Thursday, September 3, 2009

Euthanasia

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
Suicide
Jihad

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.

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