JAMAICA THEOLOGICAL SEMINARY

A GROUP PRESENTATION ON SUICIDE AND EUTHENASIA AND ITS LEGAL

AND ETHICAL ISSUES AND THE RESPONSIBILITY COUNSELLORS HAVE IN
CHANGING THEIR CLIENT’S MIND

SUBMITTED TO

MRS. ANGELA WORGES

IN PARTIAL FULFILLMENT OF THE COURSE

LEGAL & ETHICAL ISSUES

DEPARTMENT OF HUMANITIES

BY

RICHARD JARRETT
&
STACIAN ATKINSON

KINGSTON, JAMAICA

July 12, 2010

 INTRODUCTION

It is no secret that euthanasia and suicide are becoming more prevalent in the

Caribbean society and because it raises questions about the morality of killing, the desire

of the client as well as the duties and responsibilities of counselor, makes euthanasia and

suicide two of the most acute and uncomfortable contemporary problems in ethics,

especially bioethics. With medicine’s new technological capacities to extend life, the

problem is much more pressing than it is in the past and as such, the practice of

euthanasia is more widespread, but not openly labeled as such. On the other hand, the

philosophical issues concerning suicide most broadly understood as the question of what

role the individual may play in bringing about his or her own death, does put a spin on a

wide range of end-of-life contemporary dilemmas. Despite this, much of contemporary

western culture remains strongly opposed to euthanasia and suicide in that, doctors ought

not to kill patients and counselors ought not to let clients die if it is possible to save

his/her life (Battin 1994, 101).

According to World Health Organization the statistical report of suicides in the

Caribbean are considerably lower than those of the first world countries and euthanasia is

not widely practiced. The statistic however shows that there is a higher percentage rate of

males committing suicide but an even higher percentage of female attempts in the

Caribbean. This is believed to be so because of the religious beliefs held in the Caribbean

that killing is immoral. Both Euthanasia and Suicide are not new problems and they have

been discussed and practiced in both Eastern and Western cultures from the earliest

historical times to the present (Battin 1994, 101)

 As we seek to understand and explore the ethical dilemma in one trying to take

his/her own life, we’ll also seek to examine the counselor’s responsibility if any in trying

to change the client’s mind from an end of life decision whether it is suicide or

euthanasia.

What is Suicide?

Suicide is defined as the intentional, direct and conscious taking of one’s own life

(Sue, Sue & Sue 2003, 383). There are different models of suicide namely, the Medical

model which is committed by the client due to mental illness, the “Cry for Help” Model

which is the client’s emotional state, lacking familial support or having to go through a

broken down love relationship. Another is the “Sociogenic” Model which refers to the

kind of socioeconomic conditions, eg. the client’s environment in which he lives causing

him to feel inferior.

However, in seeking to understand suicide, a clear distinction must be made

between suicide and other expressions such as “suicidal act” and “suicidal attempt”. A

suicidal act is any self damaging act from which the chance of surviving is uncertain.

Nonetheless a suicidal attempt is a non lethal, self inflicted act that has its intended

outcome, death or the appearance of the willingness to die (Thomas 2002, 15). As we

grapple with the various terms and as we may even attempt to construct definitions, may

it remain that most times, suicide is the desire for, and act of, self murder.
 What is Euthanasia?

Euthanasia is seen as an end of life decision and is considered “good death.” Its

primary focus concerns relief from suffering and dying. This can also be seen as mercy

killing whether administered by the individual or the caregiver. It is also considered

“assisted suicide.”

Some reasons for euthanasia include:

 Unbearable prolonged pain and suffering

 Terminal debilitating illness

 Instances where the person is in a permanent vegetative state (PVS)

 Persons has given up all hope for living

When faced with crises such as these some individuals may choose to take the option

whether legally or illegally, to seek help in hastening their death.

Definitions and Types of Euthanasia

 Euthanasia is the intentional killing by act or omission of a dependent human

being for his or her alleged benefit.

 Voluntary /Passive euthanasia is when the person who is killed has requested to

be killed. (living will)

 Non-voluntary euthanasia occurs when the person who is killed made no

request and gave no consent.

 Involuntary euthanasia occurs when the person who is killed made an expressed

wish to the contrary.

 Assisted suicide occurs when someone provides an individual with the

information, guidance, and means to take his or her own life with the intention
 that they will be used for this purpose. When it is a doctor who helps another

person to kill themselves it is called "physician assisted suicide."

 Euthanasia By Action is intentionally causing a person's death by performing an

action such as by giving a lethal injection.

