my presentation during surgery internship..... 2013....

1. VISHNU AMBAREESH

2. 

3. 

4. Etymology

Euthanasia (from
the Greek: εὐθανασία meaning
"good death": εὖ, eu (well or good) +
θάνατος, thanatos (death))

5. 
The first apparent usage of the term
"euthanasia" belongs to the historian
Suetonius who described how the
Emperor Augustus, "dying quickly and
without suffering in the arms of his
wife, Livia, experienced the 'euthanasia'
he had wished for."

6. 
word "euthanasia" was first used
in a medical context by Francis
Bacon in the 17th century, to refer
to an easy, painless, happy death,
during which it was a "physician's
responsibility to alleviate the
'physical sufferings' of the body."

7. Definition

 Definition of EUTHANASIA
the act or practice of
killing or permitting the death of
hopelessly sick or injured individuals
(as persons or domestic animals) in
a relatively painless way for reasons
of mercy.

8. Euthanasia Definitions
• Voluntary euthanasia:
The person killed has
requested to be killed.
• Non-voluntary: When the person
who is killed made no request and
gave no consent.

9. Euthanasia Definitions
• Involuntary euthanasia: When the
person who is killed made an
expressed wish to the contrary.

10. Euthanasia Definitions
• Assisted suicide: Someone provides
an individual with the information,
guidance, and means to take his or
her own life.

11. Euthanasia Definitions
• Euthanasia By Action: Intentionally
causing a person's death by
performing an action such as by
giving a lethal injection.

12. Euthanasia Definitions
• Euthanasia By Omission:
Intentionally causing death by not
providing necessary and ordinary
(usual and customary) care or food
and water.

13. Active Euthanasia
• Something is done to the patient
to hasten Death
• Not legal in the United States
• Legal in Netherlands and
Australia
• Examples: drugs are
administered at lethal levels.

14. Passive Euthanasia
• Patient is allowed to die. Only
medication help ease patient’s
pain is administered.
• Examples:
Turning off respirator, refusing
chemotherapy.

15. Voluntary Euthanasia
• Patient request
treatment to be
stopped.
• Examples:
chemotherapy or
dialysis.

16. Non- Voluntary
• Patient cannot
decide from
themselves.
• Someone makes
the decision for
them.
•Examples: children, comatose patients,
or individuals not mentally competent

17. Involuntary
• Patient is refused a
life sustaining
treatment.
• Examples: Drugs are
too costly, limited
supply of organs.
• About 13,000 patients
are on waiting list in
the US.

18. 
Voluntary euthanasia is legal in
some countries and U.S. states.
Non-voluntary euthanasia is
illegal in all countries.
Involuntary euthanasia is usually
considered murder

19. Heath Care Surrogate

You can appoint someone, to act as
your representative in the event you
are mentally incapacitated.
Terri Schiavo did not have a Heath
Care Surrogate.
If you do not have one, by default it is
your spouse. If you are unmarried it is
your parents, or next of kin.

20. Living Will

A living will is a document
that states what your wishes in
the event you need life
sustaining care.

22. History


23. History

400 B. C. - The earliest recorded
reference to Euthanasia comes
from Hippocrates, the father of
medicine. He is quoted as saying “I
will give no deadly medicine to
any one if asked, nor suggest any
such counsel”

24. 
Euthanasia was practised in Ancient Greece
and Rome: for example, hemlock was
employed as a means of hastening death on
the island of Kea, a technique also employed
in Marseilles and by Socrates in Athens.
Euthanasia, in the sense of the deliberate
hastening of a person's death, was supported
by Socrates, Plato and Seneca the Elder in the
ancient world

25. History Cont.

673 – England prohibits suicide.
1647 – the Providence Plantations (Rhode
Island) declared that if an individual committed
suicide his/her possessions would become the
property of the King of England.
1800s – Laws of Connecticut essentially states
that any person who aids another individual in
committing suicide is guilty of murder if the
advisee actually goes through with suicide.

26. History Cont.

1828 – “The earliest American statute
explicitly to outlaw assisted suicide was
enacted in New York….Between 1857 and
1865, a New York commission drafted a
criminal code that prohibited ‘aiding’ suicide
and, specifically, ‘furnishing another person
with any deadly weapon or poisonous drug,
knowing that such person tends to use such
weapon or drug in taking his own life.”
1850 – “The California legislature adopted
the English common law, under which
assisting suicide was… a crime.”

27. History Cont.

1920 – “The book "Permitting the Destruction of
Life not Worthy of Life" was published.
In this book, authors Alfred Hoche, M.D., a
professor of psychiatry at the University of
Freiburg, and Karl Binding, a professor of law
from the University of Leipzig, argued that
patients who ask for "death assistance" should,
under very carefully controlled conditions, be
able to obtain it from a physician.
This book helped support involuntary
euthanasia by Nazi Germany.”

