Transcript Slide 1

Should patient assisted suicide be
allowed?
Under what circumstances?
Where do we draw the line for Euthanasia?
Mekhala Acharya
Jennifer Barb
March 6, 2007
Jeff Solka
BINF705
What is Euthanasia?
Euthanasia is inducing the painless death of a person for
reasons assumed to be merciful.
Euthanasia is the intentional killing by act or omission
of a dependent human being for his or her alleged
benefit. The key word here is "intentional". If death is
not intended, it is not an act of euthanasia.
(Henrickson and Martin 24)
What Euthanasia is NOT
There is no euthanasia unless the death is intentionally caused
by what was done or not done. Thus, some medical actions that
are often labeled "passive euthanasia" are no form of
euthanasia, since the intention to take life is lacking.
http://www.euthanasia.com/definitions.html
These are NOT euthanasia:
1.
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Not commencing treatment that would not provide a benefit
to the patient.
Withdrawing treatment that has been shown to be ineffective,
too burdensome or is unwanted.
The giving of high doses of pain-killers that may endanger
life, when they have been shown to be necessary.
Whats the right answer?
Timeline
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About 400 B.C. - The Hippocratic Oath: “I will give no deadly medicine to any
one if asked, nor suggest any such counsel
14th through 20th Century English Common Law: "the Anglo American
common law tradition disapproved of both suicide and assisting suicide."
19th Century United States: That suicide remained a grievous but nonfelonious.
1828 - Earliest American statute explicitly to outlaw assisting suicide
1920 The book "Permitting the Destruction of Life not Worthy of Life" was
published: This book helped support involuntary euthanasia by Nazi Germany.
1935: Voluntary Euthanasia Society was started.
1938: United States Hemlock Society established
1939: Nazi Germany: In October of 1939 amid the turmoil of the outbreak of war
Hitler ordered widespread "mercy killing" of the sick and disabled.
1995: Australia's Northern Territory approved a euthanasia bill
1998: U.S. state of Oregon legalizes assisted suicide
1999: Dr. Jack Kevorkian sentenced to a 10-25 year prison term.
2000: The Netherlands legalizes euthanasia
2002: Belgium legalizes euthanasia
2007:Italy No Disciplinary Action For Doctor In Right-To-Die Case
http://www.euthanasia.com/historyeuthanasia.html
Difference between euthanasia
and assisted suicide
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One way to distinguish them is to look at the last act – the act
without which death would not occur.
Using this distinction, if a third party performs the last act that
intentionally causes a patient’s death, euthanasia has occurred.
For example, giving a patient a lethal injection or putting a
plastic bag over her head to suffocate her would be considered
euthanasia.
On the other hand, if the person who dies performs the last act,
assisted suicide has taken place. Thus it would be assisted
suicide if a person swallows an overdose of drugs that has
been provided by a doctor for the purpose of causing death. It
would also be assisted suicide if a patient pushes a switch to
trigger a fatal injection after the doctor has inserted an
intravenous needle into the patient’s vein.
http://www.internationaltaskforce.org/faq.htm
Where is euthanasia legal
Oregon, the Netherlands, Belgium
 Oregon permits only assisted suicide
 The Netherlands and Belgium permit euthanasia and assisted
suicide
In 1995 Australia’s Northern Territory approved a euthanasia
bill. It went into effect in 1996 but was overturned by the
Australian Parliament in 1997. Also, in 1997, Colombia’s
Supreme Court ruled that penalties for mercy killing should be
removed. However the ruling does not go into effect until
guidelines, still to be drafted, are approved by the Colombian
Congress.
http://www.religioustolerance.org/euth1.htm
Some reasons why people may want
to end their life
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Depression - permanent solution to a temporary
problem
Chronic pain - poverty or lack health of health care
Terminal illness - can’t cover medical expenses
Serious disorder or disease - quality of life is very low
Continual care is needed - no longer can sustain their
own responsibilities and maintain their own life
Been told that they will die soon - why wait?
