Should patient assisted suicide be allowed? Under what circumstances?

Should patient assisted suicide be allowed?

Under what circumstances? Where do we draw the line for Euthanasia?

Mekhala AcharyaJennifer BarbMarch 6, 2007

Jeff SolkaBINF705

What is Euthanasia?What is Euthanasia?Euthanasia is inducing the painless death of a person for Euthanasia is inducing the painless death of a person for

reasons assumed to be merciful. reasons assumed to be merciful.

Euthanasia is the intentional killing by act or omission Euthanasia is the intentional killing by act or omission of a dependent human being for his or her alleged of a dependent human being for his or her alleged

benefit. The key word here is "intentional". If death is benefit. The key word here is "intentional". If death is not intended, it is not an act of euthanasia.not intended, it is not an act of euthanasia.

(Henrickson and Martin (Henrickson and Martin 24) 24)

What Euthanasia is NOTWhat Euthanasia is NOT

There is no euthanasia unless the death is intentionally caused There is no euthanasia unless the death is intentionally caused by what was done or not done. Thus, some medical actions that by what was done or not done. Thus, some medical actions that

are often labeled "are often labeled "passive euthanasiapassive euthanasia" are no form of " are no form of euthanasia, since the intention to take life is lackingeuthanasia, since the intention to take life is lacking. .

http://www.euthanasia.com/definitions.htmlhttp://www.euthanasia.com/definitions.html

These are These are NOTNOT euthanasia: euthanasia:

1.1. Not commencing treatment that would not provide a benefit Not commencing treatment that would not provide a benefit to the patient.to the patient.

2.2. Withdrawing treatment that has been shown to be ineffective, Withdrawing treatment that has been shown to be ineffective, too burdensome or is unwanted.too burdensome or is unwanted.

3.3. The giving of high doses of pain-killers that may endanger The giving of high doses of pain-killers that may endanger life, when they have been shown to be necessary.life, when they have been shown to be necessary.

Whats the right answer?

TimelineTimeline About 400 B.C. - The Hippocratic Oath: “About 400 B.C. - The Hippocratic Oath: “I will give no deadly medicine to any one if asked, I will give no deadly medicine to any one if asked,

nor suggest any such counselnor suggest any such counsel 14th through 20th Century English Common Law:14th through 20th Century English Common Law: "the Anglo American common law "the Anglo American common law

tradition disapproved of both suicide and assisting suicide." tradition disapproved of both suicide and assisting suicide." 19th Century United States: 19th Century United States: That suicide remained a grievous but nonfelonious. That suicide remained a grievous but nonfelonious. 1828 - 1828 - Earliest American statute explicitly to outlaw assisting suicideEarliest American statute explicitly to outlaw assisting suicide 1920 The book "Permitting the Destruction of Life not Worthy of Life" was published: 1920 The book "Permitting the Destruction of Life not Worthy of Life" was published: This This

book helped support involuntary euthanasia by Nazi Germany.book helped support involuntary euthanasia by Nazi Germany. 19351935: Voluntary Euthanasia Society was started.: Voluntary Euthanasia Society was started. 19381938: United States Hemlock Society established: United States Hemlock Society established 19391939:: Nazi GermanyNazi Germany: : In October of 1939 amid the turmoil of the outbreak of war Hitler ordered In October of 1939 amid the turmoil of the outbreak of war Hitler ordered

widespread "mercy killing" of the sick and disabled. widespread "mercy killing" of the sick and disabled. 1995: 1995: Australia's Northern Territory approved a euthanasia billAustralia's Northern Territory approved a euthanasia bill 1998:1998: U.S. state of Oregon legalizes assisted suicide U.S. state of Oregon legalizes assisted suicide 1999:1999: Dr. Jack Kevorkian sentenced to a 10-25 year prison term. Dr. Jack Kevorkian sentenced to a 10-25 year prison term. 2000:2000: The Netherlands legalizes euthanasia The Netherlands legalizes euthanasia 2002:2002: Belgium legalizes euthanasia Belgium legalizes euthanasia 2007:2007:Italy No Disciplinary Action For Doctor In Right-To-Die CaseItaly No Disciplinary Action For Doctor In Right-To-Die Case

http://www.euthanasia.com/historyeuthanasia.htmlhttp://www.euthanasia.com/historyeuthanasia.html

Difference between euthanasia Difference between euthanasia and assisted suicideand assisted suicide

One way to distinguish them is to look at the last act – the act One way to distinguish them is to look at the last act – the act without which death would not occur.without which death would not occur.

