Assisted suicide

Ending Life
Medical Humanities IV
Prof. Marija Definis-Gojanovic
Conceptual Issues
SUICIDE (S) – involves one intending one’s
death either as and end itself or as a
means to some further end
someone helping another person commit
EUTHANASIA (E) – involves someone doing
something to bring about someone
else’s death (killing or letting die) with
intention that the person die because the
death is in the best interests of the
person who will die
Conceptual Issues
Active (a) and passive (p) version
aS – involves inducing death (e.g., by
aAS – involves a doctor giving a patient
something (e.g., death-inducing pills)
aE – involves someone inducing death (e.g.,
injecting a death-causing drug)
Passive versions may involve acts or
Conceptual Issues
Distinction between: voluntary, nonvoluntary
and involuntary
V – willed by the party either killed or let die
IV – against the will of the party killed or let
NV – killing or letting die takes place in the
absence of there being a determination
by the person killed or let die as to what
he/she wills
Distinction between: morally permissible,
impermissible and dutiful
Assisted suicide
Committed with the aid of another person, sometimes
a physician (term is often used with physicianassisted suicide (PAS) = involves a doctor
"knowingly and intentionally providing a person
with the knowledge or means or both required to
commit suicide, including counseling about lethal
doses of drugs, prescribing such lethal doses or
supplying the drugs”.)
Assisted suicide and euthanasia are sometimes
combined under the umbrella term "assisted
dying” (other euphemisms: "physician-assisted
dying", "physician-assisted death", "aid in dying",
"death with dignity", "dying with dignity", "right to
die" "compassionate death", "compassionate
dying", "end-of-life choice", and "medical
assistance at the end of life”).
Euthanasia Definitions
• Euthanasia: the intentional killing by act or
omission of a dependent human being for his or
her alleged benefit.
Not euthanasia unless death is intentionally
caused. Thus, some medical actions sometimes
labeled "passive euthanasia" are not
euthanasia because intention to take life is
- Greek: “good death”
The modern concept of euthanasia came into
being in the 20th century after the invention of
life-extending technologies. These technologies
help to save the lives of many people who
suffer serious illness or injury.
• Voluntary euthanasia:
The person killed has requested to be killed.
• Non-voluntary:
When the person who is killed made no request
and gave no consent.
• Involuntary euthanasia:
When the person who is killed made an expressed wish
to the contrary.
• Assisted suicide:
Someone provides an individual with the information,
guidance, and means to take his or her own life.
• Euthanasia By Action:
Intentionally causing a person's death by performing an
action such as by giving a lethal injection.
• Euthanasia By Omission:
Intentionally causing death by not providing necessary
and ordinary (usual and customary) care or food and
Nazi Euthanasia Program (Action T4)
The "euthanasia campaign" of mass murder gathered
momentum on 14 January 1940 when the
"handicapped" were killed with gas vans and killing
centres, eventually leading to the deaths of 70,000
adult Germans.
Professor Robert Jay Lifton, author of The Nazi Doctors
and a leading authority on the T4 program: “The state
must own death—must kill—in order to keep the social
organism alive and healthy.”
Dr. Jack Kevorkian
• Assisted-suicide advocate, launched campaign for “right
to die”
• Tried for murder for his assists, convicted in 1999
• Saw euthanasia as “helping a suffering patient”
• Believed laws limiting euthanasia, as well as limiting
smoking, etc.
• Died in June 2011
Pros and Cons
• It provides a way to relieve
extreme pain
• It provides a way of relief
when a person's quality of
life is low
Pros and Cons
• Frees up medical funds to
help other people
• It is another case
of freedom of choice
Pros and Cons
• The right to life includes the right to die.
• Death is the opposite of life, but the process
of dying is part of life.
Pros and Cons
• Euthanasia devalues human life
• Euthanasia can become a means of
health care cost containment
• Doctors should not be involved in
directly causing death
Pros and Cons
• Mercy killing is morally incorrect and
should be forbidden by law.
• Is a homicide
• Murdering another human cannot be
rationalized under any circumstances
Catholic Church's Perspective
• Against Euthanasia
• Believe that life is a gift from God
• We are all made in God's image
• Morally wrong
o "Thou shall not kill"
• The Catholic Church does not believe that people have
a right to die.
