Euthanasia and suicide with financial aid medical
Gonzalo Herranz, department de Humanities Biomedical, University of Navarra
discussion paper at seminar "Towards a Science with Conscience".
association Cultural Albores
Wyndham Old San Juan Hotel
San Juan, Puerto Rico, November 9, 2001, 3:30 to 5:30 p.m.
A. Historical and cultural evolution of the pro-euthanasia movement (mpe)
B. Intangibility of human life: reasons for medical ethics.
Respecting terminal life is part of the medical vocation.
2. Euthanasia is not for doctors.
3. Euthanasia destroys the ethics and science of medicine.
C. status created by permissive laws: Netherlands, Belgium, Oregon
D. Conclusion: rediscovering the value of terminal life.
Euthanasia can be studied and debated for hours and hours. The bibliography on this decisive issue is immense. Therefore, the first problem we face is to limit the scope of what I have to say, although later, in the question session, we may be interested in many other aspects of this fascinating topic .
I will address three issues.
The first concerns the evolution and cultural traits of the pro-euthanasia movements. We will experience their pressure and their presence, it is certain, as long as we live: knowing their mentality and their ideology will help us to participate with more knowledge of cause in the never-ending social discussion that they provoke.
The second is an argument on the intangibility of terminal human life from the perspective of medical ethics. It will show us that the professional ethics of medicine has never succumbed, as has much of bioethics, to the temptation to relativize the value of human life in that moment of final precariousness. Moreover, to accept euthanasia would be to break the ethical and scientific fiber of Medicine.
The third question will try to describe the consequences that the legal acceptance of euthanasia has on the internship of Medicine.
These considerations lead us to one conclusion: the need to rediscover the human and ethical value of terminal life, which contains both the greatness and the misery of every human being.
A word of caution: although euthanasia and medical suicide financial aid present notable moral and legal differences, they also present profound coincidences. As far as we are concerned this afternoon, and for the sake of simplicity in my exhibition, I will simply say euthanasia to refer to both.
A. Historical and cultural evolution of the pro-euthanasia movement (mpe)
Euthanasia movements are born and develop in close connection with certain ideological attitudes and revolve around certain thematic motifs. That is why it is easy to get to know them well.
It is important to have a general overview of the history of mpe, because that history sample tells us two important things: how constant in its objectives is pro-euthanasia activism, and how adaptable it sample to the circumstances of time and place to change its motives and tactics in order to lobby public opinion and activate its proselytizing.
Since I cannot offer a systematic and orderly study of the mpe, I will limit myself to highlighting some of the most significant episodes and ideas of this history.
To learn about its external history, it will suffice to look at the two oldest mpe's, one European and the other North American, which have set precedents.
The Voluntary Euthanasia Society (VES), UK. It was born in 1935 and did so, in a typical way, with a lot of advertising and with the complacent support of some intellectuals and avant-garde artists. And, curiously, also from some progressive ecclesiastics. The mpe has never lacked the complicity of part of the social establishment. There were Julian Huxley, Herbert G. Wells, George B. Shaw, Canon Dick Shepherd, and the creator of the movement, Dr. C. Killick Millard, an enlightened and tenacious doctor-hygienist.
Throughout its history, the English VES has gone through serious crises: it has alternated phases of great activity with falls into paralysis; it has split into schismatic branches and then unified again; it has been the victim of overzealous managers who did not limit themselves to propagating ideas, but took action and, against the law, administered the sweet death to many patients, including some who had not requested it. It therefore had to change its name, in order to regain a certain social image: it was renamed Exit for some years, but recently returned to its original name. Today, the English VES defines itself as a lobbying group seeking, by democratic means, the legalization of euthanasia: it wants competent adults, in unbearable pain and in the terminal phase, to be able to actively end their lives with financial aid of the physician. On its website, the VES states that it does not offer information on ways to bring about death, because it is not a suicide club. The English VES can serve as patron saint for European mpe.
