Legalising Voluntary Euthanasia

Legalising Voluntary Euthanasia

Once you accept killing as a solution for a single problem, you will find tomorrow hundreds of problems for which killing can be seen as a solution - Dr Karel F. Gunning MD – President for World Federation of Doctors Who Respect Human Life

Medical technological advancement has achieved a point where it is difficult to determine the “natural endpoint” of human life. Facing with surmounting level of terminal incurable diseases such as cancer, it is often cited that medical intervention is only prolonging a life not worth living, a life filled with suffering; a life without dignity. In this light, many call for the legalisation of euthanasia or mercy-killing where patients’ suffering is alleviated completely through death; but is that an apt solution? Although euthanasia is only legal in Netherlands, Belgium, Luxembourg and two states in United States of America: Washington and Oregon, the debates on legalisation of such practice are mounting in countries such as Canada, Australia and New Zealand to name a few (Euthanasia, 2012).

Voluntary euthanasia refers to "a medically assisted quick painful death at the request of and in the interest of the patient" (South Australian Voluntary Euthanasia Society, 2010). With proper guidelines and checks, legalising euthanasia means giving the rights to doctors to perform such act in the interest of the patient. But the problem begins when it is difficult to validate such claim especially when 1,000 patients were killed each year in Holland through euthanasia without consent or without request from the patients (Onwuteaka-Philipsen et. al., 1991).

With that in mind, will doctors place patient's interest foremost when euthanasia is requested or will their own judgement cloud the decision involving the life of an innocent human being? What is more important will patients know the alternatives solution to manage their pain or will euthanasia be the easy way out? Surrounded by all these questions, I believe euthanasia should not be legalised as it will place unimaginable power in the hands of medical practitioners and it creates an easy exit path way for both medical practitioners and patient.

Euthanasia places unimaginable power in the hands of medical practitioners. In the plight of suffering and pain, doctor is the person of authority in eyes of a patient which means their explanation and decision hold more weight in patient’s decision making. This places a lot of power in the hand of a doctor especially when patient sometimes are unaware of the situation they are in. In a study conducted in 2001, 13% of those surveyed in Britain prefers to leave it up to doctor to decide what kind of information they prefer to disclose (Jenkins, Fallowfield &  Saul, 2001) and as high as 40% of terminally ill patient in Singapore had not been informed of their prognosis (Lee & Wu, 2002) this limits the possibility of patients in having a second opinion of their situation hence placing their end-of life decision based primarily on a single prognosis. It is not unheard of that doctors make a wrong prognosis time to time. In 1993, Jane Plant asked her doctor to end her life when she was told that she only had 2 months to live; 18 years later she is a breast cancer survivor with 6 grandchildren (Dailymail, 2011). What if Jane Plant listened to her doctor’s prognosis and opted for euthanasia would she still be alive today?

                A doctor’s judgement can certainly determine whether a patient live or not. With euthanasia as an available mean, it can be wielded at the discretion of the doctor with little guideline adhere to. In Netherland, for a person to qualify for euthanasia, a doctor has to assess the patient’s mental competence and decides whether the decision in terminating their life comes from thorough understanding of the implication and stems from own decision. There is no requirement for the doctor to find second opinion other than consulting another experienced colleague (Ko, 2010). At a Death, Dying and Euthanasia Conference at the University of Queensland, a Dutch doctor cited the case of a woman in her eighties who was lonely after her husband’s death:

“We used to visit her every week,” the doctor said. “And every week she’d say to us, ‘Please give me a lethal injection.’ So after about three months we did.”

The doctor concluded, “It was a terrible situation. She had nothing to live for. She had no family. Her friends had all died. Her husband who had been the centre of her life in every way was gone.”

Interestingly, the conference speaker responded, “Did you think about buying her a cat?” To which the doctor replied seriously, “What a good idea!” (Lansdown, 2007)

This case certainly highlighted how much easier doctors can administer a lethal dose to anyone as and when he deems fit, without much effort to think of a viable alternative solution. Basing on just the lady’s request and his own judgement, the doctor deemed that the patient is fit to choose death because of her bleak living condition. Such is the power that euthanasia will grant to doctors if it was legalised.

The above case clearly shows that euthanasia will eventually create an easy exit pathway for both patient and doctor alike.  By having death as a legal choice, it amplifies the sense of hopelessness in terminal patients because they have the right to choose death as a viable option instead of fighting the pain. It is certainly surprising that the main reason for euthanasia is not because of unbearable pain. Although it is a motivating factor, according to the data published by Oregon, only 22% expressed pain as a concern and most cited “losing autonomy” (90%) and “loss of dignity” (82%) (Oregon Public Health Division, 2012).

From this data and many others, it was concluded that psychological issues were the underlying factor in end of life decisions. This fact was confirmed by Dutch researchers in a study conducted on 138 terminally ill cancer patients. They found out that depressed patients were four times more likely to request euthanasia and of the 44% that requested euthanasia, half were depressed (van der Lee et al., 2005). Legalising euthanasia will give an easy escape route for patient as they can easily choose death instead of addressing their psychological concerns. It creates a culture of giving up and doctors are there to validate this feeling instead of solving the issue either through psychological intervention or by addressing the pain through palliative care which is what the patient need most.

