Euthanasia - -

DEFINITION The Greek word ¡§euthanasia¡¨ means ¡§to help somebody to a good death¡¨ (¡§thanatos¡¨ = death and prefix ¡§eu¡¨ = good)

In antiquity it wasn¡¦t understood in the sense of simply ¡§helping somebody to die¡¨, but in the sense of dying fast with dignity. Today euthanasia is to be seen as the intentional killing of agonised terminal ill people.

There are different types of euthanasia:

"« Direct euthanasia
In order to shorten somebody¡¦s suffering, death is caused intentionally.
Active euthanasia: to take direct measures, e.g. a lethal injection to help somebody die.
Passive euthanasia: occurs when doctors decide that it is time to remove life support, e.g. to turn of the heart-lung machine.(Nothing is done in order to prevent death)

"« Indirect euthanasia
Measures are taken to quicken the process of dying, e.g. sedatives and narcotics and to make the suffering more tolerable.

PROBLEMATIC
Euthanasia can be traced as far back as to the ancient Greek and Roman civilizations where it was sometimes allowed to help others die.
As time passed, religion increased and life was viewed to be sacred. Euthanasia was seen as wrong and immoral, because it contravenes the principle of Creation.
After the Second World War euthanasia was taboo when the truth of the Nazi excesses leaked out.
During the last years the population¡¦s general acceptance of assisted euthanasia increased.

Assisted vs. Unassisted euthanasia:
Another problem is that many patients who want to die are unable to do so without assistance. Those who are capable of assisting themselves commit suicide with guns, or in other ways, that are even more difficult to understand for those who are left behind.

Generally, there are many different aspects that have to be carefully considered before euthanasia can be performed.
Typically, a request for assisted suicide is a cry for help. It is in reality a call for counselling, assistance and positive alternatives as solutions for very real problems. But this suicidal intent is normally transient. Often patients suffer from a deep clinical depression that is caused by e.g. an accident, but is treatable. They are heavily shocked when they first realise their desire. Another reason why a person often wants to kill him or herself is to avoid pain. Modern medicine has the ability to control pain, and as a consequence of this ability the legalisation of direct and active euthanasia is seen as unnecessary. In my opinion that kind of patients should rather see a doctor better trained in the alleviation of pain.

Another problematic of legalising euthanasia can easily be described by the latest development in the Netherlands. Since voluntary assisted suicide for those with terminal illness was legalised there, it has spread to include involuntary euthanasia for many who do not suffer from that kind of disease; more than half of the killings are now involuntary, and the problems for which death is seen as the legal ¡§solution¡¨ include such as mental illness, permanent disability and simple old age. In my opinion problems are not solved by getting rid of the people to whom those problems happen. The more difficult but more humane solution to human suffering is to address the certain problem.


MEDICAL METHODS:
The medical methods and resulting effects have a large impact on how people view euthanasia. Active euthanasia is mainly performed by the two following methods:

"« A lethal injection
"« Poisoning by inhaling gas (mainly used is carbon-monoxide)

"« Withholding of food and fluids:
not only shortens the life, but it also causes additional days of great suffering. Some of the effects this ¡§treatment¡¨ has on the patient are nausea, vomiting, muscle pain, cough, and shortness of breath. As a consequence of this it is seen as an act of pure cruelty and inhumanity.
The two primary methods of passive euthanasia are:
"« the removal of life support and

"« the removal of necessary medicines.
employing life support and medicines would lead to an unnatural prolonging of life. Removing them does not shorten life, does not place the patient¡¦s family in unnecessary debt, and also does not cause prolonged suffering for the patient or for the patient¡¦s family.

A reasonable approach to the question of euthanasia involves following

Considerations:
First, one should decide that the circumstances are appropriate.
Is the patient on life-support? Is the patient elderly? Does the family believe in euthanasia? Is the patient suffering terribly? Is the patient mentally capable of participating in this decision? If the answer to two of these questions if ¡§no,¡¨ then euthanasia should not be carried out.

