The goal of palliative care is to provide artificial support the end of their life is near. Palliative care can consist of: withholding or withdrawing futile treatment, which is not considered to be euthanasia or assisted suicide. Fully legal care of terminally sick people, such as withholding or withdrawing futile treatment, should mewer involve an intention to end a patient’s life.
It is important to take onto consideration that some terminally ill patients are expressing a desire to die rather than requesting direct action. Such requests to end one’s life can be noticed when someone is experiencing serious depression or emotional distress. For example, in such cases, they may feel that they are a burden, or perhaps are suffering intolerable physical or emotional symptoms. In other cases, such decisions have been provided with extreme caution, such as deciding that life is absolutely intolerable.
It is important to understand the difference between ’passive euthanasia’ and ’active euthanasia. ‘Active euthanasia’ is sometimes used to refer to a process that involves deliberately intervening to end a patient’s life – for example, by giving them a significant dose of sedatives. ‘Passive euthanasia’ is sometimes used to refer to a process that involves causing someone’s death by withholding or withdrawing medical treatment that is necessary to maintain life. It’s important not to confuse ‘passive euthanasia’ with withdrawing life-sustaining treatment in the person’s best interests. Withdrawing life-sustaining treatment because it’s in the person’s best interests can be part of good palliative care and is not euthanasia.
Euthanasia or assisted suicide, have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures have included, among others, explicit consent by the person requesting euthanasia, mandatory reporting of all cases, the administration only by medical professionals(with the exception of Switzerland), and consultation by a second medical professional.
In general, euthanasia is defined as an act, which involves undertaken only by a physician, that intentionally ends the life of a person at his or her request.
To date, the Netherlands, Belgium, Colombia, Canada and Luxembourg have legalized euthanasia.
In some other countries, the right to die can be on a case-to-case basis. Most often judges and medics have to decide if patients should be allowed to receive euthanasia.
3. Should Assisted Suicide be a Fundamental Human Right?
In some instances people consider euthanasia to be a fundamental human right, which allows patients to determine when their own life should be taken away from them. But it is important to keep in mind, as we will look for this notion in the Charter of Human Rights. There are still a considerable quantity of instances of different laws all over the globe on this controversial, but important subject. This type of suicide always needs the assistance of other human beings (it is better than this person has medical background) – be it to prescribe the necessary drugs or to provide them. This is why many arguments are less about the sick person’s inclination to die and more about the juridical consequences for the individual who has helped with the act of assisted suicide.
3.1 Arguments for Assisted Suicide Becoming a Fundamental Human Right
Before making our decision on this controversial topic we first should put ourselves in the place of the terminally ill patient, who shows interest in receiving assisted suicide. By making assisted suicide more accessible we can greatly reduce suffering. It can be argued that reducing the suffering of other human beings is one of main goals of modern western society.
Do we take too much responsibility and go against nature then we decide to end our life? Technological advancement in medicine, as in many other areas, creates advantages and disadvantages. We live longer and more comfortably because of medical advances, such as renal dialysis, organ transplantations, joint replacement, and antidepressants. But technology, as well, can simply prolong dying. And more importantly, in some cases, it simply prolonged unnecessary suffering.
We can greatly reduce suffering. Optimal treatment of pain can remove much discomfort, although many patients don’t receive optimal pain management because of the mistaken concern that tolerance will develop to the analgesic effect or worry about addiction. Much suffering comes from unkind treatment, from insensitive caregivers, neglect from family and friends, and unpleasant surroundings. Much suffering comes from the narrowing of areas that sustain interest and pleasure, by sensory loss, invalidism, and lack of intellectual and social opportunities.
How do we distinguish depression from existential despair in the dying? If the dying person no longer enjoys usual activities, has a poor appetite, sleeps poorly, cannot concentrate well, feels hopeless, and wants to die, are these symptoms of a mental disorder (depression) or understandable and reasonable responses to the illness and its treatment, and/or the result of the illness or treatment? Can we make the case for a mental disorder? Do the symptoms hang together, are the course, family history, and response to treatment predictable? Several studies have shown that depression associated with physical illness does respond to antidepressant drugs, but no studies have included terminally ill patients.
