INTRODUCTION as mercy-killing, is defined as “painless killing of

INTRODUCTION

In the past few decades, the consideration of euthanasia has become a
more public debate in developed nations. Euthanasia had prevalence since the
times of the ancient Greeks, where it was practiced by doctors and the subject appeared
in multiple plays and philosophical texts. (13) Euthanasia, also known as
mercy-killing, is defined as “painless
killing of a patient suffering from an incurable and painful disease”. (5)
It is planned cessation of life and is carried out by administering a patient a
lethal dose of a drug by a physician to achieve a peaceful and painless death.

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Contrary to this, physician- assisted suicide is where the doctor in charge
will provide the lethal dose to the patient and they will administer the
medication themselves. (5) In
today’s world some countries,
such as the Netherlands have legalized euthanasia whereas in the United Kingdom (UK) this debate has been ongoing since the 1870’s.

(Kemp 2002, 3)   Currently, healthcare professionals in the UK
cannot euthanize nor counsel and advise someone of euthanasia; if this occurs
it is considered manslaughter or murder and the physician responsible can face
up to 14 years in jail (1)Understandably, the opposing views and the threat of legislation abuse
along with opposition from the church makes it difficult for the passing of
euthanasia in England;
therefore it has become an off-limits subject. Looking at the ethical
standpoint, there are many arguments that support euthanasia. From a
utilitarian standpoint, giving people the right to choose how they die will
make their last few days happier and will ease their anticipation of a painful
death. In support to their argument, the libertarians will argue that as long
as no one else’s rights are hindered then
people interfering with someone’s choice of euthanasia is unjustified. (1)

 

            The
manifestation of a terminal disease is out of a patient’s control and thus sentencing them into a life of
suffering would be cruel. When terminally ill patients ask for euthanasia many
of the reasons they use are: the pain, loss of dignity, and the inability to
look after themselves therefore becoming a burden on family. Additionally,
those that seek death through the healthcare system have most likely already
contemplated other modes of death, such as suicide.  (3) Euthanasia may be the
most beneficial treatment a patient can receive. For certain, within
vulnerability lies a spark of courage. A person that develops a terminal
illness, with time, turns into a vulnerable and dependent patient. This patient
will move in and out of hospital till one day they stop responding to
treatment. Knowing that the end is not going to be easy and definitely ridiculed
with pain, they are forced to put on a brave face till nature takes it course.

Not many people can understand the strength it takes for a patient to quietly
suffer till they take their last breath, and therefore it can be seen as unfair
to have healthy lawmakers decide the fate of those that this legislation will
primarily affect. For instance, Tony Nicklinson suffered a stroke which caused
the onset of “locked-in” syndrome, condemning him to be unable to
move a single muscle, therefore, a fully functioning mind was trapped in a
motionless, broken body. Tony had requested euthanasia and on two accounts was refused
by the British High Court, therefore when he was diagnosed with pneumonia he
took this chance and refused to take the antibiotics he was prescribed which ultimately
lead to his demise; an undignified and painful way to die. (9) An article
written by Tony Nicklinson’s daughter revealed the painful process of her
father’s battle with trying to get
access to euthanasia. She exclaimed that her father had shown great courage and
persistence while battling his fate. (10) As human beings when we see an animal
suffering and there are no methods of treatment available, to end their suffering
we pose to put them down; doing this is seen as humane. However, when a human
being is suffering and no treatment is available we deny them any access to
death; this is inhumane. However, many proactive thinkers argue, when looking
back a 100 years diseases that were seen as incurable and killed our ancestors
now have treatment options or are no longer present in today’s world. (6) If euthanasia was an option the ability
to understand these illnesses will die with the patient. Nevertheless, there is
no justification to prolong a patient’s
suffering, as a healthcare professional it is their duty to provide treatment
for the patient and not have pharmaceutical business in mind.

Looking at individuals whom
have accidently harmed themselves, the pain provokes them to say, “if only I would die”. Though this statement disappears after some painkillers
or a period of treatment, patients that are always in pain with no option of
treatment can have this constantly running through their minds; this pain can
become as bad as to immobilize them and steal the essence of living. On the
flipside, to define insufferable pain there is no method or scale that allows
consultants to measure pain. (6) The pain threshold of one patient will not be
identical to another’s, therefore, one can argue
that creating a set criteria will be difficult. Yet, in Accident and Emergency
we manage to get patients to scale their pain from one to ten; dealing with
each patient individually. Similarly, when dealing with euthanasia each case of
pain due to terminal illness must be treated individually and taken into
consideration; this will allow for a justified result.

