Euthanasia and Assisted Suicide: The Physician's Role

Abstract

The American Medical Association's Council on Ethical and Judicial Affairs defines euthanasia as the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy. Voluntary euthanasia is euthanasia that is provided for a competent person with his informed consent. Involuntary euthanasia is euthanasia performed without a person's consent. Assisted suicide is to provide the means whereby a suffering person may kill himself. Euthanasia was practiced by the ancients, the term means "good death." It was the practice of dying in peace and with dignity. For the physician, it meant caring for the patient with compassion and alleviating pain and suffering. However, the physician of ancient times could also cause the death of his patients. One physician would heal with compassion, another would provide the poison draught to cause death of the patient. The sick person did not know whether to expect to be healed or to be killed by the physician. The Oath of Hippocrates (500 BC) was the first attempt from a group of concerned physicians to establish a set of ethical principles that would guide the practice of medicine. This set of moral principles defined the physician as a healer, rejecting the role of purveyor of death. The principle of "primum non nocere," first do no harm, became one of the guidelines in the doctor-patient relationship and remained for 2500 years (Cameron 2001; Porter 2006). By the late nineteenth century, supported by utilitarian philosophy and Darwinian survival of the fittest, the concept of a right to death surfaced in Europe. Articles appeared in the German medical literature. In 1920, Karl Binding and Alfred Hoche published the manuscript "Permitting the Destruction of Unworthy Life." Members of the intellectual elite; Binding was a prominent jurist and Hoche a professor of psychiatry. With the intent to benefit society, the authors advised eliminating those whose life was devoid of value and a burden to society. The victims were those near death who requested to die, "idiots," whose life was without a purpose, and those in a comatose state due to trauma with little chance of recovery. The publication was a landmark for the euthanasia program that would follow; widely discussed in academic circles. Advocates of euthanasia, few at first, gradually increased in number, many were academic physicians and professors at medical schools. The systematic, organized killing began in the 1930s. It started with the killing of infants and children with congenital defects and mental retardation followed by disabled and mentally ill adults and the terminally ill. The killing criterion was subsequently expanded to include adults and children with 'antisocial behavior' and those with minor handicaps. Children and adults from psychiatric institutions were killed by lethal injection. When this method proved costly and awkward, gas chambers were built in some hospitals. Patients were transferred to these

A conceptual framework for thinking about physician-assisted death for persons with a mental disorder.

“…As a result of rapid advances in medical science, persons with incurable or degenerative diseases can live longer (Shrestha, 2005), even though their quality of life can be severely diminished (Breitbart et al, 2000). Concerns for personal autonomy (Boudreau & Somerville, 2014), coupled with limitations in palliative care for alleviating pain and suffering (Knaul, Farmer, Bhadelia, Berman, & Horton, 2015), have fostered supportive attitudes towards the use of assisted death among some practitioners in the fields of philosophy (Gill, 2009), medicine (Lee, Price, Rayner & Hotopf, 2009), and law (Hendry et al, 2013). Despite increased attention to assisted death in current academic discourse and policy-based literature, psychologists have been relatively absent in the discussion (but see Achille & Ogloff, 2004;Appel, 2007;Bergmans, Widdershoven, & Widdershoven-Heerding, 2013;Deschepper, Distelmans, & Bilsen, 2014;Johnson, Cramer, Conroy, & Gardner, 2014;Macleod, 2012;Parker, 2012;Schoevers, Asmus, & van Tilburg, 2014).…”

Misconception between palliative care and euthanasia among Thai general practitioners: a cross-sectional study

“…It is typically administered by a healthcare professional or another person at the patient’s request. Euthanasia can be either voluntary (with the explicit consent of the patient) or involuntary (without the patient’s consent, which is illegal in many places) [ 18 ], and either active (taking a direct action to end a patient’s life, such as administering a lethal injection) and passive (withholding or withdrawing life-sustaining treatments with the expectation that it will lead to the patient’s death) [ 19 ].…”

The Physician-Assisted Suicide Pathway in Italy: Ethical Assessment and Safeguard Approaches

“…The topic is highly divisive within the public and professional debate, with diverging opinions on key issues such as the existence of conditions in which autonomously chosen death can be considered a benefit (therefore favouring it would be an act of beneficence), the limits of the legislation, and the role of the physician. With respect to the last point, one ultimate position among opponents is that there is no possible role for physicians in either euthanasia or assisted suicide, that physicians have a duty to care for ailing patients and to never cause any harm and that, given the very fiduciary nature of the patient–physician relationship, these practices cannot be consistent with professional practice (Vizcarrondo 2013 ; Breitbart 2012 ; Snyder, Sulmasy, and Mueller 2017 ). However, despite an overt level of criticism from the medical community, over the past two decades, aid-in-dying practices have become more widespread worldwide and have been integrated into some healthcare systems.…”