Euthanasia and End Of Life Care

ANYURYSM- ‘S’

• The term euthanasia derived from the Greek word “eu” and

“thanatos” which means “good death” or “easy death”.

• It is also known as Mercy Killing.

• The ancient Greeks viewed illness as a bothersome affliction and

allowed sick individuals to seek the approval of the state to commit

suicide

Introduction

Euthanasia refers to “the intentional termination of a

person’s life, usually but not always at that person’s

request, and usually in the context of terminal illness and/or

incurable suffering”.

The Australian Psychological Society

Introduction

• While most Greek philosophers supported euthanasia to Aristotle,

suicide was an offence against the state.

• In 1516, for instance, Sir Thomas More wrote Utopia in which

patients living in an ideal society were encouraged to commit

suicide if they were suffering from a terminal illness or experiencing

unrelenting pain.

Background

• Hippocratic oath, which was written between 400 and 300 B.C.

The oath states: “To please no one will I prescribe a deadly drug nor

give advice which may cause his death.”

• According to him, a doctor is to relieve the pain of his patient in one hand and protect and prolong his life on the other hand

Background

• 1930’s and early 1940’s, the Nazi’s adoption of the word

“euthanasia” to describe its “mass extermination programme” .

• In Germany, euthanasia was employed to murder over 100,000 and

All the killings were committed without the patient’s consent and

generally without the patient being aware of the impending act.

• The General Assembly of the World Medical Association

Background

1) Active or Positive: It is an act of Commission. It means a

positive merciful act to end useless sufferings and meaningless

existence. For example by giving large doses of a drug to hasten death.

2) Passive or Negative: It is an act of Omission. It means

discontinuing or not using extraordinary life sustaining measures to

prolong life. For example discontinuing a feeding tube, or not carrying

out a life –extending operation or not giving life extending drugs etc.

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- Reddy KSN. The essentials of Forensic medicine & Toxicology, 26th edition. 2007;41

Types of Euthanasia

3) Voluntary: Euthanasia practiced with the expressed desire and

consent of the person concerned.

4) Involuntary: Euthanasia practiced against the will of the person

5) Non- Voluntary: Euthanasia practiced in persons who are incapable

of making their wishes known .For example in persons with irreversible

coma or severely defective infants.

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Reddy KSN. The essentials of Forensic medicine & Toxicology, 26th edition. 2007;41

Types of Euthanasia

‘Doctor provides an individual with the information, guidance, and

means to take his or her own life with the intention that they will be

used for this purpose’

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Murkey P.N. & Singh K.S. Euthanasia ( mercy Killing). Review article. - J. Ind. Acad. Forensic

Med. &Toxicol. Vol-30 no.2, 2008;92-95

Physician assisted suicide (PAS)

• Jack Kevorkian was a U.S.-based physician who assisted in more

than 150 patient suicides.

• Infamous in 1990, when he assisted in the suicide of Janet Adkins, a

45-year-old Alzheimer's patient from Michigan .

• Kevorkian agreed to assist her in a public park, inside his

Volkswagen van. Kevorkian attached the IV, and Adkins

administered her own painkiller and then the poison.

• The State of Michigan immediately charged Kevorkian with Adkins'

murder.

Dr. death

• On March 26, 1999, a jury in Oakland County convicted Jack

Kevorkian of second-degree murder and the illegal delivery of a

controlled substance and was sentenced to 25 years in prison .

• In 2010, HBO announced that a film about Kevorkian's life,

called You Don't Know Jack featuring a film legend Al Pacino as

Kevorkian

• He died on June 3, 2011, at the age of 83 .

• Ethical/Moral

-To respect sufferers’ autonomy

-This argument rests on the ideal of being able at all times to exercise

as much control over one’s own life as is possible.

• To allow individuals to value “quality of life” over “sanctity of life”

• To end suffering

Arguments in Favour of Euthanasia

• To reduce reliance on life support systems and/or advanced medical

knowledge

• To reduce risk of premature suicides

• To reduce the legal jeopardy of those who implement euthanasia

• Changes in professional and public attitudes to euthanasia

Arguments in Favour of Euthanasia

• Ethical/moral

• Absolute respect for human life

• Possibility of coercion, loss of autonomy

• Poor decision-making by the sufferer

• Conflicts of interest

• Difficulty of enforcement and monitoring

• Reduction of efforts in diagnosis, treatment, and care

• Adequacy of modern medical and palliative care

Arguments Against Euthanasia Being Available

• The Canadian law allows a person to refuse medical treatment and

the medical profession accepts the ‘living will’, but the law does not

allow the doctor to actively help someone to kill himself.