Future concerns with health – suicide is an option
Euthanasia terminology
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Assisted Suicide: providing a person with the means to end
his or her life.
Active euthanasia: taking a specific action to end a person's
life. (lethal injection)
Passive Euthanasia : withholding or withdrawing life
support, nutrition, or water without a person's consent, with the
specific intention of ending that person's life.
Doctor-assisted death: this term includes both physicianassisted suicide and active euthanasia performed by a
physician.
http://www.leaderu.com/orgs/tul/ott-euthanasia.html
Its in the Movies:
Is the movie “Million Dollar Baby”
propaganda for Euthanasia?
How it happens: …Hoping to bleed to death,
Maggie attempts suicide by biting her tongue.
She is unsuccessful. However, enough is
enough and Frankie makes the decision to
do the “right” thing and end Maggie’s suffering.
Frankie enters his friend’s room at night.
He kisses Maggie on the forehead,
disconnects her breathing tube and
injects a large does of adrenaline into
her I.V. He slips out of the room and
Maggie dies…
http://www.prisonplanet.com/articles/february2005/030205euthanasiapropaganda.htm
The movie:
“One True Thing”
The terminally ill mother with cancer
dies from a morphine overdose
“…finding a new respect for her mother and
the life she led, Ellen finds herself
contemplating euthanasia when Kate’s pain
reaches unbearable pain and her love for
life is extinguished. All of this sets the stage
for the interview with a district attorney over
her mother’s death, which serves as the
movie’s framework narrative…”
Another movie:
The English Patient
A burn victim receives an overdose of morphine from
his care giving nurse
Why didn't we notice euthanasia in
"The English Patient ?"
How it happens:
…when it's time for him to get another dose of pain
medication, he flicks a few extra vials sitting on the night
table toward Hana. She looks at him and says nothing.
Crying, she draws the overdose and gives it. He dies,
freeing her from her nursing duties and allowing her to
leave just at the time her new lover has been transferred…
http://en.wikipedia.org/wiki/The_English_Patient_(film)
It’s in the News
We all remember the Terry Schiavo case:
 Was this acceptable?
 Should they have disconnected her feeding
tube?
Terri and assisted death
Theresa Marie "Terri" Schiavo, died at 41 yrs old
-St. Petersburg, Florida, United States
-1990 – she collapsed and experienced cardiac and
respiratory arrest in her home
-suffered brain damage - dependent on a feeding tube
for 15 years
-Her diagnosis- persistent vegetative state (PVS)
“In 1998, Michael Schiavo, her husband and guardian,
petitioned the Pinellas County Circuit Court to
remove her feeding tube.”
http://en.wikipedia.org/wiki/Terri_Schiavo
Terri
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By March 2005, the legal history around the Schiavo case
included fourteen appeals and numerous motions, petitions,
and hearings in the Florida courts; five suits in Federal District
Court; Florida legislation struck down by the Supreme Court
of Florida; a subpoena by a congressional committee to qualify
Schiavo for witness protection; federal legislation (Palm
Sunday Compromise); and four denials of certiorari from the
Supreme Court of the United States.[1]
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She died at a Pinellas Park hospice on March 31, 2005, at the
age of 41.
A PBS frontline special
and 60 Minutes
Dr. Jack Kevorkian
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Dr. Kevorkian – an Armenian American
pathologist
advertised about death counseling in Michigan
newspapers in 1987
The right to die – he assisted in 130 patient
suicides between 1990-1998 – voluntary
euthanasia
His most famous quote: “dying is not a crime”
http://en.wikipedia.org/wiki/Jack_Kevorkian
Thomas Youk and Kevorkian
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Youk - an adult male with full decisional capacity who was in
the final stages of Amyotrophic lateral sclerosis (ALS- a
progressive, fatal neurodegenerative disease)
Youk provided his fully-informed consent on September 17,
1998, Kevorkian administered a lethal injection
Kevorkian was sentenced to 10 to 25 years for second-degree
murder in the 1998 poisoning of Thomas Youk, 52, of Oakland
County, Michigan.