Using this distinction, if a third party performs the last act that Using this distinction, if a third party performs the last act that intentionally causes a patient’s death, euthanasia has occurred. intentionally causes a patient’s death, euthanasia has occurred. For example, giving a patient a lethal injection or putting a For example, giving a patient a lethal injection or putting a plastic bag over her head to suffocate her would be considered plastic bag over her head to suffocate her would be considered euthanasia.euthanasia.

On the other hand, if the person who dies performs the last act, On the other hand, if the person who dies performs the last act, assisted suicide has taken place. Thus it would be assisted assisted suicide has taken place. Thus it would be assisted suicide if a person swallows an overdose of drugs that has suicide if a person swallows an overdose of drugs that has been provided by a doctor for the purpose of causing death. It been provided by a doctor for the purpose of causing death. It would also be assisted suicide if a patient pushes a switch to would also be assisted suicide if a patient pushes a switch to trigger a fatal injection after the doctor has inserted an trigger a fatal injection after the doctor has inserted an intravenous needle into the patient’s vein. intravenous needle into the patient’s vein.

http://www.internationaltaskforce.org/faq.htm

Where is euthanasia legalWhere is euthanasia legal

Oregon, the Netherlands, Belgium Oregon, the Netherlands, Belgium Oregon permits only assisted suicideOregon permits only assisted suicide The Netherlands and Belgium permit euthanasia and assisted The Netherlands and Belgium permit euthanasia and assisted

suicidesuicide

In 1995 Australia’s Northern Territory approved a euthanasia In 1995 Australia’s Northern Territory approved a euthanasia bill.  It went into effect in 1996 but was overturned by the bill.  It went into effect in 1996 but was overturned by the Australian Parliament in 1997. Also, in 1997, Colombia’s Australian Parliament in 1997. Also, in 1997, Colombia’s Supreme Court ruled that penalties for mercy killing should be Supreme Court ruled that penalties for mercy killing should be removed. However the ruling does not go into effect until removed. However the ruling does not go into effect until guidelines, still to be drafted, are approved by the Colombian guidelines, still to be drafted, are approved by the Colombian Congress.Congress.

http://www.religioustolerance.org/euth1.htm

Some reasons why people may want Some reasons why people may want to end their lifeto end their life

Depression - Depression - permanent solution to a temporary permanent solution to a temporary problemproblem

Chronic pain - Chronic pain - poverty or lack health of health carepoverty or lack health of health care Terminal illness - Terminal illness - can’t cover medical expensescan’t cover medical expenses Serious disorder or disease - Serious disorder or disease - quality of life is very lowquality of life is very low Continual care is needed - Continual care is needed - no longer can sustain their no longer can sustain their

own responsibilities and maintain their own lifeown responsibilities and maintain their own life Been told that they will die soon - Been told that they will die soon - why wait?why wait? Future concerns with health – Future concerns with health – suicide is an optionsuicide is an option

Euthanasia terminologyEuthanasia terminology Assisted Suicide:Assisted Suicide: providing a person with the means to end providing a person with the means to end

his or her life. his or her life. Active euthanasia:Active euthanasia: taking a specific action to end a person's taking a specific action to end a person's

life. (lethal injection)life. (lethal injection) Passive Euthanasia :Passive Euthanasia : withholding or withdrawing life withholding or withdrawing life

support, nutrition, or water without a person's consent, with support, nutrition, or water without a person's consent, with the specific intention of ending that person's life. the specific intention of ending that person's life.