In the United States, mpe has followed a parallel history in some respects, but not in others. The Euthanasia Society of America, founded in 1938, became the Society for the Right to Die in 1976, and Choice in Dying in 1991, in order to present a more favorable public image. As is typical in American society, the original movement has splintered into numerous independent organizations, such as Americans for Dying with Dignity, Compassion in Dying, Doctors for Mercy, and the well-known Hemlock Society USA.
This is the most influential. It was founded in 1980 by Derek Humphry, the famous author of Final Exit, a guide for the internship of suicide. Hemlock presents herself as an active advocate for the patient's right to choose how to die with dignity, to control end-of-life decisions. Hemlock boasts that she was instrumental in the passage of the Oregon physician suicide law with financial aid .
The mpe are very unevenly distributed throughout the world. According to data of the World Federation, they are established in developed countries, especially in Anglo-Saxon countries: United States, England and Scotland, Canada, Australia and New Zealand. In Europe, mpe are established in Belgium, Finland, France, Germany, Luxembourg, the Netherlands, Norway, Spain, Sweden and Switzerland. In other continents, mpe are very few and operate in South Africa and Zimbabwe, in Israel, in India, Japan and Singapore, and finally in Colombia, where the Fundación Pro Derecho a Morir Dignamente is very active and influential. In other countries, the mpe, after a brief and precarious existence, died out due to lack of leadership or social rejection.
The more active presence of mpe in advanced countries seems to point to the existence of a link between a pro-euthanasia mentality and certain economic and cultural factors. The pro-euthanasia mentality is more deeply rooted in the higher social strata. In them, there is less tolerance of suffering and a more refined sense of the quality of life. It is not easy for mpe to appeal to people who struggle daily to survive and are content with little, or to those who find solace for adversity in religion and in the strong bonds of the extended family.
It is interesting, in this context, to note that Ez. Emanuel has pointed out a close correlation between the ups and downs of pro-euthanasia activism and economic cycles: he has observed that social interest in euthanasia tends to grow in times of economic recession, when, as a result of individualistic ethics, discriminatory policies are applied against socially vulnerable groups and social and community ties are dissolved.
But it is not only these crisis situations that socially drive the pro-euthanasia mentality. sample The growth of mpe also depends heavily on the media exploitation of certain events (social, political or judicial) that are skillfully manipulated to change public opinion and increase the issue of the affiliates: dramatic cases of terminal illness, episodes of therapeutic cruelty that provoke indignation and spread a diffuse fear of medicine, moving stories in which euthanasia is presented as something very humane and compassionate, judicial sentences that set a precedent and favor the social acceptance of euthanasia as something just. The media are responsible for softening the moral resistance to putting a fellow human being to death, and present mercy killing as something just, virtuous and ethically obligatory.
Historical changes are not only organizational and external. They also affect ideology and motivations. In the early days, euthanasia was offered as a compassionate death, as a last and necessary remedy to alleviate insufferable pain. But this motive cannot be invoked today, when the treatment of pain and other symptoms of terminal illness is already very effective.
Today the motivations for euthanasia are more complex and varied: some can be attributed to the autonomous mentality of man, emancipated and closed to transcendence, who makes himself the exclusive master of his own destiny and determines it autonomously as the absolute master of his own life. Others respond to the spirit of efficiency that desires a society made up of dynamic, productive, individualistic individuals who are self-sufficient and who consider it degrading to depend on others. Others originate in the hedonistic Philosophy , which, rejecting suffering as something immoral and degrading, concludes that there are lives so painful that they are no longer life and become unworthy of being lived.
There are many elements that make up the modern pro-euthanasia ideology.
In the legal field, the harsh application of the legal argument of necessity has led to considering sweet death as an irreproachable solution to the shortcomings of a precarious and painful life, while admitting that compassion is a strong motive that justifies putting an end to the life of a loved one, since it is capable of dragging with the force of something invincible and fateful. There is no lack of those who, from the field of human rights, speak of a right to die and to be killed. The right to euthanasia is included among the most fundamental human rights, since it is nothing more than an element of the right to life.
In the cultural field, the excellence and moral dignity of euthanasia is openly spoken of as something superior and advanced, while unconditional respect for life and the very notion of the sacredness of human life are considered obsolete ideas, relics of a religious past that has already been overcome.