 Euthanasia By Omission is intentionally causing death by not providing

necessary and ordinary (usual and customary) care or food and water.

Terminating the life of the patient is deemed euthanasia only if the death is

intentionally caused by the act that was done or not done So where a Doctor administers a

very high dosage of pain relieving drugs to a terminally ill patient in order to make them

comfortable, knowing that this dosage can kill the patient may be considered "passive

euthanasia" and since the intention was not to take life and is not considered euthanasia

at all. Other such acts include not commencing treatment that would not provide a benefit

to the patient, withdrawing treatment that has been shown to be ineffective, too

burdensome or is unwanted, and the giving of high doses of pain-killers that may

endanger life, when they have been shown to be necessary. All those are part of good

medical practice, endorsed by law, when they are properly carried out

(http://www.euthanasia.com/definitions.html).

In instances where the patient on a life sustaining machine, such as the heart or

lung machine because the patient no longer can do these functions for themselves a clear

definition of death needs to be established. This is necessary to determine whether

prolonging the life of someone on life support is euthanasia or life had already ceased and

therefore not murder.

What is Death?

Medicinenet.com gives the legal definition of Death as:

1. The end of life. The cessation of life.

2. The permanent cessation of all vital bodily functions.

3. The common law standard for determining death is the cessation of all vital functions,
traditionally demonstrated by "an absence of spontaneous respiratory and cardiac
functions."

4. The uniform determination of death. The National Conference of Commissioners on

Uniform State Laws in 1980 formulated the Uniform Determination of Death Act. It
states that: "An individual who has sustained either (1) irreversible cessation of
circulatory and respiratory functions, or (2) irreversible cessation of all functions of the
entire brain, including the brain stem is dead. A determination of death must be made in
accordance with accepted medical standards." This definition was approved by the
American Medical Association in 1980 and by the American Bar Association in 1981.
(http://www.medterms.com/script/main/art.asp?articlekey=33438 accessed July 10, 2010)

The counsellor may be faced with client or clients whose relatives have a living will or

advanced directive which either gives another the responsibility to carry out their wishes

in end of life decisions or orders of their wishes in these situations which may go against

the morals of the client or his or her relatives. These documents are legal documents

which should be honoured.

Although euthanasia is not legal or widely practiced in the Caribbean a form of passive

euthanasia is practiced. Based on world trends it would seem that legislatures have no

intentions to make it legal in the near future if ever at all. Several countries and states
allow euthanasia or physician assisted suicide, these are usually allowed under strict rules

in order to protect the rights of the patient. These countries are as follows:

Belgium – both euthanasia and physician-assisted suicide legal since 2002.

Columbia – euthanasia approved by the constitutional court in 1997 but not ratified by
congress, physician-assisted suicide is illegal.
Germany – Euthanasia is illegal but physician-assisted suicide has been legal since 1751.
Luxembourg – Both euthanasia and physician-assisted suicide legal since 2008.
The Netherlands (Holland) – Both euthanasia and physician-assisted suicide legal since
2001.
Switzerland – Euthanasia illegal, but physician-assisted suicide legal since 1942.

Assisted suicide is legal in three US States and legal in a limited way in one. These are
:
 Oregon which in 1994 established the Oregon Death with Dignity Act, which
legalizes physician-assisted dying with certain restrictions
 Washington,
 Montana, and
 Texas’ Futile Care Law which allows in some situations, hospitals in Texas and
physicians the right to withdraw life support measures, such as mechanical
respiration, from terminally ill patients when such treatment is considered to be
both futile and inappropriate.

In the countries which permit euthanasia and physician assisted suicide, such as the

Netherlands there are strict laws governing this practice. The laws did not give the

doctors an open “licence to kill,” but have to follow strict guidelines, such as:

 the patient must be adults;

 have made a voluntary;

 well-considered and lasting request to die;

 must be facing a future of unbearable suffering; and

 there must be no reasonable alternative.

 A second doctor must also be consulted and life must end in a medically

appropriate way. (cnn.com)

 What is the ethical dilemma of trying to take your own life?

Looking at theology of suicide it extends logically, to consider ethics, for ethics is

about right and wrong. And so evaluation becomes a concern for Divine authority. For

example, how ethically acceptable is it to take your life instead of faces any other issues?

Suicide, normatively considered, is contrary to Divine purpose and so is ethically wrong.

Suicide even under the stressful conditions of possible crisis is wrong. Regardless of the

circumstances, suicide should not be considered as a virtuous act, but as something that is

wrong. Our reason for considering suicide as wrong is primarily because it is an act that

violates the dignity and sacredness of human life. It cannot be justified for ritualistic

purposes. In ancient society, persons were forced to commit suicide for ritualistic

purposes.

