wish. It is sometimes called passive euthanasia in cases where the patient is unable to make decisions about treatment. Living wills and Do Not Resuscitate orders are legal instruments that make a patient's treatment decisions known ahead of time; allowing a patient to die based on such decisions is not considered to be euthanasia.

Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment, with the exception of medication for symptom control (such as analgesia). It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.

Advocates of euthanasia generally insist that euthanasia should be voluntary, requiring informed consent, and that it should only be used in cases of terminal illness that cause unbearable suffering, or an eventual, complete loss of awareness. Its opponents challenge it on several ethical grounds, including a slippery slope argument that it is the first step towards compulsory euthanasia.

In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of disabled children and adults under the T-4 Euthanasia Program. This has tainted the word in German-speaking countries; the alternate term is the older "Sterbehilfe", which means "help to die".

Contents

Legislation and national political movements

Switzerland

Switzerland is the only country in which assisted suicide is legal, even if it is performed by a non-physician, provided there are no selfish reasons involved. Also, Switzerland is the only country which allows foreign citizens to be assisted to commit suicide, even if they are not physically but psychologically suffering. There is only one organization (Dignitas) that provides such help in dying. Euthanasia (mercy killing) is however illegal.

Australia

Euthanasia was legalized in Australia's Northern Territory, by the Rights of the Terminally Ill Act 1995. However, this law was soon made ineffective by an amendment by the Commonwealth to the Northern Territory (Self-Government) Act 1978. (The powers of the Northern Territory legislature, unlike those of the State legislatures, are not guaranteed by the Australian Constitution.) Three people had already been legally euthanised, however, before the Commonwealth government made this amendment.

Although it has for some time been a crime in most Australian states to assist another to commit suicide, prosecutions have been rare. In Queensland recently (2002) a group of relatives and friends who provided moral support to an elderly woman who committed suicide were extensively investigated by police, but no charges were laid.

Belgium

After an extensive discussion the Belgian parliament legalised euthanasia in late September 2002. The new legislation, however, institutes a complicated process, which has been criticized as an attempt to establish a bureaucracy of death. Nevertheless, euthanasia is now legal and its proponents in the country hope that it will stop many illegal practices (it is said that several thousand illegal acts of euthanasia have been carried out in Belgium each year).

Canada

On January 28, 2005, Marcel Tremblay of Kanata, Ontario held a press conference to announce plans to kill himself, saying his life with pulmonary fibrosis was unbearable. After attending his own living wake, the 78-year-old man committed suicide at 11:51 pm Eastern time.[1] He had previously said he would be surrounded by his wife and adult children while he placed a bag over his head and filled it with helium. Tremblay said that he publicized his suicide plans to help change laws over assisted suicide. His lawyer said police were satisfied that Tremblay had a sound mind and that authorities would not intervene. Canada decriminalized committing suicide and attempting to commit suicide in 1972.

In the early 1990s, 42-year-old Sue Rodriguez, who had amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), fought to overturn the law against assisted suicide. She lost her court battle, but died by assisted suicide with the help of an anonymous doctor. Under Canada's Criminal Code, assisted suicide is illegal and punishable by up to 14 years in prison.

The Netherlands

In the Netherlands the Termination of Life on Request and Assisted Suicide (Review Procedures) Act took effect on April 1, 2002. It legalizes euthanasia and physician assisted suicide in certain circumstances.

The law recognized a practice that had been tolerated for some 20 years. From the time that euthanasia first came to be widely practiced in the Netherlands, it was formally subject to review by boards of doctors in each hospital. The law essentially codified what had already become tolerated practice and unofficial law by judgments in the courts.

The law permits euthanasia and physician assisted suicide when each of the following conditions is fulfilled:

  • the patient has asked repeatedly
  • the patient's suffering is unbearable with no prospect of improvement
  • the doctor has consulted an independent colleague prior to the act
  • the patient is at least 12 years old; patients between 12 and 16 years of age require consent of their parents

The doctor must also report the cause of death to the municipal coroner in accordance with the relevant provisions of the Burial and Cremation Act. A regional review committee assesses whether a case of termination of life on request or assisted suicide complies with the due care criteria. Depending on its findings, the case will either be closed or brought to the attention of the Public Prosecutor. Finally, the legislation offers an explicit recognition of the validity of a written declaration of will of the patient regarding euthanasia (a "euthanasia directive"). Such declarations can be used when a patient is in a coma or otherwise unable to state whether they want euthanasia or not.

The legislation has wide support among the socially libertarian Dutch, who have one of the world's highest life expectancies. There is however persistent opposition, mainly organized by the churches.

Euthanasia remains a criminal offense in cases not meeting the law's specific conditions, with the exception of several situations that are not subject to the restrictions of the law at all, because they are considered normal medical practice:

  • stopping or not starting a medically useless treatment
  • stopping or not starting a treatment at the patient's request
  • speeding up death as a side-effect of treatment necessary for alleviating serious suffering

Euthanasia of children under the age of 12 remains technically illegal, however Dr. Eduard Verhagen has documented several cases and, together with colleagues and prosecutors, has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this Groningen protocol is followed.

Statistics and methods

In 2003, in the Netherlands 1626 cases were officially reported of euthanasia in the sense of a physician causing death (1.2% of all deaths). Usually the sedative sodium thiopental is intravenously administered to induce a coma. After making sure the patient is in a deep coma, typically after some minutes, a muscle relaxant is administered to stop the breathing and cause death.

Officially reported were also 148 cases of physician assisted suicide (0.14% of all deaths), usually by drinking a strong (10g) barbiturate potion. The doctor is required to be present for two reasons:
  • to make sure the potion is not taken by a different person, by accident (or, theoretically, for "unauthorized" suicide or perhaps even murder)
  • to monitor the process and be available to apply the combined procedure mentioned below, if necessary.

In two cases the doctor was reprimanded for not being present while the patient drank the potion. They did not realize that this is required.

Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case of vomiting, the muscle relaxant is administered to cause death.

By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.

Note that some medical authorities and investigative reporters claim there are substantial numbers of euthanasias in the Netherlands performed without consultation or official notice - see links below.

Oregon (United States)

Oregon Law, passed in 1997, states an individual must meet the following criteria:

1) 18 years of age or older,

2) a resident of Oregon,

3) capable of making and communicating health care decisions for him/herself, and

4) diagnosed with a terminal illness that will lead to death within six (6) months.

Note: It is up to the attending physician to determine whether these criteria have been met.


Statistics and methods

In 2003, in Oregon 42 cases of physician assisted suicide were reported (0.14% of all deaths), all by drinking a strong barbiturate potion, usually 9g of Pentobarbital. The doctor is not required to be present; in 12 cases he/she was.

Since 1998, 171 Oregonians have relied on the assisted suicide law.

There were three cases of regurgitation. In each case at least one third of the potion was retained, which caused death anyway, though in one case only after 48 hours.

The time from ingestion to unconsciousness was 1 to 20 minutes (median 4 minutes), the time from ingestion to death 5 minutes to 48 hours (median 20 minutes).

By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.

See also

External links

For euthanasia
Against euthanasia
Netherlands
Oregon
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