• Humans are free, but they cannot take their own lives.
Catholic Church's Perspective
• The Catholic Church does believe that it is morally
acceptable to refuse extraordinary medical treatment.
• Suicide is wrong
o Assisting suicide is looked at the same way
Two challenges to the double effect doctrine:
euthanasia and abortion
In these two situations killing is a method of
It is strange that abortion is more widely permitted than
euthanasia. A woman can choose to have her fetus
killed but not herself. The euthanasia patient is already
dying and requests death in his own interest. The
doctor kills a healthy fetus in the interest of a third
person. The paradox is partly explained by the lower
value which society puts on prenatal—as opposed to
Cases involving the termination of
life- extending treatment—or
passive euthanasia
Karen Ann Quinlan:
In 1976, KAQ, a 22-year-old woman in a persistent
vegetative state with no hope of recovery, was kept
alive using a ventilator to sustain her breathing.
Quinlan’s parents wanted to discontinue treatment but
the hospital would not do so. The Supreme Court of
New Jersey ultimately decided that the hospital could
legally discontinue treatment for a patient like Quinlan
in a persistent vegetative state – after first consulting
with an ethics committee – without fear of criminal or
civil retribution.
Cases involving the termination
of life- extending treatment—or
passive euthanasia
Nancy Cruzan:
In 1983, 25-year-old NC was in a car crash that left her
comatose. When Cruzan’s parents wanted to
discontinue artificial nutrition and hydration several
weeks after the crash, the hospital would not do so.
The case went through the Missouri court system, and
they received a ruling in their favor. They then
requested removal of the artificial nutrition and
hydration tubes, and, subsequently, Nancy Cruzan
Cases involving the termination of
life- extending treatment—or passive
Theresa Marie Schindler:
Terri Schiavo case was a legal struggle involving
prolonged life support in the United States that lasted
from 1990 to 2005. The issue was whether to carry out
the decision of the husband and legal guardian of
Theresa Marie "Terri" Schiavo to remove Terri's
feeding tube that provided life support.
The case also spurred highly visible activism from the
pro-life movement and disability rights groups.
Ethical Issues Surrounding
A range of different ethical and moral positions and
arguments exist regarding active euthanasia:
•Terminating life at the request of an individual is not
immoral because it is the individual’s decision to
•Terminating life may be justified in some circumstances
if, and only if, there is compelling evidence that to
continue living would be more harmful to the person
than dying.
•Terminating life is unethical in today’s society because
there are not enough protections that would allow for
a just and fair practice of euthanasia.
•Terminating life is always unethical because it violates
a) the moral belief that life should never be taken
intentionally or b) the basic human right not to be
But there are groups and individuals who make moral
distinctions between actively killing a person versus
passively allowing a person to die.
Supporters of the act of passive versus active
euthanasia argue:
•Physicians do not kill a patient by omitting treatment,
but rather the disease takes the patient’s life.
•Patients have a right to a “death with dignity.” Allowing a
dignified death to occur naturally is a moral act,
different from active euthanasia.
Mercy killing
(sometimes referred to as euthanasia) Is when someone
directly ends another person’s life, because believe it
is in their best interest in order to relieve pain and
suffering from an incurable or terminal condition.
Under the current law, anybody who ends the life of
another can be charged with murder and would face
mandatory life imprisonment if found guilty.
Physician Assisted Suicide
With physician assisted suicide, a doctor provides a
patient with a prescription for drugs that a patient
could use to end his or her life.
The main distinction between physician assisted suicide
and active euthanasia is that the doctor is not the
person physically administering the drugs.
In contrast to active euthanasia, where a physician
would end a person’s life, assisted suicide is an active
choice by a person to end his or her own life.
For some people, physician assisted suicide seems a
viable option that would allow the opportunity to forgo
suffering and loss of control.
The primary ethical arguments offered to justify
physician assisted suicide are that it:
- Allows autonomy and self-empowerment of the
- Shows compassion and mercy.
- Gives freedom from suffering.
• diagnosed with Amyotrophic Lateral Sclerosis
(ALS) in 1991. (progressive, neurodegenerative
disease - causes weakening of muscles and
eventual atrophy (wasting away) of body parts. )
• advocate of the legal right to assisted suicide and
“dying with dignity”.
