Chapter Ten Euthanasia: Practice and Principles
Euthanasia Euthanasia Passive Active Voluntary Involuntary Suicide Assisted suicide
Experience of Holland It is the only modern nation to fully sanction the practice of physician-assisted euthanasia
Experience of Holland (continued) Process: Patient must request Patient must be terminally ill, with no hope of improvement and in severe pain Consultation with second physician and reporting of event Procedural review mechanism
Oregon Death with Dignity Act Criteria: Capable and competent adult Oregon resident Have terminal illness with less than six months to live Voluntarily request a prescription for lethal drugs Request must be both orally and in writing
Right to Die Case Review the case Do you think patients who meet the Oregon criteria but do not have the capability to take the medications themselves have a right to be assisted?
Right to Die Case (continued) If you decided in the positive, does this expansion of the “right to die” give credence to the concept of a “slippery slope” argument?
Mercy Killing Hans Florian and Bertram Harper cases: Show consideration for the “spirit of the law”
Mercy Killing (continued) “Its Over, Debbie” case: No real patient/physician relationship Unclear communication of desire No discussion of options (hospice, etc.) No consultation with other providers
Mercy Killing (continued) Recent rise in cases involving nursing and allied health personnel Precludes all future options for patient Negative effects on community, patients, practitioners, institutions Hard to imagine an ethical justification for the decision and action
Euthanasia Passive euthanasia is currently accepted, while active is not What is the real difference? Would not active euthanasia be more humane? Why do you think we have come to accept the one but not the other?
The Hospice Alternative Many feel the genesis for support for euthanasia is based on fear of dying: In pain Separated from friends and family Following massive technical interventions that wipe out savings and cause lingering in a protracted state of unconsciousness
The Hospice Alternative (continued) If hospice could change the how of dying, would it change the desire for euthanasia?
Active Euthanasia Consider Review Exercise A in the chapter The question: is the practice of active euthanasia something that health care providers should participate in? Create a pro and con list for the adoption or rejection of the practice
Key Concepts Passive euthanasia is the allowance of the dying process to continue without intervention beyond palliative care Passive euthanasia is a generally accepted practice in cases of futility, and where no possibility of patient benefit exists
Key Concepts (continued) Active euthanasia, where the health care provider takes actions that speeds the process of dying does not have ethical or legal support in the United States Involuntary euthanasia where the patient has not indicated a desire to be assisted in death is not easily differentiated from murder
Key Concepts (continued) The Netherlands is the only modern industrial nation that has legalized voluntary active euthanasia The current Supreme Court position on a “right to die” is that it is not a right that can be construed from the American Constitution The matter has been left to the states
Key Concepts (continued) The law in regard to mercy killing is unequivocal, personal motivation is not defense in murder The public has been particularly outraged when mercy killing involves those entrusted with health care, especially nurses and allied health practitioners
Key Concepts (continued) The hospice movement, by providing relief for the terminally ill patient and addressing many of the patient’s and family’s concerns in regard to the dying process, may lesson the need for legislating physician-assisted suicide or euthanasia