In the field of medicine, euthanasia is presented as a compassionate remedy for suffering and as a means to dignify the process of dying, avoiding the harsh test of dependence and precariousness. In addition, euthanasia eliminates the fear of falling into technological abuse, into therapeutic incarceration, and at the same time lightens the health care expense .
The dialectic of the mpe relies on persuasive tactics, on the manipulation of language: it has put into circulation numerous ambiguous or misleading terms, new syntagms of fleeting success, but which poison language and contaminate thought. These are expressions such as end-of-life medical decisions, compassionate release, financial aid a bien morir, withdrawal benign medical care, euthanasia therapy, sweet death, compassionate death, dying with dignity, painless termination of suffering, humane treatment, legally authorized drug overdose, compassionate death by carbon monoxide, or by starvation, suppression of nutrition and hydration as indicated treatment, etc.
I would like to conclude this brief description of the historical and cultural evolution of the mpe by alluding to a feature that seems significant to me: the elitism of the pro-euthanasia movements.
The promoters of dignified death tend to define themselves as a select and enlightened minority. In the pro-euthanasia mentality, dignifying death means both suppressing life undermined by physical or moral suffering and rejecting dependent life. The enemies of human dignity are moral suffering, physical pain, inability to fend for oneself, loss of self-control.
The right to die with dignity is invoked as a right to prevent human dignity from being undermined by extreme disability, dependency, biological or emotional misery. Human dignity, in the euthanasia mentality, is something linked to physical appearance and social dignity. It is a direct inheritance from pagan antiquity, in which possessing dignity consisted in having class, money, physical prestige, titles, influence. It is the antipode of ontological dignity, proper to the pro-life mentality, which is intrinsically possessed by every man, inalienable, immune to the influences of fortune or grace, refractory to the process of getting sick and dying.
Palliative medicine has cornered the notion of euthanasia as liberation from insufferable pain. Thus, pro-euthanasia activism, when the idea of killing to free from pain is no longer justified, has been forced to take a new direction: the dignity of dying now consists in one's absolute control over the final phase of one's own life. In the new context, the physician has very little to do, since the enemy is no longer the advanced disease, with its pain, but the loss of self-sufficiency, the impossibility of living independently, the humiliation of renouncing one's own social image, until then prestigious and aesthetic.
In recent years, the MPEs have been advocating the vindication of the right to die with dignity as the crowning achievement of ethical progress, proper to people of penetrating vision and advanced ideas, who form a cultural elite, a minority freed from prejudices and superstitions.
At the heart of the pro-euthanasia mentality, therefore, is a rather aristocratic notion of quality of life. Some surveys have shown that there is a close correlation between social class and Degree of intellectual self-esteem, on the one hand, and adherence to pro-euthanasia activism on the other. Euthanasia promoters present themselves as the leaven in the dough, as leaders and liberators who will transform society. Their arguments and examples are, if not selectively, then preferentially aimed at select and influential groups. It is not surprising, therefore, to learn that, in the United States, support for euthanasia is markedly lower among the elderly, African-Americans, the poor and those who practice religion than among the more privileged classes. It is not surprising that, today as in the past, certain politicians, artists or writers are seduced by this mentality and the advertising that goes with it.
This elitist bias, which equates human dignity with quality of life and aspiration to excellence, is worrying. The tyranny of quality of life is thus established: when it falls below a critical level, life loses its appeal: it ceases to be a highly valued good, it lacks value and does not deserve to be lived. And that is a dangerous idea.
I know that today it is considered distasteful to connect the liberal euthanasia of our days with the Gnadentod of Nazi Germany. But it would be a mistake to forget history. Leo Alexander, just 50 years ago, in studying Nazi euthanasia, noted that it all began with minimal beginnings. It all consisted at the beginning of a subtle deviation, of accepting that, on a theoretical level, there are lives that are not worth living. Alexander says that the tiny lever that activated the whole change in mentality was the attitude towards the non-rehabilitable patient. And that is where we are debating today.
