Euthanasia & death

The term euthanasia came from the Greek words eu which means good and thanasia which is translated as death. Euthanasia, therefore, means good death. This concept has been based on the belief that a person should pass from his or her life to his or her death in a peaceful and dignified way (Kastenbaum). The word, however, later evolved and acquired the meaning “the actions of inducing a gentle and easy death” (Mishara). For laymen, euthanasia simply means killing or causing the death of a patient out of mercy – in shorter term, mercy killing. This is why an ordinary individual generally refers to euthanasia as mercy killing.

It has been peddled by people who are advocating the practice as a means of mercifully ending the life of a patient who is about to die, anyway, and who is suffering from severe pain while waiting for his or her imminent death. The Special Committee on Euthanasia and Assisted Suicide which was created by the government of Canada, on the other hand, defined euthanasia as “the deliberate act undertaken by one person with the intention of ending the life of another person in order to relieve that person’s suffering where that act is the cause of death” (Mishara).

In the Netherlands, the Commission on Euthanasia which was established by the Dutch Government in 1985 defined it as “A deliberate termination of an individual’s life at that individual’s request, by another. Or, in medical practice, the active and deliberate termination of a patient’s life, on that patient’s request, by a doctor” (Docker). A broader definition refers to euthanasia as “the intentional killing by act or omission of a dependent human being for his or her alleged benefit” (Euthanasia. com).

In this definition, ‘act’ is the deliberate or actual killing of a helpless individual whether at home, in a nursing care facility, or in a hospital by introducing a deadly medication or a highly poisonous substance. ‘Omission,’ on the other hand, refers to the failure on the part of the caregiver or the attending physician to provide the minimum necessities for sustaining life. In other words, euthanasia by omission occurs when the person who is taking care of a patient allows him or her to die by withholding the basic necessities like food, water, or the basic medication needed to prolong life.

This definition also stresses the element of intent. Simply put, euthanasia could only be alleged when there is an intention on the part of the caregiver or the attending physician to kill the patient. In instances where the “act” has been committed unintentionally, or when the “omission” occurred inadvertently or accidentally, the act of euthanasia could not be claimed to have been committed (EUTHANASIA. com). Types of euthanasia There are several types of euthanasia.

When a caregiver, an attending physician, or a third party causes the death of a patient after the latter has specifically sought his or her assistance, a voluntary euthanasia occurs. It is understood that in a voluntary euthanasia, the request made by a patient also carries with it his or her consent that his or her life be ended with the help of the person upon which the request was made. A non-voluntary act of euthanasia, on the other hand, takes place when the patient has not made any request that his or her life be ended.

It follows that in the absence of such a request, consent has also not been given by the patient. In the case of a non-voluntary euthanasia, the subject patient has not specifically requested to be killed, but he or she has neither expressed a desire to go on living. Meanwhile, when a patient who has specifically expressed a desire to go on living is nevertheless killed by his or her caregiver or attending physician, or any other third party, an involuntary act of euthanasia is claimed to have been carried out.

The main difference, therefore, between a non-voluntary and involuntary euthanasia lies in the expressed desire of the patient to stay alive (EUTHANASIA. com). Finally, an assisted suicide occurs when somebody first equips a patient with the basic knowledge about how to commit suicide, then provides him or her with the necessary means or the tools of committing it, and ultimately allows him or her to actually carry out the act. In other words, in an assisted suicide, the patient is actually the one committing the act of suicide after receiving some help from another person.

An assisted suicide could result from an explicit request made by the patient for an assistance, or could be a consequence of a caregiver’s or a physician’s compassion towards a patient who is clearly suffering from severe or insufferable pain. When the person providing the assistance is the patient’s attending physician, the act is referred to as a “physician-assisted suicide” (EUTHANASIA. com). Assisted suicide or physician-assisted suicide is the preferred term used by people (especially in the United States and Canada) who want to avoid the full punishment of the law.