Doctor-assisted death: Doctor-assisted death: this term includes both physician-this term includes both physician-assisted suicide and active euthanasia performed by a assisted suicide and active euthanasia performed by a physician.physician.

http://www.leaderu.com/orgs/tul/ott-euthanasia.html

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…

Its in the Movies:

http://www.prisonplanet.com/articles/february2005/030205euthanasiapropaganda.htm

The movie:The movie:“One True Thing”“One True Thing”

The terminally ill mother with cancerThe terminally ill mother with cancerdies from a morphine overdosedies 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:Another movie:The English PatientThe English Patient

http://en.wikipedia.org/wiki/The_English_Patient_(film)

A burn victim receives an overdose of morphine from A burn victim receives an overdose of morphine from his care giving nursehis care giving nurse

Why didn't we notice euthanasia in Why didn't we notice euthanasia in "The English Patient ?" "The English Patient ?"

How it happens:How it happens:……when it's time for him to get another dose of pain when it's time for him to get another dose of pain medication, he flicks a few extra vials sitting on the night medication, he flicks a few extra vials sitting on the night table toward Hana. She looks at him and says nothing. table toward Hana. She looks at him and says nothing. Crying, she draws the overdose and gives it. He dies, Crying, she draws the overdose and gives it. He dies, freeing her from her nursing duties and allowing her to freeing her from her nursing duties and allowing her to leave just at the time her new lover has been transferred… leave just at the time her new lover has been transferred…

It’s in the NewsIt’s in the News

We all remember the Terry Schiavo case:We all remember the Terry Schiavo case: Was this acceptable?Was this acceptable? Should they have disconnected her feeding Should they have disconnected her feeding

tube?tube?

Terri and assisted deathTerri and assisted deathTheresa Marie "Terri" Schiavo, died at 41 yrs oldTheresa Marie "Terri" Schiavo, died at 41 yrs old-St. Petersburg, Florida, United States -St. Petersburg, Florida, United States -1990 – she collapsed and experienced cardiac and -1990 – she collapsed and experienced cardiac and

respiratory arrest in her homerespiratory arrest in her home-suffered brain damage - dependent on a feeding tube -suffered brain damage - dependent on a feeding tube

for 15 yearsfor 15 years-Her diagnosis- persistent vegetative state (PVS)-Her diagnosis- persistent vegetative state (PVS)““In 1998, Michael Schiavo, her husband and guardian, In 1998, Michael Schiavo, her husband and guardian,

petitioned the Pinellas County Circuit Court to petitioned the Pinellas County Circuit Court to remove her feeding tube.”remove her feeding tube.”

http://en.wikipedia.org/wiki/Terri_Schiavo

TerriTerri By March 2005, the legal history around the Schiavo case By March 2005, the legal history around the Schiavo case

included fourteen appeals and numerous motions, petitions, included fourteen appeals and numerous motions, petitions, and hearings in the Florida courts; five suits in Federal District and hearings in the Florida courts; five suits in Federal District Court; Florida legislation struck down by the Supreme Court Court; Florida legislation struck down by the Supreme Court of Florida; a subpoena by a congressional committee to of Florida; a subpoena by a congressional committee to qualify Schiavo for witness protection; federal legislation qualify Schiavo for witness protection; federal legislation (Palm Sunday Compromise); and four denials of certiorari (Palm Sunday Compromise); and four denials of certiorari from the Supreme Court of the United States.[1]from the Supreme Court of the United States.[1]

She died at a Pinellas Park hospice on March 31, 2005, at the She died at a Pinellas Park hospice on March 31, 2005, at the age of 41.age of 41.

A PBS frontline specialA PBS frontline specialand 60 Minutesand 60 Minutes

Dr. Jack KevorkianDr. Jack Kevorkian Dr. Kevorkian – an Armenian American Dr. Kevorkian – an Armenian American

pathologistpathologist advertised about advertised about death counselingdeath counseling in Michigan in Michigan

newspapers in 1987newspapers in 1987 The right to dieThe right to die – he assisted in 130 patient – he assisted in 130 patient

suicides between 1990-1998 – voluntary suicides between 1990-1998 – voluntary euthanasiaeuthanasia