The second consideration is what regulations are feasible.
At least three people must be involved in the decision (the patient and the next of kin and the doctor). If the patient is mentally unable to decide, then the closest of kin or the doctor should decide for him. Once again, this decision must be made only when circumstances are appropriate. States should specify how frequently one can sign an euthanasia authorization.
Third, the individual¡¦s right to choose should not be overlooked. Because it is his or her own life, the patient should have full control over its length and quality.
¡§Living wills¡¨ can express the patient¡¦s thoughts towards his or her future medical treatment. These allow the patient to choose beforehand the right not to be put on life support when it is needed, which avoids unnecessary prolonging of life/suffering. Ones rights include life, liberty, and the pursuit of happiness. The pursuit of happiness could also be perceived as the pursuit of quality of life.

A final consideration are the financial and emotional benefits of euthanasia.
If the patient is on life support it does not only cause unnecessary expense, it also causes an emotional burden on the family. The family does not want to see their own relative in pain and suffering for a long period of time. The majority of patients on life-support are not removed until the decision is made to remove it, so cost rise tremendously, but the outcome is the same. "¶ Death.


GROUPS AND ORGANISATIONS:
In this century there have been formed certain groups that are for or against euthanasia. In 1935 the first community which approved the legalisation of euthanasia was formed by group of doctors in London (The Voluntary Euthanasia Society).
The first ¡§society¡¨ established in the United States appeared shortly after in 1938. It was called the Hemlock Society and it now consists of more than 67,000 members.
This society is also of the opinion, that a person must have believed in euthanasia for a certain amount of time before he or she can make the request for death.
The purpose of such organizations is to support a person¡¦s decision to die (e.g. in case of legal proceedings) and to offer support when this person is ¡§ready¡¨ for ¡§the final step¡¨.


JUDICAL HISTORY:
Definition of terms: Euthanasia or assisted suicide
The difference between those to terms is much like the difference between the doctor handing someone a loaded gun to use, or the doctor doing the shooting.
It plays a great role in judging, because in most of the nations the line is drawn between aiding in a human¡¦s death and performing euthanasia.

The first doctor was charged for performing euthanasia in 1935. It was Harold Blazer for causing his daughter¡¦s death by placing a handkerchief soaked with chloroform over her face until she had died. She was a victim of cerebral spinal meningitis and had been taken care of by her father for more than thirty years. In this trial Blazer was acquitted.
The first doctor to be found guilty was Joseph Hassman in 1986. He injected a lethal dose of Demerol into his mother-in-law by request of her family. He was sentenced to two years probation, fined 10,000 US Dollars, and ordered to 400 hours of community service.


DR. JACK KEVORKIAN:

He is definitely the most recent and controversial euthanasia doctor; he was first charged with first degree murder in 1990. He connected Janet Adkins, a member of the Hamlock Society, to his ¡§suicide machine¡¨ which allowed her to a inject lethal drugs into her body at any time by simply pressing a button. But the murder charge was dropped, because at this time there had not existed a law against assisted suicide (in Michigan).
In 1991 and 1992 he attended deaths of several people, but all the murder charges were dismissed.
February 1993, Assisted suicide laws take effects in Michigan and California and as a consequence Kevorkian¡¦s medical licenses in both states are suspended.
In September he was charged with assisting in Thomas Hyde¡¦s and Donald O¡¦Keefe¡¦s deaths (both inhaled carbon monoxide). In both cases he was released on bond on condition that he would not assist in any suicides. A month later another person dies at Kevorkian¡¦s apartment; his bail is increased and as he refuses to post his bond he is jailed; steps on hunger strike; is released three days later as a lawyer posts his bond. Only two weeks later the next person inhales carbon monoxide in Kevorkian¡¦s apartment.
In the next five years he was at least present at the deaths of more than thirty people.

