Everything in the universe is subject to change
and everything is on schedule! (Canadian bumper sticker)
CONCLUSION PartA
ORGAN PROCUREMENT - EUTHANASIA and ASSISTED SUICIDE
Active Euthanasia: to be involved with, or to participate in bringing about the death of another person.
Passive Euthanasia: To deliberately withhold or withdraw medication, which would help a patient to live longer (thus resulting in the patient's death taking place sooner).
For consideration; both of the above actions are performed with the same intention - to end the life of a human being. Views on whether our life-spans should be in the hands of other human beings differ; we should be entitled to live all the life we've been assigned.
Voluntary Euthanasia: Euthanasia at the request of someone.
Non-voluntary Euthanasia: Ending the life of someone no longer capable of communicating; performed believing this person would not want to continue living
For consideration; is administering medication to someone, intended to relieve their suffering but will have the side-effect of causing them to die, a form of active or passive euthanasia?
Other choices for those seeking early termination of their life are:
Oregon (USA) (since l997, physician-assisted suicide only).
Switzerland (1941, physician and non-physician assisted suicide only).
Belgium (2002, permits 'euthanasia' but does not define the method.
In many countries there is no specific law dealing with the matter of assisted dying, and often cases are tried based on other established laws.
Some common arguments in favor of legalizing euthanasia:
· Do not want to be an emotional and financial burden to their relatives, or society.
· Not all pain can be controlled by drugs.
Some arguments against legalising euthanasia
· We do not know if someone will never recover from a 'terminal' illness.
· People should be looked after, cared for, and helped through their last days, rather than be 'got rid of'.
· Doctors are meant to do all in their power to preserve life, not end it!
· Legalising euthanasia is giving people a license to murder.
There are countless people who have end-stage organ disease and could be saved by transplantation. Do we as a society have a responsibility to explore every possible ethical means for increasing the rate of recovery of acceptable organs? Should we accept the view that people can sometimes be required to act for the greater good and consequently accept a ‘routine recovery’? Ought we to endorse the intended legislation being introduced on many fronts that while alive, people’s organs should be considered their personal property, but after death their “organs [should be considered] a societal resource.” Or does adopting organ procurement using this practice leads to an unnecessary loss of life?
The shortage of organs for transplantation has worsened forcing clinicians to review alternative approaches to organ procurement. Organ procurement has relied on the altruism and goodwill of donors, a 40-year-old policy. However, in that not a sufficient number of people want to donate, Henri Kreis of the Faculty of Medicine Paris-Descartes, Department of Transplantation shared; “in order to increase the availability of suitable organs and allow cadaver organ trans-plantation to continue, it is time to consider new strategies other than donation.”
In Europe, the euthanasia lobby is becoming bolder and more extreme. They have let go of their traditional anthems of voluntary euthanasia for the competent and suffering to that of language that would lead to euthanasia as a human right. This serves as a useful reminder that the issue of euthanasia is not about terminal illness, compassion for the dying or ending suffering. Recently, there have been fewer restrictions on euthanasia and assisted suicide. Pressures also are appearing to establish a “right” to be killed.
Is hastening the death of a person to save the life of others not the greatest sign of love? No greater love…
FRANCE
The shortage of organs for transplantation has worsened forcing clinicians to review alternative approaches to organ procurement. Organ procurement has relied on the altruism and goodwill of donors, a 40-year-old policy. However, in that not a sufficient number of people want to donate, Henri Kreis of the Faculty of Medicine Paris-Descartes, Department of Transplantation shared; “in order to increase the availability of suitable organs and allow cadaver organ trans-plantation to continue, it is time to consider new strategies other than donation.”
The “passive" form of euthanasia is allowed, with proponents stressing that this differs from the practice now permitted in some other European countries. Unlike the situation in the Netherlands and Belgium, where doctors are not prosecuted for actively ending the life of a patient, the French legislation deals mainly with acts of omission. (see The NL and Belgium heading)
Described as a "patient's rights" bill, it will allow doctors, acting at the request of patients and their families, to end medical treatment that is seen to be maintaining life artificially. Doctors will furthermore not be penalized for administering - at the request of patients suffering from extreme pain - higher-than-normal doses of medication, even if the drugs have a secondary and subsequent effect of hastening death. A third aspect of the law will allow a gravely or a terminally-ill patient to refuse life-sustaining medical treatment. "This legislation is one that allows dying but does not allow killing. That is how it is different from euthanasia.
