B. Codes of ethics of national medical bodies

Logically, the study of CEDMs is much more complex. There are enormous differences in the extent, content and structure of Cedm from one Cedm to another. Within the same general structure between successive CEDMs of the same national medical organisation, there are variations which almost always follow a rectilinear evolution, but sometimes return to earlier positions.

It is worth starting by pointing out the most salient features.

1. Absence of references to euthanasia in the CEDMs

Some medical professional organisations have not published Cedm: this is the case of the Austrian Chamber of Physicians and the high schoolMédico de México.

The CdMs of Cyprus, Colombia, Cuba, Denmark and Honduras lack even indirect allusions to topic. The Cuban CoE refers to terminal illness by affirming a strong paternalism in relation to the information to be given to the patient. It states: "Maintain, in cases of fatal illnesses, absolute or relative reservationon the diagnosis and prognosis in relation to the patient; and select to whom this information should be given with the necessary tact".

It is worth pausing for a moment to consider the case of Colombia. The 1958 Code of Medical Morals stated in Chapter 10: "A physician shall not prescribe or perform any act which directly or deliberately tends, for whatever purpose, to destroy human life, such as abortion, euthanasia and the employmentof contraceptive methods". The 1981 Standards of Medical Ethics oblige physicians to "pledge allegiance and honour" to the Declaration of Geneva (where it states: "I solemnly promise ... to have the utmost concern and respect for human life from the moment of conception"), but article13 of the Standards merely states that "A physician shall use whatever methods and drugs are available or affordable to him or her for as long as there is hope of alleviating or curing the disease. When there is a diagnosis of brain death, it is not his obligation to maintain the functioning of the other organs or apparatus by artificial means". It is worth remembering that the Colombian Code has received legal endorsement: it is Law 23 of 1981. But it does not seem that it will constitute, by that very fact and due to the weakness of its doctrine, a firm retaining wall to oppose the implementation of the future legislation on decriminalisation of euthanasia that the Constitutional Court has asked the Government to prepare for its approval by Parliament, order.

2. Only indirect references to the deontology of euthanasia

Some CEDMs, rather than laying down rules on euthanasia, limit themselves to prescribing more or less explicitly the basic duty to respect life. This is the case in the Cedm of Finland, Greece, Iceland, Peru, Sweden and Venezuela.

Thus, the Peruvian physician recognises that the first of the ethical principles of the profession is respect for life and the human person, which is the spiritual essence of [the] ideals [of the medical profession]. The Peruvian physician solemnly undertakes to comply with the norms of the Declaration of Geneva. Euthanasia is therefore implicitly excluded, but is not strictly condemned. Regarding statusterminal, article48 of the Peruvian Code of 1970 states that: "The doctor must use all the methods and medicines available to him while there is hope of alleviating, halting the progress or curing the illness. It is not his duty to maintain life artificially when there is a definite prognosis of death, but he must try to use all symptomatic medication within his power to alleviate the patient's condition.

The Code of Icelandic Physicians (1992) is very unique and succinct. Its article1 reads: "The physician shall respect the life and sanctity of man". There is no little that can be gleaned from these brief words. In the same laconic vein are the Codes of Finland (1988) and Sweden (1968). The Finnish one says: "It is the duty of the physician to protect human life and to alleviate suffering, having as its primary aim the promotion and recovery of health". The Swedish Code says hardly anything: "The physician shall always bear in mind the importance of protecting and preserving human life.

Not much is said in the Greek Cem (1955), in its article9, which is more a recommendation not to incur iatrogenic harm than a mandate to respect life: "The physician is obliged to show unlimited care with the purposeto preserve and rescue human life. result exhibitionHe shall diligently avoid any operation that could have the effect of obstructing the reproductive capacity or of putting life at serious risk, excluding only those cases of proven and unavoidable therapeutic necessity".

3. Direct, albeit minimal, references to the deontology of euthanasia

groupWe can gather here a large number of medical organisations whose codes condemn euthanasia internshipin a nutshell. They are Argentina, Bolivia, Brazil, Costa Rica, Ecuador, El Salvador, Guatemala, Paraguay, in America. In Europe, there are hardly any formulations of this kind subject, apart from Slovakia, because, even if some of them are very brief, they often say a lot in a few words.

