Euthanasia and Assisted Suicide in the world


Introduction

For many years, humanity has struggled with the ethical issue of assisted suicide and its
legalization. In 2019, the legalization of euthanasia was widely discussed in the Czech Republic.
In the Netherlands, where hospice care is not developed, euthanasia has been legal since 2002. Six
months later, Belgium also legalized euthanasia.

The word euthanasia comes from the Greek word “eu” - good and “thanatos” - death. It could be
translated as painless death. The reasons for euthanasia can be various, such as compassion for the
sufferer, poor quality of life, reduction of treatment and hospitalization costs. Euthanasia is one
of today's bioethical issues that needs to be addressed.


The right to life, the right to die

There is a need to develop guidelines and assessments to specify the criteria for recommending
euthanasia for each type of patient. Of course, there is "informed consent," without which we
cannot deal with majority of medical procedures. Each case should be a subject of legal supervision
and investigated by a medical committee. (1)

By creating such a protocol, the disabled person's family would not be placed in a difficult
position. The performance of euthanasia involves some administrative and legal measures that need
to be addressed before legalizing euthanasia. The trained staff which will perform the euthanasia
will inject the victim with a lethal substance in a dose that will be lethal to the victim. (1)

The right to life and Czech legislation

The right to life is protected in the Czech legal system in Article 6 of the Charter of Fundamental
Rights:

1. Everyone has the right to life. Human life is worthy of protection even before birth. No one
must be deprived of life.

2. The death penalty is not allowed.

3. There shall be no violation of the rights according to this article if someone has been deprived
of his life in association with a conduct that is not a criminal offense under the law. (2)

People who are proponents of euthanasia advocate the right to decide freely about their lives and
also that a patient suffering from an incurable disease or at the terminal stage is in a state of
extreme need. (2)



Netherlands

Legal assisted suicide or euthanasia in the Netherlands is strictly regulated. In the Netherlands,
commissions are set up to assess a doctor's progress in a patients treatment. The doctor must
report a case of euthanasia or assisted suicide to one of the five regional euthanasia evaluation
commissions. Unless the doctor does  it, he gets prosecuted. That means facing up to 12 years in
prison for euthanasia and up to 3 years for assisted suicide. (3)

In the Netherlands, adolescents can apply for euthanasia from the age of 12 with the need of
consent of a parent or guardian, otherwise from the age of 16. From the age of 16 to 18, teenagers
do not need the permission of a parent or guardian, but parents must be involved. From the age of
eighteen, consent to perform euthanasia from parents or guardians is no longer required. (3)

Euthanasia cannot be performed at the request of family or relatives, only at the request of the
patient himself. The difference between assisted suicide and euthanasia is that in assisted
suicide, the doctor does not administer the deadly substance, but the patient self-administers it.
In euthanasia, only a doctor will supply and administer the fatal substance. The doctor is not
obliged to perform euthanasia, so he can send the patient to another doctor. (4)

Physician-assisted suicide is legal in some countries, under certain circumstances, including
Austria, Belgium, Canada, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland and parts of
the United States (California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon,
Vermont and Washington). (5)

Belgium

In Belgium, the applicant for death at the hands of a doctor must be of legal age, entirely sane
and informed. He/she has to apply for euthanasia twice in writing, and must be aware of the
consequences as the procedure is ireversible. In Belgium and the Netherlands, special commissions
are set up to examine whether euthanasia of a doctor has been carried out in accordance with the
law. (6)

The Division of Euthanasia

Euthanasia can be divided into active and passive. Active euthanasia involves active intervention,
for example, by administering a lethal dose of lethal injection (CLC) into a vein. Passive
euthanasia is defined as allowing a patient to die, whether it is to disconnect him from devices
without which he cannot survive, or to give him medicine, or to stop providing him with water and
food. The active form of euthanasia is considered a more significant moral dilemma than the passive
form of euthanasia. (7)

Countries that have legalized active forms of euthanasia include the Netherlands, Belgium,
Switzerland, and Luxembourg. (7)

There are countries where the passive form of euthanasia is legalized: Denmark, France, Italy, and
Germany. (7)

We can also distinguish between active euthanasia and assisted suicide. In active euthanasia, the
doctor provides and administers the drug, while in assisted suicide, the doctor provides the means
to end the life, but the patient self-administers it. (7)

                                         picture one: (8)

Most physicians condemn the active form of euthanasia, even if the patient requires it, except for
physicians in those countries where some form of euthanasia or assisted suicide is legal. Some also
consider the term passive euthanasia to be misguided. In former Nazi Germany, for example, doctors
were abused to carry out extermination programs under the term euthanasia, which were targeted at
people identified as undesirable. (7)

Palliative care versus euthanasia

We refer to palliative care as all treatments that do not lead to a permanent cure. It is the care
of the dying patient, and this care is intended to provide him with a certain comfort when dying.
Palliative care includes, above all, a sufficient amount of painkillers - so-called analgesics, as
well as anti-anxiety drugs - so-called anxiolytics and anti-depressant drugs, so-called
anti-depressants, and, of course, nursing care. (9)

The World Health Organization (WHO) describes palliative care 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." (10)

Palliative care is part of the human right to health, so doctors also have the opportunity to
certify in the palliative medicine program. This type of care is necessary for a wide range of
diseases. Most sufferers who need this type of care suffer from chronic diseases such as
cardiovascular disease, cancer, chronic respiratory disease, Acquired Immune Deficiency Syndrome,
and diabetes. (9)

Arguments for euthanasia

- The human being should have the right to decide when and how he wants to die (right to live,
right to die,

- Euthanasia allows a person to die with dignity and is subject to their own control,

- Death is a private matter for every individual, and the state should not have the right to invade
her/his privacy,

