Euthanasia for the Elderly

Dating back to the early 1800’s, euthanasia and physician-assisted death have been a topic of controversy and continues to this today. Euthanasia can be defined in many ways, according to the text from Touhy and Jett (2018), “Euthanasia means that someone other than the patient commits an action with the intent to end a patient’s life, for example injecting a patient with a lethal dose of medication” (p. 411). An eligible patient must be suffering from an incurable, chronic illness with no hope of peace or recovery.

The individual who carries out the action is either a doctor that can perform the action by law or self-administered by the patient depending upon the geographic location. Although the term euthanasia is often used interchangeably with physician-assisted death or physician aid-in-dying there is a distinct difference between them. Physician-assisted death is when the doctor assists a patient with ending their life by prescribing the lethal dose of medication, while understanding the intent of giving it but, does not personally administer the medication. The topic of euthanasia and physician-assisted suicide continues to be highly controversial because of several reasons including laws, ethics and religion.

Euthanasia and physician-assisted death are viewed differently around the world. The topic has been discussed for decades however, action has not been taken until quite recently. A few countries have legalized it under certain circumstances, while others have strict laws that forbid it. The Netherlands became the first country to legalize both euthanasia and assisted death in 2002. They developed a set of very specific conditions that must be met to be considered eligible. These conditions include that the patient must be suffering from unbearable pain, their illness must be incurable, and the request must be made in full consciousness by the patient (Staff, 2014).

An alternative method called palliative sedation, has been practiced widespread throughout their hospitals in recent years. This type of care is for patients who have a life expectancy of two weeks or less in which they are put in a medically induced coma, and all the nutrition and hydration is withdrawn. According to the Royal Dutch Medical Association, since 2005 there are 15,000 cases of palliative sedation per year (Staff, 2014).

Belgium became the second country to legalize euthanasia by passing a law in 2002 as well. The law states physicians can help patients to end their lives when they freely express a wish to die because they are suffering from unbearable pain or if the patient clearly stated it before entering a coma or vegetative state (Staff, 2014). A unique condition under their law requires the physician to be present at the bedside of the patient until their last breath unlike many other countries that only provide the means to carry out the action. In 2013, over half of the cases were patients ages 70 or older (Staff, 2014). In Germany, active assisted death is illegal while assisted death is legal if the lethal drug is taken without any sort of help.

While under Switzerland law all forms of euthanasia are illegal, it is commonly known as the place people go to for an assisted death if the motives are not selfish. Dignitas is a non-profit society that provides assisted suicide to members, dependent upon their wishes being signed off by independent doctors (Harrison, 2018). Many steps are incorporated in the protocol which must be approved to carry out the process. Euthanasia and assisted suicide are illegal in the UK and can lead to a maximum penalty of life in prison.

Therefore, people suffering from physical, mental and terminal illness travel to Dignitas clinics in Switzerland and pay thousands of dollars for an assisted death. “Founded in 1998, over 2,100 people have died with Dignitas’ help in assisted death at home or at the society’s house near Zurich” (Harrison, 2018). The Campaign for Dignity in Dying supports the belief that terminally ill people deserve the right to control the timing and manner of their death. This is supported because they are not suicidal, rather they do not have the choice to live. Considering their diagnosis means they will inevitably die, why should they have to suffer with unbearable pain until the universe says it’s time?

In the United States, euthanasia is illegal across the board. However, after the Washington v. Glucksberg case in 1997 the U.S. Supreme Court left the decision of the constitutionality of a right to a physician’s aid in dying up to the states (CNN, 2018). Since then, a few states have established laws making physician assisted death legal under certain regulations. Regardless of the state, individuals must have a terminal illness in addition to a prognosis of six months or less to live. If the criteria are met and the state laws are followed, the physician cannot be prosecuted for prescribing a lethal dose of medications to the patient.