His most famous quote: His most famous quote: “dying is not a crime”“dying is not a crime”

http://en.wikipedia.org/wiki/Jack_Kevorkian

Thomas Youk and KevorkianThomas Youk and Kevorkian Youk - an adult male with full decisional capacity who was in Youk - an adult male with full decisional capacity who was in

the final stages of Amyotrophic lateral sclerosis (ALS- a the final stages of Amyotrophic lateral sclerosis (ALS- a progressive, fatal neurodegenerative disease) progressive, fatal neurodegenerative disease)

Youk provided his fully-informed consent on September 17, Youk provided his fully-informed consent on September 17, 1998, Kevorkian administered a lethal injection1998, Kevorkian administered a lethal injection

Kevorkian was sentenced to 10 to 25 years for second-degree Kevorkian was sentenced to 10 to 25 years for second-degree murder in the 1998 poisoning of Thomas Youk, 52, of Oakland murder in the 1998 poisoning of Thomas Youk, 52, of Oakland County, Michigan.County, Michigan.

Kevorkian filmed the procedure and the death and submitted it Kevorkian filmed the procedure and the death and submitted it for broadcast on 60 Minutesfor broadcast on 60 Minutes

WAS THIS ACCEPTABLE? WAS THIS ACCEPTABLE? Should he have been sentenced to 10-25 years in Should he have been sentenced to 10-25 years in

prison??prison??

http://en.wikipedia.org/wiki/Jack_Kevorkian

The debate continuesThe debate continues

""The fundamental question about euthanasia: The fundamental question about euthanasia: Whether it is a libertarian movement for Whether it is a libertarian movement for

human freedom and the right of choice, or an human freedom and the right of choice, or an aggressive drive to exterminate the weak, the aggressive drive to exterminate the weak, the

old, and the different, this question can now be old, and the different, this question can now be answered. It is both." ... Richard Fenigsen, answered. It is both." ... Richard Fenigsen,

Dutch cardiologist”Dutch cardiologist”

Joffe billJoffe bill

The The Assisted Dying for the Terminally Ill BillAssisted Dying for the Terminally Ill Bill seeks to allow seeks to allow doctors to assist a patient who is requesting suicide to do so. doctors to assist a patient who is requesting suicide to do so. Those opposed to the bill - among them Care Not Killing - Those opposed to the bill - among them Care Not Killing - believe it will simply put vulnerable people at risk of early believe it will simply put vulnerable people at risk of early death. death.

The Joffe bill if passed it will enable 'an adult who has The Joffe bill if passed it will enable 'an adult who has capacity and who is suffering unbearably as a result of a capacity and who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his own terminal illness to receive medical assistance to die at his own considered and persistent request'. Put simply it seeks to considered and persistent request'. Put simply it seeks to legalize physician assisted suicide (PAS), along the lines of the legalize physician assisted suicide (PAS), along the lines of the Oregon Death with Dignity ActOregon Death with Dignity Act

The filmThe film

http://www.carenotkilling.org.uk/?show=315

Case studyCase study Although euthanasia is illegal in the UK, there are some grey Although euthanasia is illegal in the UK, there are some grey

areas. A doctor can legally give a person an overdose of an areas. A doctor can legally give a person an overdose of an opiate like morphine - even if they know it will kill the patient.opiate like morphine - even if they know it will kill the patient.

As long as the intention is to ease suffering, they cannot be As long as the intention is to ease suffering, they cannot be

prosecuted for murder. Known as the principle of "double prosecuted for murder. Known as the principle of "double effect", many doctors admit that they have done this - even effect", many doctors admit that they have done this - even that their motives were mixed.that their motives were mixed.

http://news.bbc.co.uk/2/hi/health/1983457.stm

The Diane Pretty caseThe Diane Pretty case Diane Pretty was said to be terminally ill with motor neuron Diane Pretty was said to be terminally ill with motor neuron

disease . She was in extreme pain and regularly begged for her disease . She was in extreme pain and regularly begged for her life to be ended.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 capacityto perform the act.