- It is financially costly to keep alive patients who does not have a chance to recover or have no
chance of improved quality of life,

- Relieving the pain and suffering of family and acquaintances who witness their relative
suffering,

- Animal euthanasia is acceptable in society, so why should it be different in humans. (11)

Arguments against euthanasia

(does not include religious arguments)

- Belittling of society's values and respect for human life,

- Existence of palliative care,

- Immense power and responsibility for doctors,

- Infringement of trust between patient and doctor,

- Halting research to develop new treatment methods and procedures,

- Insufficient motivation to invent new drugs. (11)

Sarco suicide capsule

                                         Picture two: (12)


In December this year, Switzerland approved a prototype of a new capsule, which is intended to
facilitate the course of assisted suicides. According to the inventor of this facility, patients
who choose this variant of assisted suicide will have the opportunity to die dignified, calm, and
painless. In Switzerland, liquid sodium pentobarbital has been used for assisted suicide.
Australian Philip Nitschke created the capsule (resembling a coffin) called Sarco. The capsule
should come into operation in 2022. (12)

A person who wishes to die enters a capsule, and it is activated from the inside. The capsule space
is filled with nitrogen, and the oxygen content is reduced. This phenomenon causes a person to lose
consciousness in two to five minutes and eventually die without suffocating or panicking. The
capsule is fully movable. (12)

Before losing consciousness, one may feel disoriented and have a mild euphoric state. The coffin is
made by a 3D printer and is also equipped with a safety button that one can press if one changes
one's mind to go to the afterlife. (12)

Conclusion

It is up to each individual to decide whether to accept the arguments legalizing euthanasia or take
a negative stance. In some cases, where there is a clear prognosis of impending death in suffering,
the sufferer should make this choice. This unfortunate situation of analgesics is currently being
addressed, which can also be considered euthanasia. Thanks to this analgesia, we can avoid pain,
but the psychological suffering persists, and one is aware that he is terminally ill and is exposed
to much stress when expecting to die every day. Even if one has a dull perception of reality, there
is still a feeling of fear and uncertainty about which day will be the last in this suffering. The
introduction of euthanasia and its legalization in an advanced society is a political, medical,
ethical, religious, and legal issue that needs to be addressed. If I was in such situation, where I
had to decide on the life of a family member, I am not sure which choice I would go for. Each coin
has two sides.

Some people who choose to undergo euthanasia, whether its active or passive form or assisted
suicide, have to travel abroad. This year, a 37-year-old man from the Czech Republic flew to
Switzerland to undergo assisted suicide because he suffered from incurable amyotrophic lateral
sclerosis and did not want his children to see him gradually lose control of his body and bother
his wife. The mental abilities of these patients remain unchanged, and therefore they become
prisoners in a dysfunctional body.

If they do not have the financial means (like this man), they can resort to suicide.

Some, whether for religious, moral, or other reasons, are unable to commit suicide on their own. He
asks for the help of a doctor or other family members. These people near them find themselves in an
awkward situation and solve a moral dilemma. Is it really necessary for these people to have to
choose some extreme methods when in today's modern world there are means by which to die with
dignity and in the circle of loved ones?

In my opinion, after my detailed examination of the methods when elaborating this essay, I have
come to the conclusion that a person who is mentally well should have the right to decide when,
where, and how to say farewell to life. There should be an independent comitted that examines the
patient's condition, both physical and mental. In detail, make psychological and psychiatric
examinations, and approve either assisted suicide or euthanasia.

References

1. Mishra, Vivek R. Minocha and Arima. Euthanasia: Ethical Challenges of Shift from “Right to Die”
to “Objective Decision”. https://www.researchgate.net/. [Online] April 2019.

2. Parlament České republiky, Poslanecká sněmovna. https://www.psp.cz/docs/laws/listina.html#.
[Online] 1992.

3. Netherlands, Government of the.
https://www.government.nl/topics/euthanasia/is-euthanasia-allowed. [Online]

4. Government of the Netherlands.
https://www.government.nl/topics/euthanasia/euthanasia-assisted-suicide-and-non-resuscitation-on-re
quest. [Online]

5. Wikipedia. https://en.wikipedia.org/wiki/Assisted_suicide. [Online] 19. December 2021.

6. Sterckx, Kasper Raus and Bert Vanderhaegen and Sigrid.
https://academic.oup.com/jmp/article-abstract/46/1/80/6118631?redirectedFrom=fulltext. Euthanasia
in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice. [Online]
Pages 80–107, 25. January 2021.

7. Hope, Tony. Mediccal Ethics: A Very Short Introduction. Oxford: Oxford University Press.
[Online] str.11, 2004.

8. E. Emanuel, B. Onwuteaka-Philipsen, John W. Urwin, Joachim Cohen. Attitudes and Practices of
Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe.
https://www.semanticscholar.org/paper/Attitudes-and-Practices-of-Euthanasia-and-Suicide-Emanuel-Onw
uteaka-Philipsen/6648f6dd0130507ebc3e120e13da5ba820a7bb2d/figure/0. [Online] JAMA, 2016.

9. WHO. https://www.who.int/news-room/fact-sheets/detail/palliative-care. [Online]

10. Wikipedia. https://en.wikipedia.org/wiki/Palliative_care. [Online] 13. December 2021.

11. BBC, Copyright © 2021. Euthanasia. https://www.bbc.co.uk/bitesize/guides/zynv87h/revision/3.
[Online] 2011.

12. swissinfo.ch.
https://www.swissinfo.ch/eng/sarco-suicide-capsule--passes-legal-review--in-switzerland/46966510.
[Online] December 2021.



Aneta Moudrá, Student: M20856 - FAM