Euthanasia, or assisted suicide, is a controversial topic that is defined as deliberate intervention undertaken with the express intention of ending a life to relieve intractable suffering. Today, several countries have legalized euthanasia, and some view it as a human right. Those who support euthanasia point out the importance of personal autonomy and self-determination, the right of every human being to have his/her wishes respected in decisions involving his/her own body, and the recognition of every human being as, in principle, the master of his/her own destiny.
In 2002, Holland became the first country in the world to legalize euthanasia, and in 2003, 1,626 cases were officially reported from Holland. The Dutch euthanasia law gives doctors immunity from prosecution if they help to kill patients over the age of 12 who are suffering unbearably from incurable conditions and who have repeatedly requested euthanasia.
Euthanasia Guidelines in Holland
The Dutch laid out narrow guidelines for doctors: The patient, who must be suffering unbearably and have no hope of improvement, must ask to die. The patient must clearly understand the condition and prognosis, and a second doctor must agree with the decision to help the patient die.
Euthanasia in Belgium
Belgium legalized euthanasia in 2002, but the laws seem to encompass assisted suicide as well. Since its legalization eight years ago, euthanasia now accounts for 2 percent of deaths in Belgium, or around 2,000 a year. Two doctors must be involved, as well as a psychologist if the patient’s competency is in doubt. The doctor and patient negotiate whether death is to be by lethal injection or a prescribed overdose.
Oregon Death with Dignity law
In 1994, voters in the state of Oregon approved a ballot measure that would have legalized euthanasia under limited conditions. Under the Death with Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria. In order to qualify for physician-assisted suicide, a person must be an Oregon resident, 18 years of age or older, must have decision-making capacity, and must be suffering from a terminal disease that will lead to death within six months.
Forced Euthanasia
A number of reports indicate that some medical practitioners have abused the legal privilege of euthanasia and encouraged depressive patients to select euthanasia as an option. A study found that a high proportion of deaths classed as euthanasia in Belgium involved patients who did not ask for their lives to be ended. In 1990 government-sponsored surveys found that 0.8% of all deaths in the Netherlands were euthanasia deaths that occurred without a request from the patient. In a 1995 study, Dutch doctors reported ending the lives of 948 patients without their request.
Passive Euthanasia
Although euthanasia is illegal in many countries, passive euthanasia (withholding treatment and allowing a patient to die) is being practiced. This is unethical and described as malpractice. The American Medical Association emphasizes that the intentional termination of the life of one human being by another is contrary to that for which the medical profession stands. Human life has an absolute value, and it is inhuman for a medical practitioner to terminate it.
Mrs. H, a resident of North York, Ontario, Canada, witnessed the agonizing death of her grandmother, who suffered a stroke. When she was admitted to the … hospital, the doctors said that she would not recover. After several days, the nasal feeding was discontinued. Mrs. H was near her semi-conscious grandmother all the time, and the grandmother responded to her time to time by blinking her eyes. After the removal of the nasal feeding tube, she was starving, and I could see tears in my grandmother’s eyes. She was dying, but the process was accelerated by discontinuing nasal feeding that led to an agonizing death, says Mrs. H.
Mrs. VXXX, a resident of Colombo, Sri Lanka, underwent the same experience when her 92-year-old mother was admitted to the … hospital. She was diagnosed with a benign ovarian tumour and had numerous age-related complications. During her stay at the hospital, she was only given Brufen and Vitamin B. Doctors and nurses often said that she had lived her years and taken no significant efforts to improve her condition. She was prematurely discharged, and after two weeks, she died at home. "What worries me is not my mother’s medical condition but the attitude of the medical staff," says Mrs. VXXX.
Mr. XXX, a resident of Negombo, met with a road traffic accident and was admitted to the ……………….. Hospital Intensive Care Unit. He was unconscious throughout and was on life support. By the 8th day, his condition remained unchanged. The medical staff decided to remove him from the life support system to accommodate another patient who was diagnosed with Guillain–Barré syndrome. After removing Mr. XXX from the life support system, less than 24 hours later, he passed away. His son, who is a doctor now, believes that his father was not given a fair chance at the hospital to recover.
Passive Euthanasia: My Personal Experiences in the Sri Lankan Hospitals
Unfortunately, I observed passive euthanasia in a number of Sri Lankan hospitals. The first experience I witnessed was in 1994 during my internship appointment at the Matale Base Hospital.
A 10-year-old schoolboy was brought to the surgical ward following a head injury that was caused by a road traffic accident on the Palapathwala road. I was the house officer who gave primary care to this unconscious child. I immediately realized trepanation of the skull had to be done to evacuate the intracranial hemorrhage that was pressing the vital centers in the brain. The senior house officer also agreed with me. This operation is called performing a burr hole and has to be done by a consultant surgeon. I immediately called the operating theatre and said we may need the theatre facilities to treat a boy with a head injury.
Then I called my consultant surgeon, who had just finished the evening ward round. The time was about 3.40 pm, and he was preparing to go home. The consultant surgeon was annoyed that I called the operating theatre. He ordered me to give diazepam 5 mg intravenously to the child even without seeing the patient. Again, I asked, "Sir, are we going to do a burr hole to stop the subdural hematoma?" This time, he responded to me in very dry language and asked me to give diazepam, monitor the child and maintain the head injury chart. I was powerless and did exactly what he ordered. Then the consultant surgeon left for home.