B. Intangibility of human life: reasons for medical ethics.
In medicine, there are many exciting problems to reflect on, debate, write about and talk about. Euthanasia is one of the most significant, one of the most transcendental: it is not an exaggeration to say that the essence of the Medicine of the future depends on the position that the medical profession takes on euthanasia.
The discussion on euthanasia divides the minds of physicians, just as it divides society. It may be that some physicians are still perplexed and irresolute in the face of this serious problem, but it seems to me that no one with ethical blood in their veins is indifferent to topic .
In spite of what some media say, the vast majority of doctors' professional convictions include the certainty internship that euthanasia is not a medical solution to any of their patients' problems. This is a thoughtful, matured conviction, which has not shied away from careful consideration of opposing views and which, since Hippocrates, has become part of the codes of professional ethics. For many physicians, moreover, the rejection of euthanasia is also part of their religious certainties.
Why, from the point of view of the professional ethics of medicine, should internship euthanasia not be legalized? There are many reasons. Due to time constraints, I will discuss only those that seem to me to be the most significant.
Respecting terminal life is part of the medical vocation.
Physicians are very different from one another. There are, throughout the world, very different ways of practicing medicine, but there is a common vocation: "the vocation of the physician," says article 1 of the Principles of European Medical Ethics, "is to protect the physical and mental health of man and to alleviate his pain with respect for the life and dignity of the human person". From this vocation, from this common ethical core of respect for the life and dignity of persons, emanates the rejection of euthanasia.
That euthanasia and therapeutic overkill are conduct incompatible with medical ethics is affirmed by the two Declarations of the World Medical Association association (1988 and 1992) on subject. And it is reiterated, in very different formulations, by the codes of ethics and medical deontology of countries on all continents. Not a single fissure can be detected in this common tradition, which also includes the positive mandate to alleviate suffering and apply palliative remedies. Significantly, the Rules of Conduct for Physicians of the progressive Royal Dutch Society of Physicians are silent on the physician's relationship with the terminally ill patient, a silence that means a great deal.
This rare unanimity, in time and space, on the intangibility of human life approaching its natural end should give us pause for thought. By very different paths (utilitarian arguments, healing vocation, moral imperative, adherence to professional traditions), one arrives, in different cultural areas, at the same firm conclusion: euthanasia is not a medical intervention. The times in which we live are not very propitious for proposing and defending absolute, monolithic moral norms. Not only are they not fashionable: the dominant postmodernism flees from hard ethical convictions. It must be concluded that this mandate of respect for terminal life belongs to the core of the medical profession. This is an evidence-based affirmation, a kind of worldwide referendum voted by physicians in their professional codes of ethics.
There are, of course, doctors all over the world, the Kevorkians and the Cohens, who are fierce euthanasia activists. According to some surveys, there is no lack of doctors who believe that such interventions could be tolerated in very exceptional, tragic and difficult to evaluate situations, but who pray to God never to encounter them.
2. Euthanasia is not for doctors.
The stories published by a small issue of Dutch doctors who have practiced euthanasia show them full of doubts and perplexities, undecided, almost paralyzed, between the intellectual acceptance of euthanasia and the existential repugnance of putting an end to a human life. They tell us that they have had a very hard time.
In contrast to this reluctant and uncertain attitude of physicians towards euthanasia, the theorists of dignified death, among whom the professors of Philosophy moral and Criminal Law abound, not only approve of these liberating interventions, but are enthusiastic about them, to the point of declaring that, if they knew how to practice them, they would have no objection to administer euthanasia or help those who asked them to do so to commit suicide.
In a article with a mild appearance and a profound message, a Canadian professor of internal medicine and medical ethics takes as his starting point the uninhibited attitude of philosophers to offer us a proposal that is as brilliant and intelligent as it is ethically unacceptable. He proposes that philosophers be granted legal authorization to practice euthanasia. Let it be precisely those convinced and rational activists of death with dignity, and not the doctors, who do the work. It would not cost them much to learn the lists of euthanasia drugs capable of causing sweet death, the doses necessary in each case, the routes of administration, and even how to treat the unwanted effects of these treatments.