Some psychiatrists aver that the wish to die in a terminally ill patient always represents a treatable mental disorder: if not depression then demoralization—a sense of unrealistic pessimism. This assumes that the real suffering of dying can be ameliorated, a questionable assumption. As the situation is assessed, there are inadequate psychiatric reasons for considering all instances of suicidal desires instances of psychopathology, and we cannot ameliorate all terrible suffering and lack of dignity in dying persons, although we can do a lot more than we have. The hospice movement shows that much can be done.
Do we get in a way of nature by allowing assisted suicide? We already have changed the way things are in the natural order. Technological advancement has allowed us to drastically prolong our lives, increase our quality of living and fight against birth defects. If we try to argue against assisted suicide by saying that modern society changes the way things are in nature, in this case, we will have to refuse help for women, who is having a hard time giving birth, people with birth defects, etc. By using modern medicine in order to reduce suffering, possible we should not only help upcoming life but also help those who are in the end of their path.
Most people, and all courts, recognize that patients can request discontinuation of life support measures. Do we cross some qualitative bridge between ending life support measures and assisting in suicide, or is this more a quantitative difference, or is it no difference? It seems very late in the day to concern ourselves with altering nature. For better or worse, we have grasped the helm of much that determines our lives.
More importantly, we should keep in mind that there are people who can commit suicide. But they can, also cause permanent damage by failing suicide. If a person is determined to commit act of suicide, at least contemporary medicine can provide a safe and secure option.
By saying that physicians can only heal patients and by helping someone to end their life we focus to much on the physician, instead of the patient. When healing is no longer possible when death is imminent and patients find their suffering unbearable then the physician’s role should shift from healing to relieving suffering in accord with the patient’s wishes.
3.2 Arguments Against Assisted Suicide Becoming a Fundamental Human Right
The first argument which requires addressing is that euthanasia can be abused both by patients and doctors. Patients without very serious illness which is not terminal can use euthanasia in order to avoid prolonged, complicated and expensive treatment. In order to avoid this issue, the definition of the terminal illness itself can be changed or redefined to make sure that no patient whose illness is not serious enough uses such treatment. Abuse of assisted suicide by physicians is very unlikely because in most cases it can be required for the patient to clearly state in front of the judge that he wants to receive euthanasia. Also, in some cases, relatives or other close people to the patient have to consent to euthanasia.
Perhaps one of the most important developments in recent years is the increasing emphasis placed on healthcare providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment.
In the United States, thousands of people have no medical insurance; studies have shown that the poor and minorities generally are not given access to available pain control, and managed-care facilities are offering physicians cash bonuses if they don’t provide care for patients. With greater and greater emphasis being placed on managed care, many doctors are at financial risk when they provide treatment for their patients. Legalized euthanasia raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled person ‘chooses’ to die rather than receive long-term care.
Emotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Financial considerations, added to the concern about ‘being a burden,’ could serve as powerful forces that would lead a person to ‘choose’ euthanasia or assisted suicide.
Most issues with assisted suicide can be solved by developing both medical and judicial systems.
4. Situation in Different Countries
As time passes more and more countries consider legalizing assisted suicide or making it legal in extreme cases.
The Netherlands became the leading country in this complicated matter. In April 2002, the Netherlands became the first country to legalize euthanasia and assisted suicide (Deliens L). In the Netherlands in order to receive suh treatment patient should meet a set of strict and well-defined criteria.
The legislation has provoked a fierce debate over the ‘right to suicide,’ because assisted suicide outside of the criteria set for euthanasia is still illegal and is counted as a homicide.
On the opposite side we have France. In France assisted, suicide is against the law. The president, François Hollande, promised to look at the ‘right to die with dignity but has always denied any intention of legalizing euthanasia or assisted suicide. In 2005 the Léonetti law introduced the concept of the right to be ‘left to die’. Under strict conditions it allowed doctors to decide to ‘limit or stop any treatment that is not useful, is disproportionate or has no other object than to artificially prolong life’ and to use pain-killing drugs that might ‘as a side effect, shorten life.