DianeDiane This is what brings her into conflict with the law. Her husband, This is what brings her into conflict with the law. Her husband,

Brian, wants to help her die, but faces possible prosecution Brian, wants to help her die, but faces possible prosecution should he do so - with a maximum potential jail term of 14 should he do so - with a maximum potential jail term of 14 years?years?

She decided she couldn't wait for the disease to take its course She decided she couldn't wait for the disease to take its course and face a death she believed would be distressing and and face a death she believed would be distressing and deprived of all dignity and control.deprived of all dignity and control.

After their appeal was dismissed in the British courts, Diane After their appeal was dismissed in the British courts, Diane traveled on a nine-hour ambulance journey to the European traveled on a nine-hour ambulance journey to the European Court of Human Rights in Strasbourg - to ask for the right to Court of Human Rights in Strasbourg - to ask for the right to die. die.

What life?What life?

In an interview with BBC, Diane told about her quality of life.In an interview with BBC, Diane told about her quality of life. When she wanted to say something she would make a noise When she wanted to say something she would make a noise

something like a cross between a grunt and a moan. Or make a something like a cross between a grunt and a moan. Or make a movement with her eyes to indicate what she was after. movement with her eyes to indicate what she was after.

Someone to move her arm. Or scratch her eyebrow. Or wipe Someone to move her arm. Or scratch her eyebrow. Or wipe her eyes. Or suction the saliva out of her mouth because she her eyes. Or suction the saliva out of her mouth because she couldn't clear her own throat. couldn't clear her own throat.

Or fetch a bowl so she could be sick. Or massage her legs 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 because they'd gone into spasm. Or change her catheter bag or her incontinence pad.her incontinence pad.

When asked whether life isn't always better than death she When asked whether life isn't always better than death she replied: "I am dead". When asked about her quality of life, she replied: "I am dead". When asked about her quality of life, she replied simply: "What life?"replied simply: "What life?"

Health care providersHealth care providers One of the most important developments in recent years is the increasing One of the most important developments in recent years is the increasing

emphasis placed on health care providers to contain costs.emphasis placed on health care providers to contain costs.

In the United States alone, millions of people have no medical insurance 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 and studies have shown that the elderly, the poor and minorities are often denied access to needed treatment or pain control.denied access to needed treatment or pain control.

Savings to governments could become a consideration. Drugs for assisted Savings to governments could become a consideration. Drugs for assisted suicide cost about $35 to $45, making them far less expensive than suicide cost about $35 to $45, making them far less expensive than providing medical care. providing medical care.

Legalized euthanasia or assisted suicide raises the potential for a Legalized euthanasia or assisted suicide raises the potential for a profoundly dangerous situation in which the "choice" of assisted suicide or profoundly dangerous situation in which the "choice" of assisted suicide or euthanasia is the only affordable option for some people. euthanasia is the only affordable option for some people.

Humane Med. 1993 Oct;9(4):320-1.

Forced into euthanasia?Forced into euthanasia? There is absolutely nothing in the Oregon law to prevent There is absolutely nothing in the Oregon law to prevent

HMOs, managed care companies, doctors or anyone else from HMOs, managed care companies, doctors or anyone else from suggesting, encouraging, offering, or bringing up assisted suggesting, encouraging, offering, or bringing up assisted suicide with a patient who has not asked about it.suicide with a patient who has not asked about it.

In 63% of the deaths reported, fear of being a burden was In 63% of the deaths reported, fear of being a burden was expressed as a reason for requesting assisted suicide.expressed as a reason for requesting assisted suicide.

The concern about "being a burden" could serve as a powerful The concern about "being a burden" could serve as a powerful force that could influence the decision .force that could influence the decision .

Even the smallest gesture could create a gentle nudge into the Even the smallest gesture could create a gentle nudge into the grave . The Hemlock Society designed cards to be given to grave . The Hemlock Society designed cards to be given to those who are terminally ill. It read "I learned you’ll be those who are terminally ill. It read "I learned you’ll be leaving us soon”leaving us soon”

http://www.internationaltaskforce.org/faq.htm

What about pain?What about pain? Everyone – whether a person with a life-threatening illness or Everyone – whether a person with a life-threatening illness or

a chronic condition – has the right to pain relief. With modern a chronic condition – has the right to pain relief. With modern advances in pain control, no patient should ever be in advances in pain control, no patient should ever be in excruciating pain. excruciating pain.