Philosophers, in the Canadian professor's opinion, have all the advantages: they have neither taken a professional oath to respect life as we physicians have done, nor are they bound by professional codes of ethics. In addition, patients would not lose confidence in physicians, since they can always be sure that we are exclusively concerned with restoring health and preserving life, never with ending it.
Moreover, decision-making would be much quicker and more expeditious: in contrast to physicians, who are so slow and hesitant when assessing individual cases, philosophers seem to be on firm ground when it comes to determining who is and who is not a taxpayer of euthanasia, or when it is and is not acceptable to help another to die. From what they write and speak, they see everything clearly. That clairvoyance of philosophers would ensure that the law would never be circumvented or broken by emotional interference: their lucid, razor-sharp thinking, immune to the irrational and the prejudices of experience, would prevent mistakes.
From the Canadian professor's proposal , as brilliant and humorous as it is cynical and reprehensible, one solid consequence can be deduced: that, should euthanasia be decriminalized, physicians are, of all those who populate the earth, the least qualified to be in charge of putting an end to the lives of the sick.
3. Euthanasia destroys the ethics and science of medicine.
What would happen if legislation came into force authorizing euthanasia, decriminalizing homicide by disease at internship ?
To some, the answer I give to this serious question seems too strong, too exaggerated. But, in spite of their arguments, I maintain it without amendment. If I exaggerate, I exaggerate on the side of truth.
My answer is this: legislation tolerant of euthanasia, no matter how restrictive it purports to be on paper, would not only brutalize physicians who do not object to it, but would damage the ethics of medicine as a whole and impoverish its science.
Let us begin with the calculation of the scientific consequences. Would the capitulation of the physician to euthanasia cause undesirable effects for the science of medicine? I think so. For, if physicians were to work in an environment in which the equally valid alternatives were to treat the patient or to end his or her life, they would become indifferent to certain difficult clinical situations and to certain types of patients. The quality of medical care would slowly but inexorably decline. In addition, and in the long term, the research in vast areas of pathology would wither away.
Let's take a few examples. If a physician were to conclude that sweet death is an effective and economical remedy for patients with advanced Alzheimer's disease, how could he be motivated to participate in programs of study on the causes and mechanisms of brain aging, in clinical trials that seek to treat and rehabilitate patients suffering from profound dementia? Or, if the patient with disseminated and terminal cancer is offered cooperation with suicide as the correct therapy for his disease, who is going to be interested in the mechanisms of tumor dissemination, in the correction of metabolic disorders induced by the mediators of cachexia, or in interventions that seek to prolong and give quality to that life? The same could be said of the research on the prevention and correction of hereditary defects of metabolism or of the development. What interest could there be in applying the knowledge of the research genomics to the treatment of these metabolic or malformative diseases, when neonatal euthanasia or eugenic abortion offer the possibility of disengaging from them and their victims at very low cost?
I am persuaded that research in Medicine can suffer impoverishment when some of its most pressing and difficult problems are absorbed into euthanasia.
Let us now try to calculate the ethical decline that threatens medicine when euthanasia is decriminalized. The math is not difficult to do.
I think it is possible to distinguish, in this process of ethical decay, four stages.
The first corresponds to the time of rigidly restrictive application of the legal rule . Decriminalizing euthanasia begins by meaning that compassionate and painless death is an exceptional form of treatment that is only licit to apply to certain extremely dramatic and desperate clinical situations, under strict and meticulous control of the conditions established by law.
The second phase corresponds to the habituation period. After a period of time, short in years of compliance with the law, inevitably, the accumulation of cases gradually deprives euthanasia of its exceptional character. The idea that euthanasia is not without its advantages, that it is an acceptable and effective therapeutic intervention, is slowly taking hold. So effective, in fact, that physicians should not refuse it to patients who request it. Among other reasons, because euthanasia, compared to palliative care, is undoubtedly quicker, more aesthetic, cheaper and painless. For certain special patients, euthanasia, the sweet death, is an enforceable right that should not be denied them; for those close to the patient, euthanasia is a temptation to be free of worry and discomfort; for certain physicians, it is a simple resource that saves time and effort; for health care managers, always obsessed with reducing costs, it is an intervention with an optimal cost/effectiveness ratio.