THE THOMAS YOUK CASE:
On the 13th of April l999 retired pathologist Dr. Jack Kevorkian was sentenced in Michigan, USA, to two terms of imprisonment for helping a man suffering from A L S (a degenerative nerve disease) to die. For the 2nd degree murder of Thomas Youk he received a sentence of 10-25 years and for using a ¡§controlled substance¡¨ (lethal drug) he was given 3-7 years jail, the sentences to run concurrently.
A month earlier a jury had convicted him on both counts. The case achieved enormous notoriety, not only for Dr. Kevorkian\'s publicly acknowledging that he had already helped at least 130 other people to die by assisted suicide, but Mr. Youk\'s death in September l998 was by direct injection (active euthanasia). When the law enforcement authorities in Michigan did not move to charge Kevorkian with killing Mr. Youk, he took a videotape of the incident to CBS Television, which aired it in the widely watched news program ¡§60 Minutes¡¨.
On the program Kevorkian challenged prosecutors to act: three days later
Kevorkian was charged with the offences.
The legal case against Kevorkian was, of course, watertight because his video
clearly demonstrated the process of injection. There was no question but that he was guilty in the eyes of the law. The law does not accept that a person can ask to be killed - as Tom Youk clearly did. It is still ¡§murder¡¨ legally. So, in an attempt to persuade the jury that his action had not been ¡§murder¡¨ but ¡§a justifiable act of mercy¡¨, Kevorkian defended himself.
Kevorkian was further hampered by the judge\'s ruling that he could not call the wife and brother of Tom Youk to confirm Tom\'s suffering and that the lethal injection was agreed by all three. (This aspect of the trial is likely to be one of the grounds for appeal.)
On three previous occasions when charged with ¡§assisted suicide¡¨ the juries refused to convict Kevorkian against the weight of evidence. But that did not happen this time. Soon after he started publicly helping people to die in l990, Kevorkian was stripped of his licenses to practice medicine in both states, Michigan and California.
Currently (end of April 99) Kevorkian is in custody as Prisoner # 28479( Oaks Correctional Facility)
Although it has had some reservations about a few cases in which Dr.Kevorkian has aided in a suicide, the Euthanasia Research & Guidance Organization (ERGO!) has fundamentally supported Kevorkian. Also the already mentioned Hemlock Society has also given broad support to him.
Derek Humphry, ERGO! president, who founded the Hemlock Society, said about the conviction:
¡§The severity of the sentence on Kevorkian will drive the practice of voluntary euthanasia and assisted suicide even further underground. It will not stop it. Kevorkian is by no means the only doctor who helps people die - just the one who does so and also openly campaigns for societal acceptance of the practice. Kevorkian\'s martyrdom - self-imposed as it is - will speed up the day when active euthanasia for the dying is removed from the legal classification of ¡§murder¡¨ and recognised as a justifiable act of compassion.\"

WHOSE LIFE IS IT ANYWAY? By Brian Clark

Was originally written as a television play and first appeared in 1972. Later, it became a hugely successful stage play and finally, was filmed.
SETTINGS: Rooms, offices and corridors of a general hospital.
MAIN CHARCTERS:
Ken Harrison: the patient, a car accident left him from neck onwards completely paralysed; just made physically stable, nevertheless he seems to be in a great mental condition; very intelligent, clever and charming; always has one¡¦s say and finds the fitting answer or comment, often ironically; he is realistic, but sees his desire in a rather pessimistic way, due to the facts that he probably wont be able to read or even write again ¡V there can be no question of walking or having an ordinary job;
Has found his solution and argues his right to decide over his own life or death with power and persuasion.

Dr. Michael Emerson: the hospital¡¦s consulting Physician; the ideal doctor, sees life as the highest good and as to be saved in any case; also fights for his right to treat every patient sufficiently, so that he or she will get as well as possible; very humane: After loosing the case legally, he still wants Ken to die with humanity ¡Vsurrounded by doctors, who can take measures that the moment of death at least wont be painful.