Went before the Supreme Court of Canada twice to
fight for her cause: the legal right to assisted
• progression of physical disability and deterioration
until death in 1994. (3 years after diagnosis.)
• Dr Nigel Leigh Cox (born 1945 in Surrey is an
English consultant rheumatologist and one of the few
doctors in Britain to have been charged with
attempted murder.
In 1992 he was convicted of the attempted murder of
patient Lillian Boyes, and received a suspended
Reasons for opposing assisted suicide
Medical ethics
Hippocratic Oath
Physician-assisted suicide is contrary to the original
Hippocratic Oath that has been in use since the 5th
Century BC, stating "I will give no deadly medicine to
anyone if asked, nor suggest any such counsel".
The Declaration of Geneva
The a revision of the Hippocratic Oath, first drafted in
1948 by the WMA in response to euthanasia,
eugenics and other medical crimes performed in Nazi
Germany. It contains, "I will maintain the utmost
respect for human life.”
Reasons for opposing assisted suicide
Medical ethics
The International Code of Medical
last revised in 2006, includes "A physician shall always
bear in mind the obligation to respect human life" in
the section "Duties of physicians to patients”.
The Statement of Marbella
was adopted by the 43rd WMA Malta and editorially
revised by the 44th WMA in Marbella, Spain in 1992. It
outlines guidelines for physicians when dealing with
hunger strikers. Physician-assisted suicide is not
explicitly prohibited, but is contrary to the principles of
this statement.
Euthanasia is legal in Belgium, the Netherlands and
Assisted suicide, where the patient has to take the final
action themselves (unlike euthanasia), is legal in the
Netherlands, Luxembourg and Switzerland.
In the United States there are assisted dying laws
restricted to terminally ill and mentally competent
adults in Oregon, Montana, Washington and Vermont.
Oregon was the first US State to legalize assisted
suicide, which was achieved through popular vote.
Legality by country
Assisted suicide is currently illegal throughout Australia,
but was for a time legal in the Northern Territory under
the Rights of the Terminally Ill Act 1995.
The "Euthanasia Act" legalized euthanasia in Belgium in
2002, but it didn't cover assisted suicide. In 2006,
Belgium legalized partial euthanasia with certain
Legality by country
Suicide was considered a criminal offence in Canada
until 1972, after which it was removed from the
Criminal Code. Physician-assisted suicide is
considered illegal.
In June 2014, doctor-assisted suicide or euthanasia
became legal in the province of Quebec.
Denmark has no laws permitting assisted suicide.[28]
Assisted suicide is illegal and punishable as
manslaughter by up to 3 years.
Legality by country
The controversy over legalizing euthanasia and
physician assisted suicide is not as big as in the
United States because of the country's "well
developed hospice care programme”.
In 2013 President Francois Hollande said that France
should hold a national debate on the issue and stated
his intention to introduce a bill to parliament before the
end of the year. Opinion polls in France show that the
majority of the public are in favour of an assisted
suicide law, however France's national ethics
committee has advised against any change in the law.
Living will
A living will usually provides specific directives about the
course of treatment that is to be followed by health
care providers and caregivers. In some cases a living
will may forbid the use of various kinds of burdensome
medical treatment. It may also be used to express
wishes about the use or foregoing of food and water, if
supplied via tubes or other medical devices.
In the Netherlands, patients and potential patients can
specify the circumstances under which they would
want euthanasia - by providing a written euthanasia
Hospice care is a type of care and philosophy of care
that focuses on the palliation of chronically ill,
terminally ill or seriously ill patient's pain and
symptoms, and attending to their emotional and
spiritual needs.
In Western society, the concept of hospice has been
evolving in Europe since the 11th century.
The modern concept of hospice includes palliative care
for the incurably ill given in such institutions as
hospitals or nursing homes, but also care provided to
those who would rather spend their last months and
days of life in their own homes.
Palliative care
Palliative care is a multidisciplinary approach to
specialised medical care for people with serious
illnesses. It focuses on providing patients with relief
from the symptoms, pain, physical stress, and mental
stress of a serious illness—whatever the diagnosis.
The goal of such therapy is to improve quality of life
for both the patient and the family.
Palliative care is provided by a team of physicians,
nurses, and other health professionals who work
together with the primary care physician and referred
specialists to provide an extra layer of support.