Kevorkian filmed the procedure and the death and submitted it
for broadcast on 60 Minutes
WAS THIS ACCEPTABLE?
Should he have been sentenced to 10-25 years in
prison??
http://en.wikipedia.org/wiki/Jack_Kevorkian
The debate continues
"The fundamental question about euthanasia:
Whether it is a libertarian movement for
human freedom and the right of choice, or an
aggressive drive to exterminate the weak, the
old, and the different, this question can now be
answered. It is both." ... Richard Fenigsen,
Dutch cardiologist”
Joffe bill
The Assisted Dying for the Terminally Ill Bill seeks to allow
doctors to assist a patient who is requesting suicide to do so.
Those opposed to the bill - among them Care Not Killing believe it will simply put vulnerable people at risk of early
death.
The Joffe bill if passed it will enable 'an adult who has
capacity and who is suffering unbearably as a result of a
terminal illness to receive medical assistance to die at his own
considered and persistent request'. Put simply it seeks to
legalize physician assisted suicide (PAS), along the lines of the
Oregon Death with Dignity Act
The film
http://www.carenotkilling.org.uk/?show=315
Case study
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Although euthanasia is illegal in the UK, there are some grey
areas. A doctor can legally give a person an overdose of an
opiate like morphine - even if they know it will kill the patient.
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As long as the intention is to ease suffering, they cannot be
prosecuted for murder. Known as the principle of "double
effect", many doctors admit that they have done this - even
that their motives were mixed.
http://news.bbc.co.uk/2/hi/health/1983457.stm
The Diane Pretty case
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Diane Pretty was said to be terminally ill with motor neuron
disease . She was in extreme pain and regularly begged for her
life to be ended.
She had lost her ability to move her muscles - including, eventually,
those controlling speech and breathing. The 42-year-old wanted
to end her life – but because of the immobilizing nature of motor
neuron, despite the clarity of her thoughts, she lacked the capacity
to perform the act.
Diane
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This is what brings her into conflict with the law. Her husband,
Brian, wants to help her die, but faces possible prosecution
should he do so - with a maximum potential jail term of 14
years?
She decided she couldn't wait for the disease to take its course
and face a death she believed would be distressing and
deprived of all dignity and control.
After their appeal was dismissed in the British courts, Diane
traveled on a nine-hour ambulance journey to the European
Court of Human Rights in Strasbourg - to ask for the right to
die.
What life?
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In an interview with BBC, Diane told about her quality of
life.
When she wanted to say something she would make a noise
something like a cross between a grunt and a moan. Or make
a movement with her eyes to indicate what she was after.
Someone to move her arm. Or scratch her eyebrow. Or wipe
her eyes. Or suction the saliva out of her mouth because she
couldn't clear her own throat.
Or fetch a bowl so she could be sick. Or massage her legs
because they'd gone into spasm. Or change her catheter bag
or her incontinence pad.
When asked whether life isn't always better than death she
replied: "I am dead". When asked about her quality of life,
she replied simply: "What life?"
Health care providers
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One of the most important developments in recent years is the increasing
emphasis placed on health care providers to contain costs.
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In the United States alone, millions of people have no medical insurance
and studies have shown that the elderly, the poor and minorities are often
denied access to needed treatment or pain control.
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Savings to governments could become a consideration. Drugs for assisted
suicide cost about $35 to $45, making them far less expensive than
providing medical care.
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Legalized euthanasia or assisted suicide raises the potential for a
profoundly dangerous situation in which the "choice" of assisted suicide or
euthanasia is the only affordable option for some people.
Humane Med. 1993 Oct;9(4):320-1.
Forced into euthanasia?
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There is absolutely nothing in the Oregon law to prevent
HMOs, managed care companies, doctors or anyone else from
suggesting, encouraging, offering, or bringing up assisted
suicide with a patient who has not asked about it.
In 63% of the deaths reported, fear of being a burden was
expressed as a reason for requesting assisted suicide.
The concern about "being a burden" could serve as a powerful
force that could influence the decision .
