Euthanasia and End Of Life Care

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Euthanasia and End Of Life Care
ANYURYSM- S
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Introduction

• The term euthanasia derived from the Greek word
  eu and thanatos which means good death or
  easy death.
• It is also known as Mercy Killing.
• The ancient Greeks viewed illness as a bothersome
  affliction and allowed sick individuals to seek
  the approval of the state to commit suicide

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Introduction

• Euthanasia refers to the intentional termination
  of a persons life, usually but not always at
  that persons request, and usually in the context
  of terminal illness and/or incurable suffering.
• 
  The Australian Psychological Society

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Background

• While most Greek philosophers supported
  euthanasia to Aristotle, suicide was an offence
  against the state.
• In 1516, for instance, Sir Thomas More wrote
  Utopia in which patients living in an ideal
  society were encouraged to commit suicide if they
  were suffering from a terminal illness or
  experiencing unrelenting pain.

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Background

• Hippocratic oath, which was written between 400
  and 300 B.C. The oath states To please no one
  will I prescribe a deadly drug nor give advice
  which may cause his death.
• According to him, a doctor is to relieve the
  pain of his patient in one hand and protect and
  prolong his life on the other hand

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Background

• 1930s and early 1940s, the Nazis adoption of
  the word euthanasia to describe its mass
  extermination programme .
• In Germany, euthanasia was employed to murder
  over 100,000 and All the killings were committed
  without the patients consent and generally
  without the patient being aware of the impending
  act.
• The General Assembly of the World Medical
  Association

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Types of Euthanasia

• 1) Active or Positive It is an act of
  Commission. It means a positive merciful act to
  end useless sufferings and meaningless existence.
  For example by giving large doses of a drug to
  hasten death.
• 2) Passive or Negative It is an act of Omission.
  It means discontinuing or not using extraordinary
  life sustaining measures to prolong life. For
  example discontinuing a feeding tube, or not
  carrying out a life extending operation or not
  giving life extending drugs etc.
• --------------------------------------------------
  -----------------------------------------------
• Reddy KSN. The
  essentials of Forensic medicine Toxicology,
  26th edition. 200741

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Types of Euthanasia

• 3) Voluntary Euthanasia practiced with the
  expressed desire and consent of the person
  concerned.
• 4) Involuntary Euthanasia practiced against the
  will of the person
• 5) Non- Voluntary Euthanasia practiced in
  persons who are incapable of making their wishes
  known .For example in persons with irreversible
  coma or severely defective infants.
• --------------------------------------------------
  ----------------------------------------------
• Reddy KSN. The
  essentials of Forensic medicine Toxicology,
  26th edition. 200741

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Physician assisted suicide (PAS)

• Doctor provides an individual with the
  information, guidance, and means to take his or
  her own life with the intention that they will be
  used for this purpose
• --------------------------------------------------
  -----------------------------------------Murkey
  P.N. Singh K.S. Euthanasia ( mercy Killing).
  Review article. - J. Ind. Acad. Forensic Med.
  Toxicol. Vol-30 no.2, 200892-95

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Dr. death

• Jack Kevorkian was a U.S.-based physician who
  assisted in more than 150 patient suicides.
• Infamous in 1990, when he assisted in the suicide
  of Janet Adkins, a 45-year-old Alzheimer's
  patient from Michigan .
• Kevorkian agreed to assist her in a public park,
  inside his Volkswagen van. Kevorkian attached the
  IV, and Adkins administered her own painkiller
  and then the poison.
• The State of Michigan immediately charged
  Kevorkian with Adkins' murder.

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• On March 26, 1999, a jury in Oakland County
  convicted Jack Kevorkian of second-degree murder
  and the illegal delivery of a controlled
  substance and was sentenced to 25 years in prison
  .
• In 2010, HBO announced that a film about
  Kevorkian's life, called You Don't Know Jack
  featuring a film legend Al Pacino as Kevorkian
• He died on June 3, 2011, at the age of 83 .

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Arguments in Favour of Euthanasia

• Ethical/Moral
• -To respect sufferers autonomy
• -This argument rests on the ideal of being able
  at all times to exercise as much control over
  ones own life as is possible.
• To allow individuals to value quality of life
  over sanctity of life
• To end suffering

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Arguments in Favour of Euthanasia

• To reduce reliance on life support systems and/or
  advanced medical knowledge
• To reduce risk of premature suicides
• To reduce the legal jeopardy of those who
  implement euthanasia
• Changes in professional and public attitudes to
  euthanasia

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Arguments Against Euthanasia Being Available

• Ethical/moral
• Absolute respect for human life
• Possibility of coercion, loss of autonomy
• Poor decision-making by the sufferer
• Conflicts of interest
• Difficulty of enforcement and monitoring
• Reduction of efforts in diagnosis, treatment, and
  care
• Adequacy of modern medical and palliative care

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Trends Of Euthanasia In DifferentCountries

• The Canadian law allows a person to refuse
  medical treatment and the medical profession
  accepts the living will, but the law does not
  allow the doctor to actively help someone to kill
  himself.
• However, amidst the ongoing debates, the
  Netherlands became the first testing ground for
  the world since it legalized euthanasia on 28th
  November 2000.

