The debate on whether euthanasia is an act of killing or allowing to die is decades if not centuries old. In medical terms, euthanasia is the act of intentionally ending someone’s life based on an individual’s decision or a decision taken by an individual’s family often in cases when an individual suffers from a severe disease or injury (Friedman, 2012). Euthanasia can be classified.
Passive euthanasia is otherwise called “intentionally fatal withholding”. This practice presupposes that the death of an individual results from intentional withholding of available treatment which could objectively prolong an individual’s life for a significant amount of time. The term active euthanasia is used primarily and predominantly in the meaning of a conscious decision and a subsequent effort to end one’s life, so that the medical cause of death is not a disease per se but the action taken. This process is also known as “mercy killing”.
Nevertheless, some sources distinguish between as much as three types of active euthanasia, namely mercy killing, suicide and assisted suicide, thus, treating the latter two as subtypes of active euthanasia. Regardless of classification, the basic difference between mercy killing and assisted suicide is in the perpetrator of the action. In mercy killing, a physician kills the patient, whereas in assisted suicide, for example, physician-assisted suicide, an individual kills himself or herself with the help of a health care professional. Thus, a physician may be near to provide the patient a piece of advice or medical equipment, but the physician’s physical intrusion is excluded. Self-killing, be it suicide or assisted suicide, is always voluntary. As for mercy killing, it can be voluntary when an individual openly expresses his or her desire to end his or her life and requests for assistance of the third party. Mercy killing is involuntary if an individual expresses unwillingness to die, but his or her wish is ignored. The definition of voluntary and involuntary euthanasia is valid for passive euthanasia, as well (Stewart et al., 1998; Lee, 2004; Friedman, 2012).
From the abovementioned facts on euthanasia, it is clear that medical professionals are involved in euthanasia to a greater or lesser extent. In the act of mercy killing, a health care professional plays the role of the one who makes the lethal injection. During the process of physician-assisted suicide, a medical professional plays the role of an assistant, consultant and a witness of how a patient ends his life. In passive euthanasia, a doctor is the one who stops the process of “treatment” by denying the patient medication and care, or never begins one at all. In any of these cases, the health care professional carries the burden of the patient’s death. This burden is always heavy. The caregiver always feels involved. A question arises: “Should medical professionals be involved in euthanasia?”.
The answer is just as ambiguous as the euthanasia issue itself. A reasonable assumption is that the answer should be found in the sanctum sanctorum of the medical practice – in the Hippocratic Oath. Interestingly and sadly enough, when one uses a famous search engine to perform the search on the words “Hippocratic” and “Oath”, the second source on the first page - that is, the first credible source after Wikipedia - refers to the website on euthanasia. The text says: “I will give no deadly medicine to any one if asked, nor suggest any such counsel” (The Hippocratic, n.d.). Thus, according to the Oath which all health care professionals take, euthanasia should be denied to any patient.
The second echelon in assessing euthanasia is the American Medical Association. According to opinion 2.21 of the AMA code, “Euthanasia is fundamentally incompatible with the physician’s role as healer” (Opinion, 1996). The argumentation behind this statement is that health care professional’s involvement complicates the issue and causes more harm than good. In other words, AMA echoes the ancient oath. Somehow, accepting the answers found in the Hippocratic Oath and AMA code of medical ethics as the general and undeniable truth does not feel right. Considering the fact that in some cases painless death or accelerated death is better than months or years of pain and suffering, euthanasia does not seem wrong even though it breaks the Oath. Medical professionals have to be involved because they are the last institution of relief on the patients’ way to death. Neither cost nor abstract ethical theories should stand on the physician’s way to easing the patient’s unbearable suffering. Of course, the latter statement is a subjective argument and does not claim the status of the official position of healthcare.
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Apart from the ambiguous moral side of euthanasia, there is also the legal side. Overall, euthanasia is illegal around the globe. However, some countries have legalized it. In Canada, only suicide is legal, whereas assisted suicide and voluntary euthanasia are illegal. The Netherlands legalized assisted suicide and active euthanasia in 2002, although the court decisions permitted it since 1984. Just like the Netherlands, Belgium legalized euthanasia in 2002. InSwitzerland, physician-assisted suicide and suicide assisted by a non-physician are allowed since 1941, although euthanasia is banned. In the United States, only three states - Oregon, Washington and Montana - have legalized passive euthanasia (Euthanasia illegal, 2011).
Several prominent cases show how the legal and ethical sides collide. Karen Ann Quinlan was a twenty-five-year-old woman who took a combination of alcohol and drugs which resulted in an irreversible coma and, consequently, a persistent vegetative state. When Karen was disconnected from life support (but not from the feeding) according to the Court’s ruling she did not die quickly as expected, but lived ten more years. She died of pneumonia. Quinlan’s case started on open discussion of euthanasia. Nancy Cruzan was a twenty-five-year-old woman, just like Karen, in the same condition after a car accident. According to the woman’s wish she had expressed earlier, she was disconnected of the feeding tube and died peacefully.
Terry Schiavo was a year older than Karen and Nancy when she collapsed from cardiac arrest and entered a vegetative state. Terry’s husband and family split in their visions of the woman’s future, and numerous court rulings resulted in the continuous removal and reinserting of the feeding tube. Terry died thirteen days after the feeding tube was removed for the last time. One more name to mention is the name of Jack Kevorkian, pathologist who went against the judicial and medical systems, designed a suicide machine and assisted more than one hundred people in their decision to die (Preston, 2013). Some people consider this man an evil opposite of Frankenstein, others view him as a helping hand that ends suffering. Roughly speaking, one’s attitude toward Kevorkian defines one’s attitude towards euthanasia. The debate goes on.