Even the smallest gesture could create a gentle nudge into the
grave . The Hemlock Society designed cards to be given to
those who are terminally ill. It read "I learned you’ll be leaving
us soon”
http://www.internationaltaskforce.org/faq.htm
What about pain?
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Everyone – whether a person with a life-threatening illness or
a chronic condition – has the right to pain relief. With modern
advances in pain control, no patient should ever be in
excruciating pain.
If a patient who is under a doctor’s care is in excruciating pain,
there’s definitely a need to find a different doctor. But that
doctor should be one who will control the pain, not one who
will kill the patient.
There are board certified specialists in pain management who
can not only help alleviate physical pain but who are also
skilled in providing necessary support to deal with emotional
suffering and depression that often accompany physical pain.
http://www.euthanasia.com/reasonsforeuthanasia.html
Predicting death
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The assisted suicide bill applies to those with a "terminal
disease" that is "incurable and irreversible" and will "produce
death within 6 months".
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Predicting death is an inexact science at best. Doctors can and
do make mistakes. And there is no requirement that death be
expected to occur despite provision of lifesaving medical
treatment.
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Therefore people with diabetes, kidney disease, or respiratory
failure (they are terminally ill but will not die within six
months) could be candidates for assisted suicide. In other
words, the bill could apply to those with permanent
disabilities.
http://www.mainerighttolife.com/euthanasia.php
The right to die
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Euthanasia is not simply a question of ending someone's life. The important
question is how that person's life ends. If someone can choose euthanasia,
they don't have to think about the worry and the suffering only. They can
also focus on the things they really want to do, like taking a last trip, or
making up a fight with someone in the family, or saying goodbye. The
pressure on that person becomes lighter when they know they won't have to
go on suffering. Often, people who have chosen euthanasia have such
peace of mind that they die naturally anyway.
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In fact Dr Gerrit Kimsma, from the Netherlands, supports the option of
voluntary euthanasia. He talks to them often about different treatments and
ways to relieve their pain, so that they know about all the choices, not just
euthanasia.
Dr Kimsma admits that in the case of euthanasia there is a conflict between
two of his goals as a doctor: the goal of saving life, and the goal of helping
people who are suffering. He believes that helping people is the morally
right thing to do. "My patients can be sure that I will not let them suffer
unnecessarily alone. That is my goal and duty as a physician.“
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"A Careful Death" : New Internationalist April 1997
The Impact of Euthanasia on
Society
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Euthanasia is a complex matter, there are many different types of
euthanasia, each of which has it’s own advantages and disadvantages. It can
be said that all types of euthanasia have an impact on society - or perhaps
society has an impact on them.
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People suffering from terminal diseases are often faced with the prospect of
experiencing great deals of pain as the disease progressively worsens until
it kills them. This prospect may be so frightening for them that they would
rather end their lives before they have to face it.
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The ethical question is whether people should be given assistance in killing
themselves, or if they should be forced to suffer the pain and indignity
caused by terminal illness.
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If it's only people that want to die that are going to be affected then why
should other people be worried? We have certain rights as individuals, but
society has rights of it's own as well: the rights of an individual must not
interfere with the rights of another.
Whipp, M. (2000). Euthanasia - a Good Death? Cambridge: Grove books.
Euthanasia and society
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The British Medical Association (BMA) considers that
acceptance of euthanasia as an option could exercise a
detrimental effect on societal attitudes and on the doctorpatient relationship, jeopardizing in particular, the fate of
vulnerable individuals.
Doctors take the Hippocratic oath - pledging to do no harm,
the legalization of euthanasia would mean that doctors would
take on an additional role, alien to the traditional one of healer.
The doctor patient relationship is based on mutual trust, it is
feared that this trust may be diminished if euthanasia was
legalized.
Patients may fear that their doctor will kill them if it is decided
that their life is no longer worth living. There is also a fear of
the reverse situation - patients taking greater autonomy over
their own treatment and lives will compromise the autonomy
of doctors
Whipp, M. (2000). Euthanasia - a Good Death? Cambridge: Grove books.
