Medical issues in Euthanasia, and Suicide

The whole are of the management of the terminal phase of illness and the end of life is one in which medical practice is, of necessity, deeply involved. the manner in which the patient dies, whether in acute illness or in longer term chronic illness, may even be something of a touchstone for the quality of medical care. Since the dawn of the profession, doctors have been involved in dying; relieving its distresses, seeking to support tha patient in the process, whether long or short.

Acceptance of Death One of the most difficult disciplines for the physician or surgeon is to come to terms with the ultimate failure of all the therapeutic measures available to them and with which they have practiced. Death may be posponed, even avoided, but not ultimately evaded. If it is difficult for the doctor to countenance death, seeing it as the ultimate failure of art and skill, it would be even more difficult for the doctor to see him or herself as the personal agent of that failure. The wise and experienced doctor will certainly seek to use the skills of medicine to alleviate the pains and distresses of death, and indeed to make the process of dying as free of distress as possible for the terminally ill person.

Suicide
Suicide, although not an offence in law, is perceived among the most negative of emergencies to be handled in the casulaty and intensive care areas of general hospitals and, while compassion and understanding are readily extended to the unsuccessful victim, that sympathy and understanding are directed towards the person, rather than towards the act. The suicide of a patient who has been under regular care, whether terminally ill, psychiatrically depressed or in severe distress for other reasons, is a particular trauma to most health care professionals who may carry, in addition to the sense of failure when the patient dies, an equally distressing feeling that in some way they have failed that person while they were still alive and still amenable to supportive help.

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Suicide: the taking of one's own life

While no change has occured in the definition of suicide, it would appear that public condemnation of suicide as an act is less than in previous times. Suicide is still recognised by most people as a tragedy but not a sin. This may be related to change in the personal view of life and death and of one's responsibility for life associated with a widespread rejection of Christian views and values. Even prior to 1961, when suicide ceased to be a crime in Enmgland, suicide was not criminal in Scotland. The position of the Church of Scotland on suicide remains clear. It offers compassion and understanding rather than condemnation.

Non Voluntary Euthanasia

Non voluntary Euthanasia is ending the life of a person who lacks the capacity either to know or express his or her own wishes as to continued existence. Such a situation would arise in infants; in patients with severe brain damage or dementia; in severly mentally impaired people; and in people in a persistant vegetative state. The distinction between 'involuntary' and 'non-voluntary' is more than academic since the person in the former case would be capable of making a decision if given the opportunity. It is particularly important to bear in mind the situation of infants and children in terminal or severe illness and handicap.

Much of the debate concerning euthanasia revolves around adults, notably the elderly and the younger adult with progressive illness, but the problems may arise just as acutely at the earlier stages of life. the law is, in fact, the same for every age.

Koelzer and Brittingham: The Ethics & standards of Euthanasia and Palliative Care

Viktor Koelzer and Sara Brittingham have presented an excellent overview of the ethics and standards of euthanasia and palliative care

This is an article recently published on The Lancet Student. The authors review research that shows that there is alot of insecurity and misinformation in the provision of end-of-life care amongst medical staff. As the authors are medical students themselves they speak with knowledge about the need to have more information about end-of-life issues in order to develop their skills and confidence on dealing with terminally ill patients. The authors then go on to review the historical, ethical and leval aspects of palliative care and voluntary euthanasia in Europe. They reiterate their emphasis on compassion and respect in the provision of end-of-life care whilest respecting and adhering to the law and the ethical principles of our society. Koelzer and Brittingham then proceed to compare and contrast palliative care approaches with voluntary euthanasia approaches. They authors present contrasting approaches to addressing issues such as pain management, patient autonomy, spiritual support and communication.

Both voluntary euthanasia and palliative care options currently co-exit in Europe. It is clear that each country within the EU is addressing this issue in relation to its cultural and ethical framework, however, what seems clear if that some elements such as the Hippocratic oath and a common Judeo-Christian perspective are prevalent within the palliative care approaches in Europe. The authors state their view as follows

..."In the early stages of medicine, hardly any disease could be cured; instead, the patients were accompanied and comforted, trying to palliate suffering (10). One of the earliest medical codices, the Hippocratic Oath (400 B.C.), stated that doctors must never “give deadly medicine to anyone if asked nor suggest any such counsel”. This definite statement leads us to assume that disagreements about medically assisted death were already a matter of debate during this time. With the rise of Christianity in Europe, arguments against VE were further based on religious beliefs. Thomas Aquinas(approx. 1225-1274), one of the most important Catholic scholars of the middle ages stated in his main work “Summa Theologiae” that not only killing but also suicide was a capital sin, and emphasized the Christian virtues of “caritas” (Lat. benevolence) and “misericordia” (Lat. mercy) in the care of patients. In our opinion these values are still central in palliatice care today, emphasizing the Christian roots of the palliative care movement.

