euthanasia, your death

7/27/2019 Euthanasia, Your Death

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Irish Council for Bioethics

Euthanasia:Your Body, Your Death, Your Choice?

PASIEKA / SCIENCE PHOTO LIBRARY


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Euthanasia: Your Body, Your Death, Your Choice? Information Leaflet

Q1 What is euthanasia?

The word euthanasia stems from the Greek words euthanatos meaning good death and refers to the actionof a third party, usually a doctor to deliberately end thelife of an individual. The individual must give consent forthe procedure, which is known as voluntary euthanasia.Non-voluntary euthanasia occurs when the individual isunable to ask for the procedure e.g. if s/he isunconscious or otherwise unable to communicate andanother person makes the decision on his/her behalf. Insuch cases the final decision might be based on thepreviously expressed wishes of the individual e.g. asstated in an advance healthcare directive (living will).

Assisted suicide refers to the practice of an individualtaking his/her own life on the basis of information,guidance and/or medication provided by a third party.For example a doctor might prescribe a lethal dose ofmedication for an individual, who then administers themedication him/herself. (For a full list of definitions seetable 1).

Q2 Is withdrawing and/orwithholding treatment

the same as euthanasia?

In certain circumstances treatments may be withheld orwithdrawn from a patient because their provision wouldno longer be deemed to be in the best interest of thepatient. For instance, if a treatment is considered futilei.e. it offers a low probability of success or its provisionwould be overly burdensome on a patient then it may bewithheld. Also if a treatment is initiated but becomes aburden on the individual and no longer offers anytherapeutic benefit then it may be withdrawn.

Q3 What is the principleof double effect?

When euthanising a patient, the doctor intends to causethe death of the individual. It is this intention thatdistinguishes euthanasia from other medical practices,which might also result in an individuals death. Forexample, if a patient is in severe pain, a doctor may

prescribe pain medication, the intention of which is toease the patients suffering. However, in some cases thedose of pain medication required to relieve the pain mayalso be sufficient to end that patients life.This is knownas the doctrine of double effect since the treatmentprovided to ease pain has the additional effect of endingthe patients life.

Terminology

Voluntary Euthanasia

Non-voluntary Euthanasia

Assisted Suicide

Physician Assisted Suicide

Definition

The action of a third party, which deliberately ends the life ofan individual, with that individuals consent.

Where the individual is unable to ask for euthanasia andanother person makes the decision on his/her behalf, usuallybased on previously expressed wishes.

Where an individual takes his/her own life based oninformation, guidance and/or medication provided by a thirdparty.

Where a doctor provides the information, guidance and/ormedication with which an individual can take his/her ownlife.

TABLE 1


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Q4 Does an individual havethe right to choose how

and when to die?It is generally accepted that as an expression ofautonomy i.e. ones right to make independent choiceswithout any external influences, a competent adult canrefuse medical treatment, even in situations where thiscould result in his/her death. However, when it comes toactively ending a life via euthanasia there is widespreaddebate regarding the rights of an individual to make thatchoice. Proponents argue that euthanasia allowsterminally ill people to die with dignity and without painand state that society should permit people to opt foreuthanasia if they so wish. Proponents also state that

individuals should be free to dictate the time and placeof their own death. Finally, proponents argue that forcingpeople to live against their wishes violates personalfreedoms and human rights and that it is immoral tocompel people to continue to live with unbearable painand suffering. Opponents of euthanasia, on religiousgrounds, argue that life is a gift from God and that onlyGod has the power to take it away. Others contend thatindividuals dont get to decide when and how they areborn, therefore, they should not be allowed to decidehow and when they die.They also raise concerns thatallowing euthanasia could lead to an abuse of powerwhere people might be euthanised when they dontactually wish to die.

Q5 Does personal autonomyhave limitations?

Few decisions are as important as those related to end-of-life healthcare.While an individual might want toexpress his/her autonomy by deciding to end his/her life,that decision will, in all likelihood, be influenced by theviews of third parties i.e. the individuals doctor, family orfriends. Proponents of euthanasia argue that thedecision to end a life of pain and suffering is anexpression of ones right to personal autonomy, whichshould be respected by ones family, healthcare providersand society at large. However, opponents argue thatbecause we live in an interdependent society, whereones decisions will impact on others physically,emotionally and financially, limits should be placed onpersonal autonomy in relation to end-of-life healthcarechoices.

Opponents have raised concerns about the implicationslegalising euthanasia would have for society.They statethat governments have a duty to protect society as a

whole, as opposed to individual citizens and thatallowing euthanasia could harm society. Therefore, theyargue that governments should balance an individualsright to die against potential negative consequences forthe wider community. On the other hand, proponents

argue that society is made up of individual citizens,whose rights should be protected and that ifeuthanasia is properly regulated then the rights ofsociety would not be harmed.

Q6 Does euthanasia devaluelife?