This is because the widely-held belief is that there are lesser sanctions for assisted-suicide than euthanasia under the laws in these countries. This was the reason why when Jack Kevorkian, a pathologist, was exposed in connection with the deaths of more than 130 patients during the 1990s, he defended his role in those deaths as an act of a physician assisting in suicides instead of an act of a physician who was committing euthanasia (Mishara).

However, some quarters believe that if any distinction between a physician-assisted suicide and euthanasia could be claimed to exist, such a distinction would be very fine indeed. For example, when the laws of the Australian Northern Territory legalized euthanasia from July of 1996 up to March 1997, the practice was for a physician to connect his or her patient to a lethal-substance-containing instrument which was operated by a computer. Then the lethal substance would only be “injected” after the patient pressed a particular key on the computer.

Critics of euthanasia believe that that practice was only called euthanasia in that part of Australia because the practice was by then legal under their law. The same people are convinced that if such a practice were carried out by a physician in the United States, the physician involved in the act would not call it euthanasia. Instead, he or she would insist that the action be classified as a physician-assisted suicide. Their contention is grounded on the fact that in the United States, a physician-assisted suicide is being treated less harshly than euthanasia (Mishara).

The distinction would indeed be a very fine line especially if one considers the Microsoft Encarta dictionary definition of euthanasia. According to Encarta, euthanasia is a “painless killing to relieve suffering: the act or practice of killing somebody who has an incurable illness or injury, or of assisting that person to die. ” This definition clearly does not even distinguish an assisted suicide from the general term euthanasia. In fact, it considers euthanasia and assisted suicide to be one and the same act – meaning that there should be no fine line distinction between the two.

Meanwhile, the International Task Force on Euthanasia and Assisted Suicide agreed that assisted suicide is often confused with euthanasia. However, according to the organization, the two practices could be easily distinguished from each other by looking at the final act which causes the death of the patient. The task force said that if the patient performs the final act after receiving assistance from another person, the action is actually an assisted suicide.

If another person – say, his or her attending physician or caregiver – performs the final act, euthanasia occurs. The task force issued the clarification in spite of the fact that it is against euthanasia and assisted suicide (Rhode Island Right to Life). Historical Background Euthanasia was first mentioned in the English literature in 1516 when Sir Thomas More wrote about it in his most widely-read book entitled Utopia. As a matter of fact, Sir Thomas More did not only mention it – he advocated it. His exact words were:

They console the incurably ill by sitting and talking with them and by alleviating whatever pain they can. Should life become unbearable for these incurables the magistrates and priests do not hesitate to prescribe euthanasia … When the sick have been persuaded of this, they end their lives willingly either by starvation or drugs, that dissolve their lives without any sensation of death. Still, the Utopians do not do away with anyone without his permission, nor lessen any of their duties to him (Emanuel).

Francis Bacon, during the 17th century, said that physicians should “not only restore health, but to mitigate pain and dolours; and not only when such mitigation may conduce to recovery, but when it may serve a fair and easy passage” (Emanuel). Clearly, then, Bacon, like More, was an advocate of euthanasia. His statement endorsed the belief that the role of physicians should not be limited to treating patients of their diseases, nor of relieving them of their pains – but they should also be able to assist patients die an easy and painless death.

Later French and English philosophers like Montesquieu and John Donne, while not directly advocating euthanasia, condemned religious prohibition and attacked the ban on suicides. David Hume, for his part, defended the right to suicide in his essay “On Suicide. ” He wrote that “Suicide may often be consistent with interest and with our duty to ourselves, no one can question, who allows that age, sickness, or misfortune, may render life a burden, and make it worse even than annihilation” (Emanuel).

Reading Hume, even if he did not actually endorse euthanasia, one could readily see that when confronted with the question of whether or not he would have supported euthanasia, the conclusion would undoubtedly be that he would have easily agreed to support it. However, although early philosophers and academics showed their interest in the issue of suicide and euthanasia, their interest did not appear to have had any significant effect on the medical practice during those times nor did they exert any influence on the attitude of the general population.