• However, amidst the ongoing debates, the Netherlands became the

first testing ground for the world since it legalized euthanasia on

28th November 2000.

Trends Of Euthanasia In DifferentCountries

• Australia also has a voluntary euthanasia law which is statedly

working well. In Australia, a computerized injection system is in use

to accomplice euthanasia.

• The euthanasia law was adopted in 2001 in Belgium . This law

defines conditions for doctors to avoid penal punishment.

• Physician Assisted suicide is legitimized in Switzerland.

Trends Of Euthanasia In Different Countries

• Currently in the UK, any person found to be assisting suicide is

breaking the law and can be convicted of assisting suicide or

attempting to do so

• Although two-thirds of Britons think it should be legal, a recent

'Assisted Dying for the Terminally- Ill' Bill was turned down in the

lower political chamber, the House of Commons

Trends Of Euthanasia In Different Countries

• In USA the practice of euthanasia is a clear offence too theoretically,

but in real practice the judgements of different courts during trial of

euthanasia cases seem to be liberal.

• Physician Assisted Suicide (PAS) is legal in Oregon and Washington

State in the US.

Trends Of Euthanasia In Different Countries

India

• Like almost in all other countries, euthanasia has no legal status .

The practice of euthanasia is a clear act of offence, either a suicide

and assistance to commit suicide or a murder.

• The latest judgement of Supreme Court declares that : Right to DIE

is not included in the Right to LIFE under Article 21 of Indian

Constitution.

Trends Of Euthanasia In Different Countries

• Article 21 is a provision guaranteeing protection of life and personal

liberty and by no stretch of imagination can imply ‘EXTINCTION OF

LIFE’.

• ‘Right to life’ is a natural right embodied in Article 21 but suicide is

an unnatural termination or extinction of life and therefore not

compatible and inconsistent with the concept of ‘right to life’

Trends Of Euthanasia In Different

• In Nov 27 ,1973 , Aruna Ramchandra Shanbaug, aged 24 a nurse at

KEM hospital Mumbai was attacked by Sohanlal, a sweepwer

working in the same hospital.

• Assaulted in the basement , strangulated with a dog chain resulting

in cervical injury and brain stem contusion due to lack of adequate

02 .

Incident

• Based on her assessment since 1982, Pinki Virani, a National

award winning Journalist, Social activist filed a petition ( criminal ),

number 105 , of 2009 in Supreme Court on India , for mercy killing

on Behalf of Aruna under article 32 of constitution on India.

• She pleaded Supreme court to have Aruna stopped being fed and

let her die peacefully.

• On 24 January 2011, the Supreme Court of India responded by

setting up a medical panel to examine her.

• However, it turned down the mercy killing petition on 7 March 2011

but legalized passive euthanasia.

• Assessment of the patient

• Treatment/counselling of the patient as appropriate;

• An advocacy role for the patient and/or relatives and/or carers

• educating decision makers, clinical staff, patients and the public in

the psychological aspects of euthanasia and what psychologists can

offer in the area

• facilitating others’ professional development in the area

• conducting research in the area and disseminating knowledge;

 

Roles for psychologists could include:

• There exists an inherent tension between respecting individual

autonomy and relieving people from unbearable suffering while still

protecting the principle of valuing human life remains.

• Any liberalizing of laws in relation to euthanasia needs to achieve

respect for individual rights and prevent abuse, without becoming

too unwieldy, bureaucratic and time consuming to be practical.

Conclusion

• The decision-making process raises many difficult psychological

issues. It is clearly apparent that every case where a patient

requests assistance to die should be assessed individually.

• Policy makers should consider these issues seriously and to bring

them to the attention of other professionals and policy makers.

1. Reddy KSN. The essentials of Forensic medicine & Toxicology, 26th edition.

2007;41

2. 2. Murkey P.N. & Singh K.S. Euthanasia ( mercy Killing). Review article. - J.

Ind. Acad. Forensic Med. &Toxicol. Vol-30 no.2, 2008;92-95

3. G S Neeley “The Right to SelfDirected Death: Reconsidering an Ancient

Proscription” 35 Catholic Law 111 (1995) at 116.

4. 4 New York Task Force on Life and the Law When Death is Sought:

AssistedSuicide and Euthanasia in the Medical Context (May 1994) at 79.

5. J Scherer and R Simon Euthanasia and the Right to Die: A Comparative View

(Rowman & Littlefield Publishers, Lanham 1999)

References

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