Euthanasia

Euthanasia is the termination of the life of a terminally ill person. It is called a “worthy” or “good death”, since its goal is to end the suffering of the patient with his consent or with the permission of loved ones. The practice of voluntary death was welcomed in ancient Greece, when the suicide of the elderly and the disabled was encouraged. Today, such a procedure causes heated debate: in 5 countries it is legalized, another 5 states are considering the legality of “voluntary killing”.

History

For the first time, the term “euthanasia” was used in the XNUMXth century by the philosopher Francis Bacon to define an act of easy death. The idea then, as now, is to help a terminally ill patient die. With an incurable disease, a person, at will, can ask a doctor for a lethal injection in order to die without pain and suffering. Since the twentieth century, euthanasia has gained particular popularity. But the criminal and distorted use of this practice by the Nazis completely discredited the very idea.

At the dawn of the last century, eugenics, the science of selecting the human species, was gaining momentum in Europe. In Germany in the 20s, people who promoted the idea of ​​the purity of the Aryan race were obsessed with it. The idea took root in society that the nation needed to be cleansed of “defective” ones. Patients with mental disorders, hereditary diseases, and congenital pathologies fell into this category. Over time, the list of objectionables expanded, and everyone who was unable to work or simply did not like the authorities began to fall into it. Books and scientific works were published on the topic of sterilization and getting rid of the sick.

In 1923, Adolf Hitler received the work Permission for the Destruction of Life Unworthy of Life. The work belonged to two professors – psychiatrist Alfred Gohe and lawyer Karl Binding. It was about the legality of the physical destruction of the mentally retarded, criminals and seriously ill people. These ideas will form the basis of future “death camps”. The unofficial mass use of forced euthanasia in Germany began in 1939, before that it was considered murder. The Knauer family turned to the Fuhrer for permission to euthanize their son, since he was a deep cripple. The boy was euthanized in the Leipzig clinic, and in the same year an office was organized to handle such cases.

All children under 3 years of age had to undergo an “expert evaluation”, during which terminally ill patients were identified. Those who could not become full-fledged workers in the future were put to sleep. Adults with severe pathologies and mental disorders were sterilized. By 1940, the term “children” in the documents began to apply to persons under 17 years old, and a little later, “children’s euthanasia” began to apply to all age groups. There were discussions about the method of killing in the circles of responsible persons, injections were considered an economically unprofitable method. Criminologist Albert Widman proposed a quick and affordable option – carbon monoxide.

In the “gas chambers” fell:

• people with mental disorders;
• epileptics;
• disabled persons;
• gypsies, Jews and Poles;
• patients who have been treated for more than 5 years.

Such murders were called euthanasia only because of the sonority of the term; in the documents they were sometimes called “disinfection” and the code name “T-4”. By 1941, the mass disappearance of people caused outrage among the clergy, the aristocracy and some politicians. By the end of the same year, Hitler issued an official decree to end the “disinfection”, but unofficially the program was stopped only after the Second World War. In the course of hostilities, soldiers with injuries, children and adults, captives of the non-Aryan race were also subjected to “euthanasia”.

The trials of the perpetrators and those responsible for the T-4 began only by 1950. Only a few received punishment in the trials. Most of the psychiatrists who promoted killing continued to practice medicine, and their trials never took place. Falkenhauser, the head physician of one of the mental hospitals, who practiced starvation as “euthanasia”, was sentenced to 3 years in prison for hundreds of starvation deaths. Only in 2001, the German Society of Psychiatry admitted its guilt and asked for forgiveness from the relatives of the victims.

Modern application

Today, the practice that the Reich used under the name “euthanasia” is recognized as a crime. Because of this, the perception of an easy death in society has been greatly distorted, most states consider it murder. However, in 2001 the Netherlands legalized this procedure. Since then, there has been a heated debate about the legality of humane euthanasia. In countries where it is allowed, the “good death” is applied to the terminally ill, whom medicine cannot help. Also in countries where it is legal, euthanasia can be performed on newborns with an atrophied brain. Children and adults who live only with the help of life-supporting equipment are helped to die with the consent of their relatives.

To perform euthanasia, doctors must be completely sure that the patient cannot be saved. For these purposes, the patient undergoes a comprehensive examination, including by a psychiatrist. Even after a personal request to “die with dignity,” the patient needs to make two statements, between which they take long breaks. Switzerland has allowed euthanasia for mentally ill people if their disease cannot be cured. The Swiss Federal Tribunal argued its decision by saying that mental disorders in some cases bring as much suffering as physical ones.

