Active or Passive Euthanasia
Originally published by Being Well on Medium
Euthanasia and Hippocratic oath was the title of an article I published not too long ago. Within the context of the discussion, I spoke about medically assisted suicide and how it surely yet controversially fits within the scope of clinical judgment. Today, I would like to revisit the topic by exploring various attitudes and players and how they influence the physician approach towards such a sensitive subject. However, before we begin, let us bear in mind that there is no perfect answer to the notion of passive or even active euthanasia (also referred to as assisted suicide); neither is there a one-size-fits-all solution.
The Semantics of Health, Life, Sickness, and Death
Modern medicine has been riddled with health and wellness semantics, as many people have a different concept of a healthy life, disease, quality of life, and even death. Such semantic variations are expected and perpetually affected by norms of every given society, which is influenced by the person’s lifestyle, belief, religion, faith, culture, and surrounding community.
Some define life as the state of biological functioning. Some may see it as an eternal state of nonphysical existence where the physical body is a temporary tangibility. Some discern health and wellness as the status without the disease, and others see it as the state of complete harmony between physical, psychological, and emotional clarity.
For life and death, the subject gets even more unclear!
The concept of Life, Death, and cultural perception
A person’s culture and collective norms influence how a person sees life and death. For instance, Buddhists reckon- that a person’s exit from life is crucial to find a peaceful state of rebirth when they pass away. They see life after death as a prerequisite to “rebirth.”
In the eyes of the major religions, death’s perception is diverse. The latter sees the quality of life after death as typically dependent on following a specific set of rules and norms throughout life. In most religions, departure is only permitted through the act of the ultimate power, hence God. The intentional ending of life is sin and punishable through the suffering afterlife. No matter how painful the experience and suffering, most religions prohibit euthanasia. Accordingly, the semantics of death in the eyes and ears of faith is entirely different from a modern perspective.
Laws, Ethics, Death, and the practice of Medicine
Prohibition of death is a political, social phenomenon and taboo. A law passed stating that it is illegal to die, usually specified in an absolute political division or a specific raising.
The earliest prohibition of death occurred in the 5th century BC, on the Greek island of Delos; dying on Delos was prohibited on religious terrains.
Today, primarily, the prohibition of death is an ambiguous response to the government’s failure to approve the expansion of municipal graveyards. For instance, in Spain, one town has prohibited “death”; in France, several settlements have had death banned, while in Biritiba Mirim, in Brazil, an attempt to prevent death occurred in 2005. The latter is suggestive of how an extreme political realm can dictate hypocrisy over rationale.
Today-Irrespective of the country and jurisdiction, laws around the subject of death and dying are the byproduct of prevailing, Thus norms in society and their political upshot.
A person’s norms and values are invariably influenced by faith, views, and knowledge of the constituency. Henceforth reflecting on the openness of the exchange of ideas, solid religious groundworks change modern societies, with few exceptions. Specific laws affect the subject of death and dying. It utterly prohibits intentional or direct cause of death. However, some countries like the Netherlands overcome such limitations by admitting medically assisted euthanasia for individual patients under certain circumstances over following due process.
Origin of Laws around Death
The narrative of law ties closely to the expansion of civilization. The fundamental law dares back to Ancient Egyptians, as far again as 3000 BC. It was based on the concept of Ma’at and characterized by tradition, rhetorical speech, social equality, and impartiality. By the 22nd century BC, the ancient Sumerian ruler Ur-Nammu had formulated the first law code, which consisted of casuistic statements (“if … then …”). Around 1760 BC, King Hammurabi further refined Babylonian law by codifying and inscribing it in stone.
Ethics of Death and Dying
Death is a value burdened word. The term touches our ears uttered in negativity, and to hear the word ‘death’ halts the time. Even mentioning death can be presumed to incite apprehension as we defeat the anxiety that appends to it and try to avoid views of mortality. The thought of dying spirals almost everyone, as the death of others comes into the individual’s viewpoint. When unconsciously becomes our own. We indeed confront death, and we do so with caution, a sense of unreality, and even fear.
Death is a mystery to everyone. That is why we tend to circumvent it- not only for ourselves but also for those suffering, thus imprisoned by their medical condition. We reflect on our collective consciousness and even go further and extend the sufferer’s heartbeat under the notion of humanity and the wrongfulness of eliciting death.
The mortality of a human being for a medical professional has become a double-edged sword. It is becoming more than ever cumbersome given the progress of technology, politics, bureaucracy, and population health. Indeed, death is a subject of ethical significance, which demands a personalized approach; nonetheless, the latter is easier said than done!
