Euthanasia+and+Ethics

Authors: Bharti Tailor, Ben Alcine, Janet LeBlanc

Euthanasia and Ethics

INTRODUCTION

Euthanasia is an extremely controverisal subject in today's society. It is also shadowed by past events that have made some people immediately opposed to any form of it. Their fear is that euthanasia might be a runaway train that one might not be able to stop once it has left the station and to some degree because of history this fear has some foundation. But, then again, maybe the fear isn't founded and we need to realize how much progress we have made since that time and place in history. No matter how you look at it euthanasia is a very difficult and complex question to be able to answer which is exactly why it is a difficult and complex argument. To understand more about the current situation and where euthanasia may possilbly lead we would like to discuss the following topics: the past history, infant euthenasia, and elderly or dying euthanasia.

PAST HISTORY

Many of the ethical issues raised today are based on some of the past events that still raises deep concerns in society. The history of euthanasia goes back as far the first century B.C.. This link will guide you through the entire history of euthanasia. []

In 1939 - 1945 Germany introduced a "Euthanasia Program" where for so-called scientific purposes they euthanized the mentally disabled. The mentally disabled were anybody that was "mentally or physically handicapped with mental retardation, idiocy, epilepsy, perinatal impairment with cerebral palsy, schizophrenia, brain tumors, and other cerebal disorders (Peiffer, 2006, p. 210)."

Also if one remembers there were more scientific medical breakthroughs during that time than most other times. The Germans used euthanasia on the Jews, since they were no better than dogs, to test medical theories. For example how much air could be put in an IV line before it kills someone. Was it ethical to kill an ethnic group to make such discoveries?

Because of these past incidents the ethical issues that are of a concern to society today is if euthanasia is allowed in any form where would it stop. It certainly wasn't stopped back then so what would be there to stop it now. Many might feel that a mentally or handicapped child should be euthanized since they would not be making any useful contribution to society. Some parents or society may feel that way while others would feel that they have an abundance of love to share. As history has proven people are able to make a decision based on rational rather than emotion. In October of 1939 Hitler ordered widespread “mercy killing” of the sick and disabled. The Code named “Aktion T 4,” the Nazi euthanasia program to eliminate “life unworthy of life”, at first focused on newborns and very young children. Midwives and doctors were required to register children up to age three who showed symptoms of mental retardation, physical deformity, or other symptoms included on a questionnaire from the Reich Health Ministry. A decision on whether to allow the child to live was then made by three medical experts solely on the basis of the questionnaire, without any examination and without reading any medical records. Each expert placed a + mark in red pencil or - mark in blue pencil under the term “treatment” on a special form. A red plus mark meant a decision to kill the child. A blue minus sign meant a decision against killing. Three plus symbols resulted in a euthanasia warrant being issued and the transfer of the child to a ‘Children’s Specialty Department’ for death by injection or gradual starvation. (Pfeiffer, 2006)

INFANT EUTHENASIA


 * The Groningen Protocol**

The Groningen Protocol was established in the Netherlands and is accepted within the medical community. The Groningen Protocol allows healthcare providers and parents to choose to euthanize a child based on "the judgment that the child's future quality of life is so low that death is a better option than life." It is not based on the fact that they will inevitablly die within a short period of time. So they are making a decision based on the fact that the total suffering of the child will outweigh the benefits of him living (Kon, 2008)." No one truly knows what the future would hold for a child and a cure could be just around the corner so therefore euthanizing a child might be premature. See the chart for the condition of the Netherlands Groningen Protocol.



One of the arguments the US has against this protocal is that they are not yet convinced that they "can accurately predict the extent of an infant's future suffering (Kon, 2008)". So this leads us to the question of understanding what suffering means. In order for a child to fulfill the Groningen Protocol their suffering must be unbearable. Since an infant cannot speak for themselves then this is something that a doctor must either assume by the condition of the child or from experience. This is one of the qualifications that makes a US doctor pause in bringing in the protocol since this cannot be medically ascertained as a certainity. US doctors are also troubled by the fact that they took an oath to do no harm. So in essence this is a contradictory action to their code of ethics. However, the US has allowed an infant to be removed from life support to die when that would be the inevitable outcome. This is known as passive euthanasia.

