Euthanasia and assisted suicide.

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One of the most important public policy debates today surrounds the issues of euthanasia and assisted suicide. The outcome of that debate will profoundly affect family relationships, interaction between doctors and patients, and concepts of basic ethical behaviour and public policy.

I have outlined some of the main questions concerning Euthanasia and provided possible answers.

1.  Where are euthanasia and assisted suicide legal?

Oregon, the Netherlands and Belgium are the only jurisdictions in the world where laws specifically permit euthanasia or assisted suicide.

a)        Oregon permits assisted suicide.

b)        The Netherlands and Belgium permit both euthanasia and assisted suicide.

c)        In 1995 Australia’s Northern Territory approved a euthanasia bill.   It went into effect in 1996 but                                                         was overturned by the Australian Parliament in 1997.  

d)        In 1997, Colombia’s Supreme Court ruled that penalties for mercy killing should be removed. However the ruling does not go into effect until guidelines, still to be drafted, are approved by the Colombian Congress.

2.  What is the difference between euthanasia and assisted suicide?

One way to distinguish them is to look at the last act – the act without which death would not occur. Using this distinction, if a third party performs the last act that intentionally causes a patient’s death, euthanasia has occurred. For example, giving a patient a lethal injection or putting a plastic bag over her head to suffocate her would be considered euthanasia. On the other hand, if the person who dies performs the last act, assisted suicide has taken place. Thus it would be assisted suicide if a person swallows an overdose of drugs that has been provided by a doctor for the purpose of causing death. It would also be assisted suicide if a patient pushes a switch to trigger a fatal injection after the doctor has inserted an intravenous needle into the patient’s vein.

3.  Doesn’t modern technology keep people alive who would have died in the past?

Modern medicine has definitely lengthened life spans. A century ago, high blood pressure, pneumonia, appendicitis, and diabetes meant likely death, often accompanied by excruciating pain. Women had shorter life expectancies than men since many died in childbirth. Antibiotics, immunizations, modern surgery and many of today’s routine therapies or medications were unknown then.

4.  Should people be forced to stay alive?

A lot of people think that euthanasia or assisted suicide is needed so patients won’t be forced to remain alive by being ‘hooked up’ to machines. But the law already permits patients or their surrogates to withhold or withdraw unwanted medical treatment even if that increases the likelihood that the patient will die. Thus, no one needs to be hooked up to machines against their will. Neither the law nor medical ethics requires that ‘everything be done’ to keep a person alive. Insistence, against the patient’s wishes, that death be postponed by every means available is contrary to law and practice. It is also cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That’s when hospice, including in-home hospice care, can be of great help. That is the time when all efforts should be directed to making the patient’s remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to the provision of emotional and spiritual support for both the patient and the patient’s loved ones.

5.  Does the government have the right to make people suffer?

Likewise, the government should not have the right to give one group of people (e.g. doctors) the power to kill another group of people (e.g. their patients). Activists often claim that laws against euthanasia and assisted suicide are government mandated suffering. But this claim would be similar to saying that laws against selling contaminated food are government mandated starvation. Laws against euthanasia and assisted suicide are in place to prevent abuse and to protect people from unscrupulous doctors and others. They are not, and never have been, intended to make anyone suffer.

6.  But shouldn’t people have the right to commit suicide?

People do have the power to commit suicide. Worldwide, about a million people commit suicide annually. Suicide and attempted suicide are not criminalized. Each year, in the United States alone, there are 1.5 times as many suicides as homicides. And suicide is one of the ten most common causes of death in Great Britain. Suicide is an all too common tragic, individual act. Indeed, the Surgeon General of the United States is currently campaigning to reduce the rate of suicide.

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Euthanasia and assisted suicide are not private acts. Rather, they involve one person facilitating the death of another. This is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us. Euthanasia and assisted suicide are not about giving rights to the person who dies but, instead, they are about changing public policy so that doctors or others can directly and intentionally end or participate in ending another person’s life. Euthanasia and assisted suicide are not about the right to die. They are about the right ...

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