Mandated by state law it’s an option given to individuals in Colorado, District of Columbia, California, Hawaii, Oregon, Vermont, and Washington (CNN, 2018). The option is given to individuals in Montana via a court ruling. Unlike the clinic in Switzerland that allows non-residents to travel there and receive assistance, the states require individuals to be residents. Death with Dignity National Center is a non-profit organization in the United States with the mission to promote laws based off their model legislation and the Oregon model, to provide an option for dying individuals and to stimulate nationwide improvements regarding end-of-life care (Death with Dignity, 2018).

Some of their initiatives include expanding freedom of all qualified terminally ill Americans to make their own end-of-life decisions, and providing information, education, and support about Death with Dignity as an option to patients, family, legislators, advocates, healthcare professionals, media and the public (Death with Dignity, 2018). They were actively involved with the states that passed laws legalizing physician-assisted suicide. Currently, they are working with several state legislators that have shown interest in considering Death with Dignity this year with one of those being Ohio. It’s important to keep in mind (Touhy & Jett, 2018) point, “The number of persons who have chosen to take their lives in this way remain relatively few, and the majority have end-stage cancer, are highly educated, and are elderly” (p. 411).

One of the biggest questions preventing the legalization of euthanasia or physician-assisted death remains, is it ethical? When physicians become official they all pledge to adhere to the Hippocratic Oath. The oath contains several principles they swear to follow which make up their standard morals and values. Some people stand by the original document that was created over 2,500 years ago. Throughout the oath are several statements condemning the act of euthanasia. One section states, “I will never give a deadly drug to anybody who asks for it, nor will I make a suggestion to this effect” (Nordqvist, 2017). This statement is supported by the anti-euthanasia side and holds up as a reason for being considered ethically wrong. From this perspective the physicians are breaking an oath they swore to follow which is unethical. This could be a major dilemma for healthcare professionals that may be unwilling to comprise their professional roles.

Other principles healthcare professionals follow include nonmaleficence which means do no harm and beneficence meaning do good. These principles could be justified for both sides. The anti-euthanasia perspective could be that professionals do not want to do harm to their patient by ending their life, they want to do good by the patient benefiting from their care. The pro-euthanasia perspective could be that professionals want to do good by taking their unbearable pain away from them and do no harm by not continuing to treat them when they are aware of the inevitable outcome.

On the opposite side, several people believe the Hippocratic oath is outdated considering it was established thousands of years ago. Some countries now follow an updated version which is more accepting of the act of euthanasia or physician-assisted death. A statement in an updated version of the oath reminds the physician they are to save lives however, they also have the power to take lives which is a responsibility that must be faced with great humbleness and awareness (Nordqvist, 2017). This statement recognizes the evolvement our society has progressed to since the time when the original oath was created. Majority of physicians today no longer swear to the original oath but another version of it.

Some physicians have noted how the original oath doesn’t mention anything regarding the ethics of contemporary issues, one of those being the physicians societal or legal responsibilities (Nordqvist, 2017). The modern versions take more of a penalty-free approach which allows for the physician to feel comfortable and secure in their decisions rather than feeling threatened.

There is a plethora of valid concerns on both sides regarding euthanasia or physician-assisted death, which is why many states have not acted to implement laws thus far. Several of those concerns are related to the morality of the action. Starting with basic human rights, we have the freedom of choice. Individuals have the right to choose if they accept or refuse healthcare plans and medications so, why should this choice be different? A similar aspect pertains to the patient’s dignity.

Every individual deserves the right to die with dignity and lying lifeless in constant, chronic pain does not sound dignified. Of course, the patient is the primary concern, but the family is also involved throughout this process. They are there witnessing their loved one’s excruciating pain without being able to ease it. It’s thought that allowing physician-assisted death can help shorten the family’s grief and suffering as well as letting the patient pass with dignity on their terms (Nordqvist, 2017). Another impactful point is assessing the individual’s quality of life. As a healthcare professional, quality of life is always measured to ensure everything is being done to optimize it. However, the patient is the only one who truly knows how they feel. They are the only one experiencing the physical and emotional pain of their illness and how prolonged death impacts their quality of life (Nordqvist, 2017).