Euthanasia and family
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The concept of suffering being good for caregivers raises
another issue – the effect it has on the family of the patient.
Loved ones, friends and family are all going to be involved in
the dying process, in the case of slowly progressing diseases
they may have to watch the symptoms get worse over a long
period of time.
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They will be involved right to the end, by which time they may
be greatly distressed or traumatized. Doctors and hospital staff
have the advantage of being used to seeing such things and
having clinical detachment, friends and family do not. If
euthanasia were an option, the family of the patient (as well as
the patient himself) could be spared a great deal of distress.
When do we draw the line?
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The consequences of legalizing euthanasia could be profound, but it is
thought that only a small number of people would request it, many would
be reassured that the option would be available if their condition were to
become unbearable later on. When abortion was legalized, however, it was
predicted that it too would only be used by a very small number of women.
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Advances in medical treatments have enabled us to keep people artificially
alive, using respirators and methods of artificial feeding. Drugs used to try
and control diseases can be very expensive; chemotherapy treatments used
in the fight against cancer, for example, cost a great deal of money.
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There comes a point where these treatments are no longer offering
therapeutic benefits, and they are merely prolonging the dying process. If
the patient were to request euthanasia such treatments would not be given,
thus saving a considerable amount of money. This money could be used to
provide resources for people who have a chance of surviving, improving
hospital facilities, buying more equipment - it could be used in ways that
would save lives. People choosing euthanasia would in fact be helping
society.
Rachels, J. (1986). The End of Life, Euthanasia and Morality. Oxford: Oxford University Press.
Safeguards
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One of the most worrying issues in this debate is that of the socalled 'slippery slope'. The BMA said that "by removing legal
barriers to the previously 'unthinkable' and permitting people to be
killed, society would open up new possibilities of action"
Thus what may start out as a safe system which allows terminally ill
patients to end their lives on their own terms whilst protecting the
vulnerable members of society, may degenerate to a system where
"eventually laws will be created to allow the state to kill anyone that
it deems to be worthless"
Safeguards would have to be put in place, these would make sure
that assistance in committing suicide would only be given to people;
with terminal illnesses, who feel that their life is not worth living
(because of unbearable pain, loss of dignity, loss of capability), who
repeatedly ask for assistance in committing suicide, and who are of
sound mind and not depressed. These safeguards should ensure that
people aren't requesting it because they feel pressured to, and it
might also identify people with depression who would otherwise
commit suicide and allow them to be treated.
(1997). Last Rights? Assisted Suicide and Euthanasia Debated. (ed. M. Uhlmann).
Key points
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A request for assisted Suicide is typically a cry for help.
Suicidal Intent is typically transient. Of those who attempt
suicide but are stopped, less than 4 percent go on to kill
themselves in the next five years; less than 11 percent will
commit suicide over the next 35 years.
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Terminally Ill patients who desire death are depressed and
depression is treatable in those with terminal illness.
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Pain is controllable. Modern medicine has the ability to
control pain. A person who seeks to kill him or herself to avoid
pain does not need legalized assisted suicide but a doctor
better trained in alleviating pain.
You don't solve problems by getting rid of the people to whom
the problems happen. The more difficult but humane
solution to human suffering is to address the problems.
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Source: Suicide Factsheets, NRLC Dept. of Medical Ethics
Do we have a consensus?
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In conclusion then, euthanasia is a complex issue. There are
many pros and cons towards legalizing euthanasia, it would
give people greater autonomy over their own lives and give
terminally ill people a chance to avoid great pain and
emotional distress.
However, it begins the degradation of the prohibition of
murder, and opens up the possibility of further erosion of the
system.
The Select Committee report summed up the issue as follows;
"The death of a person affects the lives of others, often in ways
and to an extent which cannot be foreseen. We believe that the
issue of euthanasia is one in which the interest of the
individual cannot be separated from the interest of society as a
whole".
http://www.nt.gov.au/lant/parliament/committees/rotti/rotti.shtml