Origin of Ethics and its implications on Euthanasia
The subject of euthanasia invites several complex moral dilemmas, such as if it is appropriate to end the life of a critically ill who is enduring severe pain and suffering. Under what conditions can euthanasia be justified, or is there a moral estrangement between annihilating someone and lapse in peace. At the core of these wiles are people's distinct impressions about the significance and value of human actuality.
Very often, as societies witness the pain and suffering of patients in the face of scientific evolution, people also call euthanasia the ‘mercy killing.’ Perhaps those who use the term are deeming it for terminally ill and suffering prolonged, intolerable pain.
Ethics is the branch of philosophy that deals with the concept of euthanasia. It examines right and wrong moral behavior, decent concepts such as justice, virtue, duty, and moralistic vocabulary.
Various ethical principles pose numerous answers to the subject, hence the highest good!
Ethics elaborate on a complete set of proper behaviors for individuals and groups based on patients’ values and physicians who live in a given society. In other words, — ethical theories are closely related to forms of life in various social schemes. The latest is a phenomenon not uncommonly overlooked by the modern medical practice, not necessarily because of physician’s and patients’ reluctance. But due to the overwhelming politicization, centralization, and bureaucracy of the healthcare system.
Why people Support Euthanasia
Most people think unendurable pain is the foremost reason people seek out euthanasia. Still, some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of intractable pain.
Incurably ill persons can severely damage their quality of life by physical conditions such as incontinence, nausea, vomiting, breathlessness, paralysis, and difficulty swallowing.
Emotional influences that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or aversion to being dependent. Based on this doctrine, more and more societies are embracing Death with Dignity laws.
Supporters of “death with dignity” have accomplished legalizing what is also known as physician-aid-in-dying in five U. S. states by convincing voters, lawmakers, and courts that terminally ill patients have the right to die without suffering intractable pain in their final primes. That opens another chapter for discussion over the physician’s role as the healer.
Physician or Healer and Death
Assisting in dying is contentious, precisely because it factors the many ethical dilemmas our society has wrestled with and concerns of violations that primarily affect the deprived, the need to protect vulnerable populations and the strains between patient choice and control. That is in contrast to the position of the physician as a healer. Indeed, aid in dying is controversial; because of the potential risk of inquests on physicians’ professional integrity as a healer. Physicians are programmed to heal, but the healer’s standards plummet when the patient can no longer be physically treated.
As physicians, we don’t do a great job of optimizing dying patients' dwindle tranquility, partly because clinicians are often uncomfortable when they can no longer heal the patient. Medical culture too often sees death as a failure, and physicians find it challenging to address mortality.
Another group explains their rationale for not engaging in assisted death based on religious grounds. Some also believe lines have already been blurred between the Hippocratic Oath’s mandate and the potential for harm in the treatments we provide. Nevertheless, the Hippocratic oath does not harm principle see life as ending in dignity; and health as a state of harmony between “Comfort always, often treat and Heal sometimes!”
Medicine, Life, and Death
Too often, doctors entomb themselves in treating disease based on symptoms and clinical judgment that disconnect them from the realism of life and death. This phenomenon is even more profound when physicians rely more and more on technology and evidence-based medicine.
The dissociation of modern medicine from personalized care is inevitable, given the takeover of the art of healing by revolutionary technologies such as artificial intelligence and machine learning. Therefore, for medicine to familiarizes itself with life and death, it must provide physicians the education and autonomy to connect with the patients individually, recognize their needs, and honor them accordingly.
Until healthcare honors personal expectations, it will fall short of delineating between extending quality life and prolonging pain, suffering, and death.
The Bottom line of Physician Attitude, Practice of Medicine and Death
Medicine is about keeping human beings in comfort, devoid of disease, suffering, and pain. Of Course- irrespective of the treatment and efficacy of the rendered care, a physician shall not cause intentional harm. However, whether death stands for injury or the procedure- is a matter of ethical significance and depends on the patient’s view of life, health, and objective findings of the doctor; still, euthanasia is a decision that we must observe within the framework of the doctor-patient relationship.
No physician must be obliged to render assisted death, while no patient with debilitating (End stage) ailments such as Amyotrophic Lateral Sclerosis (ALS) should be allowed to live in agony. Legislations must respect individual autonomy but ensure the transparent and accountable execution of such laws.
Medicine that ignores pain and suffering in any form is not linctus, mainly when science and technology come to a halt in resolving the upheaval. The latter is the point where euthanasia becomes the optimum treatment.
Extending death is not part of Hippocratic medicine, despite the overwhelming miss perceptions. Hippocratic medicine is about the individual slant to the patient’s life, health, and wellness. It is about keeping patients contented without refuting death as part of the human journey. So, let us keep bureaucracy away from medical practice, personalize healthcare, honor patients’ needs, and respect the physician’s objective and personal beliefs even if it pertains to a choice between life and death.