28. Nazi Germany

 1939 – In “Nazi Germany…Hitler ordered
widespread ‘mercy killing’ of the sick and disabled.”
 1935 – “The Euthanasia Society of England was
formed to promote euthanasia.”

29. History Cont.

 1995 – Australia's Northern Territory approved the
“Rights of the Terminally Ill Act . “ It went into
effect in 1996 and was overturned by the Australian
Parliament in 1997.”

30. Legalized in Oregon

 1994 - the Oregon Death with Dignity Act was
passed, which legalized assisted suicides.
Other states such as California, Michigan, Maine,
Hawaii, Arizona, and Vermont have tried to pass
similar bills. All attempts have been unsuccessful.

31. The Oregon Experience
Oregon legalized physician-assisted
suicide in 1997 . . .

32. History Cont.

 2002 – Euthanasia is legalized in Belgium
 2005 – “Netherlands set to give the go-ahead to child
euthanasia.”

33. Various nations


34. Japan

In 1995 Japanese legalized "Active
euthanasia" when four criteria are satisfied:
unbearable pain, proximate death, no other
way to relieve pain; and clear consent.
Passive euthanasia, without consent, is also
allowed if relatives consent.

35. International Laws

Belgium and The Netherlands have legalized
Euthanasia
In 1995, with the passage of the "Rights of the
Terminally Ill (ROTI) Act," Australia’s Northern
Territory became the only jurisdiction in the world
with both legalized assisted suicide and
euthanasia. The law went into effect in July 1996.
It was repealed on March 25, 1997.

36. History in Netherlands

Started in 1973 became legal until 2002
The Dutch situation between 1973 and
2002 was an outgrowth of a series of court
decisions and medical association
guidelines, beginning with a 1973 District
Court case in which Geertruida Postma, a
Dutch physician, was convicted of the
crime of euthanasia after she ended the life
of her seriously ill mother.

37. Holland
legalized euthanasia starting in
the early 1970s

38. The Dutch Guidelines
1. Must be performed by a doctor
2. Must be requested by patient while competent
3. Request must be free of doubt, well-documented,
and repeated
4. A second, independent physician must be
consulted.
5. Determination that no one pressured patient
6. “Unbearable pain” or condition that is otherwise
intolerable
7. No available means to improve patient’s condition

39. Euthanize Children!

The Dutch government has decided to
endorse guidelines for Nonvoluntary
euthanasia of infants.
Under the so- called Groningen protocol,
euthanasia will be allowed when a child is
terminally ill with no hope of recovery and
suffering great pain, when two doctors agree
that the case is hopeless and when the
parents consent.

40. Belgium- not to be
outdone…

The Belgian act legalizing euthanasia was passed
on May 28, 2002 and went into effect on
September 23, 2002.
It limited euthanasia to competent adults and
emancipated minors.
Just recently, the government announced it intends
to extend its euthanasia law to newborns and
children
Approximately 2,000 people have used the law

41. Australia

“Death by Laptop”
Performed by Dr. Philip Nitschke
Used the law to assist four people with
their suicides.
Hooked up IV to patient which was
connected to laptop.

42. Australia (cont.)

 Dr. Philip Nitschke

43. Australia (cont.)

 Death by Laptop

44. Australia (cont.)

Computer asked three questions:
Are you aware that if you go ahead to the last screen
and press the ‘yes’ button, you will be given a lethal
dose of medicine and die? Yes / No
Are you certain you understand that if you proceed
and press the ‘yes’ button on the next screen, you will
die? Yes / No
In 15 seconds you will be given a lethal injection. Yes
/ No
Nitschke still researching ways to help people kill
themselves

45. Canada

Current bill being considered that would legalize
euthanasia
Bill C-407 legalizes both euthanasia and assisted
suicide.
For people with chronic suffering and mental pain.
Person does not need to try to find other ways of
helping ease pain, they may refuse and just choose
euthanasia
Anyone can help euthanize a person, does not need to
be a physician, but need “confirmation”

46. International
Organizations

Council of Europe has rejected bills that would
legalize euthanasia
UN is against euthanasia
However, wording of new draft for rights of people
with disabilities seems to leave the door open:
The text makes illegal all "medical or related
interventions," possibly including life-saving nutrition
and hydration, carried out without the "free and
informed consent" of the person concerned or his
legal representative.
Needless to say, Catholic church is strongly opposed
to euthanasia

47. Cases and Controversies


48. Euthanasia program

The so-called "Euthanasia"
program was National Socialist
Germany's first program of mass
murder, predating the genocide of
European Jewry, which we call the
Holocaust, by approximately two
years

49. 

50. Dr. Jack Kevorkian
• Assisted-suicide advocate, launched
campaign for “right to die”
• Tried for murder for his
assists, convicted in 1999
• Saw euthanasia as “helping
a suffering patient”

51. Dr. Jack Kevorkian
• Believed laws limiting euthanasia,
as well as limiting smoking, etc.
were infringement on rights
• Died in June 2011

52. Karen Ann Quinlan

 In 1975 a 21-year-old woman named Karen Ann
Quinlan suffered a respiratory arrest that
resulted in severe and irreversible brain damage
and left her in a coma.
Several months later, after doctors informed
them that their daughter's recovery was
extremely unlikely, Quinlan's parents requested
that artificial means of life support be removed.
The hospital refused this request.

