Monday, September 7, 2009

Euthanasia court

Further to my last writing on euthanasia, I need to add something I missed. Euthanasia is a modern term and people attach their own meaning to it. In fact, dying voluntarily is common throughout the ages. I read about some ancient customs still being practiced in tribal communities. When a person got very old and became a burden to the village, he would go away into the wild to die voluntarily. Relatives in the village would see him off and throw a big farewell party. This happened in many cultures. Two I heard, one was in the arctic when the aged left for the ice pack alone, and the other in the tropic where the person went into the jungle alone.

I missed an important form of dying voluntarily which should fit between suicide and jihad. That is sacrifice. From history, and recent news, many people died voluntarily for others. This happened all the time during wars where soldiers died to win battle, or to save comrades. There were also many heroic stories during emergencies and natural disasters. When people died for others in vain, we would also call it suicide. When people died and killed at the same time, they may either be jihad or hero, depending which side you are on.

On the more specific area of euthanasia, medical technology does play a major role. Modern medical technology can take lives peacefully. It can also prolong lives. A prolonged life is a debatable issue. Some live on with only biological functions like vegetable; some may barely live a normal social life like going to dinner parties; only a few are still productive and can continue to contribute to the community. Depending on where you sit, you may stand for euthanasia for certain people.

The present debate on euthanasia is very complex. It touches on many subjects, and the right to live and die is only a small part. Most of the criticism are on the extreme situations: how euthanasia could be abused for murder, getting rid of the burden of the aged, getting rid of unwanted citizens. There is also a strong and rigid religious interpretation that men should not do god's work of creation and destruction of life. In fact, humans have been continuously creating and taking lives for millions of years.

We have seen many euthanasia cases in court. Not only were those assisted in euthanasia sometimes being charged, but many persons would wish to exercise their right to die with dignity and thus challenge the administration. The reality is that many people have already exercised such right themselves with or without the sanction of the authorities. This has led to many situations where people died in pain or violently, or simply with a mistaken mind.

That is why I think a euthanasia court may be necessary. Instead of ending lives, it could be saving lives. The prerequisite is for a change of mind to clearly acknowledging the right to die with dignity and good reasons. With this important principle established, proper laws could be enacted for a legal framework to be set up for examining applications for euthanasia. The meaning of euthanasia could be extended to any person wishing to terminate his life voluntarily. While most cases now in dispute are those with terminal illness, there are many not disputed cases simply done unnoticed. A properly established court could examine and authorize euthanasia cases based on medical, scientific, humanitarian and legal grounds. Jilted boyfriends/girlfriends, those too heavily in debt, seeking revenge or suffering from depression who wish to die could apply for euthanasia. The court could judge whether euthanasia should be exercised or any other remedial and corrective actions should be taken. This will kill two birds with one stone. While genuine euthanasia cases can be properly addressed, suicide cases when brought to the open would likely be resolved with professional help.

Thursday, September 3, 2009


Euthanasia is a hotly debated topic for a long time. We have on one side human right activists and humanitarians arguing for the right to die with dignity and freedom, and on the other side rigid religious interpretation and bureaucratic practices based on out-dated laws. Policies on euthanasia vary between countries and even states within a country. Some allow medically assisted termination of life with the patient's consent, and some allow passive termination without direct medical intervention. But some just plainly prohibit any attempt.

Recently, there were two major incidents of euthanasia which again spiced up the debate. Sir Edward Downes and his wife died in July this year in Switzerland. Sir Edward, 85, was a renowned conductor. He was losing his sight and hearing. His wife, 75, a ballet dancer and a choreographer, was suffering from terminal illness. They administered their own death with dignity in a suicide clinic. The case was reported in BBC News. Several European countries, including Switzerland, Netherlands, Belgium, France, Germany, Sweden and Finland, do not consider assisting suicide by medical professionals a crime. In UK, assisting suicide carries a maximum sentence of 14 years imprisonment. None of the cases of UK citizens died in the Swiss suicide clinic has so far involved any criminal charges, but many have resulted in police investigations.

