Euthanasia


Introduction

The phenomenon of humanity lies in the unrepeatability of everyone. Killing an incurably ill and
suffering person at their request out of compassion is one definition of euthanasia. Euthanasia is
a serious topic for society-wide discussion and one of medical science's most contentious topics.
The debate over euthanasia has its origins far back in history.  Different countries have different
attitudes to the perception of this topic. Euthanasia is not legal in the Czech Republic. Potential
abuse seems to be a significant problem on this issue. Although this may seem like an element of
compassion, killing is no means of care. With modern technologies in medicine, society understands
that death is avoidable. On the contrary, death is the only certainty in life. Death is inevitable.

Whether the treatment is helpful for the patient and will benefit him or an unnecessary burden for
the patient in certain situations. Always helping and never harming is one of the ethical rules of
doctors and an essential prerequisite for mutual trust between the patient and the doctor. Debates
about euthanasia work with the idea that the person who euthanizes is a doctor. That assumption has
been challenged (Prokopetz, 2012). I unequivocally agree with the approach of the Czech Medical
Chamber. Euthanasia is contrary to medical ethics, and it is not necessary to introduce this
institute into the Czech environment because palliative care is at a high level. The aim of this
thesis is to evaluate the arguments for and against euthanasia based on professional articles.

Text of the essay

Euthanasia - facts

Everyone has a different idea of death. Medicine, thanks to its progress, makes it possible to
prolong life. But at what cost. This topic is becoming more and more discussed, although death is
still taboo for many people. In situations where the patient can express his will, he can refuse
treatment. The problem arises when the patient cannot express his will, and the decision remains
with the doctor. In a state where the patient is in the stage of an incurable disease, the question
arises when and whether to transfer him from intensive care to palliative care, which will allow
the patient a dignified life survival. In some countries, not only European countries, such as the
Netherlands or Belgium, euthanasia is legalized. In the Czech Republic, this is a crime that is
evaluated as murder.

Currently, three concepts can be distinguished in this issue. Euthanasia, assisted suicide and
withdrawal from treatment. Euthanasia is an active act, the deliberate killing of a person at his
request, and is carried out by a doctor. Assisted suicide is the intentional death of oneself with
the help of another person, and withdrawal from treatment is the patient's right when,


upon agreement by the doctor, treatment will not be initiated, or therapy will not continue, which
should keep the patient alive.

Euthanasia and autonomy

What is the cause of a person's decision to end life? Are these main conditions where they suffer
from pain, and are they making decisions out of desperation? At present, the principle of respect
for autonomy is much mentioned. This model is applied in the concept of death when the goal is to
rid the patient of the fear of treatment, which is often futile and brings the patient to a state
where he cannot control himself. Increasingly, movements are emerging to legalize euthanasia.
(Sjöstrand, 2013)

In its codex, the Czech Medical Chamber has stated, " The doctor effectively soothes pain, saves
human dignity, and alleviates suffering in the incurably ill and dying." It is not the goal of
medicine to prolong life at any cost. Today's care is at a high level, and it is possible to
provide treatment for pain and accompanying symptoms so that there is no need for a request for
death. Respect for autonomy is one of the main arguments in favor of groups calling for the
legalization of euthanasia. (Sjöstrand, 2013) Autonomy is first and foremost a value that needs to
be protected, and euthanasia can also mean the destruction of the patient's autonomy. Respect for
autonomy is a contentious issue in support of euthanasia. In this context, freedom is understood as
the possibility of choosing one's path and controlling oneself.

Arguments for euthanasia

We live in a society that highly values freedom, unfortunately, this freedom is still denied to us
when deciding the end of our own lives. It is completely unacceptable for society to pressure
anyone to leave this world. On the other hand, we constantly close our eyes to a certain group of
terminally ill patients who are eager to end their suffering, to die peacefully and with dignity.
(Annadurai, 2014) Today, these people do not have a legal way to do this, so we deny them the
opportunity to leave the world according to their wishes. Or rather, they could travel abroad in
such a complicated way that they can listen to the wishes of the terminally ill to leave according
to his wishes.

There is nothing nice about dying, and especially dying of cancer or other deadly diseases. It is a
painful process full of suffering. How to offer sick people as much choice and support as possible,
no matter how they decide their fate. However, there is also a smaller number of terminally ill
people who do not like palliative care or do not want it and their wish is assisted death.



Euthanasia and palliative care

Inadequate or futile treatment and that no longer benefits the patient is the main reason for
switching to palliative care. Palliative sedation is defined as terminal pain relief. It is a
procedure consisting in the treatment of a patient in an advanced or terminal stage of a serious
and incurable disease of any origin, the side effect of which may be to shorten his life.  This
practice is currently legitimate but is not much discussed. This procedure can be considered a form
of euthanasia since the doctor is forced to administer high doses of painkillers. By administering
a high dose of drugs, life is shortened or the patient dies.

