Friday, December 20, 2013

Euthanasia and Assisted Suicide.

A nursing home in Norway, Thomas Bjarkan, (Wiki..)

by Louis Shalako

One of the foremost ethical dilemmas of the 21st century will be the question of euthanasia and assisted suicide.

Would you help someone to die if they asked you?

Would you help your own child to die if they were terminally ill and their lives were nothing but an unremitting hell of unbearable suffering?

Do we have the right to die on demand or to demand that on behalf of our children?

If we ourselves asked for an assisted suicide, should our wish be granted?

After much controversy, Belgium has approved euthanasia of children.

“"Why wouldn't you give children, who are incurably sick and who are unbearably suffering the same possibilities adults have?" asked Dr. Jan Bernheim from the research team for terminal care at the Free University Brussels, speaking to DW before the law was approved.”

“In Belgium euthanasia implemented by doctors has been legal for 11 years. Almost 1,432 elected to be euthanized in 2012 alone.” The population of Belgium is about 10.8 million.

“The debate over euthanasia has heated up over the last few months after several spectacular cases emerged. In the October version of the Belgian magazine ‘Panorama,’ TV journalist Dirk Leestmans reported on a detainee who was granted the right to be euthanized.

“The inmate said the detention and the conditions in jail had caused him extreme psychological suffering and he therefore wanted to die. The case is still being reviewed by the courts. The inmate hasn't been euthanized yet, but his request seems poised for approval.”

“This is not the only case that created an international sensation. At the beginning of October, a 44-year old, going by the name of Nathan, was euthanized after a failed sex change operation. He said his wish to die was legitimate because of unbearable psychological suffering.”

“Carine Brochier of the European Institute of Bioethics in Brussels says, ‘Family members, hospital staff and doctors are extremely burdened by the euthanasia law.’”

"Euthanasia is not easy. It's not fun to kill someone. Euthanasia is really killing and that's not good for the person doing it, even if it is to kill suffering. It's also killing society," Brochier said.
Euthanasia has been around for a long time. It’s nothing new. It goes back to the Stone Age.
France is slowly moving towards assisted suicide.

“On the strength of the panel’s recommendations, left-wing daily LibĂ©ration expects the socialist government to present a draft text by next summer, although widespread grassroots opposition earlier this year to the legalization of same-sex “marriage” might make president François Hollande wary of bringing yet another sensitive issue to the fore.

“It is the President himself, however, who decided last September to have the National Advisory Ethics Committee (CCNE) assemble a representative panel of French citizens chosen by a commercial polling company, IFOP, so that it could express ordinary people’s opinions on end of life. The 18 ‘sages’ gathered for four consecutive weekends in order to hear officially mandated experts, many of them favorable to at least one form of voluntary ending of life, including Jean-Luc Romero, president of the Association for the right to die with dignity (ADMD).”

From the same story comes the following.

“’The possibility of committing suicide with medical assistance, as well as assisted suicide, constitute in our view a legitimate right of the patient who is in the end phase of his life or who is under the burden of an irreversible pathology, a right which rests mainly on his informed consent and full consciousness,’ they write.”

 “In practice, this would mean non-terminally but incurably ill patients – such as tetraplegics – should be eligible for this type of assistance, which is in fact akin to homicide.” (Life Site News.)

(Tetriplegic is another term for quadriplegic. – ed.)

The wording is significant, as it entails the right, “…to obtain medical help in order to finish life with dignity.”

The B.C. Supreme Court upheld the province’s ban on assisted suicide, which will now be appealed to the Supreme Court of Canada. It’s important to see the distinctions.

Euthanasia is present in all societies. It is simply not much talked about. It’s not exactly the same as assisted suicide.

A friend’s dad was on a respirator after a major heart attack. A doctor spoke with the family after two weeks and told them there wasn’t much hope for recovery.

Under Canadian law, patients or anyone who makes a will can specify that ‘no extraordinary means’ will be used to keep them alive in the event of a major medical event.

