Only If We Must, Only. Euthanasia.


Mr. Edward Brongersma, an 86-year-old man, wanted to die.

             He claimed that after the passing of nearly all his friends and relatives, that his life was, “a pointless and empty existence.’  He decided to request his general practitioner, Dr. Philip Sutorius, to perform a physician-assisted suicide on the basis that life was too unbearable to continue.  After multiple requests, Dr. Sutorius provided assistance in suicide to Mr. Brongersma. Beginning in the Netherlands in 2001, the country that the previous story took place in, the legalization of euthanasia began.  Following shortly thereafter, Belgium adopted it as well, and many more nations have since begun practicing it.  Along with such new legislation has come different forms of abuse, as can be seen from the case of Mr. Brongersma.  Due to the controversy euthanasia has elicited and cases such as the one previously mentioned, numerous studies have been done to better understand the basics behind it.  Such studies include a look at potential motivating factors behind euthanasia, a critique on the policy and practice of euthanasia in Belgium, and a look at the pitfalls and future preventative approaches to euthanasia globally.  Current research is lacking in the realm of the psychological effects of euthanasia, and I believe that the emotional toll on the physician needs to be assessed.  In the meantime, I intend on discovering what it takes to successfully implement euthanasia as a potential option for physicians globally.  In this article, the basic concept of euthanasia will be discussed, as well as reasons for its place in medicine and some of the bioethics involved.

What is Euthanasia?

            The Merriam-Webster Dictionary defines euthanasia as “the act or practice of killing or permitting the death of hopelessly sick or injured individuals in a relatively painless way for reasons of mercy.”  On April 10, 2001, the Netherlands became the first country in the world to legalize euthanasia.  Legalities aside, the practice of euthanasia can be broken down into three categories: passive, active, and non-active.  Passive euthanasia is when a person is killed through a lack of any action, typically the stopping of a beneficial antibiotic of some sort.  Active euthanasia is the exact opposite of its passive form, and occurs when a drug is administered that purposefully kills the patient.  Active euthanasia is not to be confused with physician-assisted suicide, or PAS, in which the patient has a more deliberate role in the final steps.  Lastly, non-active euthanasia is similar to passive euthanasia and is most commonly associated with the termination of life support.  As barbaric as these practices may seem, the potential reasons behind them will help dispel the mystery surrounding euthanasia.

Why Do People Choose Euthanasia?

            Much research has been done concerning the basic practice of euthanasia, but little has been done to understand why people choose to do so.  In a recent study, two prominent gerontologists, Givens and Mitchell, tested multivariable circumstances to see if they were positively correlated to a rationale approving of euthanasia.  With a sample size of 786 participants, 70.6% found euthanasia agreeable in the circumstance of a terminal illness.  Results showed that financial burdens and emotional turmoil contributes greatly towards support for euthanasia.  Additionally, a fear of poor-quality health care and an immense amount of pain also instigated support for euthanasia. The last circumstance dwelt upon the basis that the individual’s religious community would be helpful near the end of life, and the results showed that these certain people are less likely to support euthanasia than others.  The response to such reasoning is incredibly predictable, and I believe research needs to be done studying people’s view of euthanasia without the confines of a certain scenario.  It seems logical that a patient in immense pain and having no hope or people to take care of him or her would prefer death.  It also brings into question when hope is considered lost, and if euthanasia will silence the occurrences of medical miracles.  With a basic knowledge of what euthanasia is and a few potential motivating factors, it is now vital to analyze the bioethics involved.

Bioethics

            Euthanasia has forced the medical community to reevaluate its standards of practice and has questioned the ethics of physician-patient relationships.  The troubling question, posed by retired cardiologist Richard Fenigsen, is “Should we tell the patient that he is dying?”  This question relates to the transparency of physician-patient relationships and the repercussions of the truth.  I believe that it is the physician’s responsibility not to inform, but to save.  In accordance, Fenigsen posits that there is something more important than truth, and that is life.  He stresses to not only care for the physical body of the patient, but also the mind.

            Truth about a diagnosis can be damaging to the mind and the morale, and physician’s need to understand that not every bit of information can be treated objectively and without incident.  Concordantly, Fenigsen finds that the truth should be delivered lightly with an understanding of the fallibility of diagnoses and knowledge of how it will affect the patient’s outcome.  Fenigsen illustrates the problems within the medical community regarding the truth, with the story of an Eastern European woman, Mrs. P, who immigrated to the United States.  She fought with multiple malignancies in her organs for three years, and experienced occasional bouts of hope and wellbeing.  However, each time she saw the slightest potential of cancer in an x-ray, her mind was so tormented that it greatly affected her health.  Her doctors would provide the information against her will, and not being able to handle the distress it caused, finally succumbed to her battle with cancer.  This is a sad example of when a physician, for his patient’s own benefit, should have withheld information for the mental health, and ultimately the physical health of the patient.  The insensitivity towards the woman is appalling and it begs the question if these physicians understood the correlation between stress and immune susceptibility.  It magnifies the need in medicine for a more holistic approach to patient care and addresses the issue that physicians need to be aware of all aspects of their patient’s lives.