If a patient who is under a doctor’s care is 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 there’s definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who doctor should be one who will control the pain, not one who will kill the patient.will kill the patient.

There are board certified specialists in pain management who There are board certified specialists in pain management who can not only help alleviate physical pain but who are also can not only help alleviate physical pain but who are also skilled in providing necessary support to deal with emotional skilled in providing necessary support to deal with emotional suffering and depression that often accompany physical pain.suffering and depression that often accompany physical pain.

http://www.euthanasia.com/reasonsforeuthanasia.html

Predicting deathPredicting death The assisted suicide bill applies to those with a "terminal The assisted suicide bill applies to those with a "terminal

disease" that is "incurable and irreversible" and will "produce disease" that is "incurable and irreversible" and will "produce death within 6 months". death within 6 months".

Predicting death is an inexact science at best. Doctors can and Predicting death is an inexact science at best. Doctors can and do make mistakes. And there is no requirement that death be do make mistakes. And there is no requirement that death be expected to occur despite provision of lifesaving medical expected to occur despite provision of lifesaving medical treatment. treatment.

Therefore people with diabetes, kidney disease, or respiratory Therefore people with diabetes, kidney disease, or respiratory failure (they are terminally ill but will not die within six failure (they are terminally ill but will not die within six months) could be candidates for assisted suicide. In other months) could be candidates for assisted suicide. In other words, the bill could apply to those with permanent words, the bill could apply to those with permanent disabilities.disabilities.

http://www.mainerighttolife.com/euthanasia.phphttp://www.mainerighttolife.com/euthanasia.php

The right to dieThe right to die Euthanasia is not simply a question of ending someone's life. The 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 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. 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 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. 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 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 have to go on suffering. Often, people who have chosen euthanasia have such peace of mind that they die naturally anyway. such peace of mind that they die naturally anyway.

In fact Dr Gerrit Kimsma, from the Netherlands, supports the option of In fact Dr Gerrit Kimsma, from the Netherlands, supports the option of voluntary euthanasia. He talks to them often about different treatments and 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 ways to relieve their pain, so that they know about all the choices, not just euthanasia.euthanasia.

Dr Kimsma admits that in the case of euthanasia there is a conflict between 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 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 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 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.“unnecessarily alone. That is my goal and duty as a physician.“

"A Careful Death" : New Internationalist April "A Careful Death" : New Internationalist April 19971997

The Impact of Euthanasia on The Impact of Euthanasia on SocietySociety

   Euthanasia is a complex matter, there are many different types of Euthanasia is a complex matter, there are many different types of

euthanasia, each of which has it’s own advantages and disadvantages. It 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 can be said that all types of euthanasia have an impact on society - or perhaps society has an impact on them. perhaps society has an impact on them.

People suffering from terminal diseases are often faced with the prospect People suffering from terminal diseases are often faced with the prospect of experiencing great deals of pain as the disease progressively worsens 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 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. would rather end their lives before they have to face it.

The ethical question is whether people should be given assistance in killing 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 themselves, or if they should be forced to suffer the pain and indignity caused by terminal illness.caused by terminal illness.

If it's only people that want to die that are going to be affected then why 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 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 society has rights of it's own as well: the rights of an individual must not interfere with the rights of another. interfere with the rights of another.

Whipp, M. (2000). Whipp, M. (2000). Euthanasia - a Good Death?Euthanasia - a Good Death? Cambridge: Cambridge: Grove books. Grove books.

Euthanasia and societyEuthanasia and society The British Medical Association (BMA) considers that acceptance The British Medical Association (BMA) considers that acceptance

of euthanasia as an option could exercise a detrimental effect on of euthanasia as an option could exercise a detrimental effect on societal attitudes and on the doctor-patient relationship, societal attitudes and on the doctor-patient relationship, jeopardizing in particular, the fate of vulnerable individuals.jeopardizing in particular, the fate of vulnerable individuals.

