Euthanasia and Physician Assisted Suicide

Euthanasia and Physician
Assisted Suicide
Health Law and Bioethics
Flávia de Sá nº1570
Professor: Helena Pereira de Melo
• Euthanasia came from de Greek word “euthanatos”, which
means “good death” or “soft death” – “the act of
deliberately killing a patient afflicted with a painful and
incurable disease in order to put an end to his/her suffering”
(Paulo Pulido Adragão).
Voluntary euthanasia: when the procedure takes place
as the result of a request made by a competent patient.
Involuntary euthanasia: euthanasia is performed against
the will of the patient.
Non- voluntary euthanasia: euthanasia is performed on
a patient without request(unconscious patient or patients
with Alzheimer’s disease, for instance).
 Active Euthanasia: when a doctor kills his patient by
administrating a lethal injection.
 Passive Euthanasia: when the death occurs by omission
of the doctor .
 Voluntary
Active Euthanasia vs Physician
Assisted Suicide
is “halfway between suicide and voluntary
euthanasia” (Paulo Pulido Adragão).
• This procedure takes place when a patient, not being
able to commit suicide by his/her own means, seeks
assistance from a physician to do it.
• It is the patient who performs the last act which causes
the death.
• The physician’s role is to provide the necessary means
and advice, also making sure death occurs without pain
to the patient.
The controversy
 Arguments in favor
 Autonomy
 The right to quality of life
 Human dignity
 Compassion
 The final benefit
Arguments against
Sanctity of human life;
More pressure upon the most vulnerable into choosing
death by euthanasia or assisted suicide;
Autonomy ?
- autonomy is not absolute being subject to several
- The effects of an undiagnosed depressive illness;
- the final decision is taken by the doctor;
A change in the law in order to legalize VAE/PAS, would
subvert the integrity of medical profession;
Possible abuses on the performance of such
Showing compassion towards the patient is about
seeking to relieve his/her physical and mental pain, but
respecting the value of life;
These procedures undermine the
palliative care as a real alternative;
Dangerous obstacle to the improvement of more
effective therapies for the cure of several diseases.
 Physician Assisted Suicide
• Among those who support the legalization of this practice
is often said there is discrimination between those who are
able to commit suicide by themselves and those who are
not capable to do that by their own means, needing the
assistance of another person to achieve their wish.
Is there a violation of the principle of equality in these
situations ?
 True story – Marc & Eddy Verbessen
• This is the case of two Belgian twins, 45 years old, both
born deaf, who requested to be euthanized after
discovering that they were going blind with glaucoma.
• Belgium was the second country in the world, after
Netherlands, to allow euthanasia in September 2002.
•After spending all their lives together, the belgian twins
couldn’t bear the thought of not being able to see each
• The local hospital refused the twins’ request arguing that
their situation didn’t fulfill the strict requirements imposed
by belgian law regulating euthanasia. It took the belgian
twins almost two years to find a hospital willing to comply
with their will to die, the Brussels University Hospital.
• On 14 December 2012, the twins finally accomplished
their wish after being administered with lethal injections.
Their last moments were spent along with their parents
and older brother, Dirk Verbessen.
• Some days after, Dirk told to the press his last
conversation with his brothers- “I tried to talk them out of
it even at the last moment. Together with my parents, I
said goodbye. Marc and Eddy waved again at us. ‘Up in
the sky’, they said ‘Up in the sky’, we replied. And then it
was over”.
 The Belgian law
The Belgian Act on Euthanasia
• On 16 May of 2002 and after intense debate, the Belgian
parliament approved the bill on euthanasia with 86 votes
in favor, 51 against and 10 abstentions. The Senate had
already approved the proposed law in 2011, with 44 votes
in favor, 23 against and 2 abstentions. The new law came
into force on 23 September of 2012.
• According to Belgian law, euthanasia remains a crime,
not punishable if certain requirements are met.
•The legal act starts by providing a definition of
euthanasia: “intentionally terminating life by someone
other than the person concerned, at the latter’s request”
(chapter I, section 2).
The the law sets out a number of strict requirements
under which the performance of euthanasia is available
(chapter II, section 3):
• The patient is an adult or an emancipated minor, and is
“legally competent and conscious at the moment of
making the request”;
• “The request is voluntary, well considered and
repeated, and is not the result of any external pressure”;
• The patient is in a condition of “constant and
unbearable physical/mental suffering that cannot be
alleviated, resulting from a serious and incurable disorder
caused by illness or accident”.
In addition, before carrying out the procedure the
physician must:
• Inform the patient about his/her health condition
and life expectancy and discuss with the patient
his/her request and the possibility of alternative
treatments like palliative care.
• Be certain of the patient’s condition and of the
durable nature of his/her request. “To this end, the
physician has several conversations with the patient
spread out over a reasonable period of time, taking
into account the progress of the patient’s condition”;
• “Consult another doctor about the serious and
incurable character of the disorder”.
• According to this law, euthanasia is not limited to the
terminal ill. In the case of a request made by a nonterminal ill, the same requirements must be respected.
Besides the attending physician must also consult a
second physician.
• In these situations the attending physician must “allow
at least one month between the patient’s written
request and the act of euthanasia”.
• The patient’s request must be in writing, dated and
signed by the patient himself/herself.
• The case of the belgian twins brothers was particularly
controversial because none of them was terminally ill
or suffering physical pain.
•Shortly after Marc and Eddy death, the Belgian
government announced the intention to amend the
euthanasia law in order to extend it to children and
patients with Alzheimer’s disease.
 The Portuguese law
•Constitution of Portuguese Republic:
right to life (art.24º)
right to personal integrity (art.25º)
• European Convention on Human Rights
“Everyone’s right to life shall be protected by law. No one
shall be deprived of his life intentionally…” (art.2, nr.1) applicable in portuguese internal law by disposition of
article 8º, nr. 2 of the Constitution.
• Code of Medical Deontology
“The physician must keep respect for the patient’s dignity
at the end of his/her life ” (art.57º, nr.1).
The practice of assisted suicide or euthanasia is prohibited
(57º nr.2).
 Penal Code
• According to the Portuguese Penal code, the performance
of VAE can be qualified as:
 Homicide (art.131º)
 Privileged Homicide (art.133º)
 Homicide by request (art.134º)
• According to our penal the performance of physician
assisted suicide can be subsumed under article 135º Inciting or assisting suicide.
 Council Of Europe
• Recommendation nr.1418 (1999) – Protection of human rights
and dignity of the terminally ill and the dying
“The vocation of the Council of Europe is to protect the
dignity of all human beings and the rights which stem
therefrom.” (1)
 “This respect and protection find their expression in the
provision of an appropriate environment, enabling a human
being to die in dignity” (5).
 The Assembly recommends that the member states carry
out the same vocation (9).
 “A terminal ill or dying person’s wish to die cannot of itself
constitute a legal justification to carry out actions intended to
bring about death” (9, c), iii))
• Recommendation nr.1859/2012 – Protecting human rights
and dignity by taking into account previously expressed
wishes of patients
intended to deal with the issues
suicide. Euthanasia, in the sense
of the intentional killing by act
or omission of a dependent
human being for his or her
alleged benefit, must always be
prohibited” (5).
Should the Portuguese law
be relaxed?
Thank you for
your attention!