Dr. Clare Scott: Junior Registrar; intelligent; well informed about Ken¡¦s case; as a good doctor, of course, she is primary interested in the patients survival, but also able to accept his decision, knowing, that he had carefully considered all aspects; compassionate; still keeps trying to convince him; wants the best for Ken (understands, that there can be a situation, in which life itself isn¡¦t worth to be lived anymore).

Sister Anderson: an elderly and experienced nurse, cares for Ken for quite a while and knows about his jokes and seems to be a bit agonised. In a way she hopes that Ken would be able to find a new sense in life, wants him not to talk so pessimistically;

Kay Sadler: new young staff member, she still has to get used to the mundane side of being a nurse and is impressionable; seems to be very attractive, charming and compassionate; Ken -just in order to cheer himself up a little bit- and also John try to hit on her;

OTHER CHARACTERS:
John: is responsible for Ken¡¦s physical hygiene (e.g. trims his beard), also feels sorry for Ken, but does not show it in his presence; jokes around with him without a sign of compassion.

Philip Hill: a lawyer, convinced to help Ken getting discharged from hospital; has to consider all the legal aspects that are involved in this case; represents the patient ¡§in court¡¨;

Mrs. Gillian Boyle: a medical social worker, who is sent into Ken¡¦s room in order to make him aware of the abilities he will have and to probably make him think about it in a more optimistic point of view; Ken starts to argue and later on shout heavily and gets so furious that he has to be calmed down with oxygen.

Dr. Paul Travers: the hospital¡¦s consultant psychiatrist, is sent to talk to Ken in order to find out, whether Ken is suffering from a clinical depression; In their conversation or not. Mr. Harrison gets distressed due to the fact that he does not know how to prove his sanity.

Dr. Barr: consultant psychiatrist from another hospital ¡V brought in for second opinion
Peter Kershaw and Andrew Eden: Two lawyers brought in to consider the aspects of this case legally;
Mr Justice Millhouse: the judge, makes the final decision, after Ken¡¦s is proved to be mentally balanced;


PLOT:
Ken Harrison, a former sculpting ¡V teacher at an art school, was paralysed in a car accident and just physically stabilised. His state of mind is to all appearances clear. After realising the consequences he will take from this immobilisation and after considering all the possibilities he will have in his future life, he decides that life for him isn¡¦t worth living. Due to the several experiences Dr. Scott and Dr. Emerson have made during their careers they believe that Mr. Harrison is suffering from a clinical depression and - as it is common practice - treat him with tranquillizers. He feels to be withdrawn of the only part of his body he is still able to use (his brain). Knowing that the doctors would try to convince him in any way Ken orders the Sister to call his solicitor before he definitely lets the medical staff to know about his final decision. (End of Act One)
The next mourning Mr Harrison¡¦s lawyer, Philip Hill, comes for a visit in order to talk about an insurance-compensation. Ken explains his situation, that he had coolly and calmly considered and now wants to be discharged from hospital (outside he is not able to live longer than a week). He would need Mr. Hill to represent him in a legal case. The solicitor wants to talk to Dr. Emerson first and wait for his reaction before he decides, whether to help Ken or not. The doctor reacts heavily (not knowing what Hill had exactly come for) and consequently he decides to represent the patient. Mr. Emerson and Mr Hill come to the agreement that a psychiatrist from another hospital is brought in for a second opinion, because he is said to be incapable of making a reasonable decision.
Then, two other barristers (one for Ken and one for the hospital) and a judge are brought in to consider all facts and to decide, if Mr. Harrison is in a clear state of mind. He is judged as mentally balanced, and his wish can be fulfilled, but dies in hospital as a consequence of the refusal of necessary medicines.

EXPLORATION:
The play centres around Ken Harrison¡¦ determination to exercise a choice over his own life or death. Opposing him are the forces of medical bureaucracy. The legal case against him is put by various members of the medical profession with a good deal of humanity, so much so that the issues are presented in all their complexity.