I observed the poor child until midnight. Several times, he went into seizures. Since we were given unofficial instructions not to transfer patients to the Kandy hospital at night by the Surgeon, we had no way of sending the child to the Kandy Teaching hospital for special management. The surgeon did not respond to our calls that night. So we waited and prayed for his life. At around 1.30 am the child died. In my opinion, we could have saved this child if the surgeon had done the surgery or allowed us to transfer the child to the Kandy Hospital. When I look back at this incident after 18 years, I feel that the consultant surgeon who was supposed to give us knowledge, ethics, and leadership did nothing but force us to perform passive euthanasia.
I was trained in anesthesia by Dr. Priyangani Ariyarathne, consultant anesthetist at the North Colombo Teaching Hospital, in 1999. I worked in the ICU and in the operating theatres at the North Colombo Teaching Hospital for about a year and observed that when the medical staff get new acute patients to the ICU, they sometimes remove the life support systems of the old patients and fix them to the new patients. Due to a lack of beds in the ICU, the medical staff was compelled to do it. But still, I had mixed feelings about this unorthodox practice.
When the Ja Ela bomb exploded on December 18, 1999, killing General Lucky Algama, hundreds of patients were brought to the Colombo North Teaching Hospital. The individuals who were critically injured were admitted to the ICU. There was a young man who was on the life support system following organophosphate poisoning, and the medical staff removed him from the life support system; his bed was given to a bomb victim. Without the ventilator and other life support systems, the young man died the following day. One can always argue that the first patient became ill as a result of self-induced poisoning and the second patient became a victim of a terrorist act. But my question was, Who are we to decide their fate and the duration of their life span?
When I was working at the Chilaw hospital, I had the opportunity of working at the ICU, and I saw this life support removal occurring there too. Once we had a snakebite case, and in order to accommodate him, the doctors removed another patient who was on the ventilator with dengue hemorrhagic fever. The snakebite case survived, and the dengue patient died. Again, it became a dilemma for me. So instead of working in the ICU, I decided to work in the operating theatre.
Over the years, I witnessed how some of my colleagues became indifferent to human lives. I remember one doctor at the Negombo hospital who was against giving blood transfusions to the severely anemic alcoholic patients. "These people are alcoholics, and they deserve to die without wasting medical resources," he openly stated. Another PHO (Pediatric House Officer) told me that when he suspects cerebral palsy in newborns, he cuts off the oxygen supply to them. I am doing a favour to the child and the parents, so they are free of lifelong suffering with a disabled child, he told me with confidence. I became so disgusted and replied that it was illegal, a crime, and under the Hippocratic Oath, he was violating professional ethics. I do not know whether he stopped this unethical practice after my brief lecture.
Euthanasia declines in the quality of care.
Euthanasia devalues human life; in the long run, euthanasia can become a means of health care cost containment. In Holland, legalized euthanasia has led to a severe decline in the quality of care for terminally ill patients. Dr. Els Borst, the former health minister and deputy prime minister who guided the euthanasia law through the Dutch parliament, recently admitted that medical care for the terminally ill had declined since the law came into effect.
Euthanasia and Murder
According to the Criminal Code, a person commits homicide when, directly or indirectly by any means, he causes the death of a human being. In this context, euthanasia is merely murder. The main aim of the medical practitioners should be focused on improving and enhance the care of the patient. Under the Hippocratic Oath, medical practitioners cannot engage in euthanasia.
Dr. Jack Kevorkian, alias Dr. Death
Dr. Jack Kevorkian is a pathologist who actively supports voluntary euthanasia. He designed a so-called death machine (thanatron) that was used by several terminally ill patients to commit suicide. He had helped more than 130 terminally ill people end their own lives. In 1994, he faced murder charges in the death of Thomas Hyde, who suffered from a terminal nerve illness. He was convicted of second-degree murder. Some experts consider Dr. Jack Kevorkian highly obsessed with mercy killings and gradually losing the human touch. Instead of promoting health as a doctor, Dr. Jack Kevorkian promoted death.
Harold Shipman
The British doctor Harold Shipman murdered 215 of his patients using the drug diamorphine over a period of 20 years. He killed an average of one patient a month during his medical career. Young Shipman observed the painful death of his mother, who suffered from terminal cancer. In the later years, he killed mainly elderly women who were suffering from various illnesses. He was an addictive serial killer who may have believed that he was helping the patients to end their suffering. Shipman hanged himself in January 2004 while in custody.
NAZI Movement and Euthanasia
Those who support euthanasia should study what the Nazis did in Germany and in their occupied countries. The Nazis widely used euthanasia as a social cleansing method. First, they exterminated the mentally ill and disabled Germans. Subsequently, they extended euthanasia as a political tool. Nazis used the medical practice to propagate racial supremacy. Dr. Josef Mengele, alias the Angel of Death, used to do horrible experiments, euthanizing men, women, and children. The Nazi genocide machine started with euthanasia, and it ended with the Final Solution. During Hitler’s regime, 6 million Jews were murdered.
Conclusion
Before the advances in medical science, diseases like leprosy, syphilis, etc., were considered incurable, and relatives often performed mercy killings to end the suffering of the patients. Today the doctors are struggling with terminal cancer and sometimes suggest euthanasia as a temporary answer. The future advancements in medical science would bring viable solutions to many incurable diseases, and euthanasia would be considered an outdated, inhuman, and unprofessional form of practice.
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