Sunday, November 22, 2009

Euthanasia

As a healthcare worker and a student of bioethics I am forced to reconcile my beliefs on the topic of euthanasia.
First let us define euthanasia.
Euthanasia is ending the patient's life to end their suffering. There are two types of euthanasia, passive and active. Passive euthanasia is the withholding of lifesaving treatment. (Rachels , Contemporary Moral Issues, 1997) An example of this would be not giving CPR to one that is in cardiac arrest. Active euthanasia is where there are actions taken so that life ceases, such as overdosing a terminally ill patient on morphine. (Rachels, 1997)
Do these practices exist within the Canadian healthcare system? Absolutely. Is it right to practice these strategies?
For example, in Canada at this time, we have "Do Not Recusitate" (DNR) orders. These are documents that the patient fill out in the event that they do not want CPR or other lifesaving skills performed on them in case of cardiac arrest. Terminally ill patients and aged patients usually fill these out. It is important to note that sometimes family members fill these out for patients that are unable to fill them out, so the decision for DNR orders are made by the family and not the patient. In these particular incidences it could be argued that there is a minimization of the suffering of the patients.
J.S. Mill Greatest Happiness Principle or the Principle of Utility (J.S. Mill 1861) states that "Actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness".
If we are to believe that the minimizing of suffering produces happiness then, according to Mill, a DNR order is right.
Immanuel Kant states in his categorical imperative (Kant, Fundamental of the Metaphysics of Morals, 1785) "act only on that maxim whereby thou canst at the same will that it should become a universal law".
If we are to believe that if it is alright to kill the terminally ill, then it is alright to kill anyone for any reason. If this point of view is taken, then even with a DNR order it is wrong to withhold treatment that may save a patients life.
A DNR order is a vehicle for passive euthanasia.
An example of active euthenasia is a physician overdosing a patient on morphine so that the patient passes on. These patients are always terminally ill and suffering a great deal, with no cure in sight. A physician will order that a morphine pump be set up for the patient, and the patient can control the trigger the device. Usually these devices are set up so that a limit is set for each dosage given, and the number of doses that can be delivered within a certain amount of time. These pumps are manually set by the healthcare staff as per the doctor`s orders. Doctors sometime knowingly set these limits beyond tolerance levels, so as the patient squeezes the trigger they are overdosing on the medication, and the patients are doing this knowingly.
Again according to J.S. Mill this is an acceptable practice because suffering is being relieved.
According to Kant, this is wrong, simply because we can not make killing a universal rule.
My beliefs lie with J.S. Mill in this case.
Having been a personal witness to friends and family members suffering from terminal illnesses where no cure was evident or existing, I strongly believe that passive euthanasia was right.
Active euthanasia is practiced in Switzerland. Panels of doctors are set up. The patient makes request to the panel for active euthanasia, usually in the form of assisted suicide. It has to be proven that the patient is terminal, is suffering terribly and that there is absolutely no cure for their condition. The panel then looks at each case individually and makes their decision. If all criteria are met then the decision is made in favour of the patient.
As a quick side note, President Obama recently introduced a healthcare reform package to the American public, and to stir fear in the Americans, those that opposed the healthcare bill, stated that there would be "death panels" like there are in Europe. Of course this is a red herring, simply because the opposers of the reform did not state all of the criteria for the Euthanasia panels or cite the panel`s real purpose.
In Canada, these panels do not exist. Doctors take it upon themselves to act on the patients` behalf, to follow the wishes of the patients, on individual basis.
In conclusion, I do believe that both passive and active euthanasia are allowable practices, providing that certain criteria are met by the patient and patient`s condition.

2 comments:

  1. I had a response prepared but then I came across this: http://www.theglobeandmail.com/news/world/thought-to-be-in-a-23-year-coma-belgian-man-heard-everything/article1374846/

    And so I'm still mulling it over...

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  2. I like your points and they are reflective of a greater discussion.

    I believe in the right to choose. If I choose death, then it should be an option.

    I think the discussion needs to be said and yours is an excellent argument.

    I still have an issue with panels of doctors. I am not always convinced they are the right people to have on panels. They may understand the science but not always the psyche.

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