Assisted death can be a form of assisted suicide, where the doctor prepares the patient with a
means that the patient must apply himself. Euthanasia is a form of assisted death where the lethal
agent is applied directly by a doctor (Mercandante, 2020). Patients who refuse palliative care, are
of age and legal capacity, their request is made voluntarily and without coercion, they are
terminally ill because of injury or illness and this situation is unavoidable according to current
scientific knowledge, finding that they suffer permanently and unbearably physically or mentally
without hope of improvement could have this possibility. The patient should be able to revoke his
application until the last moment.

Palliative care should be much more easily accessible. Quality palliative care should reduce the
number of requirements for euthanasia. The purpose of society is to protect life and reduce the
suffering of each of us. This goal should never be achieved through euthanasia but through the
improvement of palliative care and palliative sedation. In countries where euthanasia is legally
permitted, they have not such a well-developed palliative care system. Some agree that better
palliative care should be provided, but this idea is supported by the view that creating euthanasia
legislation should motivate opponents to think about providing better palliative care. Insufficient
expertise of physicians results in a negative impact on patients who prefer palliative care.
Improving palliative care and the expertise of doctors in its provision is, therefore, a necessary
step. (Cuman, 2017)

No doctor may be forced to carry out the death, and no one, including the medical staff, may be
forced to participate in the process. If any employee does not agree to assisted death, the
employer must respect this and cannot be ordered to assist. Involvement must be entirely voluntary.

Euthanasia is allowed in Europe in Belgium, the Netherlands, and Luxembourg. Assisted suicide is
also possible in Switzerland and Germany. Other countries, such as Spain and Portugal, are
discussing legislation. It is up to us whether the Czech Republic will join these countries and
stop ignoring the wishes of patients in the terminal stage of the disease, or whether these people
will continue to be forced to die according to the ideas of a minority part of society or to flee
across borders. But it is not a good way.


Euthanasia is not medical treatment

In debates about euthanasia, there is often a reference to the Hippocratic Oath, where it is
mentioned: "I will not give anyone a lethal cure, even if I am asked to do so, nor will I give
anyone a recommendation to that effect." This issue is ethically complex. There are opinions that
hold the theory that prolonging suffering in an incurable person at the end stage of the disease,
who asks to end his life is possible provided that the necessary legislation is strictly
controlled, and the necessary legislation is set. On the other hand, there are fears of abuse,
whereby human life is considered untouchable and no one under any circumstances should help in
ending it or even ending it. (Boudreau, 2013)

They make it easier for each patient to understand and provoke an appropriate response to their
vulnerability in a particular situation. In this context, the patient should be considered a
vulnerable person. This connection is important for building and further promoting patient-doctor
care relationships to enhance both the level and quality of communication. Communication itself is
a key element. This means that it is essential to promote and strengthen the dignity of patients as
much as possible, given their vulnerable position.

Euthanasia is a problem for society, not only for doctors and patients. In the Netherlands,
euthanasia or assisted suicide accounted for four percent of all deaths in 2016. Since 2002, cases
have increased every year and applications are being assessed more and more benevolently and have
been extended to include the mentally ill. Should euthanasia be more accessible to humans, or even
legal? Historic debates have not yet achieved significant results. Meanwhile, history has convinced
us what terrible mechanism euthanasia can become. It is necessary to realize that the very first
step, from which the whole other way of thinking received its impulse, was the attitude towards the
terminally ill. (Boudreau, 2013) And it is precisely this seemingly small shift in emphasis on the
doctor's attitude that needs to be carefully examined.

Why are doctors against the introduction of euthanasia? The reasons are many.  There are ethical,
moral, and religious reasons. The main argument is that no it is not a therapy. Most doctors accept
their role as a fundamental and indisputable characteristic in their profession. The relationship
between the patient and the doctor is characterized by intense ambivalence. Unlike many other
contemporary medical-ethical dilemmas, neither death nor euthanasia is a new topic today.

Part of a doctor's job is to help people die with comfort and dignity. However, doctors do not want
to help commit assisted suicide.  Such actions are considered bad ethical thinking, bad medicine,
and bad politics. The patient has a choice to refuse treatment, and doctors have a duty to treat
pain and other accompanying symptoms, even with the risk of accelerated death due to palliative
sedation. However, helping patients with suicide is something quite different. (Sulmasy, 2016)

When considering the possible involvement of the health sector in the provision of euthanasia,
account should be taken of those aspects of the medical mandate that are immutable and eternally
relevant. Patients are vulnerable and susceptible. It is the duty of physicians to be able to view
patients with compassion and to be able to show empathy. To require physicians to use and develop
their unique influences and persuasive skills. Communication is very important. Moreover, I believe
that even if you were to admit that euthanasia would be ethically acceptable, which it is not,
there are many unanswered questions and many opportunities for abuse.

