Abstract
A hundred years ago, sitting alongside a dying family member was a normal experience. Nowadays, death is considered to be an undesirable guest in our homes, and most people die in hospitals or hospices. While the sentence “I wish I would die” is often heard, it should be interpreted as a call for help, rather than as a demand for euthanasia. Surveys in countries where euthanasia or physician-assisted suicide are legal revealed that the demand of the dying person is often a consequence of social, emotional, or even financial circumstances. Euthanasia should never become a shortcut to relieve society of the burden of people approaching the end of their life. In circumstances of severe deficiencies in palliative care, a debate on euthanasia is ethically problematic. Investment in facilities for palliative medicine and in the related activities in education and research should become a priority. Only when the goal of decent palliative care for everyone is achieved, will a discussion on euthanasia truly become a discussion on individual autonomy, rather than a discussion based on utilitarian ethics.
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Notes
- 1.
I have the data for the Institute of Oncology in Ljubljana for years 1995–1999 when I was director: one suicide and one suicide attempt. For 320 hospital beds and close to 100,000 total days of hospitalization per year, this is not a big number, even if we take into account unrecognized suicides, for example due to overdoses.
- 2.
Janez Milčinski: physician and legal expert, one of the fathers of medical ethics in Slovenia.
- 3.
More than one motivation factor for demanding physician-assisted suicide may apply.
References
Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA. 2016;316:79–90. https://doi.org/10.1001/jama.2016.8499.
http://www.cbsnews.com/news/netherlands-sex-abuse-victim-euthanasia-incurable-ptsd-assisted-suicide/
Suggested Reading
Baider L, Surbone A. Patients’ choices of the place of their death: a complex, culturally and socially charged issue. Onkologie. 2007;30:94–5.
Barutta J, Vollmann J. Physician-assisted death with limited access to palliative care. J Med Ethics. 2015;41:652–4. https://doi.org/10.1136/medethics-2013-101953.
Boudreau JD, Somerville MA. Euthanasia is not medical treatment. Br Med Bull. 2013;106:45–66. https://doi.org/10.1093/bmb/ldt010.
Branigan M. Desire for hastened death: exploring the emotions and the ethics. Curr Opin Support Palliat Care. 2015;9:64–71. https://doi.org/10.1097/SPC.0000000000000109.
Chambaere K, Bernheim JL. Does legal physician-assisted dying impede development of palliative care? The Belgian and Benelux experience. J Med Ethics. 2015;41:657–60. https://doi.org/10.1136/medethics-2014-102116.
Cholbi M. Kant on euthanasia and the duty to die: clearing the air. J Med Ethics. 2015;41:607–10. https://doi.org/10.1136/medethics-2013-101781.
Cohen-Almagor R. First do no harm: intentionally shortening lives of patients without their explicit request in Belgium. J Med Ethics. 2015;41:625–9. https://doi.org/10.1136/medethics-2014-102387.
Connolly S, Galvin M, Hardiman O. End-of-life management in patients with amyotrophic lateral sclerosis. Lancet Neurol. 2015;14:435–42. https://doi.org/10.1016/S1474-4422(14)70221-2.
Dewar R, Cahners N, Mitchell C, Forrow L. Hinduism and death with dignity: historic and contemporary case examples. J Clin Ethics. 2015;26:40–7.
Gillon R. Sanctity of life law has gone too far. BMJ. 2012;345:e4637. https://doi.org/10.1136/bmj.e4637.
Gillon R. Why I wrote my advance decision to refuse life-prolonging treatment: and why the law on sanctity of life remains problematic. J Med Ethics. 2016;42:376–82. https://doi.org/10.1136/medethics-2016-103538.
Jones J. Do not resuscitate: reflections on an ethical dilemma. Nurs Stand. 2007;21:35–9.
Landry JT, Foreman T, Kekewich M. Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada. Health Policy. 2015;119:1490–8. https://doi.org/10.1016/j.healthpol.2015.10.002.
Luce JM. Chronic disorders of consciousness following coma: part two: ethical, legal, and social issues. Chest. 2013;144:1388–93. https://doi.org/10.1378/chest.13-0428.
Mallia P, Daniele R, Sacco S, Carolei A, Pistoia F. Ethical aspects of vegetative and minimally conscious states. Curr Pharm Des. 2014;20:4299–304.
Marx G, Owusu Boakye S, Jung A, Nauck F. Trust and autonomy in end of life: considering the interrelation between patients and their relatives. Curr Opin Support Palliat Care. 2014;8:394–8.
Mesquita AC, Chaves ÉCL, Barros GAM. Spiritual needs of patients with cancer in palliative care: an integrative review. Curr Opin Support Palliat Care. 2017;11:334–40. https://doi.org/10.1097/SPC.0000000000000308.
Pérez Mdel V, Macchi MJ, Agranatti AF. Advance directives in the context of end-of-life palliative care. Curr Opin Support Palliat Care. 2013;7:406–10. https://doi.org/10.1097/SPC.0000000000000007.
Rabiu AR, Sugand K. Has the sanctity of life law ‘gone too far’?: analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not ‘gone too far’. Philos Ethics Humanit Med. 2014;9:5. https://doi.org/10.1186/1747-5341-9-5.
Ramondetta LM, Sun C, Surbone A, Olver I, Ripamonti C, Konishi T, et al. Surprising results regarding MASCC members’ beliefs about spiritual care. Support Care Cancer. 2013;21:2991–8. https://doi.org/10.1007/s00520-013-1863-y.
Rodríguez-Prat A, Monforte-Royo C, Porta-Sales J, Escribano X, Balaguer A. Patient perspectives of dignity, autonomy and control at the end of life: systematic review and meta-ethnography. PLoS One. 2016;11:e0151435. https://doi.org/10.1371/journal.pone.0151435.
Rys S, Deschepper R, Mortier F, Deliens L, Atkinson D, Bilsen J. The moral difference or equivalence between continuous sedation until death and physician-assisted death: word games or war games?: a qualitative content analysis of opinion pieces in the indexed medical and nursing literature. J Bioeth Inq. 2012;9:171–83. https://doi.org/10.1007/s11673-012-9369-8.
Walker P, Lovat T. Life and death decisions in the clinical setting: moral decision making through dialogic consensus. Berlin: Springer; 2017. ISBN-13: 978-9811043000.
Walton L, Bell D. The ethics of hastening death during terminal weaning. Curr Opin Crit Care. 2013;19:636–41. https://doi.org/10.1097/MCC.0000000000000027.
Weinberger LE, Sreenivasan S, Garrick T. End-of-life mental health assessments for older aged, medically ill persons with expressed desire to die. J Am Acad Psychiatry Law. 2014;42:350–61.
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Zwitter, M. (2019). Dying and Death. In: Medical Ethics in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-00719-5_18
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