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Trends Of Euthanasia In Different Countries

• Australia also has a voluntary euthanasia law
  which is statedly working well. In Australia, a
  computerized injection system is in use to
  accomplice euthanasia.
• The euthanasia law was adopted in 2001 in Belgium
  . This law defines conditions for doctors to
  avoid penal punishment.
• Physician Assisted suicide is legitimized in
  Switzerland.

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Trends Of Euthanasia In Different Countries

• Currently in the UK, any person found to be
  assisting suicide is breaking the law and can be
  convicted of assisting suicide or attempting to
  do so
• Although two-thirds of Britons think it should be
  legal, a recent 'Assisted Dying for the
  Terminally- Ill' Bill was turned down in the
  lower political chamber, the House of Commons

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Trends Of Euthanasia In Different Countries

• In USA the practice of euthanasia is a clear
  offence too theoretically, but in real practice
  the judgements of different courts during trial
  of euthanasia cases seem to be liberal.
• Physician Assisted Suicide (PAS) is legal in
  Oregon and Washington State in the US.

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Trends Of Euthanasia In Different Countries

• India
• Like almost in all other countries, euthanasia
  has no legal status . The practice of euthanasia
  is a clear act of offence, either a suicide and
  assistance to commit suicide or a murder.
• The latest judgement of Supreme Court declares
  that Right to DIE is not included in the Right
  to LIFE under Article 21 of Indian Constitution.

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Trends Of Euthanasia In Different

• Article 21 is a provision guaranteeing
  protection of life and personal liberty and by no
  stretch of imagination can imply EXTINCTION OF
  LIFE.
• Right to life is a natural right embodied in
  Article 21 but suicide is an unnatural
  termination or extinction of life and therefore
  not compatible and inconsistent with the concept
  of right to life

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Incident

• In Nov 27 ,1973 , Aruna Ramchandra Shanbaug, aged
  24 a nurse at KEM hospital Mumbai was attacked by
  Sohanlal, a sweepwer working in the same
  hospital.
• Assaulted in the basement , strangulated with a
  dog chain resulting in cervical injury and brain
  stem contusion due to lack of adequate 02 .

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• Based on her assessment since 1982, Pinki Virani,
  a National award winning Journalist, Social
  activist filed a petition ( criminal ), number
  105 , of 2009 in Supreme Court on India , for
  mercy killing on Behalf of Aruna under article
  32 of constitution on India.
• She pleaded Supreme court to have Aruna stopped
  being fed and let her die peacefully.

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• On 24 January 2011, the Supreme Court of India
  responded by setting up a medical panel to
  examine her.
• However, it turned down the mercy killing
  petition on 7 March 2011 but legalized passive
  euthanasia.

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Roles for psychologists could include

• Assessment of the patient
• Treatment/counselling of the patient as
  appropriate
• An advocacy role for the patient and/or relatives
  and/or carers
• educating decision makers, clinical staff,
  patients and the public in the psychological
  aspects of euthanasia and what psychologists can
  offer in the area
• facilitating others professional development in
  the area
• conducting research in the area and disseminating
  knowledge
•  

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Conclusion

• There exists an inherent tension between
  respecting individual autonomy and relieving
  people from unbearable suffering while still
  protecting the principle of valuing human life
  remains.
• Any liberalizing of laws in relation to
  euthanasia needs to achieve respect for
  individual rights and prevent abuse, without
  becoming too unwieldy, bureaucratic and time
  consuming to be practical.

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• The decision-making process raises many difficult
  psychological issues. It is clearly apparent that
  every case where a patient requests assistance to
  die should be assessed individually.
• Policy makers should consider these issues
  seriously and to bring them to the attention of
  other professionals and policy makers.

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References

1. Reddy KSN. The essentials of Forensic medicine
   Toxicology, 26th edition. 200741
2. 2. Murkey P.N. Singh K.S. Euthanasia ( mercy
   Killing). Review article. - J. Ind. Acad.
   Forensic Med. Toxicol. Vol-30 no.2, 200892-95
3. G S Neeley The Right to SelfDirected Death
   Reconsidering an Ancient Proscription 35
   Catholic Law 111 (1995) at 116.
4. 4 New York Task Force on Life and the Law When
   Death is Sought AssistedSuicide and Euthanasia
   in the Medical Context (May 1994) at 79.
5. J Scherer and R Simon Euthanasia and the Right to
   Die A Comparative View (Rowman Littlefield
   Publishers, Lanham 1999)

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Thank you