The third phase is reached when decisions about death become commonplace due to the popularization of living wills and advance directives, or the introduction of patient self-determination laws. There is then a real risk that doctors and nurses, fascinated by ideals of justice and efficiency, will become surrogate proxies for terminally ill patients. Faced with a patient unable to express his or her will and who has not expressed it in advance, they reason thus: "It is horrible to live in such precarious conditions. That is not life. I would not want to live like that. Death is a thousand times preferable. The best thing to do in this case is euthanasia". For those who wholeheartedly accept voluntary euthanasia, non-voluntary euthanasia is an inevitable consequence, although they are not unaware that the law requires the lucid and free request of the patient as a necessary condition for the legality of the euthanasia act. This legal requirement is subjectively eclipsed by the imperative of justice, of moral coherence, of those who consider euthanasia to be a genuine medical act.
The fourth phase is reached with involuntary euthanasia. The utilitarian bias, inherent in the euthanasia attitude, leads certain physicians to conclude that the tacit or expressed desire of certain patients to continue living is irrational, since they have an abhorrent, unproductive or abusively costly prospect of life ahead of them. This doctor reasons as follows: the lives of certain patients capable of making decisions are so lacking in quality, require such high expenses, consume so much time and dedication of doctors and nurses, that they are not worth living, they are not worth living. The desire of these patients to continue living is an unfair desire, which causes an irrational consumption of economic and human resources. There are a thousand better places to spend that money and work effort. In the context of beneficial euthanasia, it is very easy to expropriate the patient's right to decide for himself: others, with greater knowledge, decide for him and for his life.
Is this four-phase model a creature of fiction or is it, in reality, a calculation based on data? I believe that a realistic description of what is already happening in Holland and Belgium, that great social laboratory where euthanasia is being tested, can give us the answer.
C. status created by permissive laws: Netherlands, Belgium, Oregon
Where euthanasia is introduced, there is a slow but unstoppable process of brutalization of the physicians who consider it ethically acceptable. These physicians become cynical and insensitive.
In the Netherlands, the internship of euthanasia is expanding. From year to year more and more applications are found. In addition to statistical figures, which are misleadingly low, this is confirmed by court rulings and the reports of physicians themselves. Euthanasia, only authorized by law for those who request it freely and insistently, is also applied to those who are incapable of requesting it. Curiously, this illegal internship has received the blessing of the judges. Doctors who have broken the law, having given sweet death to malformed neonates, brain-damaged children, depressed patients, elderly patients with pneumonia, comatose patients, senile insane or healthy but tired of living individuals, all conditions not provided for by law, received at the end of the legal proceedings not only acquittal, but congratulations from the judges: their actions had served to expose the imperfections of the legal rule .
The committee appointed by the Dutch Attorney General has reported on more than one occasion that its investigations reveal that doctors only notify the authorities of a part, less than half, of the cases of euthanasia they practice, when the law obliges them to report all of them. From the anonymous surveys made to physicians, it can be deduced that the patient intervenes in the process of deciding the end of his life in only half of the cases, since in 40% of the cases it is not possible because of the weakened state of his conscience. However, a more alarming fact is that 10% of the patients whose lives were ended by general practitioners were not invited to participate in such a momentous decision when they could have done so: the physicians, for paternalistic reasons, ended their lives without warning their patients. These physicians suspected that, if the patients had been warned that they were to be administered the sweet death, they might have objected to being victims of an unsolicited euthanasia.
It is even more surprising to note that the internship of involuntary euthanasia is not exclusive to the Netherlands. It is practiced with even greater intensity in the Flanders region of Belgium and in Australia. As is known, euthanasia has not received legal approval in these two countries. But, it is claimed, society, including certain physicians and judges, as is the case in the Netherlands, accepts that physicians terminate the lives of their patients when they deem those lives to be worthless.
In the face of these flagrant but unprosecuted abuses of the law, the Royal Dutch Society of Physicians has been recommending since 1997 that its members abandon euthanasia in favor of the financial aid medical approach to suicide, which is immune to many of the reported misuses of legal euthanasia.