Types of euthanasia

Depending on whether the doctor is directly involved in the process, two forms of the “act of easy death” are distinguished: active and passive. Also, on the part of the patient, the process can be voluntary or involuntary (from an aesthetic point of view, it is not called “forced”).

Passive

This type of termination of life is also called the “delayed syringe method”. They say about the passive form when the treatment does not help the patient. In this case, medical assistance aimed at prolonging life is terminated. The patient receives only symptomatic therapy, for example, pain relief. This type of procedure allows a person to leave naturally and without suffering. Some of the supporters of this idea doubt that such a process can be called “euthanasia” at all.

Active

More disputes and doubts are caused by the active form of the process. It implies the direct participation of a health worker in the death of a person. It is used only in exceptional cases. In Switzerland, anyone can claim it, including healthy relatives or spouses of a deceased person. To perform the act, the doctor must introduce or give the patient a substance that will gently stop the body from working. As a rule, this is a large dose of painkillers that lead to death in a dream.

The controversy surrounding this form of euthanasia is due to the fact that not every health worker is ready to take on such responsibility. Even in countries where the service is legalized, only a few specialists are ready to carry out the procedure.

Voluntary

Supporters of euthanasia call voluntary death the realization of the right to die. Everyone has the right to independently manage their own lives, and decent care is part of this right. A voluntary procedure occurs when the patient himself asks the doctor to end his life. To implement the idea, a long period and testing of all possible methods of treatment is required. The patient is also working with a psychiatrist. For people with mental disorders, confirming the desire to die is quite difficult. Therefore, such an opportunity is so far only in Switzerland.

involuntary

Involuntary euthanasia is a very controversial issue for doctors and relatives of the patient. It occurs when the patient himself cannot express the desire to leave. At the same time, it must be precisely proved that there is no chance of returning a full life to him. An additional factor for the decision is the pain that the person may be experiencing. Without the consent of the patient himself, euthanasia can be applied only in countries where it is allowed and after the unanimous decision of a council of doctors and relatives.

Euthanasia procedure

Each state that has legalized euthanasia has its own regulation of its implementation. Legislation clearly controls the criminal-legal side of the issue. Medicine is responsible for the accuracy of the arguments about the incurability of a person.

General factors for the procedure:

1. The patient must be terminally ill, feel the desire to die and declare this at least 2 times.
2. If the patient is conscious, he must sign the application for the procedure himself.
3. For the euthanasia of an unconscious person, the application of relatives is required.
4. The process is possible only if the patient’s quality of life is too low and there is no chance of recovery.
5. The application is considered by a council of doctors and legal authorities.

Once the decision is made to carry out an active “act of honorable death”, the process takes place in two stages. First, painkillers are administered intravenously to the patient, within half an hour the person is immersed in anesthesia. After that, substances based on barbiturates are administered, which stop the respiratory function. The procedure is followed by a doctor to make sure that the person really leaves without suffering.

The passive form can take an indefinite amount of time. A person receives all the medicines so that his condition does not bring pain. However, the patient, not receiving drugs to prolong life, dies from the very cause of his condition. Also, euthanasia is carried out at the request of relatives, if a person has been on life support for a long time and there is no chance of recovery. In such cases, the authorities must ensure that the relatives have no material benefit in the death of the patient.

What does a person feel

The question of how the patient feels during the process is very theoretical. Doctors also argue about it, among which some support the idea, while others do not. It has been suggested that the patient may feel that he is suffocating. The author of this theory remained unknown, but he has a lot of followers. This is argued by the fact that barbiturates slowly depress the central nervous system, stopping breathing. The “opposition” to this assumption believes that this is unreasonable, since the person at this point is in a state of deep anesthesia. It is also impossible to answer unambiguously the question of what a person feels during euthanasia, as to the question: what happens after death.

Legislative regulation in the countries of the world

Such a controversial procedure requires a solid legislative basis. In countries where it is legalized, doctors act within the law. In some countries, an exclusively passive form of conduct is allowed. However, even where it is considered murder, passive euthanasia is still used, although this is not brought up for general discussion.

Легализация

Only a small part of states abroad are ready to give a person the right to make an independent decision about death. Fully legalized “easy death” in:

• Canada;
• the Netherlands;
• Switzerland;
• Belgium;
• Luxembourg.

In the US, this service is only legal in California, Oregon, Montana, Vermont. In Washington, euthanasia was legalized, but since 2012 it has been banned. In some European countries, the passive form is allowed. There is no clear ban on “easy death” in:

• Israel;
• Germany;
• Albania;
• Spain;
• France.