When treating a patient,
their will is of utmost importance and that the patient has the full right to
control what happens to their body. (7) Voluntary
euthanasia allows patients that are bedridden and feel as if a burden on
family, to die a peaceful and dignified death. 
On the other hand, when a patient is unable to give consent and further
treatment is not an option, a trusted, assigned next of kin can make the
judgement; it is upon the attending physician to provide the necessary
information for the individual to make an informed decision. One of the
underlying problems is that the government is unable to pass legislation that
can predict and prevent the misuse of a euthanasia law. As the chairman of the
house of Lords, Lord Walton exclaimed “it is virtually impossible to ensure that all acts of
euthanasia are truly voluntary”. (7) This can be argued
that no law passed can be perfect, with use, amendments will be made to any fill
loop holes. Furthermore, a law does not prevent crimes from occurring; murder,
rape and theft occur repeatedly in the UK regardless of laws. Likewise, making
euthanasia illegal will not stop it from happening. Legalization of euthanasia
will allow a wider spread of knowledge of ‘what it is’ and other
alternatives that can be used instead.

Additionally,
people argue that decisions can be influenced and the rate of euthanasia will
sky rocket. However, a study conducted in the Netherlands by the New England
Journal of Medicine presented that a decade before the legalization of
euthanasia 0.4% cases of euthanasia were acted on, whereas ten years prior to
the legalization of euthanasia 0.8% of cases were carried out; therefore, by
legalizing euthanasia we can save more lives. Furthermore, in the UK roughly
57,000 patients are removed from life support and put on pain management till
their demise; (9) therefore doctors already practice euthanasia without its
label. Therefore, the legalization of euthanasia can protect doctors from legal
action that may ensue and ensure that a synthetic death is also the patient’s will.

Nevertheless,
human beings are known to be indecisive and therefore it is understood that
people change their minds frequently and that it is possible for it to occur
after deciding to end one’s life. As a medical practitioner, when administering the
lethal dose, they should confirm that this is what the patient wants; if there
is any uncertainty then to immediately stop the procedure. If euthanasia is
legalized then it would be ideal to train specialists in the procedure of euthanasia
that can read physical, emotional and verbal cues of uncertainty; having
trained professionals will also be beneficial in educating the patient and
family about what it really means to end one’s life and the following
implications. It is important to assure that the patient has the right support
and information when making the decision.

 

COURAGE IN EUTHANASIA

It is considered that a doctor’s job is to preserve life as the Hippocratic oath states
that as a doctor one shall do no harm. (11) Additionally, it is also believed
that a doctor’s job is to
relieve the patient of pain.  As a
physician, it can be difficult to justify your moral standpoint of ending a
life. Many people believe that the right to end someone’s life is not in their
hands, this can be controversial due to the fact that religion and culture are
influencing a doctor’s ability in
providing maximum care. Depending on the strength of their beliefs, they can
refuse to administer such lethal doses; however, they should refer the patient
to a doctor that is more willing to participate in the action. Having courage
in a health care setting can be defined as acting despite of fear and having
the confidence in one’s actions
and thoughts. This can be challenging especially when one’s ideas of euthanasia does not match
those of their colleagues. Looking at the Dutch government as guidance, they
have set out extensive criteria in which multiple elements must match for
euthanasia to take place. As one of their clauses, any doctor has the right to
refuse to carry out euthanasia. (16) This clause allows physicians that do not
want to participate in the act, to wilfully decline.