How to Prevent Abuse

            Euthanasia has been abused through non-specific legislation and negligent, if not murderous, physicians.  As a specialist in bioethics, Cohen-Almagor  stated that the Royal Dutch Medical Association regarded the definition of “unbearable suffering” as too broadly interpreted.  This notion was observed in response to the case of Dr. Philip Sutorius and his patient, Mr. Brongersma.  Dr. Sutorius was prosecuted under Dutch law, stating that Mr. Brongersma’s condition did not fulfill the physical prerequisite of  “hopeless and unbearable pain” and his request should have been denied.  Although found guilty, Dr. Sutorius was not sentenced because his actions were based upon the request and concern of his patient.  Unfortunately, evidence for abuse related to euthanasia does not stem only from negligence of the law.  Cohen-Almagor states in Belgium, in 1998, there were 1,796 cases of physicians administering lethal doses of drugs to a patient without their consent.  The most alarming aspect of this statement is that it is complete contradiction to the purpose of a doctor.  It appears that the Hippocratic oath of medical honor has lost its bearing in situations such as these, and that certain doctors are abandoning their desire to save.  The abuse stretches further than that, and is explained through another issue regarded as terminal sedation.  As Cohen-Almagor points out, terminal sedation is related to euthanasia in its desired effect, but differs in the fact that terminal sedation does not require the consent of the patient.  It is used chiefly in intensive care units and has been looked upon as a means to painlessly dispose of someone and to cut the overall costs of care in a hospital.  Have doctors lost sight of their mission, to work tirelessly in an attempt to find the cure?

              Although the problem is complex, the solution is simple and relies heavily upon the integrity and discernment of physicians everywhere.  The first step involves clearer guidelines, as Cohen-Almagor notes the need for a stricter policy of euthanasia and better transparency of its use.  A doctor with less room for interpretation is not only alleviated of costly and emotionally straining decisions, but it eradicates the possibility of abuse of the system.  To help observe its practice, a committee should be created following the format of Beglium’s National Evaluation and Control Commission for Euthanasia.  The Commission evaluates all cases of euthanasia and determines the appropriateness of its practice, thus eliminating potential abuse.  Lastly, physicians need to be more attentive to the well-being of their patients.  As Fenigsen puts it, a physician needs to approach his patients with “gentleness and caution”.  Along those lines, Cohen-Almagor stresses the importance of expressing all available choices in response to situations.  Advances in palliative care along with more effective ways to treat illness must be discussed in conjunction with the choice of euthanasia.  Not only that, but doctors need to regain their integrity and determination.  Doctors should never give up on their patients but search for every available means to save them.  An understanding of past abuse and future, preventative measures will help ensure a safe, appropriate practice of euthanasia.

A Reflection on the Social Implications

             All precautions and bioethics aside, the impact of euthanasia on the general public cannot be overlooked.  Questions instantly arise as to what constitutes a life worth living, and it is difficult to give an objective viewpoint on the issue.  How will the United States of America respond to this alternative practice?  It certainly needs to be discussed openly, and with a good understanding things will hopefully become clear.

The Future

           As trends would indicate, euthanasia is slowly gaining momentum internationally.  While surrounded in controversy, the present data suggest that with a basic knowledge of what euthanasia is and why it is practiced, along with informative bioethics and the knowledge to prevent abuse, euthanasia can be safely practiced.  The medical community has faced a great deal of criticism over its handling of this issue, and wrongfully so.  As Cohen-Almagor, Fenigen, Givens, and Mitchell demonstrated, the central purpose of physicians is to provide excellent care to their patients, with a holistic approach always in mind.  The values of the physician of the 21st century have not diminished in the least.  They are still the same driven, tireless individuals that view life with high regard and will always strive to help their patients.  The introduction of euthanasia, under strict rules and regulations, is simply another option that physicians can provide to patients with insurmountable odds.  It will never replace a physician’s desire to save a life, but is looked upon as an absolute last resort to end pain and misery.  Future research needs to be done regarding more effective parameters for euthanasia as well as the psychological effects felt within the medical community.  An analysis of the differing psychological effects correlated to voluntary euthanasia and physician-assisted suicide would be a brilliant start.  Euthanasia, under the appropriate parameters, can be a potential peace officer to the individual in immense pain and misery and on an otherwise hopeless journey.

