EUTHANASIA AND LEGAL SYSTEM OF THE WORLD
3rd Year, Dept. of Law, Calcutta University.
"Death solves all problems...no man, no problem." ... Joseph Stalin
Every human is desirous to live and enjoy the fruits of life till he dies. But some times a human being is desirous to end his life by use of unnatural means. While 'suicide' denotes the manner by which a person ends his life by his own acts, the intentional termination of a patient's life, by act or omission of medical care, is called 'mercy killing' or 'euthanasia'. It presents a paradox in the code of medical ethics, for it involves a contradiction within the Hippocratic oath, which is essentially the promise to prolong and protect life even when a patient is in the late and most painful stages of a fatal disease. The paradox lies in the fact that while an attempt to prolong life violates the promise to relieve pain, relief of pain by killing violates the promise to prolong and protect life.
The most commonly accepted definition of euthanasia is : The intentional killing of a dependent human being by an act or omission for his or her alleged benefit.The key word here is "intentional". If death is not intended, it is not an act of euthanasia.
We can elaborate by the following illustrations:
Illustration(1) Euthanasia By Action : Intentionally causing a person's death by performing an action such as by giving a lethal injection.
Illustration(2) Euthanasia By Omission : Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.
TYPES OF EUTHANASIA:
i)Voluntary euthanasia : When the person who is killed has requested to be killed its is know as commission of voluntary euthanasia.
ii)Non-voluntary euthanasia: When the person who is killed made no request and gave no consent,then it is known as non-voluntary euthanasia.
iii)Involuntary euthanasia : When the person who is killed made an expressed wish to the contrary,then it is known as involuntary euthanasia.
iv) Assisted suicide : Someone 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. When it is a doctor who helps another person to kill themselves it is called "physician assisted suicide."
Thus from the very definition it is highlighted that consent of the euthanized person,the reason behind his consent and the intention of the person who is performing the act are important ingredients of the definition of euthanasia.On this basis euthanasia can be further categorised in the following ways.
Different categories :
1)PSEUDO EUTHANASIA :
People who, perhaps because of a serious illness or perhaps for reasons unrelated to their illness, are extremely depressed and say they want to die.They become frustrated and feel guilty about being a burden on their family.But social workers and psychologists have routinely found that when people like this talk about or attempt suicide, the vast majority don't really want to die. What they want is to get the attention of those around them.Even if we accept the idea that some people might make a reasoned decision to commit suicide,we would be show prudence in excluding the people who are in moments of depression,or otherwise not fully competent.This type of euthanasia can be termed as pseudo euthanasia.That is the case which envisages the situation where the actual intention is not to get euthanized but to get attention is termed as pseudo euthanasia.
2) PASSIVE EUTHANASIA:
People who are suffering from illnesses that make them unable to communicate. This includes people who are in a coma, or paralyzed, or simply so sick and weak that they cannot make meaningful sounds or other communication.The quality of life of such patients is so low that they are better off dead .In the United States, the most frequent way of killing such people is by taking away their food and fluids, so that they starve to death.This is one of the most agonizing ways to die. They give them drugs to prevent their bodies from going into convulsions as they starve.This is called "passive euthanasia". "Passive" because they are not directly killing the personally.They just define food and fluids as "medical treatment", and then stop this "medical treatment".
Pro-euthanasia people often say that "of course euthanasia should be limited to people who are terminally ill". The term "terminally ill" is can be defined as condition of the person who will die within a few months with or without medical treatment.
3) DOCTOR OF DEATH:
People who are recommended death because he has become a burden on society.As Jack Kevorkian, the "Doctor of Death" who has been involved in a number of euthanasia in Michigan, put it, "If a rational policy of planned death can be attained, the benefit for society is incalculable".[Transcript from hearing in Michigan v Kevorkian, Oakland Circuit Court, 9 June 1990 , Kevorkian's testimony]
Now lets take a glance look at laws governing euthanasia throughout the world:
Netherlands: In 2002, the government legalized assisted suicide and euthanasia (the doctor administers a fatal injection of drugs). The law is not limited to adults, nor does an applicant for euthanasia have to be terminally ill. The main basis for a request is hopeless and unbearable suffering, regardless of life expectancy.
