Yes, Euthanasia should be legal in some countries and there should be many rules that regulate it, in order to make sure that it serves the best interest of the patient. The reason I believe so is that many countries which are against euthanasia have, in fact, witnessed cases where euthanasia was ruled for. This creates a contradiction.
Ideas Related to Euthanasia
Voluntary vs. Involuntary
One should make a difference between two types of euthanasia: voluntary and involuntary euthanasia. The first one refers to the situation where the patient, the one who is willing to be euthanized, voluntarily expresses his wish to terminate his life or rather to be assisted in ending his/her life (Manning, 1998). The other type of euthanasia is when someone who acts on behalf of the patient, either because the concerned person has asked for it or because this person (a relative or a parent most of the time) believes it would have been the wish of the patient if he/she could express his/her wish (Kaveny, 1997).
Direct, Indirect, and Assisted Euthanasia
The procedure of euthanasia can take three forms: direct, indirect euthanasia, and assisted euthanasia. Direct active euthanasia means taking specific actions to cause a patient’s death, including administering an overdose of drugs. Indirect active euthanasia means administering drugs that are supposed to be used to ease pain but at levels that would lead to death. Assisted euthanasia or suicide is defined as providing patient with the means to end with their life (CMAJ, 2009).
Under the issue of authorizing euthanasia one can discuss ethical considerations. Euthanasia is a controversial issue about life and the right to take one’s life (voluntary euthanasia) or take someone’s life (involuntary euthanasia). At the heart of the debate about euthanasia there are arguments that are related to ethics. There are people who are pro-euthanasia because they believe in the right that a terminal patient to be alleviated from unnecessary pain or kept in a vegetative state (scientific term for when the patient is kept alive only by machines) knowing that s/he will not get over it. There are also people against euthanasia. These people do not believe in the positive benefits of legalizing a procedure that threatens the very ethical foundation of medicine- which is preserving life (Robertson, 2004).
One might add that there are also religious considerations, in countries where religious weight is still important, that further complicate the issue. For instance, the Catholic Church is against euthanasia and in a country such as Italy, although a secular country, the Church does express often its opinion against the procedure. There will be a reference to this afterwards.
Euthanasia: Practice and Legal Debate Worldwide
In any case, the very act of euthanasia is debatable voluntary or not. Countries have adopted various attitudes towards the issue. Paradoxically, most countries around the world have authorized euthanasia at least once; however, few of them have completely legalized the procedure. It is interesting that even in countries that declare themselves against euthanasia, there have been actually cases where it was performed, usually after some legal battle has been conducted.
In Italy, a country where euthanasia is illegal, on the 5th of this month, a woman who has been on a vegetative state for 17 years has been allowed to die (Donadio, 2009). The woman, Eluana Englaro has been accorded involuntary euthanasia. Her father was was the one seeking the procedure. She got this ruling from the highest court in Italy. A decision that had created debate especially among the religious clerics who have pointed out that it was illegal to take the feeding tube off the woman.
It is interesting to see that a vegetative state that is almost two decades old was still difficult to win. There are difficulties to accept the practice even when there is proof of no improvement. There is obviously no medical rationale behind it. Clearly, after such a long period, a patient like Eulana would not wake up.
On the other hand, the fact that the case was concluded in favor of Eulana in country anti-euthanasia shows some “schizophrenic” attitude about the procedure. Such case just adds more ambiguity to the legal position of the country. Is Italy for or against euthanasia? This betrays somehow a lack of courage to take a position.
Paradoxically, the Vatican, the highest religious institution in Italy, says that “no one can in any way permit the killing of an innocent human being’ (Isaacs, 2003). At the same time, it supports the use of palliatives on the ground that “When inevitable death is imminent… it is not permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life” (Isaacs, 2003).Even at the religious level, there is no clear stand.
Indeed, this Italian case illustrates the problematic issue. Even when countries do not formally legalize the procedure, they do face situations where they might go opposite their stand. In such case as the case of Eulana, it is understood that keeping a patient who will never come to life is merely an illusion. Vegetative state is maintaining a fake life.
There is a material consideration too. Significant amount of money is necessary to maintain a patient: the nutrients, the equipment, and the staff. Such resources could be used in order to help those who still stand a chance to get better.
In the UK the famous case of Bland has caused debate. Bland was a patient that had been on a vegetative state for more than three years. His parents sought involuntary euthanasia, asking for taking off the tubes that were feeding their child. The way they went about it is by arguing that it is not killing rather it is “an omission” of treatment. The point was to show that it was not in fact a procedure for killing. The vegetative condition of Bland was argued was based on “futile” treatment because it does not constitute a primary care treatment.