It is surprising to see that even with high level of palliative care in most part of the developed world many patients still do not have proper access to a proper palliative care. In studies about cancer patients’ pain control, result consistently shows that half of patients receive inadequate analgesia and 30% do not receive appropriate drugs for their pain (Goudas et. al., 2001). This stems from several issues including doctor’s baseless anxieties about opioids and general lack of knowledge, insufficient training and exposure to pain management (Brennen, Carr & Cousins, 2007). Given this situation, with legalisation of euthanasia, doctor will have less incentive to strengthen their knowledge in pain management and just opt for the easy way out: death.

In conclusion, legalising euthanasia opens the flood gate to many practices that bring more harm than good to the society. It is already very selfish to end a life thought to be meaningless, what is even more selfish is to implicate medical practitioners and even relatives in the act of taking that life, legally. In essence suicide is not illegal and the means of doing it is available but what is illegal is abetting someone in that act, at least for now. By legalising euthanasia, it allows doctor to be the point of authority to decide whether a man fits to die and that is against the principle of medicine.  “I will give no deadly medicine to any one if asked, nor suggest any such counsel” such was written in the Hippocratic Oath and what euthanasia advocates are asking is to go against that principle for the “right to die” of individual. Is it really the right to die or just an excuse to give up? Now due to doctor’s unwillingness to participate in physician assisted suicide, proponents of euthanasia is progressing toward a path where medical personnel is not needed but instead professionals whose job will be to terminate a person life at their request (W. J. Smith, 2012). This is the start of a very steep slippery slope.

References

Brennan, F., Carr, D. B., & Cousins, M. (2007). Pain management: a fundamental human rights.Anesthesia & Analgesia, 105(1), 205-221. doi:10.1213/01.ane.0000268145.52345.55.

Emanuel, E. J. (2005). Depression, euthanasia, and improving end-of-life care. Journal of Clinical Oncology, 23(27), 6456-6458. doi:10.1200/JCO.2005.06.001.

Euthanasia (n.d.). Euthanasia. Euthanasia.com. Retrieved September 9, 2012, from http://www.euthanasia.com/

Gunning MD, K. F. (1997). Why Not Euthanasia. Schreeuw om Leven - Abortus. Retrieved September 9, 2012, from http://www.schreeuwomleven.nl/Publications/Ec3/GunK9701.htm

Jenkins, V., Fallowfield, L., & Saul, J. (2001). Information needs of patients with cancer: results from a large study in UK cancer centres. British Journal of Cancer, 84(1), 48-51. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2363610/pdf/84-6691573a.pdf.

Ko, J. (2010). Legalization of euthanasia violates the principles of competence, autonomy, and beneficence. BC Medical Journal, 52(2), 92-94.

Lansdown, A. (2007). If people were dogs & other false arguments for euthanasia. Life Ministries. Retrieved September 9, 2012, from http://lifeministries.org.au/pamphlets.php?content_id=63

Lee, A., & Wu, H. Y. (2002). Diagnosis Disclosure in cancer patients – when the family says “No!”. Singapore Medical Journal, 43(10), 533-538.

Nicholas, S. (2011, January 22). Told they had terminal cancer and had as little as weeks to live, the miracle survivors' club have proved the doctors wrong | Mail Online. Dailymail. Retrieved September 9, 2012, from http://www.dailymail.co.uk/femail/article-1349105/Told-terminal-cancer-little-weeks-live-miracle-survivors-club-proved-doctors-wrong.html

Onwuteaka-Philipsen, B. D., Van der Heide, A., Koper, D., Keij-deerenberg, I., C. Rietjens, J. A., Rurup, M. L., . . . Van der Maas, P. J. (2003). Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. The Lancet, 1 - 5. Retrieved from http://image.thelancet.com/extras/03art3297web.pdf.

Oregon Public Health Division (2012). Characteristics and end‐of‐life care of DWDA. Public Health Division Home | Public Health. Retrieved September 9, 2012, from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year14-tbl-1.pdf

SAVES (2010). South Australian Voluntary Euthanasia Society. South Australian Voluntary Euthanasia 

Society. Retrieved September 9, 2012, from http://www.saves.asn.au/resources/facts/fs06.php

Smith, W. J. (2012, July 26). Euthanasia Backers Now Want Assisted Suicide Without Doctors | LifeNews.com. LifeNews.com - The Pro-Life News Source. Retrieved September 9, 2012, from http://www.lifenews.com/2012/07/26/euthanasia-backers-now-want-assisted-suicide-without-doctors/

Van der Lee, M. L., Van der Bom, J. G., Swarte, N. B., M. Heintz, A. P., De Graeff, A., & Van den Bout, J. (2005). Euthanasia and depression: a prospective cohort study among terminally ill cancer patients. Journal of Clinical Oncology, 23(27), 6607-6612. doi:10.1200/JCO.2005.14.308.