Fictitious Euthanasia Scenario: July 7th was Joan’s duty day in the Maryland Hospital oncological unit. A fateful evening it was, as there were so many appointments for radiotherapy during the day and some had to be extended to the night. The logging, preparation of documents, not to mention the handling of patients in different cancer phases was just too energy draining for her. And when a call came through from one of the oncology wards, she was so hesitant to pick it up.
A flash glance at the phone and the number was one she has often seen in the better part of the week – it was Christine, a 25 year-old family woman who had suffered the excruciating ordeal of stomach cancer. The cancer spread from the stomach and was now in the intestines.
The woman had no appetite, but the cancer also made it very difficult for her to relieve her bowels. Imaging in the previous week showed that the cancer had metastasized to the pelvis, and the pain on her hips was so excruciating to even allow her to walk.
Joan knew what Christine wanted, she wanted it all week – a relief, a rest from all the pain and suffering she had endured in the last seven months. But Joan had been very categorical, she was not going to abscond from her professionalism principles of vowing to protect and prolong life at all costs. Even if she knew Christine was a lost cause- four failed surgeries and no reception of painkillers, it was not in her position to grant Christine her wishes. But the patient had requested it so desperately, and made it look like it was the ultimate aphrodisiac.
This time she would give it to her. Four doses of Pentobarbital (Nembutal) in her coat pocket, Joan walked into Christine’s room, placed the medication in Christine’s hands, and stepped back to watch life leave someone’s body slowly. Five minutes and it was done. The pain was gone and life was gone too.
Inside this article:
The Concept of Euthanasia
Just like in the introductory scenario, euthanasia has always been an ethical dilemma with the bulk of the contemplating left for the healthcare provider. Most religions and socio-political societies have prohibited euthanasia in all its forms. However, most countries have not yet spelt out detailed legislation over the matter, with only a few countries like Canada, Belgium, and Netherlands making strides in legalizing some extent of euthanasia and spell out the limits too.
The initial concept of Euthanasia has always been pro-life versus pro-choice, whereby the demands of the patient are weighed against the professional ethics of protecting life by all means. Euthanasia has, however, been abused and relatives are now given a say in determining the fate of a loved one due to other reasons other than alleviating pain. Some have requested euthanasia based on predictions that the medical costs will go over the roof alongside some certainties that the patient may not make it in the end. All these are ethical issues that require adequate support from legal regulations with all possible scenarios addressed in detail.
Types of Euthanasia
This is euthanasia administered to a patient in accordance with their wishes. In this case, the patient is conscious, and believed to be of sound mind and body to make the important decision. It remains a debate on whether a patient’s judgement may be clouded by the prevailing suffering such that they choose to commit suicide rather than hang on for some time.
It’s done against the wishes of a patient. This covers all forms including mercy killing, request from family members, and the withholding of medical aid. In involuntary euthanasia, the patient spells out their wishes in a sound state but they are rather circumvented by the attendant.
This is done without the consent of the patient. Here the patient is not in a position to make the decision; could be unconscious, incapacitated, or underage such that the decision has to be made by someone else responsible.
Refers to euthanasia administered fully by the attendant. In common cases the attendant injects a drug like morphine into the patient’s bloodstream, causing their death.
The one administered indirectly by the healthcare provider. The attendant may withhold medical aid (e.g life-support), withdraw the support, or watch as the patient administers euthanasia on themselves.
This is where a physician or responsible official ends a patient’s life to alleviate them from suffering. Mercy killing is done without the patient’s consent, and may consist of all forms of euthanasia save for voluntary.
This is where the patient voluntarily takes their own life without the intervention of others. This may happen with or without the knowledge of the physician responsible but they do not play part in it. A patient may take fatal overdoses, cut off life-support themselves, or do anything else that takes the form of suicide.
Other people rather than the patient administer euthanasia. This could be the family, friends, or other people with their own intentions making the decision on behalf of the patient or fulfilling the patient’s decisions.
Entails the partial participation of the physician in charge in administration of the euthanasia or availing of necessary requirements for the patient to administer it themselves. In the introductory case scenario, the patient administers the euthanasia themselves but the drugs are presented by the physician in charge. This is assisted suicide.
Ethical Issues in Euthanasia
There exists a thin morality line between euthanasia (directly induced death), and allowing the patient to die through delaying or withholding medical aid. Artificial life-support treatment methods are considered extraordinary treatment, and some may accept the withholding of this form of treatment. On the other hand, withholding ordinary treatment in the form of drugs is widely condemned as unacceptable.
Ethicists have time and again debated over the level of participation of a physician in the death of a patient through euthanasia. Just like we may not condemn a chemist for selling lethal drugs in a suicide case, the physician who passively participates in euthanasia may not be condemned as much as the one who administers the euthanasia themselves, wishes of the patient notwithstanding.
Bottom line: Euthanasia is a moral dilemma, but the physician ought to practice in the full awareness of the laws governing the administration of euthanasia in different scenarios: the level of the physician’s participation, consent from the patient or the family, and the type of drugs used. Different countries have different regulations, but in all states involuntary euthanasia remains prohibited.