The Dutch experience sample clearly shows that, in subject of euthanasia, it is not possible to set legal limits to actual abuses. Euthanasia is facilitated by a mixture of different factors acting synergistically: the physician's deadly compassion, the family's fatigue, the wear and tear of social control mechanisms, the patient's feeling of withdrawal or leave self-esteem. goal In an environment of social acceptance of euthanasia, the physician's compassion is distorted, becomes instinctive and irrational, and ends up justifying behavior that no longer respects the freedom and conscience of the patient or the professional judgment of good medical internship .
Among the things that the Dutch experience teaches us is this: that euthanasia replaces medicine. The numbers tell us so: If we put in common language, and not in the technical-legal language of Dutch law, the reasons for internship euthanasia, we find that if we add up the 3000 declared cases of voluntary euthanasia, the almost 400 of suicide with medical financial aid , the 1000 of termination of life without request of the patient, the 3000 in which treatment was administered with the intention of anticipating death and the 17000 in which death was caused by not initiating or fail treatment with the explicit intention of hastening death, we find a total of about 24000 cases that, in the whole world, are considered to be cases of euthanasia. They come to represent a little more than one in four deaths. In other words, in more than a quarter of the patients who die each year in the Netherlands, doctors have replaced palliative medicine and terminal care with the efficient resource of euthanasia.
Most Dutch physicians no longer live in a Hippocratic ethical culture. They feel they are pioneers of a new, more rational and liberated ethics. But, with their colleagues in Flanders and Australia, they stand alone and act as a counterexample. When, five years ago, the possibility of legalizing euthanasia was raised in the United Kingdom for the fifth time in the 20th century, the Chairman of the House of Lords Committee appointed for this purpose had the wise intuition that, before making recommendations to Parliament, it was necessary to take a close look at the Dutch experiment. He went, with the members of the Commission, to the Netherlands and after a few weeks of visits to hospitals, contacts with general practitioners, interviews with professional and judicial authorities, they came to the simple conclusion that euthanasia should remain a criminal offence in the United Kingdom. The reason given by the Commission was as sensible as it was elementary: euthanasia cannot be legally authorized because it is impossible to control its illegal internship afterwards.
When laws seem to be applied with a bit of seriousness and control, which seems to be the case with the physician-assisted suicide program, the Death with Dignity Act, in force since 1997 in the State of Oregon, things show a very different face, although it is not without pain. Several things have been seen there. That the financial aid to suicide does not generally have to do with medicine: the reason for requesting financial aid to suicide lies more in psychological reasons (feeling the patient is a burden to others, losing independence), than in causes linked to the disease (pain and symptoms of advanced cancer). That when palliative treatment is offered, most of the requests for financial aid to suicide are retracted. That the 1997 Act responded, rather than to the real needs of the people, to the intoxication of public opinion with Hemlock's pro-euthanasia slogans and to the progressive mentality of some legislators. An analysis reveals the following: there have been a total of 20,700 cancer deaths in Oregon in the three years the law has been in effect. If, as the polls showed, 66% of the population of that State were seriously in favor of assisted suicide, a potential figure of 13,000 requests for financial aid to suicide could be calculated. The fact that in those three years alone 96 formal requests were made for financial aid to suicide and that only 69 of them were consummated, suggests that the legal rules and regulations bears no relation to the real needs of terminally ill patients. Although not statistically strong, it is worth noting that the only demographic variable linked to suicide request was the level of Education: as the level of Education rose, the probability of apply for the financial aid to suicide increased. One more test , albeit weak, of the elitist character of the pro-euthanasia mentality.
In the response it has just given to the request for immunity from prosecution for the person who helped Mrs. Diane Pretty commit suicide, the British Medical association sums up very well the doctors' institutional thinking on euthanasia. "The association ," said its leaders, "opposes euthanasia and suicide by medical financial aid . It accepts, however, that patients may refuse treatments that seek to prolong their last days. And it also accepts that interventions that seek to keep patients pain-free may shorten the calculated length of their lives. But association believes that euthanasia is not only alien to the traditional ethos and moral orientation of medicine, but that, if accepted, it would irrevocably change the context of health care provided to all patients, but especially to the weakest and most vulnerable."