It has been argued that permitting euthanasia coulddiminish respect for life. Concerns have been raised thatallowing euthanasia for terminally ill individuals whorequest it, could result in a situation where allterminally ill individuals would feel pressurised intoavailing of euthanasia. There are fears that suchindividuals might begin to view themselves as a burdenon their family, friends and society or as a strain on

limited healthcare resources. Opponents of euthanasiaalso contend that permitting individuals to end theirlives may lead to a situation where certain groupswithin society e.g. the terminally ill, severely disabledindividuals or the elderly would be euthanised as a rule.

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However, proponents of euthanasia argue that legalisingthe practice would not devalue life or result in pressurebeing put on individuals to end their lives but wouldallow those with no hope of recovery to die with dignity

and without unnecessary suffering. They state that itwould be imprudent not to implement legislationbecause this would drive euthanasia undergroundwhere it would be unregulated. They also raise concernsthat the current legal vacuum has led to many Irishpeople travelling abroad (while they are still physicallyable to) to avail of euthanasia/assisted suicide beforethey feel they are ready to die.

Opponents state that suffering assists in formingpersonal identity and therefore, argue againsteuthanasia. However proponents argue that there is novalue in suffering and state that individuals who have nohope of recovery should not be obliged to suffer unduly.

Q7 Would legalisingeuthanasia underminethe level of healthcareprovided?

There are fears that allowing euthanasia wouldencourage the practice to become the norm, as it mightbe easier and cheaper to provide than other forms of

end-of-life healthcare.

Palliative care attempts to improve the quality of life forpatients facing a life-threatening or life-limiting illnessthrough the prevention and relief of pain and othersymptoms, including physical,psychological, social andspiritual problems. However, it has been estimated thatin a minority of cases (approximately 5%) an individualspain cannot beeased with palliativedrug treatment andconcerns have beenraised regarding theprofound spiritual

and psychologicalsufferingexperienced byindividuals facedwith their imminentdeath.

Opponents ofeuthanasia arguethat more resourcesshould be put intopalliative care, which allows people to die with dignityand which offers support and comfort to family andfriends. Proponents argue, however, that individualsmight prefer to die on their own terms and at a time oftheir choosing and suggest that euthanasia should beoffered as a viable alternative for those individuals whoare not satisfied with palliative care.

Q8 Is euthanasia only anissue for the terminallyill?

While euthanasia is often associated with terminally illpatients, there have been suggestions that voluntaryeuthanasia might also be relevant to very elderlyindividuals, individuals with chronic or degenerativeillness, individuals with mental health problems andsociety as a whole. One area of healthcare whereeuthanasia has been widely debated of late is in the careof severely premature babies.

In effect, the same treatment and care decisions applyfor extremely premature babies (those born after only 22 25 weeks of pregnancy) as with end-of-life care

decisions for adults i.e.should treatment beadministered or shouldthe baby be allowed todie. For extremelypremature babies, the

chances of survival canbe very low, and thosebabies who do survivecan show increasedincidence of seriousand long-lasting healthproblems. Some wouldargue that, because ofpotential future healthrisks, extremelypremature babiesshould not be made to

suffer and argue that under such circumstanceseuthanasia for babies would be acceptable. On the other

hand, opponents state that euthanasia should never beconsidered in such cases because they believe that allpossible treatment should be provided to give severelypremature babies every opportunity to survive andpotentially live a normal life.

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Q9 Is euthanasia and/orassisted suicide legal inthe Republic ofIreland?

Both euthanasia and assisted suicide are illegal inIreland. Under the Criminal Law (Suicide) Act 1993 it isan offence to aid, abet, counsel or procure the suicide ofanother person, or an attempt by another person tocommit suicide. The maximum penalty for this offenceis 14 years imprisonment. Nonetheless, the weight oflegal opinion in Ireland recognises the right of acompetent adult to decide on the nature of theirmedical treatment. A competent individual has the rightto refuse medical treatment to facilitate a naturaldeath, but this is not considered a right to die byartificial means nor through the actions of a third party.


Q10 Is euthanasia and/orassisted suicide legalelsewhere?

There are a number of different jurisdictions, whichallow euthanasia and/or assisted suicide to varying

degrees. In Europe, Euthanasia is only legal in theNetherlands and Belgium, provided certain conditionsare met. For example, the patients request must bevoluntary and well-considered; the patient must beexperiencing unbearable physical or mental suffering,with no prospect of relief; the patient must be informedabout their situation and prospects; at least one other,independent, doctor must be consulted. In Belgiumeuthanasia is only allowed if the patient is an adult.However, in the Netherlands euthanasia is allowed forchildren aged between 12 and 16 years of age, with theconsent of their parents/guardians and for individualsaged 16 years and over. Assisted suicide is legal in theNetherlands, Switzerland and the state of Oregon in the

US. As with euthanasia certain criteria need to be metbefore an individuals request for assisted suicide isfollowed, e.g. the patient must be considered competentand aware of their situation. In Oregon the individualrequesting assisted suicide must be terminally ill, but inthe Netherlands and Switzerland an individual need nothave a terminal condition in order to request it.


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The Irish Council for BioethicsRegus House, Block 4,Harcourt Centre, Harcourt Road, Dublin 2.

E-mail: [email protected]

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