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Euthanasia as a European Topic

Present Debate in Europe & in the USA


Jozef Glasa
Institute of Medical Ethics and Bioethics n. f.
Bratislava, Slovak Republic

Definition/s (are the part / mean of the debate!)


euthanasia (from Greek - good death): killing (terminating the

life) of a person (or an animal) in a presumably painless or minimally


painful way

assisted suicide providing means and/or the help to a person, who want to terminate his/her life
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euthanasia by means
[e.g. insulin in a diabetic]
active
aggressive using lethal dose of medicaments, or lethal
substance/s, or force to kill
non-aggressive withdrawing life support
passive withholding common treatments/giving a medication
to relieve pain, knowing that it may also result in death

euthanasia by consent
voluntary with the persons direct consent
non-voluntary without the persons direct consent (e.g.
someone not legally competent, or unable to make the decision),
decision made by a proxy
involuntary against someones will

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terminal sedation
letting die, futile treatments,

WMA Declaration on Euthanasia


Euthanasia, that is the act of deliberately
ending the life of a patient, even at the
patients own request or at the request
of close relatives, is unethical.
This does not prevent the physician from respecting
the desire of a patient to allow the natural process
of death to follow its course in the terminal phase
of sickness.
WMA, 2002
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History
Hippocratic Oath (400 300 BC)
To please no one will I prescribe a deadly drug nor give
advice which may cause his death.
English Common Law since 1300s until today
disapproved suicide and assisted suicide
1828 euthanasia explicitly outlawed in the USA
1900s growing support in some intellectual circles
1935 society to promote euthanasia in England
1937 doctor-assisted suicide legal in Switzerland
1938 society to promote euthanasia in USA
1939 Action T4 Nazi Germany
1948 Nuremberg trial
1977 living wills in California (later on in other states of USA)
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History
1990 Dr. Jack Kevorkian (Michigan, USA) encouraging

and assisting people in committing suicide, tried and convicted in 1999


for a murder displayed on television (to be paroled 2007!)

1993 Netherlands decriminalization of doctor-assisted


suicide
1994 Oregon (USA) Death with Dignity Act
(US Supreme Court decision 1997, attempts to stop the law by
amendment of the drug law failed 2001)
1995 Northern Territory (Australia): euthanasia bill;
overturned by Australias legislative branch 1997
1999 Texas (USA) Futile Care Law passed
2002 euthanasia laws in the Netherlands, in Belgium
2005 Terri Schiavo case
2005 Groningen Protocol (euthanasia in children)
and the history continues nowadays!
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Some Arguments for Euthanasia

Choice: Choice is a fundamental democratic principle and the basis of


the Free Enterprise system.
Self-determination, autonomy: People have to have the possibility to
decide about themselves including on ending of their lives.
Financial: It is a burden to keep people alive past the point they can
contribute to the society. (utilitarian argument)
Quality of Life: The pain and suffering a person feels during a disease
can be incomprehensible, even with pain relievers, to a person who
has not gone through it. Even without considering the physical pain, it
is often difficult for patients to overcome the emotional pain of losing
their independence. Society should not be able to force them to endure
such hardship.
Resources: Today in many countries there is a shortage of hospital
space. The energy of doctors, nursing staff, and hospital beds could be
used for the people whose lives could be saved instead of continuing
the life of those who want to die which increases the general quality of
care and shortens hospital waiting lists.
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Some Arguments against Euthanasia


Hippocratic Oath: Every doctor must swear upon some variation of it, and the
original version explicitly excludes euthanasia.
Moral integrity and trustworthiness of the health care professionals.
Detrimental for a health professional patient relationship.
Moral: Euthanasia is a type of murder i. e. it is morally unacceptable.
Theological: Euthanasia and suicide are sinful acts (prohibited by Gods or
other religious authority commandment).
Competence: Euthanasia can only be considered voluntary if a patient is
mentally competent to make the decision, i.e. has a rational understanding of
options and consequences. Competence can be difficult to determine, or even
define.
Necessity: If there is some reason to believe the cause of a patients illness or
suffering is or will soon be curable, the correct action would be to attempt to
bring about a cure, or engage in palliative care.
Wishes of Family: Family members often desire to spend as much time with
their loved ones as possible before they die.
Pressure: All the arguments listed for voluntary euthanasia can be used by
hospital personnel to form a psychological pressure on people to consent to it.
( plus the managed care situation)
Slippery Slope: The moral and legal situation would progress.
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Euthanasia in the USA