Furthermore, due to the fact that it is illegal to advise a
patient about euthanasia in the UK, it takes a large amount of courage and persistence
in not helping them with their query; as it is in a doctor’s nature to provide the maximum
amount of information and help with patient questions. On the contrary, there
is enormous amount of courage when a physician goes against their moral code to
carry out the last wishes of their patient; to know when to stop treating a
patient and therefore following through with it. Moreover, a doctor can assess
a patient and acknowledge that that no treatment is available to restore their
quality of life. Though the physician sees the situation in this way, it is wrong of a him or her to suggest
to a patient that euthanasia is an option left for them. If a patient were to
make such a choice, it should be an uninfluenced decision to request such an
extreme form of treatment

            Physicians will face a dilemma each
time they encounter a patient requesting euthanasia, however, it is important
to recognize the courage of the patient. Death is feared by many people around
the globe, many fear that a painful and undignified death is what is held for
them. (9) Much like anyone else, this is also the driving force with many
patients that request death from their healthcare team. Death not only means
the end of pain, it also means leaving loved ones behind, things they have
worked hard to achieve and perhaps unattained hopes and dreams; allowing us to
conclude that it takes a great amount of courage not only to come to a decision
to end one’s life but
also acting on it.

 

 VULNERABILITY
IN EUTHANASIA

Many people assume that if
euthanasia is legalized those that are vulnerable will be put at a higher risk.

People that are included in this are the elderly, children, those that cannot
communicate their wishes, such as comatose patients. Looking at the countries
that have legalized euthanasia, it is only accessible to those that are
terminally ill.  In the Dutch clauses,
for a patient to access euthanasia, a patient’s suffering must be prolonged and have no possibility in
cure, additionally a second physician unrelated to the case must give a
secondary opinion on the patient’s
eligibility. (12) This eliminates the possibility of having euthanasia incidents
that are unnecessary, however, it is necessary for safeguards to be put in
place. Furthermore, assuring that only patients that are terminally ill have
access to such medical measures can assure that those that are elderly and not
in need of pain relieving death are at risk. Furthermore, the process of
acquiring legal consent for euthanasia would be lengthy, which may prevent
people from going through the process. Furthermore, many argue that the elderly
may feel pressure undergo euthanasia. Conversely, the message that should be
sent to those deemed vulnerable in society is that they have ample support and
do not need to feel pressured into seeking euthanasia. (12)

 Looking at patients that are comatose and on
life support, if no treatment is available and according to a doctor’s judgement euthanasia is the humane thing to
do, a family member should be involved in making the decision alongside the
courts. This would prevent doctor’s
from acting out their own will when they have no family to contact, because as
a doctor it would seem unjust to make that decision without knowing the choices
of the family. If legalized, this as a clause can prevent family members from
taking legal action against doctors that were acting “in the best interest of the patient”.  Our
society runs on strict rules that must be followed, and having some rules about
euthanasia are better than having nothing in place.

Vulnerability can also be
an emotional state. When a loved one is asking for death but is being denied
and the patient asks a family member to assist them, though completely healthy
they are put into a fragile position. In 1996, Paul Brady was being charged
with murder of his brother whom had been suffering from Huntingdon’s disease: a
neurodegenerative disorder. However, it was found that his brother had
requested that his brother assist him in his suicide. (15) When a family member
or a patient wants to find comfort in death, this can cause destructive, emotional
consequences on those that are forced to standby. While the political debate on
euthanasia is stretched by religious and ethical arguments, a major focus of
the public is death with dignity. (2) A vast number of people are worried about
the abuse towards the vulnerable, is one of the major reasons as to why it hasn’t
been legalized in many countries. However, some people argue that this alone
should not take away someone’s right of dignity in death and that legislation
that is passed should have effective methods of safeguarding those are seen to
be at high risk. (12)

 

CONCLUSION

Euthanasia has been a
controversial issue for decades. People that want to leave this planet earlier
than their set time, always have an influencing factor that significantly
impacts their quality of life. These can vary from neurodegenerative diseases to
being fully immobilised. Doctors, patients and loved ones display a vast amount
of courage when faced with such a contentious subject. However, this ongoing
debate seems to resolve nothing and therefore continues to make patients with
the poorest quality of life suffer longer; making them more vulnerable than
they already are.

In the UK, where even the
discussion of euthanasia is prohibited for healthcare professionals makes it
difficult when a patient demands for it. Additionally, knowing that a patient wants
such action, if capable, they will try at commit suicide within their homes. Home
suicide attempts, if they fail, can result in more damage done. Having a trusted
place to go to for information and advice can ensure that patients have a
painless death or can even deter from wanting it. Not only can this benefit
terminally ill patients but it can bring forward people that simply want to
commit suicide for mental health reasons. The ability to advise patients about
euthanasia gives medical professionals the room to identify whether it is a cry
for help or if it is someone’s painful struggle with untreatable illness that
drives them.