On March 9, 2018, the Constitutional Chamber of India legalized only passive euthanasia. In states where the procedure is allowed, it can be applied to citizens from the age of 18. The main requirement for the euthanasia of a child is his awareness of what is happening. In 2014, Belgium allowed a “good death” to be performed on young children if there were legal and medical justifications for doing so. Also in Belgium, the treating doctor can prescribe a kit for the procedure if the patient has requested it. The patient conducts forced suicide himself with the help of a set of drugs and instructions.

The ban on the procedure

Active euthanasia is equated with intentional homicide in those countries where it is not permitted by a separate law. Behind the scenes, the passive form of the procedure is carried out in almost all states. The moment when the patient receives only symptomatic treatment without a prognosis of life extension is passive euthanasia. Active in most states is considered as complicity in suicide or premeditated murder.

In Russia, the draft “On the Protection of the Health of Citizens” forbids doctors “to satisfy the request of the patient to hasten his death.” The doctor is criminally liable for any assistance in the intentional suicide of a patient. Under this law, active euthanasia remains prohibited. In cases where it is impossible to save the patient, the same passive form is used.

In the Australian state of the Northern Territory, a bill has been in force since 1995 that allowed death to be assisted. But already in 1997 the law was repealed. In 2017, it became known that another state of Australia – Victoria – will legalize the “right to an easy death” in 2020.

The most controversial attitude towards euthanasia can be found in the laws of Japan. In 1995, a Yokohama doctor was sentenced to 2 years in prison for killing his patient. The ward was ill with the last stage of cancer and, according to forecasts, had to live a few more days. After the verdict, the court listed the conditions for “assisted dying”:

1. The sufferer must be in unbearable pain.
2. All methods of pain relief have already been tried and failed.
3. The patient himself expressed a desire to die.
4. The imminent death of the patient is inevitable.

Despite this list of criteria, the Japanese constitution prohibits any type of euthanasia and is criminally punishable. The controversy about its legalization in the “Land of the Rising Sun” has been going on since 1962.

Medical assistance in death is prohibited in all post-Soviet countries. There is a clearly negative attitude towards such actions in all Islamic states. However, the Sunnah and the Koran, the main religious and legislative scriptures, allow the refusal of treatment. So, in Islam, anyone can refuse treatment, thereby gaining the right to a passive form of the procedure.

Suicide tourism

It is possible to obtain the right to an assisted death only in a few states. In this regard, such a service as medical or suicide tourism has appeared. Seriously ill patients who cannot undergo euthanasia in their own country come specifically for this to places where it is allowed. So far, only Sweden and Zurich (Switzerland) officially accept “tourists”. There are clinics in these countries where they provide such a service to both local residents and foreigners.

The scientific publication Journal of Medical Ethics claims that over the past 5 years, the number of foreigners who came to Zurich for an “easy death” has doubled. In May 2011, a referendum was held in which the people of Zurich had to vote “for” or “against” the cancellation of suicide tourism. 84,5% of those polled voted to keep euthanasia legal.

Pros and cons

Such a sensitive topic cannot be left without public attention. Few people remain neutral on the question of whether euthanasia is permissible in principle, what pros and cons it can have. Supporters and opponents of this idea, as a rule, start from different dogmas and aspects. Some are based on religion, others on moral and ethical standards. Hence, two fundamentally different opinions.

Religion

The main opponent of the artificial suspension of life is religion. Despite completely different dogmas, world confessions have an almost identical attitude towards euthanasia. In any religion, life is the highest gift and blessing, something absolutely sacred. Hence the strong resistance to euthanasia.

In Christianity, as in many other religions, only God has the right to give and take life. Therefore, suicide or murder is considered the highest sin, equated with a challenge to God. Only those suicides who were in a state of mental disorder at the time of their unauthorized departure from life are not considered sinners. This position applies to all branches of Christianity: Protestantism, Orthodoxy, Catholicism.

Judaism regards the shortening of life even for a minute as a mortal sin. The main argument of the Jews is that the body does not belong to man. We use it temporarily as a vessel, but we cannot fully dispose of it on our own. Even passive euthanasia, according to the rabbis, goes beyond Jewish religious principles.

Hinduism, including all its manifestations, is more ambiguous about such a procedure. This branched religion is based on the idea of ​​karma – the law of the consequences of actions. If a person has lived his life well and left it well, good things await him in rebirth. A “good” departure occurs when a Hindu:

• is at home (or on the banks of the Ganges);
• conscious and said goodbye to relatives;
• there should be no bowel movements in the form of vomiting, urination, bleeding.