My friend’s sister and mother could not bring themselves to do it. That left it up to my friend, and there’s no doubt it affected him deeply. He and the doctor put their hands on the switch at the same time.

They turned the respirator off. His father died of complications resulting from a heart attack. They have to put something as the cause of death on the official death certificate. He was eighty-seven years old.

The end of a life.
My own father suffered from Parkinson’s Disease and after ten years, his condition was deteriorating on a daily and weekly basis. He was having a lot of falls, and a lot of choking incidents, and his quality of life was not very good. And yet he was prepared to continue living, which is only normal—he would have very much liked it if medical science had found a cure for Parkinson’s Disease. Whenever something happened, he would be bedridden for some time, and then he seemed to be recovering, but never to the level he had enjoyed before. That is a feature of Parkinson’s.

I got the call about six a.m. one morning. He’d had some kind of problem, and he was in the hospital. His lungs were full of blood, and he was unconscious, and yet with his eyes open, wide and staring at the ceiling. 

With my siblings all there, the doctor asked us what we wanted to do. 

The sound of his breathing was horrifying. That great body wanted to live, but Parkinson’s had killed him, or it was killing him. Finally.

The doctor explained as we agonized.

“We can operate, but there’s no telling if we can really do anything for him…or what would be left if he did regain consciousness.” The doctor’s voice was calm and sympathetic, but he’d clearly seen all of this before. “I can give him something to make him more comfortable—”

"So what are you trying to say, Doctor?"

"Your father is dying. Here, today, in this room. You need to understand that. It's really just a question of how long."

We decided that that was the thing to do—to give him something to make him more comfortable, and my siblings left the room while I took a turn, holding onto my father’s hand, and the nurse stuck a big ampoule of something into him.

It’s hard. There’s nothing harder than easing your loved one into the afterlife or the next world, which I don’t really believe in.

I thought his breathing would just stop, and he kept going. My siblings weren’t prepared to deal with this, and as the eldest I took a lot of responsibility for my father that day.

I was glad they were out of the room and didn’t have to see this. My sister just couldn’t handle it and my younger brother wasn’t much better.

It was a way of acknowledging my father, for all the responsibility that he took for his children over the years. 

It was the right thing to do for a first-born son. He had expressed his wishes clearly for us, and had signed the declaration while still of sound mind, although his body was ravaged by the disease.

My father’s suffering was finally over, and there was nothing there to bring back. It would have done nothing more than to extend his suffering. It’s not that I haven’t thought about it since.

What if we had gone ahead with an operation? He might have lived another six weeks in a hospital bed, and the next medical crisis would have killed him anyways. Why put him through that suffering, why put the rest of the family through all that?

But to go against his wishes, clearly stated, would be wrong. To keep him alive by extraordinary means would have been wrong.

There was no doubt my father was going to die—the question was how long it would take. Three hours, three days, three weeks—it was going to happen.

The four hours between the time I got the phone call and the time he died was the toughest four hours of my life. When I think about it, I sure wouldn’t want to take four hours when I die—

The really strange thing is that even with three full ampoules of morphine in him, the body still kept drawing in those deep racking, breaths, and that horrible drowning, sucking noise just kept going, on and on.

At some point the nurses came into the room and ushered me out. A few minutes later as I sat in a waiting room, one of them came out and told me that my father was gone.

But that’s why there was more than one family member and more than one medical person involved in the decision. No one should be asked to shoulder that responsibility alone.

Euthanasia probably happens in the western world, it happens in Canada and the U.S., and in every other developed nation that the reader would care to name. It happens even more frequently in the undeveloped world, out of natural human feelings of compassion and empathy.

It happens because it is a necessity, even though we call it something else, palliative sedation.

(Jacob Windham, Wiki.)
So Belgium’s decision to liberalize euthanasia, certainly of the elderly, simply regularizes a situation that already exists, it’s just that no one really wants to talk about it. It’s a serious subject and a troubling one at that.