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This is thoughtful article for anyone interested in this debate.

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Different kinds of euthanasia? Some Definitions

The last post mentioned the need to examine the language that we are using to refer to end of life issues and in particular euthanasia. The different forms of euthanasia are futher explored in the following article from the BBC.

Active Euthanasia is doing something, such as giving a drug with the intention to bring about death.

Passive Euthanasia is the deliberate shortening of life through an omission to act. The term "passive euthanasia" is applied quite inapprorpiately to treatment withdrawal, where the treatment concerned is proving ineffective in achieving recovery and should rightly be stopped. Neither the withdrawal of inappropriate treatment nor the decision to refrain from using it can correctly be called euthanasia. These decisions are the expression of good clinical judgement.

A failure by a doctor to provide a patient with treatment thought by responsible medical opinion to be necessary in the circumstances, could well be a criminal omission, whereas at the other end of the scale, no doctor need resport to 'heroic methods' to prolong life.

Voluntary Euthanasia: is ending the person's life at their specific request. this category has been at the centre of attempts to legalise euthanasia. The 'specific request' is currently interpreted by supporters of the procedure, not only as a request at the time of the distressing illness, but also in advance, for instance by means of a Living Will.
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CreditsThe picture of the lfying bird was done by Kashyap-HC

Changes in the Language of Dying: some definitions

The original definition of euthanasia derived from two Greek words, eu thanatos -'dying well' or 'good death'. This concept of an easy or good death is one in which the relief of symptoms is sufficient to allow the patient to continue normal relationships and cognitive thought right to the immediate pre-terminal phase of life, without the intrusion of pain or other distress. This original meaning has changed.

Today, euthanasia means deliberately terminating the life of another person by an act or omission in the context of terminal, painful or distressing illness. Mercy-Killing is also used, defining motivation as much as action. In the context of the euthanasia debate it is interesting that groups seeking the introduction of voluntary euthanasia and assisted suicide tend to use language which conceals the lethal nature of the acts proposed. One no longer commits suicide- one performas 'self-deliverance'. A physician under a "right to die" law would no longer gie a lethal injection, he would administer an "aid in dying measure" This quote is an excerpt from na book by Joni Eareckson Tada entitled When it is right to die?

We shall be exploring in the next few post different words and meanings within the end-of-life debate.



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Credits
The picture of the floating feather was taken by Lutz-R Frank

Why is Euthanasia such a hot topic?

The national increase in the number and proportion of elderly people in the population in Europe and in the UK is well documented. This is usually contrasted to the decrease of the younger population by a falling birth rate. Families are smaller; people travel and work abroad far more easily now than 20 years ago and our communities lack cohesion precisely because of the increased mobility. All of these factors have reduced the availability of potential carers for older and disabled people, throwing an ever greater load upon voluntary and statutory health-care and supportive services.

Medical advances, life-supporting technology and pharmacological solutions have increased the public’s expectation of life and the expectation of cure to the point that illness and death are less accepted as part of normal human experience. Our bodies are healthier, medical know-how is available to sustain life for longer spans and as a result, our society is living longer. In an ageing population, questions are being asked about our financial capacity to continue care at current or increased levels, and the option of voluntary euthanasia or physician assisted suicide is continuously being presented as an option. These issues are no longer discussed in the privacy of hospital rooms or churches, but under the public glare of the media. The public seems eager to know of the harrowing details of the very personal confrontation with death of individuals afflicted with pain and terminal illness.

In the UK, pressure for the introduction of euthanasia as a legally acceptable treatment is constant and a number of countries in Europe have already legalised assisted suicide options. However, what does this move towards seeing life as disposable, say about our society? Where have our cultural roots been filed in this ethical connundrum?

One of the primary and fundamental principles in the Judeo-Christian ethic is that of the sanctity of human life. This also applies in most other religious systems and it is enshrined in article 2 of the European Convention for the Protection of Human Rights and Fundamental freedoms, and in article 6 of the International Covenant of Civil and Political Rights. “You are precious in my eyes and I love you”. This could be the refrain of a popular love song, but it is not; it comes from the Hebrew Scriptures (Isaiah 43:4) and is one of the foundations to understanding a Christian approach to end-of-life issues.

How can honour and love be at the heart of the euthanasia debate? A Christian understanding of the value of human life derives from the belief that we are made in the image of God and that God loves, honours and respects us. There is something of the sacred within each one of us. Our lives, no matter how frail are not disposable.





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Credits
The photograph of the dying rose was taken by Zivash

Hello World

This blog has been created to examine a variety of issues surrounding the end of life debate. The pressure for the introduction of euthanasia as a legally accepted teatment option in the UK and internationally is prevalent. This blog will present current positions surrounding voluntary euthanasia and assisted suicide whilest being informed by a perspective that proposes compassion for patients and their carers through the strengthening of palliative care options.