It was not until the 19th century that euthanasia was finally advocated by medical practitioners as well as by some laymen. The proposal to resort to euthanasia in some terminal cases was brought about by the discovery of ether as an anesthetic and morphine and chloroform as palliatives for pain (Emanuel). Some in 1846, the first operation which used ether as an anesthetic was performed by John Warren. The success of that operation prompted Warren to observe, two years later, that ether could be used to lessen the pain associated with death.

In his “Etherization; with remarks,” which was published in 1848, he wrote that ether could be used “in mitigating the agonies of death. ” In that paper, he described his experience with an old woman of 90 years whom he anesthetized with ether. According to him, he was able to successfully treat the “pain of mortification, (and pain) of the abdomen with convulsive twitchings of the limbs, with perfect relief. ” Morphine, on the other hand, gained widespread use as an effective pain reliever starting with the United States Civil War.

Meanwhile, the palliative potential of chloroform was the subject of a report which was published by Joseph Bullar in the British Medical Journal. In that article, Bullar recounted his experience in using chloroform to soothe the pains of four dying patients. However, both Bullar and Warren did not directly endorse the practice of euthanasia by making use of the anesthetic characteristics of ether, morphine, or chloroform. Instead, their recommendations had been focused on the palliative characteristics of these substances in terms of relieving terminally-ill patients of the pains associated with the onset of death.

In other words, the two physicians never suggested the use of anesthetics to put dying patients out of their misery but merely proposed anesthetizing them so that they would not be left to suffer from the extreme, excruciating, and sometimes embarrassing pain that death often entails (Emanuel). As the 1870s approached, however, the discussion veered from the effectiveness of these substances as palliatives or as anesthetics.

The general trend of the studies surrounding anesthetics took on a different course from “the [simple] management of the dying (and) the treatment best adapted to the relief of the sufferings” to the possibility of using such substances to put terminally-ill patients to death. Ironically, the first proposal to put to use like substances to euthanasia was not even a physician. Speaking before the members of the Birmingham Speculative Club, Samuel D. Williams became the first advocate of euthanasia through the use of anesthetic substances like chloroform.

Williams was not satisfied with the recommendations made by Bullar and Warren to merely use anesthetics to relieve dying patients of the pains of death, so he went farther and proposed their use to deliberately end the life of a patient. Specifically, Williams proposed that: …in all cases of hopeless and painful illness, it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer chloroform or such other anaesthetic as may by-and-by supersede chloroform-so as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted.

to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient (Emanuel). When euthanasia was mentioned by Bacon and More several years earlier, it did not take long for the issue to fizzle out and escape the public’s attention because nobody, especially the media, followed up on it. This time around, however, the comment made by Williams before a small gathering of men grabbed the spotlight and, thus, caught the attention of many people.

Williams was quoted in the Popular Science Monthly which had a wide circulation and in 1872, his proposal was even published in the form of a book. The book received favorable reviews and Williams was complimented by prominent literary as well as political journals in Great Britain. Nevertheless, majority of the British journals chose to reject his proposal because, according to them, there was a grave danger that when put to actual practice, euthanasia as proposed by Williams would be seriously abused (Emanuel).

His proposal, though, sparked a heated debate on the issue of euthanasia both in Great Britain and in the United States. An article published in an 1873 issue of the Medical and Surgical Reporter posed the inevitable question: “Whether, when a patient is past all hope, a victim to a fatal disease, entailing great agony … (and) he and the family alike beseech us to ‘put an end to his misery,’ we ought to do so?

” The succeeding years witnessed medical associations in both continents hotly debating the issue while medical journals would generally refer to the proposal made by Williams in their editorials. The prevailing and dominant view among American and British physicians, however, remained opposed to euthanasia. The sentiment among physicians at the time was summed up in the statement that “opium [should be] administered to the dying, as an anodyne to relieve pain … (not to throw) the patient into a sleep from which he may not awake.

” This was probably why when the South Carolina Medical Association held a vigorous debate on the issue in 1879, one of its primary considerations had been whether to make the American public privy to their discussions or whether to make the public know that they were even discussing the issue. For his part, Dr. Wilhite, a practicing physician from South Carolina emphatically argued that attending physicians could and should lessen a patient’s suffering but should never cause that patient’s untimely death (Emanuel).

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