Hence, the artificial extension of life in torment and unconsciousness refers to a bad end. Consciously and with dignity to leave with the help of voluntary euthanasia in Hinduism is permissible if a person does it on his own and does not regret his departure.

Buddhism strongly supports end-of-life care, i.e. palliative care. Active euthanasia in this doctrine is unacceptable. Because Buddhism is not centralized, its interpretation varies greatly from region to region. So, some Buddhists refuse treatment, including pain relief. This allows them to meet death with dignity and a clear mind.

Islam is also categorically against the artificial suspension of life. No one can compare himself with Allah and decide who lives and who dies. However, patience and submission to the will of God are important qualities for Muslims, so arbitrary refusal of therapy is allowed. It is also allowed not to artificially prolong life if the mind has died out in it. The moral and legal problem is the exact establishment: where the mind has died out, and where it has not yet.

Bioethics

An integral participant in euthanasia is a doctor, even if it is a passive and voluntary form. The physician in this case must either stop saving the person or kill him. Both that, and another violates bioethical norms. Any negative action or inaction in the salvation of a person is contrary to the Hippocratic oath: “I will not give anyone a lethal agent asked of me and will not show the way for such a plan.”

There are not many doctors who undividedly support this idea. To commit such an act, the doctor needs to transgress both professional ethics and his own morality. The situation is even more difficult with seriously ill children or patients in an unconscious state. Not many doctors agree to deliberately end someone’s life. Some experts view euthanasia as selfish: “I can’t kill myself, so do it for me.”

WHO in a declaration of 1987 defines the act of interrupting the life of a patient, even at his request or at the request of relatives, as unethical actions. However, this practice has already been legalized in several countries, and other states are discussing the possibility of legalizing it. And where it is “in the law”, someone spends it. This means that even among doctors there is a split in opinion. Someone sees a lethal injection as the only way to help a person avoid torment.

In 1952, the UN received a petition from doctors, scientists and prominent cultural figures from Great Britain and the USA. The petition stated that the right of the terminally ill to demand an easy death for himself should be added to the Universal Declaration of Human Rights. The appeal collected 2 signatures, but was rejected by the UN as inhumane.

A 1994 survey among Russian physicians showed that half of those surveyed aged 41 and over “have never thought (a) whether euthanasia is acceptable.” Among doctors aged 21 to 30, 49% agree with the procedure. A survey of medical students in 2000 showed that 78,4% were in favor of euthanasia.

Modern ethics

The survey described above shows that the majority of young doctors have a positive attitude towards performing an “act of a good death.” In the modern world, ideas about the human right to choose and responsibility for one’s own life are increasingly developing. Euthanasia in the XNUMXst century is far from new, but it still remains a revolutionary practice. The trend of gradual legalization suggests that over time humanity will either improve methods of treatment, or accept the fact of euthanasia.

Statistics

The UN and WHO do not provide global reports on the development of assisted death. However, the statistics of individual countries show a sad demand for such a service. In the Netherlands and Belgium, the annual increase in euthanasia performed is 5% each since 2008. Statistics Switzerland released data for the period 1998 to 2009. In 1998, 43 deaths were registered, in 2009 – already 300 deaths from euthanasia. In Zurich, 300 foreigners receive this “charity service” every year, and the number is growing.

Every year the number of people over the age of 80 who have resorted to “easy death” is decreasing. The number of cancer patients under the age of 40 who have resorted to euthanasia is steadily growing. Such indicators are associated with an increase in cases of malignant tumors and the lack of a cure. According to data from Switzerland, 44% of cases of “legal suicide” are cancer patients, 25% are diseases of the cardiovascular system and the central nervous system, and another 3% are depression.

Is there any alternative

Opponents of the idea of ​​a “good death” rely on the fact that it is impossible to accurately establish the hopeless situation of the patient. A diagnostic error is also not excluded, perhaps the person is not terminally ill, and there are chances to cure him. The concept of incurability depends on the possibilities that are currently available to medicine. The progress of pharmaceuticals and technology leaves hope that the necessary medicine may appear immediately after the procedure.

A worthy alternative to assisted death is called palliative care. This is a direction created specifically to make life easier for the seriously ill and dying. It includes psychological assistance, full symptomatic therapy, an integrated approach to meet all the needs of the patient. This practice also relieves pain and aims to make the patient’s life as full and active as possible.

In this case, the onset of death is neither delayed nor accelerated.

Euthanasia is a controversial method of delivering a person from suffering. Despite the controversy of scientists and prominent figures about the legality of killing a person out of compassion, the main side of the dispute is patients who demand such a right for themselves. After all, people who have never faced such a choice cannot fully appreciate euthanasia as something humane or criminal.