In German-speaking countries, the term ‘euthanasia’ is generally avoided because of its association with the eugenicist policies of the Nazi era. The law, therefore, tends to distinguish between assisted suicide and ‘active assisted suicide. In Germany and Switzerland, active assisted suicide – ie a doctor prescribing and handing over a lethal drug – is illegal. But German and Swiss law does allow assisted suicide within certain circumstances. In Germany, assisted suicide is legal as long as the lethal drug is taken without any help, such as someone guiding or supporting the patient’s hand.
5. Court Practice
Interesting Court practice regarding assisted suicide can be seen in the United States. In January 1994, Dr. Harold Glucksberg and three other doctors, three terminally ill patients, and an organization called Compassion in Dying filed suit in federal court for a declaration that Washington State’s assisted suicide ban was unconstitutional as applied to terminally ill, mentally competent adults. The U.S. Supreme Court unanimously decided that Washington’s assisted suicide ban was not unconstitutional.
The Court observed that in “almost every State – indeed, in almost every western democracy – it is a crime to assist a suicide. The Court concluded that “we are confronted with a consistent and almost universal tradition that has long rejected the asserted right, and continues explicitly to reject it today, even for terminally ill, mentally competent adults.” The Court declared that to “hold for respondents, we would have to reverse centuries of legal doctrine and practice, and strike down the standard policy choice of almost every state.” Because assisted suicide has been consistently rejected in the history and tradition of our nation, the Court wrote, “the asserted ‘right’ to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause.” The Court’s ruling was 9-0. (Washington v. Glucksberg. (n.d.), 2018)
Dr. Timothy Quill, along with two other physicians and three terminally ill persons, challenged the assisted suicide ban in New York State. They alleged it violated the due-process liberty and equal protection guarantees of the Fourteenth Amendment. The U.S. Supreme Court unanimously held that New York’s prohibition on assisting suicide does not violate the equal protection rights of terminally ill adults seeking physician assistance in committing suicide. (Vacco v. Quill. (n.d.), 2018)
The Court rejected the notion that ending or refusing lifesaving medical treatment is nothing more or less than assisted suicide. The Court held that the “distinction comports with fundamental legal principles of causation and intent … when a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication.” A doctor who assists in suicide and a patient who consumes a lethal prescription have the specific intent of causing death, “while a patient who refuses or discontinues treatment might not.”
Then speaking about assisted suicide it is important to talk about the Netherlands. As it was stated before nowadays it is legal to provide assisted suicide. But in 1973 it was not. The year 1973 is extremely important in this question because at that time the question of assisted suicide rose in the Netherlands. (E, 1992)
The Dutch debate on euthanasia was sparked by a court case in 1973(the same year in which the Dutch Society for Voluntary Euthanasia was formed). In this case, a general practitioner was prosecuted for ending the life of her mother, who had suffered a cerebral hemorrhage, was partly paralyzed, was deaf, and had trouble speaking. After the mother had repeatedly expressed the wish to die, the daughter ended her mother’s life by giving her a lethal dose of morphine. The court (of Leeuwarden) found her guilty, not because she had hastened the death of her mother (who was incurably ill and suffered unbearably), but because she had directly ended her life instead of stepping up the doses of morphia with the secondary effect that the patient’s life would have been shortened. The court gave her a suspended sentence of one-week imprisonment and put her on probation for a year. In later decisions, the courts no longer exclude that a doctor may bring about the death of the patient in a direct way, but they have elaborated the criteria developed in the Leeuwardendecision and added other requirements.
Assisted suicide and euthanasia are dark realities of our existence. For some reason, we are fine with using technological advancements in order to prolong life of the patient, but we ending the suffering of the same patient is often seen as wrongful doing.
Given the fact that more and more European countries are allowing assisted suicide on some level, it is safe to assume that only more countries will adopt such practices in the future.
When addressing this issue it is important to give a priority to rational thinking and put emotional factors on second place. As hard and depressing it is, we should try to put ourselves in the patients’ place. There is a big difference in the quality of life and enjoyment of mundane things when we compare terminally ill and perfectly healthy people. Obviously, a terminally ill, helpless person has absolutely different view of life and day-to-day activities.
In order to make sure that assisted suicide is not abused or misused meaning of such words as terminal illness, passive and actively suicidal, possibly should be redefined. It is also important to make sure that all the countries which decide to adopt the practice of assisted suicide have made sure that the patient has not only consent but also, actual medical experts should give their opinion.