All cases are reviewed by medical committees, and instances of suspected wrongdoing are referred to judicial investigators. The Dutch government is reviewing a protocol to allow euthanasia, with parental consent, for infants born with terminal and painful illnesses.
Switzerland: Article 115 of the Swiss Penal Code exempts people who assist in a suicide for honorable motives, such as to help bring an end to suffering. Switzerland also allows voluntary organizations to help people, including foreigners, end their lives. Where lethal medication is required, a doctor's prescription is obtained. All acts of assisted suicide are reported to the police and investigated.
Belgium: The Belgian Act on Euthanasia, passed in 2002, defines euthanasia as "intentionally terminating life by someone other than the person concerned at the latter's request." Assisted suicide remains illegal. Requirements include that the patient should have attained the age of majority, that the request be "voluntary, well-considered and repeated" and the patient be "in a futile medical condition of constant and unbearable physical or mental suffering that cannot be alleviated." All acts of euthanasia must be reported to the authorities.
Britain: A bill was introduced this month in the House of Lords that would allow a competent and terminally ill person who has reached the age of majority and is suffering unbearably to request either assisted suicide or voluntary euthanasia. It sets requirements including an assessment by an attending physician that the patient is likely to die of natural causes within a few months, that the patient is competent to make the request and that he or she is suffering unbearably. The patient must sign a written declaration of intent. If this has not been revoked within 14 days of the date on which the request was first made, the patients can receive the means to take his or her own life or, if the patient is physically unable to do that, have his or her life ended through voluntary euthanasia. A medical committee would review all cases.
Taking into consideration the legal provisions,let us try to decipher the rights of the patients in case of euthanasia.
While dealing with law related with medical sector,it is often overlooked that patients have the common law right to refuse any medical treatment.A doctor who treats a patient against his or her express wishes can be charged with assault.
This can be interpreted in two ways:
Firstly,a patient can refuse any medication inorder to end his life.thus leading to a case of voluntary euthanasia.in a way this helps to propogate the concept of euthanasia substantially.
Secondly,contradicating the first point completely,it takes away the right of doctors to prescribe euthanasia.That is,it gives right to the patient to stop the doctor from committing or prescribing him to be euthanized with out his expressed wish.Thus arises the question whether the patient"s gaurdian or relative or the doctor has the right to take decision of commiting euthanasia on his behalf when the patient is incompetent to dictate his wish,for example when in coma.
In the present climate ,it is easy to imagine a doctor giving a lethal dose of pain-killing drug and then claiming that death was the best way to eliminate physical suffering. If the doctor could also show that the patient had requested the lethal dosage, the court might well interpret the law in the doctor's favor.
Many do not find the prospect of legal voluntary active euthanasia in any way alarming. But two things should give us pause.
First, as a soon-to-be-published Canadian study will show, most health care professionals who work with the dying endorse the patient's right to refuse medical treatment, but oppose legalizing active euthanasia. The professionals recognize that if pain is controlled, as it can be in virtually all cases, very few terminally ill people ask to be put to death.
Second, experience in Holland tells us that voluntary Euthanasia can quickly become involuntary euthanasia. Holland is widely regarded as one of the world's most civilized countries. Active euthanasia is legal there, but for the past decade the government has not prosecuted doctors who report having assisted their patients to commit suicide. A recent Dutch government investigation of euthanasia has come up with some disturbing findings. In 1990, 1,030 Dutch patients were killed WITHOUT THEIR CONSENT. And of 22,500 deaths due to withdrawal of life support, 63% (14,175 patients) were denied medical treatment WITHOUT THEIR CONSENT. Twelve per-cent (1,701 patients) were mentally competent but were NOT CONSULTED. These findings were widely publicized before the November 1991 referendum in Washington State, and contributed to the defeat of the proposition to legalize lethal injections and assisted suicide. The Dutch experience seems to demonstrate that the "right to die" can soon turn into an obligation.
This concept is dangerous, and soon we could find ourself the victim if Euthanasia becomes legal.We need to reflect carefully on the consequences of legalizing active euthanasia.If we enshrine the absolute right to die, then it might become illegal to intervene to obstruct would-be suicide. Pharmacists will be obligated to sell a lethal dose of hemlock to anyone who is temporarily depressed.