UK
Euthanasia in the UK
Although it is illegal to actively end the life of another person, in reality doctors in the UK regularly practice a form of 'passive euthanasia' when they turn off life-support machines in cases where there is 'nothing more they can do'.
Cost-effectiveness of transplantation
In addition to saving lives, transplantation is highly cost-effective, and represents incredible savings to the NHS budget and is the treatment of choice for many patients, particularly those with end-stage renal failure.
There are over 37,800 patients with end-stage renal failure in the UK. Nearly 21,000 are on dialysis, whilst the remainder have a transplant.
The indicative cost of a kidney transplant (including induction therapy but excluding NHSBT costs) is £17,000 per patient per transplant.
The immuno-suppression required by a patient with a transplant costs £5,000 per patient per year. Kidney transplantation leads to a cost benefit in the second and subsequent years of £25,800 pa.
The cost benefit of kidney transplantation compared to dialysis over a period of ten years (the median transplant survival time) is £241,000 or £24,100 per year for each year that the patient has a functioning transplanted kidney. At the end of March 2009, the UK Transplant Registry had records of over 23,000 people in the United Kingdom with a functioning kidney transplant. On 1 April 2009 there were 6,920 patients waiting for a transplant of which the majority were on dialysis, costing around £193m per year. If all of these patients received a transplant, the approximate cost would be £41m per year, which represents a saving to the NHS of £152m per year.
(USA) Some physicians have advocated a policy of "presumed consent," which allows physicians to retrieve organs unless the deceased opted out by specifically stating an opposition to organ donation prior to death. It was suggested that drivers’ licenses could be used for this purpose.
A countered argument is that presumed consent is fraught with legal and ethical traps. "It will only take one case in which someone’s decision not to donate is overlooked or ignored to put an end to presumed consent for good."
More popular with both physicians and ethicists is the policy of "required request," mandating that hospitals ask families about organ donation in every case of brain death. Many hospitals across the country have voluntarily adopted such a policy, and several states have enacted or have pending required-request legislation.
Many people support the right of a terminally ill patient to die - but what if the act becomes an obligation? And what of the potential for abuse by those might profit through the death of another? And for the purpose of this paper, should the death of a terminally ill patient be sacrificed to harvest life saving organs?
· Should dying patients have the right to order their doctors not to start or continue medical treatment?
· Should doctors be protected from prosecution if they shorten a patient's life expectancy with pain-killing drugs
The NL and Belgium
Euthanasia and assisted suicide were legalized in the Netherlands and Belgium in 2002. The Netherlands had effectively legalized euthanasia and assisted suicide by the decree of the courts in 1985, with the 2002 legalization simply codifying accepted practice into law.
The Netherlands are often hailed as a model when arguing for the legalization of euthanasia, where it is allowed if:
· The patient is in unbearable pain, with no improvement in sight
· The patient has voluntarily requested euthanasia on more than one occasion
· The patient is aware of their condition and options
· At least two doctors agree that these conditions are present
· That euthanasia is carried out in a medically appropriate manner
· That the patient is at least 12 years old.
The Netherlands
Cost containment is one of the main aims of the health care policy in Holland and Belgium. In an effort to contain costs and increase speedy procurement of body parts euthanasia training has been part of both medical and nursing school curricula since the early 1990s. The expense of the training is quickly recouped when those trained get their hands on patients. Euthanasia has been administered to people with diabetes, rheumatism, multiple sclerosis, AIDS, bronchitis, and accident victims.
Holland is widely regarded as one of the world's most civilized countries. Active euthanasia is legal there, but for the past decade the government has not prosecuted doctors who report having assisted their patients to commit suicide. A Dutch government investigation of euthanasia revealed some disturbing findings . In one year in the early 1990s, 1,030 Dutch patients were killed without their consent. And of 22,500 deaths due to withdrawal of life support, 63% (14,175 patients) were denied medical treatment without their consent. Twelve per-cent (1,701 patients) were mentally competent but were not consulted
The Dutch experience seems to demonstrate that the "right to die" can soon turn into an obligation. We need to contemplate the potential reality for abuse if mercy killing becomes legal. What if someone stands to gain by the expedient death of another?
Right-to-die advocates often point to Holland as the model for how well physician-assisted, voluntary euthanasia for terminally-ill, competent patients can work without abuse.
The main argument in favor of euthanasia in Holland has always been the need for more patient autonomy -- that patients have the right to make their own end-of-life decisions. Yet, over the past 20 years, Dutch euthanasia practice has ultimately given doctors, not patients, more and more power. The question of whether a patient should live or die is often decided exclusively by a doctor or a team of physicians.