Those laws will benefit the survivors. It will take some of the burden off of them, and the doctors, but with reasonable minds and loving hearts, it will never be easy. To take the life of a suffering child, even at the child’s own decision, would be ten times worse for all concerned.

We have to think of the living, their survivors, as well in this debate.

It is certainly possible that there could and most likely would be abuses under more liberalized euthanasia.

Euthanasia is different from palliative sedation, and that is different from assisted suicide. It is a series of issues or questions.

Polls reveal much about the debate and the issues raised.

“Widespread support in Quebec for Bill 52, legislation proposing to legalize ‘medical aid in dying,’ drops sharply when Quebecers are told of the dire consequences similar statutes have brought in other countries, a new poll has found.”

“In the poll, conducted by Abingdon Research from October 24-26, respondents first gave their initial impressions of the legislation and then gave their final impression after being asked their opinion of various scenarios that have come up with similar legislation.”

“Scenarios included doctors killing elderly or disabled people without their consent, doctors helping suicidal teens carry out their deaths, or abusive family members pressuring the elderly to seek ‘medical aid in dying.’”

These concerns are certainly valid, each to some degree, yet it's kind of sensationalized as well, and it’s amazing how fast those poll results can change when the information changes and the presentation changes. But it’s important for voters and citizens to be well-informed and to think about a decision, whether legislative or in their own personal life and circumstances.

“LifeCanada, the national pro-life educational group that commissioned the poll, said the results show that support for Bill 52 is ‘a mile wide but a foot deep.’”

That seems like fair comment, but then this is a contentious issue—and respondents are sophisticated enough to know that. We probably don’t spend enough time thinking about many of the political and social issues of the day.

What’s interesting about the Canadian body politic is that it’s not divided up solely on ideological grounds. 

People really had to scratch their heads a bit on this one.

In the twenty something years since the Sue Rodriguez case, has Canada’s social landscape shifted?

A British Columbia group will ask the Supreme Court that question. (National Post.)

“Four months after the 1994 decision, Ms. Rodriguez died by assisted suicide in her B.C. home. The procedure, a lethal injection, was carried out illegally by an anonymous doctor.”

“’This is a matter of extreme urgency; the fate of gravely ill Canadians hangs in the balance,’ said Grace Pastine, litigation director for the B.C. Civil Liberties Association, which launched the case in 2011.”

There are some important distinctions to be made, questions to be asked.

What is the difference between the merciful easing of a terminally-ill elderly person into death, and the assisted-suicide of a younger person whose ailment makes life unbearable or unliveable?

The ultimate vacation: traveling to Switzerland, the world’s capital of assisted suicide. (National Post.)

Disclaimer: Under Canadian Law it is an offence to counsel to commit suicide, and it is an offence to harm yourself or to try to harm yourself or to threaten to harm yourself. Few serious authors state otherwise.

This author still encourages families and friends to ask themselves these questions, and to discuss them with each other, so that last wishes are known, and actions are open and responsible so that the dying may pass with dignity and so that the living can go on with their own lives without fear and regret.

Here is the Roman Catholic Church’s position on euthanasia.

“No matter how ill a patient is, we never have a right to put that person to death. Rather, we have a duty to care for and preserve life.”

“But to what length are we required to go to preserve life? No religion or state holds that we are obliged to use every possible means to prolong life. The means we use have traditionally been classified as either ‘ordinary’ or ‘extraordinary.’”

“Ordinary" means must always be used. This is any treatment or procedure which provides some benefit to the patient without excessive burden or hardship.”

“’Extraordinary’ means are optional. These are measures which do present an excessive burden.”

The only thing I learned from all of this is that it really is a slippery slope.


Additional Resources.

Living Will. The living will should also provide some direction for end of life wishes, including a statement of whether the loved on would or would not prefer ‘extraordinary means’ to continue life in the absence of any real hope of recovery.

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