Here are two cases and the facts. Once case is from the Netherlands the other from the US.



There are of course small yet distinct differences in these two cases. The child from the Netherlands would have continued to live but not without much care and apparent distress. So the decision was based on the fact of future unbearable suffering. However the case in the US was based on the fact that the child would never be able to live off of the ventilator. These are profound differences and the exact differences that the US still considers worthy of more thought.

Moral differences between passive and active euthanasia @http://euthanasia.procon.org/viewanswers.asp?questionID=000147

ELDERLY/DYING EUTHENASIA

The United States has been commonly practicing passive euthanasia for about 20 years now. Passive euthanasia is allowing the withdrawal or withholding of life-sustaining machines such as respirators or feeding tubes. But now we are currently looking at active euthanasia which is to deliberately cause an early death.

Never before in history have we had to face this question to the degree that we are facing it now due to technology. In the last twenty years we have developed technology that has allowed us to preserve life even when there is only a glimmer of life left. Due to this we find ourselves having to make the decision of when is keeping someone alive beneficial or at what point does it become harmful. US doctors are realizing that there is coming a time when active euthanasia could become a possibility. This completely goes against the oath that they take to even be able to practice their profession.

There is a fine line to deciding who should be allowed to die and who shouldn’t based on their circumstances. And opening the door to one could also open the door to situations we have yet to think about and we all know an opened door is more difficult to close than one that has never been opened at all. Society can go forward more easily than it can go back. Currently our society is moving forward faster than our medical profession can ethically keep up with.



Situations describing the different scenarios ethicists face when distinguishing between active and passive []

Basing a decision on future suffering can leave a lot of room open to interpretation. Let’s look at a cancer patient who is diagnosed but told he could have five to ten years of life. Emotionally he decides he cannot deal with the thought of the future suffering that he may have to endure. According to our current ethical standards he would have to live out the rest of his life. His future suffering might be extremely unpleasant but no one can determine how unbearable it might be or not be. He may have three or four years of quality of life that he may cut short if he decides to end his life.

The same principle is also applied to the elderly in regards to quality of life. Being old and feeling as if your life has no purpose or meaning anymore isn’t reason enough to want to end it. Nor is it reason enough that others might think you have nothing left to offer and you are using up time and resources by merely existing. These are the dilemmas we could be facing with active euthanasia.

Making decisions based on the what-ifs can try even the most brilliant mind or morally conscientious person. Anyone can say their emotional or physical suffering is unbearable but we have yet to actually have a proven scientific way to accurately measure this. So the decision would have to be based on experience or the patient’s word. Doctors are still not able to truly predict how long a patient can live. The best they can do is an educated guess and many times a patient has outlived or short lived his predictions.

If death as a treatment were to become a part of our medical practice one might begin to be concerned that a doctor might not try as hard to cure the sick or elderly. In Holland there was an unpleasant side to this practice. The doctors were making the decision many times without even consulting the patient or the patient’s family. The safeguards were supposed to be that the patient “was terminally ill, in considerable pain and mentally competent and must repeatedly express a wish to die (Shapiro, 1994).” When the family brought the doctors to trial they usually won the court case on the basis they were acting in the best interest of the patient. This type of situation is what leads to the “slippery slope”.

"Slippery Slope" is the controversial phrase for the ethical side of euthanasia. This is when voluntary euthanasia could lead to involuntary euthanasia to get rid of the people who may be classified as undesirable for one reason or another.

Some ethical arguments in regards to the slippery slope are (Arguments Against Euthanasia, 2009):
 * takes away society respect for life
 * projects the feeling that some lives are worth more than others
 * could lead to killing undesirable groups of people
 * it might not be in the best interest of the person being euthanized
 * it may affect the rights of others, like family, not just the patient

Pros and Cons of "Slippery Slope" in Belgium and Holland @http://euthanasia.procon.org/viewanswers.asp?questionID=000151

CONCLUSION

Based on these two facets of euthanasia, infant and edlerly/dying, there are different approaches that can be used to come to a conclusion. An absolutist approach would consider what is the most beneficial to the patient. They would not readily take into consideration the details of each case because the process is quite simple. If the future for sees a life of unbearable suffering or the patient expresses a wish to die then the choice is straightforward - euthanize.