Doctors take the Hippocratic oath - pledging to do no harm, the Doctors take the Hippocratic oath - pledging to do no harm, the legalization of euthanasia would mean that doctors would take on legalization of euthanasia would mean that doctors would take on an additional role, alien to the traditional one of healer. The doctor an additional role, alien to the traditional one of healer. The doctor patient relationship is based on mutual trust, it is feared that this patient relationship is based on mutual trust, it is feared that this trust may be diminished if euthanasia was legalized. trust may be diminished if euthanasia was legalized.

Patients may fear that their doctor will kill them if it is decided that 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 their life is no longer worth living. There is also a fear of the reverse situation - patients taking greater autonomy over their own reverse situation - patients taking greater autonomy over their own treatment and lives will compromise the autonomy of doctors treatment and lives will compromise the autonomy of doctors Whipp, M. (2000). Whipp, M. (2000). Euthanasia - a Good Death?Euthanasia - a Good Death? Cambridge: Grove books. Cambridge: Grove books.

Euthanasia and familyEuthanasia and family The concept of suffering being good for caregivers raises The concept of suffering being good for caregivers raises

another issue – the effect it has on the family of the patient. another issue – the effect it has on the family of the patient. Loved ones, friends and family are all going to be involved in Loved ones, friends and family are all going to be involved in the dying process, in the case of slowly progressing diseases the dying process, in the case of slowly progressing diseases they may have to watch the symptoms get worse over a long they may have to watch the symptoms get worse over a long period of time. period of time.

They will be involved right to the end, by which time they They will be involved right to the end, by which time they may be greatly distressed or traumatized. Doctors and hospital may be greatly distressed or traumatized. Doctors and hospital staff have the advantage of being used to seeing such things staff have the advantage of being used to seeing such things and having clinical detachment, friends and family do not. If and having clinical detachment, friends and family do not. If euthanasia were an option, the family of the patient (as well as euthanasia were an option, the family of the patient (as well as the patient himself) could be spared a great deal of distress.the patient himself) could be spared a great deal of distress.

When do we draw the line?When do we draw the line? The consequences of legalizing euthanasia could be profound, but it is 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 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 reassured that the option would be available if their condition were to become unbearable later on. When abortion was legalized, however, it was 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.predicted that it too would only be used by a very small number of women.

Advances in medical treatments have enabled us to keep people artificially Advances in medical treatments have enabled us to keep people artificially

alive, using respirators and methods of artificial feeding. Drugs used to try alive, using respirators and methods of artificial feeding. Drugs used to try and control diseases can be very expensive; chemotherapy treatments used in and control diseases can be very expensive; chemotherapy treatments used in the fight against cancer, for example, cost a great deal of money. the fight against cancer, for example, cost a great deal of money.

There comes a point where these treatments are no longer offering There comes a point where these treatments are no longer offering therapeutic benefits, and they are merely prolonging the dying process. If the therapeutic benefits, and they are merely prolonging the dying process. If the patient were to request euthanasia such treatments would not be given, thus patient were to request euthanasia such treatments would not be given, thus saving a considerable amount of money. This money could be used to saving a considerable amount of money. This money could be used to provide resources for people who have a chance of surviving, improving provide resources for people who have a chance of surviving, improving hospital facilities, buying more equipment - it could be used in ways that hospital facilities, buying more equipment - it could be used in ways that would save lives. People choosing euthanasia would in fact be helping would save lives. People choosing euthanasia would in fact be helping societysociety..

Rachels, J. (1986). Rachels, J. (1986). The End of Life, Euthanasia and MoralityThe End of Life, Euthanasia and Morality. Oxford: Oxford University Press. . Oxford: Oxford University Press.