Let us look at some examples. The Code of Ethics of the Medical Confederation of the Argentine Republic (1964), in its Chapter XVI, Art. 117. Art. 117. On Euthanasia: "In no case is the physician authorised to shorten the life of the patient, but only to alleviate his illness by means of the therapeutic resources available. In Brazil, the Brazilian Medical Union Code of 1931 states: "article16. The physician shall not advise or practice euthanasia, because one of the most sublime purposes of medicine is to preserve and prolong life. But, at the same time, the professional has the right, which is also a duty, to relieve those who suffer; but this relief cannot be taken to the extreme of mercy killing". The doctrine vanishes in the 1945 Code, a singular code, because it only contains prohibitions, which reads in point 5 of article4º. It is forbidden for doctors to advise or practise euthanasia. The 1953 and 1965 editions of the code gradually returned to the original text, in which it is stated in the affirmative, in the same article4th paragraph: "The fundamental duties of the physician are: a) to have absolute respect for human life and never to use technical or scientific knowledge for the suffering or extermination of man". The evolution came to a close in 1988. The Code currently in force states at article7th: "The physician shall have absolute respect for human life, always acting in the best interests of the patient. He shall never use his knowledge to cause physical or moral suffering, to exterminate human beings or to permit or cover up attacks on their dignity and integrity.

The text that the Ecuadorian Medical Federation dedicates to euthanasia in its 1985 Reformed Code of Medical Ethics, article90, is minimal: "The physician is not authorised to shorten the life of the patient. His fundamental mission statementin the face of an incurable illness will be to alleviate it by means of the therapeutic resources appropriate to the case". Richer and more expressive are the high schoolde Médicos y Cirujanos de Guatemala and the Círculo Paraguayo de Médicos. The former states in article42 of its 1991 Code of Ethics: "The physician is not allowed to shorten the life of the patient entrusted to his science, being on the contrary his moral obligation to provide healing, relief and comfort; he should not resort to techniques or procedurethat are in themselves unsuccessful when brain death has already been established". And the Paraguayan Code of Ethics prescribes, in article22, that "The following acts are contrary to medical morality: ... s) Advising or practising active euthanasia" and adds in article46 that "The doctor must do everything possible to alleviate the pain of his patient, he must not contribute with his committeeor with his actions to anticipate the patient's death".

4. Direct, explicit and concise references to euthanasia

The subjectis dealt with by some codes in a very concise but sufficient manner. This is the case in Ireland, Israel, Luxembourg and Norway.

Thus, for example, the guideof ethical conduct of the Irish Medical Association committeestates, at article43: "Euthanasia. When death is imminent, it is the physician's responsibility to ensure that the patient dies with dignity and with as little suffering as possible. Euthanasia, which involves deliberately causing the death of the patient, constitutes professional misconduct and is illegal in Ireland.

In the 1995 Rules of Medical Ethics of the Israeli Medical associationand in the 1991 Cdm of the Luxembourg Medical high schoolwe find what is almost a verbatim copy of the Principles of Medical Ethics for Europe. The Isreal rule, after recalling in article1 that "The physician's workis to protect the physical and mental health of the human being and to alleviate his suffering, with respect for the life and dignity of the individual", states in 14 that: "In the case of terminal illness, the patient's independence and freedom must be respected, insofar as he is capable of expressing them. The physician shall alleviate physical and mental suffering, protect the quality of life that is approaching its end, and safeguard the dignity of the dying person.

The text of article45 of the Luxembourg Code repeats: "In the case of incurable and terminal illness, the doctor must alleviate the physical and moral suffering of the patient by administering appropriate treatment, avoiding any hopeless therapeutic overkill, and maintaining as far as possible the quality of a life that is coming to an end. The physician must attendthe dying person to the end and act in a way that allows the patient to maintain his or her dignity. The physician has no right to deliberately bring about the death of the patient.

The Norwegian Physicians' associationhas managed to write the basics of the ethical doctrine on auethanasia in a few lines. Paragraph 5 of the Cem (1994) states: "When the patient's life is at an end, the physician must respect the patient's right to self-determination. Active euthanasia, that is, the use of measures to hasten a patient's death, is not acceptable. Nor may a physician assist a patient to commit suicide. It is not to be considered euthanasia to failor to refrain from initiating treatment that is not useful.