53. 

54. Court sided with Family

After a lengthy legal battle, in 1976 the
Quinlans obtained a court order allowing
them to remove the artificial respirator that
was thought to be keeping their daughter
alive.
The New Jersey Supreme Court ruled that
the Quinlans could disconnect the device so
that the patient could "die with dignity."

55. Turned off respirator

This decision spawned increased discussion
of the scope of patients' rights to control their
death.
Although the respirator was removed in
1976, Quinlan began to breathe on her own.
She lived until 1985 without ever regaining
consciousness.

56. Katrina Track…


57. Louisiana probes 215
deaths

 A state investigation into whether critically ill
patients were left to die or were euthanized at a New
Orleans hospital during the chaotic aftermath of
Hurricane Katrina is part of a probe into an
estimated 215 deaths at nursing homes and hospitals
across the area, according to the Louisiana
Department of Health and Hospitals. As Reported
10/17/05

58. Tough Decisions at
Hospital

 Staff doctors in a New Orleans hospital may have
euthanased critically ill patients with massive doses
of morphine in the chaotic aftermath of Hurricane
Katrina. According to the London's Mail on Sunday,
the doctors say that the patients would have died
anyway and some were in great pain. They were
unable to care for them properly when the power
failed and looters and rapists were roaming the
wards.

59. 
Canada: Sue Rodriguez, popularly
known as 'Victoria woman' and
diagnosed with Lou Gehrig's disease in
1991, asked legislators in 1992 to change
the law banning assisted suicide. The
Supreme Court rejected her plea, but she
committed suicide in 1994 with the help
of an anonymous doctor.

60. 
 England: Anthony Bland, in March 1993, ended up
in persistent vegetative state after suffering severe
brain damage in the Hillsborough football stadium
stampede. After three years, a court allowed the
withdrawal of life-prolonging treatment on him. He
was the first patient in British legal history to be
allowed to die.

61. Euthanasia in India


62. Aruna Shanbaug case

 Aruna Shanbaug is a former nurse from Haldipur, Uttar
Kannada, Karnataka in India. In 1973, while working as a
junior nurse at King Edward Memorial Hospital, Parel,
Mumbai, she was sexually assaulted by a ward boy,
Sohanlal Bhartha Walmiki and has been in a vegetative
state since the assault. On 24 January 2011, after she had
been in this status for 37 years, the Supreme Court of
India responded to the plea for euthanasia filed by
Aruna's friend journalist Pinki Virani, by setting up a
medical panel to examine her. The court turned down the
mercy killing petition on 7 March 2011

63. 
However in its
landmark judgment, it
allowed passive
euthanasia in India

64. 
Gautmni Nair will
played Aruna in
Malayalam film “
maranam peyyumbol”

65. 
Jeet Narayan of Mirzapur in Uttar
Pradesh in 2008 pleaded for euthanasia
for his four sons - Durgesh (22),
Sarvesh (18), Brijesh (13) and Sushil (10)
- all crippled and paralysed below the
neck. Narayan wrote to the president of
India, but his plea was rejected.

66. Thalaikoothal

Thalaikoothal (Tamil: தலைக்கூத்தல், lit.
showering) is the traditional practice of
senicide (killing of the elderly) or
involuntary euthanasia, by their own
family members, observed in some
parts of southern districts of Tamil
Nadu state of India.

67. 

68. 
 Typically, the elderly person is given an extensive
oil-bath early in the morning and subsequently made
to drink glasses of tender coconut water which
results in renal failure, high fever, fits, and death
within a day or two. This technique may also involve
a head massage with cold water, which may lower
body temperature sufficiently to cause heart
failure. Alternative methods involve force feeding
cow's milk while plugging the nose, causing
breathing difficulties (the "milk therapy") or use of
poisons.

69. Ethics


70. 
As of 2006, euthanasia is the
most active area of research
in contemporary bioethics

71. Good consequences of euthanasia
It would be possible to respect the self-determination
of competent patients who
want it.
It would reassure the large number of
people who want to have the option of
euthanasia
Some pain and suffering can only be
relieved by euthanasia (psychological as
well as physical pain).

72. Potential bad consequences
Undermine moral center of medicine, “first,
do no harm”
Weaken society’s commitment to provide
care for dying patients (its easier to kill
them)
Some patients may feel pressured to accept
death because of a felt burden
There may be a slip into non-voluntary
euthanasia

73. 

74. Doctors’ attitudes toward
euthanasia
20% of physicians who care for the
seriously ill and terminally ill say they
have been asked for assistance in
speeding the dying process.
Of those, 3% have written prescriptions
to assist suicide
and 5% have given lethal injections.