Euthanasia

Euthanasia

Introduction

Euthanasia or physician assisted suicide (PAS) is one area in bioethics that continues to divide and plagues the opinions of physicians and experts around the world. Such is the nature of the subject that physicians all over have developed their own definitions of the issue on emotional lines. Generally, euthanasia refers to a voluntary act on part of the physician that intentionally ends the life of a patient on their request with informed consent. This action has been a controversial one which has sparked global debate. At this moment, euthanasia is legal by law only in Belgium and Netherlands. In the United States and the rest of the world, it is illegal to practice euthanasia.

PAS refers to the physician's act of providing medication, a prescription, information, or other interventions to a patient with the understanding that the patient intends to use them to commit suicide. PAS is legal in the Netherlands, Belgium, and Switzerland. In the United States, Oregon legalized PAS in 1997, and the practice was legalized in Washington State in March of 2009. The state Supreme Court of Montana ruled in 2009 that state law permits physician-assisted suicide for terminally ill patients (Bernards, 1989).

Practical Guidelines

A multistep approach to handling requests for euthanasia or PAS should allow satisfactory resolution of most cases. The following is a brief summary of the steps that should be followed when such a request is made. Additional suggestions about how to explore some of these issues are provided below.

First, listen to the person's request and affirm that you understand that a great deal of suffering underlies the request.

Being heard and affirmed can remedy some of the major sources of psychosocial suffering that tend to accompany such requests. Avoid taking a moral stance. While it is helpful to understand the issues and acceptable to have your own opinions about the morality of euthanasia and PAS, it is usually not helpful to make it part of the patient-clinician relationship. A principled stance against the act can make the person who has just requested euthanasia or PAS feel judged, which may add to his or her suffering. A principled stance for the act risks inadvertently compounding the person's sense of worthlessness and conviction that they would be better off dead.

Second, conduct a comprehensive assessment like the kind done by palliative care specialists to understand the nature and sources of all the patient's physical, psychological, spiritual and social suffering.

Third, address each of those sources of suffering with the full armamentarium of palliative care strategies.

Most pain and other physical causes of suffering can be reduced to acceptable levels. Much of the depression, anxiety and other psychological suffering can be minimized. Spiritual suffering can be addressed, as can social issues. With skilled use of palliative care, most experts find that a great majority of cases are resolved and the request goes away. Consulting a specialist in palliative care may well be necessary for difficult cases.

Fourth, for cases that do not resolve even with these measures, make ...