5. The most developed texts

Medical organisations in Belgium, Chile, Croatia, France, Germany, Italy, Poland, Portugal, Spain, Switzerland, the United Kingdom, the United States, the United Kingdom, the United States and Uruguay, within a marked variety of styles and emphases, state in detail the deontological rules and regulationson euthanasia. I will leave for later the commentary on that very interesting thing which is the diversity of stylistic expression and ethical emphasis. I will limit myself now to some demonstrative examples.

Let us start with Germany, which in the 1997 Code gives great prominence to palliative medicine. It describes the function of the physician in paragraph 2: "It is the physician's function to preserve life, to protect and restore health, to alleviate suffering, to accompany the dying, and to collaborate in the preservation of nature with regard to human health". And he develops in paragraph 16 the idea of accompanying the dying: "The physician must - with respect for the will of the patient - renounce measures that seek to prolong life and limit himself to alleviating discomfort, in order to prevent the postponement of inevitable death from ultimately becoming a precarious prolongation of pain. The physician cannot actively shorten the life of the dying. He cannot place his own interest or the interest of a third party above the well-being of the patient. It is worth remembering this doctrine when, in a moment, I make a brief allusion to the Declaration on Euthanasia which is now under discussion among German physicians.

What the 1995 FNOMCO Code of Ethics of the FNOMCO tells us can be found at modelof rules and regulationsof the Mediterranean deontology area. There, the doctor has to take an oath, taken from the Declaration of Geneva, which includes the following words: "Aware of the importance and solemnity of the act I am performing and of the commitment I am undertaking, I swear: ... never to commit actions that may deliberately cause the death of a patient; to abide in my activity by the ethical principles of human solidarity, against which, in respect for life and the person, I will never use my knowledge". Chapter V of the Cdm is devoted to attendancefor the dying. It reads as follows: Art. 35. "The doctor, even if requested by the patient, must not carry out treatments aimed at diminishing the patient's psychological and physical integrity, shortening his life or causing his death". To which Art. 36 adds: "In the case of illnesses with a surely unfortunate prognosis that have reached their terminal phase, the doctor may limit his work, if this is the patient's specific wish, to the moral attendanceand to the treatment that seeks to spare him useless suffering, providing him with appropriate treatments and preserving as far as possible the quality of life".

It is very interesting, for all intents and purposes, what the Cem of the committeeof Ethical and Legal Affairs of the American Medical Association associationsays about euthanasia and financial aidmedical suicide. purposePoint 2.21, merged with 2.211, states: Euthanasia is the administration to a sick person of a lethal agent by another person for the purpose of alleviating the patient's intolerable and incurable suffering. It is understandable, but tragic, that some patients in situations of extreme hardship - such as suffering from a terminal, incapacitating and painful illness - may come to believe that death is preferable to life. However, allowing doctors to euthanise would do more harm than good. Euthanasia is fundamentally incompatible with the physician's healing role, would be very difficult or impossible to control, and would carry very serious social risks. Rather than engaging in euthanasia, physicians should respond energetically to the needs of patients as death approaches. Patients should never be abandoned once it has been concluded that cure is impossible. Patients must continue to receive emotional support, comfort care, adequate pain control, respect for their autonomy, and a good relationship from speech".

Code of Medical Ethics, Venezuela, 1985. Dedicates Chapter IV to the terminally ill. It has 11 articles. Of these, nine deal with the rights of the terminally ill patient. Two refer to the duties of the physician. No other code is comparable in its detailed and humane approach to the deontology of terminal illness.

6. The case of Spain

Organización Médica Colegial, Code of Medical Ethics and Deontology, 1990. These articles are included in Chapter VI (Reproduction, Respect for Life and Human Dignity):

article28.1. A physician shall never intentionally cause the death of a patient either by his or her own decision, or at the request of the patient or the patient's relatives, or by any other requirement. Euthanasia or "mercy killing" is contrary to medical ethics. article28.2. In the case of incurable and terminal illness, the physician must confine himself to alleviating the physical and moral pain of the patient, maintaining as far as possible the quality of a life that is coming to an end and avoiding undertaking or continuing hopeless, futile or obstinate therapeutic actions. He shall assist the patient to the end, with the respect due to the dignity of man.

A new Code is currently pending adoption. The text of the articles has been amended. It does not appear that things will change much on the surface, although the text is highly perfectible. It reads as follows.

Art. 28.

1. The physician is obliged to attempt to cure the patient whenever possible. And when it is no longer possible, he is still obliged to apply all palliative measures and comfort care within his power.