Conclusion

Euthanasia is currently legal in several European and non-European countries, and the Czech
Republic has so far taken a negative stance, and I think this is the right thing to do. The
professional public is clearly inclined to the opinion that euthanasia is not medically acceptable
and contradicts ethical principles. (Bordeau, 2013)

Debates about the ethical dilemmas of euthanasia have a deep historical context. Many of these
arguments used for and against remain even today. Any form of discussion on this topic often
provokes emotional reactions, both among members of the medical profession and from the public. For
this reason alone, this topic will continue to be discussed at all levels of society, which is
natural. However, there are other factors that ensure that euthanasia remains a subject of great
controversy.

Euthanasia is a criminal act, although in some passive form it occurs daily in the form of
palliative sedation in the hospitals. Medicine is one of the fastest-growing fields. This rapid
development has made it possible to artificially prolong the life of an increasing number of
patients than was possible in the last century. There is an ethical problem in relation to the
patient’s rights and autonomy and the rights and duties of doctors. It's important to think about
when he should be the one to euthanize at all because it's not possible to automatically appoint a
doctor. (Prokopetz, 2012)

Euthanasia is not just a matter of morality. The active killing of patients is obviously wrong in
principle. In order to maintain human dignity and autonomy, it is important that a person can die
peacefully and painlessly, ideally in the environment closest to him. (Hain, 2014) Nowadays,
palliative care can provide this. Palliative care is not provided only in hospices. It is a type of
therapy that is applied even in hospital facilities. There are also home care agencies that are
able to provide palliative care in the home environment. Palliative care is part of medicine, as is
dying.  The arguments for introducing the institute of euthanasia seem unfounded in this context,
but the possibility of a discussion on this topic, especially at the expert level, cannot be ruled
out. As a non-medical healthcare professional, I have experience in the hospital environment and my
opinion is that euthanasia in our country is currently not justified, which is also the opinion of
the professional society.

References

ANNADURAI, Kalaivani, Raja DANASEKARAN and Geetha MANI. ′Euthanasia: Right to die with
dignity′. "Journal of Family Medicine and Primary Care". Retrieved 2014, 3(4) [Retrieved
2021-12-20]. ISSN 2249-4863. Available from: doi:10.4103/2249-4863.148161

BOUDREAU, J. D. and M. A. SOMERVILLE. Euthanasia is not medical treatment. British Medical Bulletin
 [online]. 2013,  106(1), 45-66 [Retrieved 2021-12-19]. ISSN 0007-1420. Available from:
doi:10.1093/bmb/ldt010

CUMAN, Giulia and Chris GASTMANS. Minors and euthanasia: a systematic review of argument-based
ethics literature. "European Journal of Pediatrics". Retrieved 2017, 176(7), 837-847 [Retrieved
2021-12-20]. ISSN 0340-6199. Available from: doi:10.1007/s00431-017-2934-8

HAIN, R. D. Euthanasia: 10 myths. Archives of Disease in Childhood [online]. 2014, 99(9), 798-799
[cit. 2021-12-20]. ISSN 0003-9888. Avilable from: doi:10.1136/archdischild-2014-306218

MERCADANTE, S. and T. PICCIONE. Assisted suicide, euthanasia, or more need for palliative
care? "Annals of Oncology". Retrieved 2020, 31(5) [Retrieved 2021-12-19]. ISSN 09237534. Available
from: doi:10.1016/j.annonc.2020.02.005

PROKOPETZ, Julian J.Z. and Lisa Soleymani LEHMANN. Redefining Physicians' Role in Assisted
Dying. New England Journal of Medicine  [online]. 2012,  367(2), 97-99 [Retrieved 2021-12-19]. ISSN
0028-4793. Available from: doi:10.1056/NEJMp1205283

SJÖSTRAND, Manne, Gert HELGESSON, Stefan ERIKSSON and Niklas JUTH. Autonomy-based arguments against
physician-assisted suicide and euthanasia: a critique. Medicine, Health Care and Philosophy
[online]. 2013,  16(2), 225-230 [Retrieved 2021-12-19]. ISSN 1386-7423. Available from:
doi:10.1007/s11019-011-9365-5

SULMASY, Daniel P., John M. TRAVALINE, Louise A. MITCHELL a E. Wesley ELY. Non-Faith-Based
Arguments against Physician-Assisted Suicide and Euthanasia. The Linacre Quarterly [online].
2016, 83(3), 246-257 [cit. 2021-12-20]. ISSN 0024-3639. Available from:
doi:10.1080/00243639.2016.1201375


Michal Houzvicka, M20629