SafeguardsSafeguards One of the most worrying issues in this debate is that of the so-One of the most worrying issues in this debate is that of the so-

called 'slippery slope'. The BMA said that "by removing legal called 'slippery slope'. The BMA said that "by removing legal barriers to the previously 'unthinkable' and permitting people to be barriers to the previously 'unthinkable' and permitting people to be killed, society would open up new possibilities of action"killed, society would open up new possibilities of action"

Thus what may start out as a safe system which allows terminally ill 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 patients to end their lives on their own terms whilst protecting the vulnerable members of society, may degenerate to a system where vulnerable members of society, may degenerate to a system where "eventually laws will be created to allow the state to kill anyone that "eventually laws will be created to allow the state to kill anyone that it deems to be worthless" it deems to be worthless"

Safeguards would have to be put in place, these would make sure Safeguards would have to be put in place, these would make sure that assistance in committing suicide would only be given to people; that assistance in committing suicide would only be given to people; with terminal illnesses, who feel that their life is not worth living with terminal illnesses, who feel that their life is not worth living (because of unbearable pain, loss of dignity, loss of capability), who (because of unbearable pain, loss of dignity, loss of capability), who repeatedly ask for assistance in committing suicide, and who are of repeatedly ask for assistance in committing suicide, and who are of sound mind and not depressed. These safeguards should ensure that sound mind and not depressed. These safeguards should ensure that people aren't requesting it because they feel pressured to, and it people aren't requesting it because they feel pressured to, and it might also identify people with depression who would otherwise might also identify people with depression who would otherwise commit suicide and allow them to be treated. commit suicide and allow them to be treated.

(1997). (1997). Last Rights? Assisted Suicide and Euthanasia DebatedLast Rights? Assisted Suicide and Euthanasia Debated. (ed. M. . (ed. M. Uhlmann). Uhlmann).

Key pointsKey points A request for assisted Suicide is typically a cry for helpA request for assisted Suicide is typically a cry for help. . Suicidal Intent is typically transientSuicidal Intent is typically transient. Of those who attempt . Of those who attempt

suicide but are stopped, less than 4 percent go on to kill suicide but are stopped, less than 4 percent go on to kill themselves in the next five years; less than 11 percent will themselves in the next five years; less than 11 percent will commit suicide over the next 35 years. commit suicide over the next 35 years.

Terminally Ill patients who desire death are depressed and Terminally Ill patients who desire death are depressed and depression is treatable in those with terminal illness. depression is treatable in those with terminal illness.

Pain is controllablePain is controllable. Modern medicine has the ability to . Modern medicine has the ability to control pain. A person who seeks to kill him or herself to avoid control pain. A person who seeks to kill him or herself to avoid pain does not need legalized assisted suicide but a doctor better pain does not need legalized assisted suicide but a doctor better trained in alleviating pain. trained in alleviating pain.

You don't solve problems by getting rid of the people to whom You don't solve problems by getting rid of the people to whom the problems happen. the problems happen. The more difficult but humane The more difficult but humane solution to human suffering is to address the problemssolution to human suffering is to address the problems. . Source: Suicide Factsheets, NRLC Dept. of Medical EthicsSource: Suicide Factsheets, NRLC Dept. of Medical Ethics

Do we have a consensus?Do we have a consensus? In conclusion then, euthanasia is a complex issue. There are In conclusion then, euthanasia is a complex issue. There are

many pros and cons towards legalizing euthanasia, it would many pros and cons towards legalizing euthanasia, it would give people greater autonomy over their own lives and give give people greater autonomy over their own lives and give terminally ill people a chance to avoid great pain and emotional terminally ill people a chance to avoid great pain and emotional distress. distress.

However, it begins the degradation of the prohibition of However, it begins the degradation of the prohibition of murder, and opens up the possibility of further erosion of the murder, and opens up the possibility of further erosion of the system. system.

The Select Committee report summed up the issue as follows; The Select Committee report summed up the issue as follows; "The death of a person affects the lives of others, often in ways "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 and to an extent which cannot be foreseen. We believe that the issue of euthanasia is one in which the interest of the individual issue of euthanasia is one in which the interest of the individual cannot be separated from the interest of society as a whole".cannot be separated from the interest of society as a whole". http://www.nt.gov.au/lant/parliament/committees/rotti/rotti.shtmlhttp://www.nt.gov.au/lant/parliament/committees/rotti/rotti.shtml