Euthanasia - the extreme of the doctor-patient relationship
Almos Trif MD, PhD, JD, USA
Abstract: The article tries to bring the attention of the reader on the historical and the intellectual background of the topic of euthanasia, differentiating its entity from the trivializing pseudo-cultural approaches. After offering some clear short definitions for the most used terms, the author deals with the history of the human attitudes towards Death, Dying, Suicide, Assisted suicide, and Euthanasia.
Talking about euthanasia becomes more and more difficult and risky. This is not only because of the political environment, but also because of the sometimes violent ways in which everyone’s religious views are openly expressed.
Recently, the deleterious effect of this uninformed discussion has become evident in the general culture; it is the pseudo-culture coming mostly from the erroneous information posted purposely on the web. The speculative minds of some “bogus creators” insidiously and continuously infest the minds of the young generation, many of whom appear to have stopped reading books, with all kind of nonsense data.
To demonstrate this I want to share with the reader three results of a “quick search” on the already indispensable, overwhelming and “ominous” search engine - Google. At your choice, you may easily find “information” about the Canadian music band called “Euthanasia”, promoted through sales of more or less shockingly “cool” posters, including photographic pranks about suicidal practices. Alternatively, looking at another result of the same search you may find out that “Euthanasia” is a kind of Internet pseudo-religion.
The most egregious finding was the quoting of “Euthanasia” from “Uncyclopedia” - the content-free encyclopedia, where it is written about the “Democratic Republic of Euthanasia”, exhibiting a bogus flag and other bogus data, such as follows: <National Motto: "You are what you eat."; Official language: Engrish; Capital: Euthanasia City; Premier: Lord High Chancellor of the Excheuary Eric Theodore Cartman; Religion: Athiest (sic); Independence: Never; Currency: Buckazoids; National Anthem: Crazy Frog; National Game: Half Life 2; Oscar Wilde on Euthanasia: “I thought she was rather incontinent.”; Noel Coward on Euthanasia: “A little Euthanasia never hurt nobody.”; George W. Bush on Euthanasia: “I approve! Who wouldn't want to be younger?”>
I think that such fallacious and deceitful information posted on Internet is potentially harmful, because most of the internet consumers (surfers) are deprived of either cultural background or of the needed time to digest the new information or of both -- making it quite difficult for a neophyte to discern the truth.
On the other side, beside academic information on specific websites of organizations, universities and so on, there is a genuine activism for euthanasia, expressed publicly on debates, demonstrations, meetings, and in internet websites and “blogs”.
The activists claim the necessity of advocating for euthanasia, because they emphasize there are still two roads to death:
The usual one – the dying patient passes progressively through the following stages: sleepy, lethargic, obtunded, semi-comatose, comatose, and dead. The difficult road – the dying person become restless, tremulous, experiences hallucinations and mumbles in delirium, presents myoclonic jerks and seizures before becoming semi-comatose, comatose and dead. Fighting against the difficult road to death makes the “subject” of euthanasia debate.
There are some actual accepted definitions, which try to make easy the necessary delimitations:
§ Suicide: individual A kills him/herself
§ Assisted Suicide: individual B assists (helps) individual A to kill self
§ Physician assisted suicide: Medical Doctor helps a patient to die earlier, cutting unbearable suffering
§ Euthanasia: individual B kills individual A who is in extreme suffering or terminal (usually a patient)
§ Voluntary euthanasia - the case when patient chooses to be put to death because of extreme suffering: with individual A’s permission (request), B injects a drug deemed to kill; it concerns the autonomy of the patient, and it is called sometimes “mercy killing”
§ Non-voluntary euthanasia - the case when individual A is silent about the issue or unable to express his or her opinion, but B does something to end his/her suffering; it is the case of very sick infants and comatose patients who are put to death, sometimes with a court order allowing this.
§ Involuntary euthanasia - the case when B gives drug against A’s will and kills A; patient chooses not to be put to death, and expresses explicitly this, but is killed anyway.
The most extreme debate comes actually from another type of classification: active and passive euthanasia.
· Active euthanasia occurs in those instances in which someone takes active means, such as a lethal injection, to bring about someone’s death.
· Passive euthanasia occurs in those instances in which the caretaker simply refuses to intervene in order to prevent someone’s death; the physician or the nurse lets the patient die by withholding or withdrawing treatment.
There is also debate on the difference between the omission of withholding and the action of withdrawal. Some scholars claim in extremis that withdrawing treatment is an “act” similar to injecting KCl intravenously in the death penalty procedure.
Approaching the idea of “people’s rights” in the general theory of law means we have to consider two types of rights: the Negative rights, which impose duties of non-interference on others, and the Positive rights, which impose duties of assistance on others. Accordingly we may ask the following question: “Is there a Right to Die?”
Physician Assisted Suicide (PAS) is the case when a medical doctor assists a patient to kill him/herself. From the legal point of view, currently there are several situations in the world:
· If there is no right to have a doctor to assist you, i.e. a negative right - no one will be able to force a MD to do this on anyone, so PAS will be illegal.
· If in the Legal Code of a certain state or country there is mentioned a positive right to assisted suicide, PAS may be legal in some circumstances.
· In Netherlands, PAS is legally regulated in the professional, civil and criminal law.
· In Oregon State, USA in certain specifically explained circumstances, PAS is legal.
In the case when death follows the administration of painkillers for the relief of pain in cases of terminal illness, death is considered as a side effect. Most Catholic ethicists hold that this is morally different from deliberate euthanasia for the relief of pain – and they call it the “principle of double effect”. The action itself [morphine injection] must be morally good or morally indifferent. The motive must be the achievement of the good effect [alleviating pain] only. The effect is bad, not the means by which the good effect is achieved. The good effect must be at least equivalent in importance to the bad effect.