In the 1990s in Holland:
· 52% were killed by doctors (active, voluntary euthanasia).
· 12% died as a result of doctors providing them with the means to kill themselves (physician-assisted suicide).
· 48% died from involuntary euthanasia, meaning that doctors actively killed these patients without the patients' knowledge or consent.
· 14% of these patients were fully competent.
· 72% had never given any indication that they would want their lives terminated.
· In 8% of the cases, doctors performed involuntary euthanasia despite the fact that they believed alternative options were still possible.
8,100 patients died as a result of doctors deliberately giving them overdoses of pain medication, not for the primary purpose of controlling pain, but to hasten the patient's death. In 61% of these cases (4,941 patients), the intentional overdose was given without the patient's consent. According to the Remmelink Report, Dutch physicians deliberately and intentionally ended the lives of 11,840 people by lethal overdoses or injections--a figure which accounts for 9.1% of the annual overall death rate of 130,000 per year.
The majority of all euthanasia deaths in Holland are involuntary deaths. The most frequently cited reasons given for ending the lives of patients without their knowledge or consent were: "low quality of life," "no prospect for improvement," and "the family couldn't take it anymore."
In 45% of cases involving hospitalized patients who were involuntarily euthanized, the patients' families had no knowledge that their loved ones' lives were deliberately terminated by doctors.
Critics have claimed that the Dutch initiative for euthanasia will trigger a wave of "euthanasia tourism", and this potential boom has begun through the establishing of death clinics in Cambodia and Mexico.
In 2003, a group of “ethicists” at the Groningen University Hospital began looking at the question of infant euthanasia in the Netherlands. The 2002 law allowed the euthanasia of consenting persons over the age of 12. The problem that the committee at Groningen University was attempting to solve was: what should be done with newborns that are born with anomalies? The Groningen Protocol allows euthanasia of infants when the parents give consent and when the child is considered to lack an “acceptable” quality of life.
In the Netherlands, the goal is the legalization of the “last-will pill.” This is a prescription that would be given to healthy individuals (usually the elderly or people with disabilities) who were tired of living.
Switzerland
Switzerland has tolerated assisted suicide for many years. Suicide groups have been assisting suicide within Switzerland based on a legal interpretation of their 1918 suicide law. In other words, Switzerland never legalized assisted suicide, but tolerates the practice based on a legal interpretation. The Dignitas Suicide clinic is probably the best known of these groups.
The Dignitas clinic has now changed its suicide technique from the use of a prescription to that of the plastic bag with helium (an exit bag). Using the plastic bag with helium method to eliminate the need for a physician to agree to assisting the death, because even many physicians who support assisted suicide would often refuse to write lethal prescriptions for people who weren’t dying or suffering. The clinic is known for its encouragement of suicide tourists from countries around the world where euthanasia is not permitted or tolerated, who go to Switzerland to die. It is estimated that two out of three people who die at their suicide clinic are suicide tourists.
The Dignitas assisted suicide groups in Switzerland, has some 2,000 members and welcomes foreigners. Dignitas must be fully informed in advance of a person’s wishes, circumstances, and agree to help. It is not (yet) a ‘walk-in’ clinic. The most serious question facing Dignitas concerns welcoming and assisting the the mentally ill or depressed as much as those suffering a physical illness and pain. Dignitas members argue that mentally ill people have the same right to take their own lives as others: "You can't say and you shouldn't say that mentally ill people should not have human rights." "A lot of people feel lonely, lonesome at that stage and they say, 'Well, I have nothing more. I have no relatives, I have no friends, no life ... Why am I still living anymore,'" says Eichenburger. "That's when I say that the dying has begun."
Although the Dignitas market is largely German, by late 2008, approximately 100 British citizens had travelled to Switzerland from the UK to die at one of Dignitas' rented apartments in Zurich. Just a month later the number of British members of Dignitas had risen to 725. Assisted suicide is not a criminal act under Swiss law if it is motivated by altruistic considerations.
Dignitas launched an effort to gain legal permission for healthy foreigners, including married couples committed to suicide pacts, to end their lives in Switzerland. Dignitas has found
If voluntary euthanasia is made legal for "persons of sound mind" there will inevitably be tremendous pressure to provide it for those who "would request it if they were able to" - the mentally ill or handicapped, the senile, the unattached or non-productive elderly, etc. One can easily argue too to link euthanasia and health care costs in the same breath; financial pressures will multiply in the coming years as our population ages.
Sven Ljungholm
Soldier
Govan Corps
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