Another argument had been that the vegetative state was maintaining Bland in a poor quality life and that he was imprisoned in his body. This argumentation rather is ethical and not based on medical justification.
In the end, the court has in favor of the parents’ petition. The Bland case showcases a UK stand whereby it “Prohibit[s] physicians caring for patients…from actively killing them. However, it appears to allow them to kill by omission by withdrawing treatment and tube-feeding based on the supposed “worthwhileness” of the available treatments, not on the worthwhileness of the patient or the quality of his or her life” (Keown, 2003).
There is a lack of clarification in the legal system regarding the issue in many other European countries, not only Italy. In the UK, a woman was seeking assisted euthanasia: Purdy, 37 years old, decided to look for it in Switzerland because she could not in her home country; she had lost in the UK a legal battle over the demand for assisted euthanasia (CMAJ, 2009).
France has also problems with the legalization of euthanasia. The latest case with regards has been that of a woman, named Chantal Sebire, who had been widely covered by media. Chantal had been suffering esthesioneuroblastoma (the scientific name for the illness she had) that disfigured her and made her live under intolerable and permanent pain. She sought without success to get assisted suicide in her country. Her demand was rejected because the country’s 2005 “end of life” law allowing the withdrawal of medical treatment was against assisted suicide (CMAJ, 2009). The patient ultimately died, which spared France to take a decisive conclusion on Chantal’s case.
In Europe, Netherlands is known as a country that has legalized the procedure. Netherlands has passed a law in 2002 that allowed voluntary euthanasia. A second medical opinion is required and the decision is delivered by a committee (CMAJ, 2009).
The legalization has not come at once in Netherlands, now an example on pro-euthanasia. It has been a long process that started out as early as the 1980’s. Indeed, in 1984, the Dutch Supreme Court ruled that a physician who terminated a patient’s life could invoke a “necessity” defense (John, 2003). This has created a precedent.
The procedures to require euthanasia, in so far as medical request is concerned, have been outlined by the Royal Dutch Medical Association, even before the Court’s ruling. The association had published guidelines for euthanasia. They are based on the principle of voluntarism. The request for the procedure should be expressed explicitly by the patient. The guidelines also required that there “be intolerable, not necessarily physical, suffering with no possibility of improvement, no available alternatives, and that the terminating act be carried out only by a physician following consultation with another physician experienced in this field”(John, 2003). This reflects an ethical concern that death is brought about by professional was because there is no better prospect. A control mechanism has also been sought: the association has required death be reported to a local medical examiner who in turn submits report to a legal representative, a local prosecutor.
From the overview of legal debate and practice of euthanasia in Europe one remarks that there is no clear cut stand or position for countries. Netherlands has been clear in its stand legalizing the procedure and outlining when it should be legalized and when it should not. However, in such countries as Italy and the UK the stand has not been clear. These counties do not have laws allowing euthanasia. Still, cases are being won for such procedure, notably for long vegetative states.
In such countries it is perhaps better to legalize the procedure, otherwise, there is contradiction in the legal system. The case of Bland has been won just by turning around the issue and finding way to play with the system. In the end, Bland is a case of euthanasia.
The reluctance to legalize the procedure is healthy in itself. It shows that there is concern about respecting the principle of life. The concerns can be adequately addressed even by legalizing euthanasia. Netherlands has not legalized the procedure at once. There has been a medical and legal effort to set out guidelines for such procedure. Netherlands should be taken as a model.
Isaacs, D. “ To kill or to let die?”, Journal of Paediatrics & Child Health, 2003, Vol. 39 Issue 2, p.135-136.
1st page of search on ebsco, search term: To kill or to let die? Web.
CMAJ: Canadian Medical Association Journal, “Legal consensus eludes Europe”, 2009, Vol. 180 Issue 3, p. 282-283. Web.
DONADIO, RACHEL. “Woman To Be Allowed to Die In a Private Clinic” New York Times,2009, p16. [New York Times archives, key word Rachel Donadio].
Manning, Michael. Volantary Euthanasia, 1998. Online reference: www.Euthanasia Procon.org.
Kaveny, Cathleen. Unvolentary Euthanasia, 1997. Online reference: www.Euthanasia Procon.org
Keown, John. “Euthanasia, Ethics and Public Policy: An Argument Against Legislation”, Journal of Legal Medicine, 2003, Vol. 24 Issue 3, p395.
Robertson, John. “Euthanasia, Ethics and Public Policy: An Argument against Legislation”, Ethics, Book Review, University of Texas 2004, Vol. 114 Issue 3, p. 621-62. Web.