illegal in most of the USA
early attempts to legalize euthanasia in USA
beginning of 20th century (part of eugenics movement)
ballot initiatives
(Washington, 1991; California, 1992; Oregon, 1994; Michigan, 1998)
legislation bills
Oregon Death with Dignity Act, passed 1994;
California Compassionate Choices Act, not passed 2006; in 2007?
Texas Futile Care Law, passed 1999;

cases, case law (Karen Ann Quinlan 1985; Nancy Cruzan


1990; Terry Schiavo 2005)
Jack Kevorkian - Doctor Death (sentenced 1999)
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Euthanasia in Europe

illegal in most of the Council of Europe MSs


legal in Belgium (2002), and in the Netherlands (1993, 2002)
assisted suicide allowed in Switzerland (one way tickets to Zurich)
other legislation attempts failed, so far
United Kingdom, France, Czech Republic,

the topic is much debated in public, health professionals and


patients organizations, and in some European institutions
(Council of Europe, Parliamentary Assembly, European
Parliament,)
the hard cases e. g. Ramon Sanpedro (Spain, 1998), Vincent Humbert
(France, 2003), Piergiogio Welby (Italy, 2006), Immaculada Echevarria (Spain
2007)

and euthanasia/assisted suicide seem to gain ground!


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Belgiums Euthanasia Act of 28 May 2002


-- lays down the conditions under which a doctor may practice
euthanasia without being punished
sets out the criteria (very similar to those in the Netherlands):
the patient be adult and conscious;
the request be made of the patients own volition, after
reflection, and be repeated;
there be no medical solution to the situation;
the patient be experiencing constant, unbearable physical
or mental suffering that cannot be relieved;
the patients condition as a result of accident or illness
be serious and incurable.
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Belgiums Euthanasia Act of 28 May 2002


A further provision for any citizen of adult years, in possession
of his or her faculties, to draw up a prior declaration
requesting euthanasia in the event of unconsciousness that,
to the best of current medical knowledge, is not reversible
(valid for five years and renewable).
Those who draw up such declarations may also designate
one or more representatives to inform the doctor responsible
of the unconscious patients wishes.
This provision should be seen alongside the Patients Rights Act, a more
general piece of legislation on the rights and duties of medical practitioners
in relation to patients, in which patients representatives play an even
broader role inasmuch as they step in to exercise rights that the patient
cannot exercise for himself or herself due to incapacity, whether temporary
or permanent.
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Belgiums Euthanasia Act of 28 May 2002


the procedure to be followed by the doctor:
supplying the patient with information;
confirming the persistence of the symptoms and
of the patients wish;
consulting a second doctor;
consulting the care team and, if the patient so wishes,
other parties;
a time-scale to be observed;
the procedure be documented in the patients file;
a declaration be submitted to a federal commission
whose tasks are to:
ensure that procedure is properly followed,
compile annual statistics for parliament,
forward to the Office of Public Prosecutions any declarations pertaining to
cases, where it suspects the statutory conditions have not been
observed.
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Some good European Documents


Recommendation 1418 (1999) of the Parliamentary
Assembly of the Council of Europe
Protection of the human rights and dignity of the
terminally ill and the dying
Convention on Biomedicine and Human Rights
(Oviedo, 1997)
Euthanasia and physician-assisted suicide: a view
from an EAPC Ethics Task Force (2003)
(European Association of Palliative Care)
(somewhat weaker that the position of Boards of Directors
statement of 1994)
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Euthanasia in (Central) Eastern Europe


illegal so far
not debated so much openly, interest curiosity growing
problem of s. c. social euthanasia

political, social, cultural changes


transitional problems reforms, transformations,
difficult economical and social situations
lack of resources
demographic situation
deficiencies in health and social care systems

moral scars and unhealed wounds from the recent past


CEE societies not used to debate (aftermath of totalitarianism)
debate introduced from outside, and from inside
active pro-life movements / active pro-euthanasia forces
example: 1992 Slovakias law on preservation of human life
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within the health care (passed by the government, euthanasized by the parliament

Euthanasia debate Europe vs. USA

more similarities than differences


intertwined influencing each other
arguments re-imported continuously
experiences + know how shared
USA
more fostered by lawyers, NGOs + media
more individual, case-oriented
more open, or brutal
Europe: more by politicians + media
in both Europe and USA a lot of hypocrisy, clouding,
ambiguities, euphemisms used, confusion in terms and
goals,
term tolerance terribly misused in both democracies
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Thank you for your attention!


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