I would say more important than any of the previously mentioned concerns is the concern of being humane. Isn’t it more humane to let the patient with an incurable, terminal illness suffering from continuous pain to be allowed to choose to end that suffering if they wish? Think of it in terms of having a pet that is suffering from an illness that has completely diminished their quality of life. As hard as it is to make the decision to put the animal down that’s what we know is best for them. It is viewed as an act of kindness to take away their suffering knowing they will soon be at peace. Taking this into consideration it makes you wonder why we deny humans this act of kindness.

On the other side there are reasons to support the idea that physician-assisted death is morally wrong. One of the principles of criteria that must be met to be considered eligible for the action is that the patient must be competent when this request is made. The argument can be made that an individual going through this life-altering situation cannot be considered fully competent. Particularly if they are depressed which could absolutely be an associated illness, they would be more likely to request the action when thinking unclearly.

Sadly, a dark consequence that could happen is guilt. The individual may feel like a burden on their family and caregivers which could persuade them to request it. This kind of relates to them not being of sound mind when making the decision but we cannot read their mind. At this point it should be up to the physician to approve their request after consulting with the individual. Not to be overlooked is the possibility that the diagnosis could have been incorrect. It does not happen often but there is always a chance no matter how small that the patient makes a recovery. The criteria that the patient’s diagnosis must be six months or less is included to ensure this isn’t a likely possibility (Staff, 2014).

Another significant argument pertains to the religion and cultural perspectives of euthanasia or physician-assisted death. Life is seen as a gift in every culture, terminating that gift can be perceived as dishonorable and morally wrong. Several forms of religion view euthanasia as a form of murder, meaning the individual would not be saved in the afterlife because they committed such a horrible sin on earth. The Catholic church strongly opposes any form of euthanasia because it is going against God’s word.

Scriptures say that one must not kill which is why suicide is also considered a sin in their eyes. Because most religions share a similar belief that suicide is unacceptable, our society needs to stray away from using the term physician-assisted suicide. The term automatically has a negative connotation which causes people to be close-minded about euthanasia being a medical practice. Integrating the term physician-assisted death would help take the stigma away from the concept. People must remember these individuals are not choosing to die because they want to but because they have no other outlet. They are individuals suffering from constant pain with little quality of life waiting for the clock to run out.

A study was conducted in Germany to investigate the attitudes of grieving family members of cancer patients towards euthanasia. They took a survey consisting of 211 people who had recently lost a loved one to cancer (Kohler, 2018). Participants were asked about their thoughts on whether euthanasia should be part of medical practice. Two models were created to determine the various factors that influenced their attitudes toward euthanasia and physician-assisted death. The statistical result was, “About 70% and 75% of the respondents approved active euthanasia and assisted suicide, respectively” (Kohler, 2018).

The most prevalent influencing factors identified were religious denomination and psychological distress. Regarding their deceased loved ones about 10% of them requested active euthanasia (Kohler, 2018). Overall, acceptance of euthanasia was similar between people who have witnessed end-of-life care and the general population. It was discovered attitudes toward euthanasia were associated with psychological distress and cultural values that shaped their opinions rather than the experience of end-of-life care (Kohler, 2018). Majority of grieving family members were accepting of euthanasia being a part of medical practice, while their attitudes towards it reflected their own religious and cultural beliefs.

Euthanasia and physician-assisted death are extremely complex actions that require intense thought and consideration. The bottom line is, we do not know how we would react in the situation until we were forced to. The individuals who are suffering from an incurable disease are the only people who should have a say. They are typically elderly people who have lived a fulfilled life and want to pass with dignity. After researching, many countries including the U.S. have been entertaining this idea and are making strides toward an appropriate decision. There will always be ethical and cultural reasons that make it controversial however, having laws in place that allow it to be a possibility seems to be a sufficient compromise. Euthanasia or physician-assisted death should be a medical practice under laws and regulations. While I believe this, physicians should have the right to choose if they want to take part in this kind of care under their medical license.