“Euthanasia is a long, smooth-sounding word, and it conceals its danger as long, smooth words do, but the danger is there, nevertheless.”-Pearl S. Buck

            To the proponents of euthanasia, tread lightly for you are stepping upon hallowed grounds.  Death is inevitable, unfortunately dignity is not. That’s the standard to which you will be held accountable.  Abuse of the system seems to be an inherent human characteristic, but if euthanasia is ever to be responsibly used, you must do everything in your power to strictly regulate it.

              To the opponents of euthanasia, your concerns are just as valid.  Life is precious, and if it were an ideal world, emptiness would be filling this space.  Unfortunately, we must make do with what we are given, and as a community of human beings, it is our responsibility to provide compassion and support to those in need.  By actively taking care of your fellow Man, this article and the many bearing its resemblance can hopefully be forgotten.  Until then, let us move forward.

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Article based upon these references:

Givens, J. L., & Mitchell, S. L. (2009). Concerns About End-of-Life Care and Support for

Euthanasia. Journal of Pain and Symptom Management, 38(2), 167-173.

Cohen-Almagor, R. (2009). Euthanasia Policy and Practice in Belgium: Critical

Observations and Suggestions for Improvement. Issues in Law and Medicine,

24(3), 187-218.

Fenigsen, R. (2009). Other People’s Lives: Reflections on Medicine, Ethics, and Euthanasia.

Issues in Law and Medicine, 24(3), 221-257.

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About aflorin8

Simply a friend, biologist, photographer, avid reader, volleyball nut, humanitarian, and man.

3 comments

  1. lifereconnected

    This is a very interesting and thought-provoking post and I thank you for it. I do have an uncomfortable feeling though around the issue of doctors not telling the truth to their patients. Is it really true that doctor’s role is to ‘save not to inform’. Surely it is a doctor’s role to treat patients in an open and empowering way? I find the example of ‘Mrs P’ a bit hard to understand – “her mind was so tormented that it greatly affected her health?” How was this measured exactly? Perhaps if she had the right support her illness may have taken on a different meaning for her? Is this article suggesting that she died because she had been told she was suffering a terminal illness?

    • First off, thank you for taking the time to read this article, I sincerely appreciate your time and thoughts on the issue. I completely understand what you’re talking about here, and it highlights a huge ethical dilemma. The example of ‘Mrs. P’ was used to highlight the psychological implications of dealing with a harrowing prognosis. It is dangerous to assume correlation between understanding your prognosis and failing health, and I acknowledge that their method of measuring via observation isn’t really the most empirical method, but possibly now with the advances in fMRI, they might have a tangible scale to assess what is really going on. The reason I mentioned it is that through the literature I’ve read and witnessed firsthand, sometimes when dealing with severe illnesses, people will analogize what they’re going through to ‘war’ and while some respond resiliently, others break. When their outlook becomes bleak, their health actually begins to slip more due to the psychological toll taken. And I completely agree, extraneous variables could definitely have added to the toll on Mrs. P, had she had solid support, this might have been avoided. It wasn’t suggesting she died because of full disclosure, but that it potentially hampered her ability to recover due to a “seen” change in her outlook. In an ideal system, the physician would have enough time with the patient to know not only the disease, but the person the disease has, and would then know how to help the individual the best. It is at that point that it becomes murky, and the line between sincere help and full disclosure becomes blurred. I also believe that the way in which the “bad news” from physicians needs to be delivered in a delicate, yet caring, hopeful manner, but that is a whole other matter. 🙂 Thank you for your time and for sharing your thoughts, I hope this helped?

  2. lifereconnected

    It did indeed help thank you. I am interested in your description of how people who’s outlook becomes ‘bleak’ their health actually begins to slip more. In the case of potentially terminal illness could this be an example of the crux of this whole debate – the difference between ‘prolonging’ of life in all cases as opposed to the ‘quality’ of that life. Perhaps the ‘breaking’ or giving in to a terminal illness is that individual’s only way of bringing about an earlier death? I am of course only referring to treatment of terminal illness here and know full well the effect of psychological outlook and prognosis of any medical condition. It is a minefield I do appreciate but I still feel that being truthful with patients is the best way to protect both patient and doctor.
    i could go on to debate the example of Mr. Brongersma but I suspect I live in a different time zone to you so alas it will have to wait. Sleep beckons!

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