The very point of 'Advanced Directives' is in itself confounding issue as frequently it is the patient's imaginary fears about loss of body functions and pain that drives them to such conclusions.
So it is cleanly obvious that in palliative care settings it is not uncommon for patients to succumb to momentary pain and wish for euthanasia but very rarely such requests are persistent. Instead of legalizing euthanasia, efforts must therefore be concentrated on improving the palliative care. This could take the form of improving pain control measures and providing loving and caring service to patients.
Legalizing Euthanasia (Implications)
Very few nations in the world have legalized euthanasia. Holland was the first country to do so and euthanasia was quite common even in the 1970's. In 1985 the country made some amendments to the existing laws which made the procedure even easier. The 'terminally ill' clause was struck off from the laws that governed euthanasia and the immediate effect was shocking. In 1990 for example there were a total of 11,800 euthanasia induced deaths of which 1000 patients were euthanized without the consent of the patients. In all, euthanasia accounted for around 9% of all the deaths that happened in that year. [Pregnant Pause] in Netherlands, the law allows the physician legal immunity from criminal action. Instances of patients who are not terminally ill and incompetent to disclose their wishes being euthanized have been reported in some studies. In fact euthanasia has been extended for handicapped infants, comatose patients and even adults with severe depression which is really saddening. These statistics are indeed scary and explain the reasoning behind the anti-euthanasia group who have opposed legalizing the procedure.
In the United States Oregon' is the only state to have legalized euthanasia. The 'Death with Dignity act' of 1997 legalized the procedure in the state. Since then the number of physician assisted deaths have increased every year to a total of 171 deaths between 1998 and 2003. This is just around 1/7th of one percent of the total number of deaths in that state and pales into insignificance compared to the Dutch figures. However, a look at the 'end of life concerns' for these patients who opted for voluntary euthanasia, has raised questions about the validity of the claim that fear about 'unbearable pain' and 'loss of bodily functions' are the main concerns prompting patients to resort to euthanasia. As per the 2003 statistics, only 21% of the patients regarded insufficient pain control as their reason for choosing Physician-assisted Suicide while 57% quoted fear of loosing bodily functions. The astounding fact is that 93% of the people indicated loss of autonomy and inability to enjoy life as their important 'end of life concerns' that motivated them to opt for euthanasia. [DHS]
Legalizing euthanasia can lead to abuse of it by physicians. Though most physicians are loving, caring and good professionals committed to their Hippocratic Oath of healing people, there are some 'weeds among the wheat'. Instances of wanton abuse of the procedure in the recent past have only furthered our fears about the dangers involved. The notorious case of Dr. Kevorkian,...
The astounding fact is that only 25% of the patients whom Dr. Kevorkian euthanized were terminally ill and fit to be candidates for euthanasia. When there are no clearly defined clinical safeguards there is greater risk for abuse. [Lori a. Roscoe] Instead of approving euthanasia it would be a better and positive approach to improve pain control procedures "The delivery of [adequate pain relief] is 'grossly inadequate' today, and efforts to make such care universally available have not yet succeeded." [Life Issues Institute].
Conclusion
Euthanasia is without doubt a complex issue with serious ethical, social, and moral implications. From a purely moral bent of mind we could never approve euthanasia and it is also in total contradiction of medical ethics. To develop this into a legalized procedure and to administer it in health care settings would be a serious breach of the Hippocratic Oath of doctors. However in some very rare and exceptional circumstances where the rationality of the request is beyond any reasonable doubt it would be forthright to provide assisted deliverance. In general, it would send a wrong signal if euthanasia is legalized and practiced as an approved procedure. Evidence from nations where the procedure is legalized have beyond doubt proved the possibility of abuse and the drastic effect on palliative care. There is no question of doubt that approving euthanasia would seriously compromise the quality of palliative care and at the same time carry severe psychological implications for patients.
Bibliography
Eric Gargett, "Changing the Law in South Australia," World Right-to-Die
Newsletter, May 2001, p. 3. (a World Federation of Right to Die Societies
Publication)
Richard a. Epstein, "Voluntary Euthanasia," Accessed on November 29th 2004, http://www.lse.ac.uk/clubs/hayek/Ama- gi/Volume1/number1/voluntary_euthanasia.htm http://www.lse.ac.uk/clubs/hayek/Ama- gi/Volume1/number1/voluntary_euthanasia.htm
Pregnant Pause, "Euthanasia in the Netherlands," Accessed on November 30th 2004, http://www.pregnantpause.org/numbers/netheuth.htm
DHS, "Physician-Assisted Suicide: Death with Dignity: Annual Report 2003," Accessed on November 30th 2004, http://www.ohd.hr.state.or.us/chs/pas/ar-index.cfm
5) World Health Organization, "Cancer Pain Relief and Palliative Care,"
Technical Report Series 804, Geneva: WHO, 1990
Twycross RG., "Pain relief in Advanced Cancer," Edinburgh: Churchill
Livingstone, 1994: pg 554-5
7) Southern Cross Bioethics Institute, "Euthanasia Website Material," Accessed on November 29th 2004, http://www.spuc.org.uk/papers/euthanasia.pdf
9) Lori a. Roscoe, L.J. Dragovic and Donna Cohen, "Dr. Jack Kevorkian and Cases of Euthanasia in Oakland County, Michigan, 1990 -1998," New England Journal of Medicine, Volume 343:1735-1736, December 7, 2000.
10) Jennet B " Inappropriate use of Intensive Care," British Medical journal, 1884, 289, 1709-11
