«  “Euthanasia would be a negative answer to a problem that can be solved by positive action.” (Cicely Saunders)

In advanced disease the patient’s interests and rights mainly concern how he lives his remaining days and how he dies. The doctor’s duty is to care for the patient in good faith and in the patient’s best interests. In the case of a patient near death, stopping certain treatment (but never treatment to relieve pain and other distressing symptoms) may be appropriate to the patient’s best interests.

The well known medical aphorism still applies:

“Thou shalt not kill,
but shalt not strive,
officiously to keep alive.”

This brief discussion focuses on the issue of voluntary euthanasia (when a patient requests death and someone else kills him). A conscious competent patient has the right to refuse life-sustaining treatment, but does not have the right to be killed.

The timely withdrawal of life support machines is a separate issue, and is not “passive euthanasia”, as it is too often mislabeled by those who advocate voluntary euthanasia. Advocates of voluntary euthanasia occasionally even argue that adequate pain control somehow constitutes “passive euthanasia” because use of morphine allegedly “shortens life”. There is simply no credible medical evidence for this assertion. (The appropriate use of morphine in titrated doses to reduce or abolish pain can on occasion extend life by releasing a patient from his physical suffering.)

Patients facing death or dependence sometimes ask “Can’t you put an end to it all?” It is often a question asked by those who most fear dying. On further discussion it rarely means “Please kill me”, but rather “Will I get pain?” or “Do you understand how awful it is to be dependent on others?” or “Am I being a burden?” Sometimes it is a way of introducing a specific fear that the patient finds difficult to discuss, or a plea for some control over his situation, or for some understanding. Very rarely is it a request to be killed.

Euthanasia is illegal. Those in favor of legalizing voluntary euthanasia argue that individuals have the right to self determination and a right to make choices about how and when they die. Hospice care also emphasizes giving control back to patients and allowing them (and helping them) to make their own decisions. A person’s right to die cannot be translated into a right to be killed, nor into a duty upon someone to kill him. Euthanasia may sometimes appear a helpful way to put an end to everyone’s suffering. In fact, legalized euthanasia would increase suffering.

The main arguments against euthanasia are:

1. It is morally wrong to kill. Any other rule or law in a society is open to abuse.

2. Legalized euthanasia would put pressure on the elderly, the disabled and the dependent. (“I’m such a burden, maybe I ought to ask for it.”) A human being is infinitely precious. None of us can judge our own or other people’s lives as worthless.

3. Legalized voluntary euthanasia would be open to abuse. In theory the person would repeatedly and voluntarily request death, but pressure could be brought to bear on that person in many subtle ways to consider doing this, both by family members and professionals.

4. Legalized euthanasia would promote the attitude that an illness may get so bad that “I may end up asking to be killed.” With genuinely compassionate and competent care that need never be the case.

5. Killing a patient would become a therapeutic option. The basic principle of the medical profession is as a servant of life, and the public has a right to absolute trust in that assumption.

6. No one has pure motives (and some people have bad intentions). Even caring family members sometimes say “We just can’t cope.”, when with a bit of extra support they cope very well and (on looking back) are proud of their achievement. Persuading a person to request euthanasia might appear a tidy solution to an emotionally painful or practically inconvenient situation, but it would bring great guilt to the family, just as a suicide in a family brings guilt and suffering, because any act of killing is wrong.

7. Patients are vulnerable and open to persuasion by a doctor they trust. Doctors who practiced euthanasia could bring considerable non-verbal pressure to bear on patients by their attitudes, and unscrupulous doctors might deliberately put pressure on patients to consider this option.

8. If actively killing a patient became a therapeutic option, the unthinkable would become all too thinkable. There already have been very occasional incidents where health professionals (singly or jointly) have taken it upon themselves to end the lives of elderly and comatose patients (without consent), in effect to relieve their own suffering.

9. Who would do it? Most doctors and nurses would not want to be involved with active killing. Indeed, nurses often feel very guilty if a terminally ill patient dies shortly after a perfectly appropriate injection of drugs given to relieve suffering.

10. We do not know the future. Important things can happen to a person in the last few days of his life, and important things can happen to the whole family, too. It is often a time of reconciliation, reaffirmation and growth. For those who work in hospice and palliative care this is one of the strongest arguments against euthanasia.

Extracts of a letter from a nurse:

"I’d like to share with you my experience of dealing with physicians at the hospital where Sandra P. was admitted (after requesting euthanasia), having attempted suicide. She was in mental torment, curled up in the fetal position, not communicating. The resident physician said he did not feel it was worth getting psychiatric help. I asked to see the attending physician who told me, (quote) ‘We don’t usually refer these people to a psychiatrist’. I asked what he meant by “these people” and he said ‘She’s got cancer’. I kept insisting Sandra needed some kind of help, and she was finally transferred to the hospice. I went there to see her before she died. She was very pleased to see me . . . She was smiling, relaxed and more at peace than I had seen her for a long time. . ."

In the secure environment of an in-patient hospice Sandra was encouraged to express her fears and anguish, and her sense of worthlessness. A combination of good physical care and counseling helped her regain her self control. She was visited and taken out for walks in a wheelchair by her son (whom she had previously refused to see). She died peacefully and naturally about a week later.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.

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