POTENTIAL FOR ABUSE
We need to think of the potential for abuse if mercy killing becomes legal.What if someone stands to inherit one million dollars when a relation dies? Might the heir not find it tempting to nudge her in the direction of accepting a lethal injection? Or, if she didn't get the hint, to make her miserable enough to want it? If voluntary euthanasia is made legal for "persons of sound mind" there will inevitably be tremendous pressure to provide it for those who "would request it if they were able to" - the mentally ill or handicapped, the senile, etc. Finally, despite genuine compassion for the suffering of dying people, does there not also lurk in many hearts a less admirable motive? Few people are so tasteless as to link euthanasia and health care costs in the same breath, but there is a widespread few that medical care for the elderly costs more than we can afford. These financial pressures will multiply in the coming years as our population ages. Many elderly people are already responding to this not-so-subtle message by declaring their willingness to die when their lives are no longer productive. Their reluctance to be a financial burden on the young is admirable, but the long term consequences could be brutal. What will happen to the trust that people still feel toward their doctors if our country follows Holland? The fatal question lingers amidst the cry of legalising euthanasia.
Case study(1)- A doctor went to visit a patient in a nursing home. The director of the nursing home told him that a couple had recently come to visit their mother at the home, and told him that they wanted him to euthanize her. They frankly told him, "We just can't make it without grandma's inheritance", and they were getting impatient waiting for her to die on her own. The nursing home director threw them out. The next time my doctor friend visited, the director told him that the couple had transferred grandma to another nursing home. Two weeks later, she was dead.
Case study(2)- Related by a Dutch doctor: He diagnosed a woman with cancer. He checked her into the hospital on a Thursday and began treatment. The treatment was quite successful. By Saturday she was showing definite signs of improvement. On Sunday he was quite hopeful she would fully recover. On Monday he came to visit and there was a different patient in her bed. He asked the hospital staff where they had moved her. "Oh", a resident replied, "we needed the bed, so we gave her the injection last night". He meant a lethal injection, of course.
According to Rita Marker of the International Anti-Euthanasia Task Force, euthanasia now accounts for 15% of the deaths in the Netherlands. A few years ago Governor Richard Lamm of Colorado said that the "terminally ill elderly have a duty to die and get out of the way". ["Elderlys' Duty to Die", New York Times, 29 March 1984]
THE ALTERNATIVE TO EUTHANASIA
The alternative to legalized euthanasia is not extraordinary, futile treatment to hopelessly dying patients.The alternatives are appropriate medical care- Researcher"s have suggested various methods which can be applied in medical field to reduce pain.But foremost it has been suggested to deal such patients with compassion and care.For example if we take up the following conditions:
Those in uncontrollable pain
They are not getting adequate medical care and should be provided up-to-date means of pain control, not killed. Even Dr. Pieter Admiraal, a leader of the successful movement to legalize direct killing in the Netherlands, has publicly observed that pain is never an adequate justification for euthanasia in light of current medical techniques that can manage pain in virtually all circumstances.[ Why, then, are there so many personal stories of people in hospitals and nursing homes having to cope with unbearable pain? Tragically, pain control techniques that have been perfected at the frontiers of medicine have not become universally known at the clinical level. What we need is better training in those techniques for health care personnel -- not the legalization of physician-aided death.
What would it say about our attitude as a society where we to tell those who have neither terminal illness nor a disability, "You say you want to be killed, but what you really need is counseling and assistance," but, at the same time, we were to tell those with disabilities, "We understand why you want to be killed, and we'll let a doctor kill you"? It would certainly not mean that we were respecting the "choice" of the person with the disability. Instead, we would be discriminatory denying suicide counseling on the basis of disability. We'd be saying to the non disabled person, "We care too much about you to let you throw your life away," but to the person with the disability, "We agree that life with a disability is not worth living." Most people with disabilities will tell you that it is not so much their physical or mental impairment itself that makes their lives difficult as it is the conduct of the non disabled majority toward them. Denial of access, discrimination in employment, and an attitude of aversion or pity instead of respect are what make life intolerable.
This methods might look inadequate and hard when it comes to application but that doesnot gives us the reason to take away a life when we cannot return it back.
True respect for the rights of people with disabilities would dictate action to remove those obstacles -- not "help" in committing suicide.