For the enlightened reader who wants to know more, I would try to present a quick travel through the history of the attitudes towards Death, Dying, Suicide, Assisted suicide, and Euthanasia in the views of Pagans, Greeks, Romans, in different Faiths and Religions, through the Middle Ages and Renaissance, until the Modern times.
God of Death in Greek mythology - Thanatos (θάνατος = death) was the personification of death (Roman equivalent: Mors); Son of Nyx (Night) and Erebus (Darkness) and twin of Hypnos (Sleep). In early mythological accounts, Thanatos was perceived as a powerful figure armed with a sword, and possessed of a shaggy beard and fierce some face. His coming was marked by pain and grief. In later eras, as the transition from life to death became a more attractive option, Thanatos came to be seen as a beautiful young man.
Asclepios in Greek Mythology was the god of medicine, son a mortal woman, Coronis and of the god Apollo, who left the child Asclepios in the care of the centaur Cheiron. Cheiron raised and taught Asclepios the art of healing and the pupil soon surpassed his master for he could resurrect even the dead. This power of resurrection of the dead enraged Hades, lord of the underworld, who was losing clientele, and he appealed to Zeus. Zeus considered the act “hubris”, and slew Asclepios with a thunderbolt. Afterwards realizing the good Asclepios had brought to man, the great Zeus made him into a god. Eventually Asclepios was placed among the stars, transformed into the constellation Ophiuchus (the serpent-bearer).
Hippocrates of Kos, ca. 460 - ca. 370 BC, considered the “Father of Western Medicine” talks in his famous Oath about the commitment of not assisting suicide (fragment from Harvard classics translation):
· I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion…
· Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves...
Socrates, 470-399 BCE, Greek philosopher has allegedly made some of the following statements described in Plato’s Apology. “The unexamined life is not worth living.” ”Wisdom begins in wonder.” “There is only one good, knowledge, and one evil, ignorance.” Plato describes also the Death of Socrates as politically mandated. Because Socrates questioned the men of Athens about their knowledge of good, beauty, and virtue, he was considered supercilious, obnoxiously arrogant. His paradoxical wisdom made the prominent Athenians he publicly questioned look foolish, turning them against him and leading to accusations of wrongdoing. He was found guilty for corrupting the youth of Athens, and sentenced to death by drinking a mix of the poisonous hemlock. “After drinking the poison, he was instructed to walk around until his limbs felt heavy. After lying down, the man who administered the poison pinched his foot. Socrates could no longer feel his legs. The numbness slowly crept up his body until it reached his heart.” The previous description was the inspirational subject of some famous painters: Jacques-Louis DAVID (French, 1748-1825), Jean-François-Pierre PEYRON (French, 1744-1814).
In his 2003 book “A Merciful End: the Euthanasia Movement in Modern America”, Ian Dowbiggin, Ph.D. states: "Many ancient Greeks and Romans had no cogently defined belief in the inherent value of individual human life, and pagan physicians likely performed both voluntary and involuntary mercy killings. Throughout classical antiquity, there was widespread support for voluntary death as opposed to prolonged agony, and physicians complied by often giving their patients the poisons they requested."
Plato, 428 - 348 BCE, Greek philosopher makes some interesting remarks about state medicine and law towards eugenic-euthanasic practices in The Republic, Dialogues, 3. 410, translation by Benjamin Jowett, 1894, English scholar and theologian (1817-1894)
· “This is the sort of medicine and this is the sort of law, which you will sort in your state.
· They will minister to better natures, giving health both of soul and of body.
· But those who are diseased in their bodies will leave to die, and the corrupt and incurable souls they will put an end to themselves.
· That is clearly the best thing for both the patients and for the state!”
Aristotle, 384 - 322 BCE, Greek philosopher brings the ideas of eugenics to public attention in Politics, Chapter IV, 7.13, translation by Bejamin Jowett 1885.
§ “This fault the Lacedaemonians did not fall into, for they made their children fierce by painful labor, as chiefly useful to inspire them with courage: though, as we have already often said, this is neither the only thing nor the principal thing necessary to attend to.
§ As to the exposure and rearing of the children, let there by a law that no deformed child should live”
Epicurus (341-270 BCE) – Greek atomist philosopher, hedonist, talking about the “good pleasures” Hēdonē (Ηδονή) he describes ATARAXIA – bliss, which he thinks is easy to experience if you overcome your fear of Gods and your fear of death. He thinks that fear of death is often based upon anxiety about having an unpleasant afterlife. This anxiety should be dispelled once one realizes that death is annihilation, because the mind is a group of atoms that disperses upon death. Epicurus uses the 'no subject of harm' argument in the Letter to Menoeceus: “If death is bad, for whom is it bad? Not for the living, since they're not dead, and not for the dead, since they don't exist.” He adds that if death causes you no pain when you're dead, it's foolish to allow the fear of it to determine you pain now. This idea is latter followed and developed by Lucretius.
The “art to die” in Ancient Rome is described by Yolande Grise, “Le suicide dans la Rome Antique”, Morntreal & Paris, 1982, pp. 325: “Since suicide in Rome was generally regarded as a legitimate means to avoid dishonor, no punishment of any kind was attached to it. As Roman legislation under the Antonines shows a balance was sought between a citizen’s rights to “LIBERUS MORTIS ARBITRIUM” and safeguarding the political and economical interest of the state.“
Lex doudecim Tabularum – a code of laws published in Rome at 451 B.C. on 12 bronze tables, by the 10 members [decimviri] was stipulating the need to sacrifice the malformed newborns as soon as possible after their birth - text edited by Georg Bruns & Otto Gradenwitz, Tübingen, 1909.