Euthanasia

1. Quality of life

2. Objectives
• To understand the quality of life
• The factors enhances and affect quality of life
• Care of terminally ill patients
• Palliative care
• Euthanasia
• Types of Euthanasia

3. • Quality of life is the third topic that must be
reviewed in order to analyze a problem in
clinical ethics.
• Any discussion of quality of life necessarily
involves medical indications and patient
preferences.

4. • The most fundamental goal of medical care is
the improvement of quality of life for all
those who need and seek care, and also relief
of pain and improvement of function.
• All activities, such as examining, evaluating,
diagnosing, treating, curing, comforting and
educating, aim at improving the patient’s
quality of life.

5. Meaning of quality of life
• It expresses a value judgment: the experience
of living, as a whole or in some aspect, is
judged to be “good” or “bad”, “better” or
“worse”.

6. • In recent years, efforts have been made to
develop measures of quality of life that can be
used to evaluate outcomes of clinical
interventions.
• Such measures list a variety of physical
functions, such as mobility, performance of
activities of daily living, absence or presence of
pain, social interaction, and mental acuity.

7. • In general, quality of life can be defined as a
multidimensional construct that includes
“performance and enjoyment of social roles,
physical health, intellectual functioning,
emotional state, and life satisfaction or well-
being.”

8. • Quality-of –life judgments must consider
personal and social function and performance,
symptoms, prognosis, and the individual,
often unique values that patients ascribe to
the quality of their life.

9. Several important questions:
• who is making the evaluation—the person
living the life or an observer?
• What criteria are being used for evaluation?
• What types of clinical decisions are justified
by reference to quality-of- life judgment?

10. Enhancing quality of life
• Recently, medical skills have been used to
improve on normal conditions：cosmetic
surgery responds to the desires of individuals
for a more beautiful appearance,
administration of growth hormone increases
height for persons of short stature……

11. The distinction between treatment
and enhancement:
• Treatment attempt to respond to physical,
physiologic, or psychological defects that
deprive persons of normal characteristics.
• Enhancement are made in response to patient
preference and to improve quality of life.

12. Palliative care and treatment of
pain
• Palliative care medicine is defined as “an
approach that improves the quality of life of
patients and their families facing the
problems associated with life-threatening
illness, through the prevention and relief of
suffering by means of early identification and
impeccable assessment and treatment of pain
and other problems, physical, psychosocial
and spiritual.

13. • Relief of pain is a traditional medical goal.
• Increasingly, palliative care medicine deals
with pain and suffering at the end of life.
• Palliative care medicine uses methods to
achieve global aims: aiding patients to deal
with their impending death and its effect on
others.

14. Pain relief for terminally ill
patients
• Palliative care includes skilled application of
pain-relieving drugs.
• Competence in palliative care includes not
only science and skill in managing pain but
also understand and application of ethical
principles.

15. • Patient should not be kept on a drug
regimen inadequate to control pain
because of the ignorance of the
physician

16. • Attempt to achieve adequate pain relief have
another side effect, namely, the clouding of
the patient’s consciousness and the hindering
of the patient’s communication with family
and friends.
• This consequence may be distressing to
patient and family and ethically troubling to
physicians and nurses.

17. • Instead, sensitive attention to patient’s needs,
together with skilled medical management,
should lead as close as possible to the desired
objective: maximum relief of pain with
minimal diminution of consciousness and
communication.

18. Euthanasia

19. Euthanasia
• The word Euthanasia originated from the
Greek language : eu means “good” and
thanatos means “death”.
• Another word for euthanasia is mercy killing.
• Euthanasia literally means ’good death’ and
generally aims to hasten the death of people
who suffer severely without any hope of
recovery.

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

21. • The act of euthanasia is today understood as
termination of life on request.
• But it has not always been people’s choice.
• The voluntary decision to terminate life has
been misused during the human history,
especially between 1933 and 1945 during the
German Nazi regime in Europe.

22. • This criminal regime murdered millions of
people because they were disabled, ill, old, or
of different ethnic group.
• Murders committed for these reasons were
also called “euthanasia”.
• Nazi regime excused their criminal deeds as
termination of “worthless lives”.
• This is against the humane nature of love and
compassion, and equal human rights.

23. • Assisted suicide: Someone provides an
individual with the information, guidance,
and means to take his or her own life with
the intention that they will be used for this
purpose.

24. • Physician Assisted Suicide: When it is a
doctor who helps another person to kill
themselves.

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

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

27. • The crimes committed in the past are one of
the reasons why termination of life on
request is a criminal act in almost all States of
the world.
• In the Netherlands voluntary euthanasia has
been decriminalized.
• This made the Netherlands the first country
in the world to formally sanction mercy killing.
(Belgium, Oregon)

28. • Under the new law, euthanasia is
administered only to patients who are in a
state of continuous, unbearable and incurable
suffering.
• There are other requirements as well:
• A second opinion from an external physician;
• The patient must be judged to be of sound
mind;
• A request to die must be made voluntarily,
independently and persistently.

29. These are NOT euthanasia:
1. Not commencing treatment that would
not provide a benefit to the patient.
2. Withdrawing treatment that has been
shown to be ineffective, too burdensome
or is unwanted.
3. The giving of high doses of pain-killers that
may endanger life, when they have been
shown to be necessary.

30. Care of the dying patient
• Attention to relief of pain and discomfort and
enhancement of the patient’s ability to
interact with family and friends become
predominant goals.
• Hospice care and palliative medicine work to
achieve these goals.
• Cure sometimes, support frequently, comfort
always.

31. Quality end-of-life care requires:
• Appropriate control of pain and symptoms;
• Avoid inappropriate prolongation of dying;
• Enhance the control of patients over their care;
• Rest with family;
• Supported by physicians, nurses, and social workers.