D. Conclusion: rediscovering the value of terminal life.
The terminally ill and the dying are an enigma for everyone: for relatives and strangers, for doctors and nurses. They are an enigma because they impose on us the difficult task of discovering and recognizing, beneath their biologically impoverished appearance, all the dignity of a human being.
For a gaze that sees only appearances, terminal illness, so often accompanied by pain, anguish and anxiety, and biological decay, tends to eclipse the dignity of the sick person: it hides it, it even seems to have destroyed it. Just as being healthy gives us the capacity to reach a certain measure of human fulfillment, being seriously ill limits, in different ways and at Degrees , that important dimension of dignity which is the capacity to develop the project of life that each one of us harbors.
It is not difficult for the physician to cooperate in the restoration of his patient's health while there is hope for a cure. But it is hard for many physicians to recognize the value of their work when, in the trance of terminal illness and the dying process, there is no longer room for that hope. Medical students and young physicians are educated to overcome disease and tend to view death as both a scientific and economic failure. They tend to think that incurable disease, and, even more so Degree , terminal and painful disease, can be of any interest. Trained in a medical culture dominated by pathophysiology, they find it difficult to understand that terminal illness is not only about molecular or cellular disorders that are beyond repair, but also about the human problem of making sense of dying.
In doing so, they ignore one of the most human and professional aspects of medicine. One of the creators of palliative medicine put it very well. He stated that, in his opinion, the strongest medical and human argument against euthanasia is the use he had seen many patients, and their families, make of the final days of their existence, once pain and other symptoms are mitigated. Waiting for death was full of serenity. He added that to remove, by an act of merciful death, that last opportunity to express dignity staff was tantamount to depriving the family and society of the unique value that is concentrated in the final days and hours of a human life.
Euthanasia subverts the ethical tradition of the health professions. These professions were born and have grown driven by the fertile idea of understanding that the weak are important, that they fully possess the dignity of every human being. This idea of Christian origin, it is not difficult to intuit, informed the progress and expansion of medicine. Being weak was degree scroll enough to receive respect and protection. Even being economically weak ceased to be a mark of discrimination for medical care. In this sense, the socialization of medicine constitutes a gigantic historical effort of justice, of homage to the human dignity of all. Today, however, this effort seems to be suffering from an intense ethical fatigue. partner There is open talk of reducing the admittedly gigantic costs of health care; of rationing medical care, of stratifying care, not according to its benefit/cost ratio, but according to the patients' economic conditions (age, ability to pay, state of health).
Medicine thus runs the risk of becoming an instrument of social engineering. But that is an idea totally foreign to the ethics of health care. The specific thing of doctors and nurses is to help, with their knowledge and skills, human beings who live the crisis of losing their physical vigor, their mental Schools , their life.
I believe it is worth insisting on this idea: respect for the dignity of man takes on a peculiar and specific form in medicine: respect for debilitated life. Palliative medicine is justified by the recognition of the final and extreme fragility of man who cannot be abandoned, for to do so would be to subject him to the most hurtful contempt.
Res sacra miser. A sacred and miserable being. With this denomination of Christian-Stoic origin, the special status of the humanity of the terminally ill person is magnificently expressed. It translates marvelously the inseparable coexistence of the sacredness and dignity of all human life with the misery caused by illness. When the sick person is considered in this light, as something both dignified and miserable, we have found the ultimate foundation of the ethics of medicine, the strongest condemnation of euthanasia that can be conceived.
Euthanasia and the medical financial aid to suicide are putting to test the true humanity of physicians and of all men. To overcome this test the physician has the firm support of the timeless ethics that is inscribed in the very nature of the medical act. And we all have the resource of the Christian faith. Blessed Josemaría Escrivá memorably said: "This world will be saved [...] not by those who try to narcotize the life of the spirit, reducing everything to questions of economics and material well-being, but by those who have faith in God and in man's eternal destiny. And he added, anticipating the motto of this seminar, that "faith is [...] certainty that neither science nor conscience [...] can accept reasons of lying efficacy".