2. The physician must avoid overtreatment and therapeutic overkill. He/she must not undertake or continue hopeless or obstinate therapeutic actions; moreover, he/she must not initiate or discontinue them.

3. Unless the patient is unable to decide, the explicit wish of the patient not to receive extraordinary treatment or life-sustaining techniques shall be respected by the physician.

4. It is right to use analgesics even if this could result, as a side effect, in a possible shortening of life. In such a case, status, the physician should inform the patient of this possibility and, if possible, obtain the patient's informed consent apply for.

5. A physician shall never intentionally cause the death of a patient, even at the patient's express request.

C. Statements by National Medical Bodies on Euthanasia

a. Spain

On euthanasia (adopted by the General Assembly on 21 June 1986)

In articles and talk shows, the expressions "financial aida morir" or "muerte digna" (death with dignity) are frequently used. Such expressions are confusing because, although they have an acceptable appearance, they often conceal attitudes contrary to medical ethics. "Moreover, they tend to blur the boundary that should separate".

Medical assistance to the dying is one of the most important and noble professional duties of the physician, whereas euthanasia is the deliberate destruction of a human life, and even if it is performed at the request of the victim or out of pity for the person who performs it, it is still a crime that is deeply repugnant to the sincere medical vocation.

In accordance with Articles 28.1 and 28.2 of our Code of Medical Ethics and Deontology, physicians are obliged to fulfil their genuine role in assisting and caring for the dying of their patients by competent treatment of pain and distress. He or she should strive for the greatest possible material well-being; he or she should, according to the circumstances, provide spiritual attendanceand human comfort to the dying; he or she should also support the dying person's relatives. The physician also dignifies death and financial aidwhen he refrains from painful and unjustified treatments and when he suspends them because they are no longer useful.

But the physician would be betraying his vocation as a healer and protector of human life if he were to kill a sick person or assist in his voluntary suicide. A physician can never deliberately cause death: that is not what medicine is for. Even if a law were to permit it, a physician may never use the power and prerogatives that society has granted him or her to carry out a capital punishment ordered by a court of law or to end the life of a sick person, even if requested to do so by the sick person, or by his or her family, or by a hospital care provider, committee.

A doctor is guilty of a serious breach of ethics if he refuses to provide a dying person with competent medical care attendanceand, above all, if he arrogates to himself the unbridled power to voluntarily destroy a human life.

A Declaration on the incorrect use of the term passive euthanasia, 1995, which recommends its exclusion in the debates: if euthanasia is deliberate killing, understanding the suspension of futile treatments as passive euthanasia is not euthanasia. Nor is passive euthanasia euthanasia caused by the omission of care necessary to save life: that is active euthanasia committed, executed, by omission.

b. United Kingdom

BMA: The law should not be changed. Deliberately killing a human being must remain a crime. This rejection of any change to the current law, so that doctors would be allowed to intervene to end a person's life, (...) is, above all, an affirmation of the supreme value of the individual, no matter how worthless or hopeless he or she may feel".

Comments

Family trees or zones of influence. The Principles of Medical Ethics for Europe line, which has informed the regulation of some Eastern European countries (Slovakia, Poland) and has also spread to the Latin American continent.

The absence of God. Lack of references to attendancereligious. Charters of patients' rights (Spain, no). But there are timid and diffuse references to emotional, moral support, but the right to receive religious attendance, forgotten or disguised. Late consequences of Geneva. Is there only spiritual support in the Catholic Church?

Autonomy support. An ambivalent idea, curiously universal. Put it in perspective. Because, deep down, the patient can be autonomously capricious, suicidal, pro-euthanasia. To study whether so much autonomy does not create a dominant right, which in the end does not even prevent the medical financial aidsuicide.

An allusion to the dignity of life that is coming to an end. What is terminal dignity? A capital topic. Biological deterioration and human decay to mere derailed biology. Or intrinsic, absolute, inalienable dignity. The persistent presence, in pro-euthanasia claims, of dependence on others.

Role of quality of terminal life. Another problem: it is invoked, to signify the permanent duty of care, or it is invoked to absolutise quality and decide that lives with a deficient quality are not worth living.

Firmness of the anti-euthanasia position. Favourable balance. For how long? History of how one cannot live on the moral rents of the past. There is no more inheritance, it has been consumed. Effort to negotiate talent.

The BMA's position. A giant with feet of clay. The grossly consequentialist argumentation.