However, a utilitarian would want to approach each case based on what will produce the greatest benefits over harms. This would require going over the details of each case. All affected family members as well as the patient would be involved. If the infant was to only look forward to a life of suffering they would consider euthanasia but if a elderly/dying person just didn't want to deal with the emotional stress of an illness and the suffering could be managed they may choose not to euthanize.

Now a virtue-based approach would want to look at the morals. They would take into consideration that all life is valuable and a doctor's oath is to save lives not take them. However, again if the suffering would be intolerable they would also consider it moral character to know when living is no longer beneficial but harmful and that euthanasia should be allowed.

In order to make a well rounded decision all approaches would need to be included and reviewed when establishing the guidelines. This could prove to be beneficial for all parties in the process as well as avoiding the possibility of exempting any safeguard that would need to implemented. "Deliberations regarding euthanasia as a general matter, as well as infant euthanasia more specifically, are complex. In the United States, The American Nurses' Association Council on Ethics and Human Rights has been working to define for nurses the differences between euthanasia, assistance in dying, and palliative care (American Nurses' Association [ANA], 2008) (Catlin, 2008, p. 249)."

PERSONAL CONCLUSION As I was researching euthanasia and ethics I began with the opinion that each situation and circumstance is unique and where it falls ethically is also unique. I, too, am afraid that if active euthanasia becomes legal that it just might be like opening a pandora's box because it is almost impossible to move forward in the future without taking the past into consideration. However, I also realize that it is practically inevitable that active euthanasia will become a reality. I can only hope that the ethicists are furitively working on developing a moral code that might be acceptable and contain as many safeguards as possible. I also hope that the each and every doctor will have the choice of whether to participate or not in this program just as a patient or healthcare decision maker will have a choice. (Janet)

PERSONAL CONCLUSION In conclusion euthanasia is not murder. It can be a way to show mercy to a loved one who is suffering. It is in no way meant to be suicide with a partner. It was and is currently and always will be a very controversial topic. Every person is entitled to their own opinion and it is extremely hard to get everyone on board with being for it or against it. The laws regarding euthanasia vary from country to country but the question remains the same. Is it ethical? Well that can vary from the church’s perspective to the senate to your own personal heart. (Ben)

PERSONAL CONCLUSION Euthanasia is a twin-aged weapons. While most patients who opt for mercy killing may be terminally ill with absolutely no chance of recovery, there are chances of misuse like wrong diagnosis, hallucinations of patients and collusion of patient's relatives and doctors. To tackle this problem all such case should be reviewd by a panel of experts including physcians, neurologists, psychiatrists, psychologists and lawyers. In any case, judicial approval should be take in all cases. (Bharti)

REFERENCES  Peiffer, J. (2006). Phases in the Postwar German Reception of the “Euthanasia Program” (1939–1945) Involving the Killing of the Mentally disabled and its Exploitation by Neuroscientists. //Journal of the History of the Neurosciences//, //15//(3), 210-244. doi:10.1080/09647040500503954.

Kon, A. (2008). We Cannot Accurately Predict the Extent of an Infant's Future Suffering: the Groningen Protocol is too Dangerous to Support. //American Journal of Bioethics//, //8//(11), 27-29. Retrieved from CINAHL Plus with Full Text database.

Shapiro, J., & Bowermaster, D. (1994). Death on Trial. (Cover story). //U.S. News & World Report//, //116//(16), 31. Retrieved from Academic Search Premier database.

Lowance, D. (2002). Withholding and Withdrawal of Dialysis in the Elderly. //Seminars In Dialysis//, //15//(2), 88-90. Retrieved from MEDLINE with Full Text database.

Baley. A (2009 September). The Perfect Balance Reflection, P.24-25 Retrieved on 01/12/09 From research library database (Document Id AN 44584410)

Catlin, A., & Novakovich, R. (2008). The Groningen Protocol: What Is It, How Do the Dutch Use It, And Do We Use It Here?. //Pediatric Nursing//, //34//(3), 247-251. Retrieved from Academic Search Premier database.  //A////rguments against euthanasia//. (2009). Retrieved from @http://www.bbc.co.uk/ethics/euthanasia/against/against_1.shtml