The other case widely reported in August was a court ruling in Australia allowing a quadriplegic man the right to refuse food and water leading to death. The ruling relieved the nursing home caring for the man of being criminally liable for the death. Some see this as a major victory for the right-to-die campaigners. A full report can be read in CNN.

The medical profession does not see this as a major change of policy in euthanasia. From the medical point of view, euthanasia is narrowly defined as active participation in assisted suicide involving making available the fatal drug and setting up of the drug administration equipment. On the other hand, not providing life sustaining treatment is passive participation which could be done without criminal intent. I consider such distinction hypocritical, which is made mainly to avoid being seen as breaking the law.

When a person decides to take his own life, there must be a reason, rightly or wrongly. There are circumstances where the person is not sane physically or mentally, or having a wrong belief, or the wrong faith. There are also cases where the person is very clear about his intention, and he makes it after careful consideration. Not matter what, there is no absolutely effective way of keeping a person from taking his own life.

I think of the ways people die voluntarily, very loosely defined in circumstances ranked according to the severity to others, in order to find out which one could be regarded as euthanasia. There are:
Denial of rescue
Anesthetic assistance
Refusal of life sustaining treatment
Advance directives for medical decisions
Medically assisted termination of life
Self-administered termination of life

Denial of rescue is commonly used in hospitals. In many terminal cases, the doctor would ask the agreement of the patient and the family not to undertake rescue actions should the patient's condition becomes critical. The reason is that the rescue could not ensure recovery but could increase the suffering.

Anesthetic assistance. In case where a terminally-ill patient is approaching unconsciousness, the doctor would ask the patient and the family whether anesthetic, normally morphine, should be administered in order to relieve pain. The result is that the patient could then never become conscious until his death.

Refusal of life sustaining treatment is debatable. If a patient refuses to use life sustaining equipment or to receive basic life sustaining treatment, the doctors and nurses may have an obligation to force him to do so. This is an area which concerns the medical ethics.

Advance directives for medical decisions. A patient could make advance directives on how treatment should be made on him. This is a record of his true intention before he becomes unconscious. Or the patient could be actively refusing treatment, such as not undertaking painful therapy or simply not going to the hospital.

Medically assisted termination of life. This is what the suicide clinics are doing. They do it in a humane way, with full consent of the patient. Usually the clinic provides the drug and the injection mechanism, with the patient administering the drug himself.

Self-administered termination of life. This may be similar to medically assisted termination of life, except that a medical professional is not present. Many common drugs are actually fatal if overdosed. A person could take his own life peacefully with the right dosage of drug.

Suicide is a violent form of taking one's own life. We read about horrible suicide cases everyday. It does not require sophisticated instrument nor drugs, just a misguided thought.

Jihad comes from a misguided religious belief. It is the most violent form of taking one's own life while taking the lives of other people at the same time.

Among these many ways, we are only debating on the third and the fifth. We call them euthanasia, but the medical profession only considers the fifth euthanasia. Actually, on the present debate on euthanasia, we are not truly concerned with the right of a person taking his own life, but the liability of the medical professionals involved in the process.

A person's mind is free and freedom cannot be restricted easily. As seen in the cases in Europe, people are flocking to Switzerland and other countries to seek help from the suicide clinics. They have a deep belief that termination of life is best for them. Even if suicide clinics are all banned, people could still commit suicide if they consider termination of life is best for them. In many court cases on euthanasia, it has been demonstrated that there were sometimes valid reasons for such decisions.

However, in most cases of suicide, the reasons are unknown. The absence of an opportunity to examine the reasons may lead to the suicide cases unnoticed until too late. The solution is for the disturbed persons to come out and speak to someone, such as the Samaritans, so that the cause could be assessed and corrected if appropriate. Thus a legal framework for the right to die should be established. A strict application of the bureaucratic laws preventing all forms of termination of life, including the humane ones, does not solve the problem, nor does it prevent people from taking their own life.