Human beings are distinct in that they are created in the image of God and

therefore, the taking of one’s life is an effort to annihilate God’s image in man. In

addition, to take the decision to end ones life is to overstep the boundary of one’s

authority because only he who gives life is authorized to take it. Hence, only God gives

life and therefore (He) alone should be responsible for taking it away.

The ethical dilemma arises when the individual’s right to end his life based on

autonomy, conflicts with nonmaleficence and Christian ethics. According to Corey, for

the Christian the sanctity of life must be preserved. The bible endorses this as is seen in

Ps.139:13, and the fact that life is God given. It is God who gives and takes life as seen in

Job 14:5. The Christian Counselor’s moral position would be based on the 6th

commandment that thou shall not kill, or in some versions thou shall not commit murder.
Therefore there is no distinction between thou shall not kill (commit murder) or mercy

killings.

Do counselors have any responsibility to try to change the clients mind?

It is the counselor’s responsibility to ask what the client's problem is, what might

be causing or is the cause of the problem, how the problem is affecting the client and

others, as well as to try and find a treatment or solution making suggestions of

alternatives to the client’s decision to end his life.

Even though these responsibilities are clear, opposing suicide and euthanasia

could be seen as a serious moral error in some instances. One might ask on what

grounds? This is so on the grounds of autonomy and justice. It shall be argued for the

rightness of granting a person humane, merciful deaths, if he or she wants it, even when

this can be achieve only by direct and deliberate killing. Autonomy goes further in the

case of suicide as it is the counselor’s position to acknowledge the right for his/her client

to choose and to also act in accordance with the wishes of the client. (Corey 2007, 17).

Not excluding paternalism, it is the responsibility of the counsellor to safeguard the

interest of the client who cannot do so for himself in some cases of euthanasia and so if

the client’s interest is of such, then he should be given the privilege to exercise his

interest. Moreover, if the client signs a living will or a Do Not Resuscitate Order (DNR)

it has now become legal for the client to determine his/her death.

While it is deemed necessary and important to know the client's freedom to

exercise autonomy which the counsellor should acknowledge, it is also the responsibility
of the counsellor to exercise authority of duty. In carrying out such authority it is the

counselor’s responsibility to exercise nonmaleficence which is to avoid doing harm

which includes refraining from actions that risk hurting clients. It is the responsibility of

the counsellor to not engage in any practices that have the potential to result in harm. It is

on this principle that the counsellor would exercise authority in challenging the client to

change his mind. Additionally the counselor is responsible to take the position of

acknowledging the sanctity of life which is to treat all living things as intrinsically

valuable knowing the value that is place on sustaining lives especially in the Caribbean is

immensely high and as such people go to all ends to ensure that life is preserved.

Taking one’s life not only affects the immediate family members and close

friends but society at large. A client wanting to take his/ her own life is also taking away

from society. The sudden and intentional death of someone robs society of the great if not

potential contribution he/she could make and the lasting impact for further growth and

development to that specific geographical location.

 CONCLUSION

The ongoing debate over the reasonability and acceptability of an individual to

take his/her own life whether self inflicted (suicide) or assisted suicide (euthanasia),

either way challenges the ethics, morals and values of those who may counsel them in

light of modern culture or ethnicity. For the counselor to be in a position to these

individuals with these end of life decision he/she must be clear on the issues and properly

assess each case presented to them in light of the ethical principles of authority of

God/conscience, authority of duty, autonomy, nonmaleficence, sanctity of life and

paternalism.

Reference List:

Battin, Margaret Pabst. 1994. The Least Worst Death: Essays in Bioethics on the End of
Life. Oxford University Press. New York.

Corey, Gerald. 2007. Issues and Ethics in the Helping Profession: Seventh Edition.
Thompson Brook. USA.

Moreland, J.P. and Rae, Scott. 2000. Body and Soul: Human Nature and the Crisis in
Ethics. Intervarsity Press. USA.

Sue David, Derald Wing Sue & Stanley Sue. 2003. Understanding Abnormal
Psychology: Seventh Edition. Haughton Mifflin Company, Boston MA. USA.

Thomas Donovan A. 2002. Confronting Suicide. Helping Teens at Risk. Youth House
Publishers. Kingston Jamaica.
Internet Sources:

http://www.euthanasia.com/definitions.html accessed July 10, 2010.

http://www.medterms.com/script/main/art.asp?articlekey=33438 accessed July 10, 2010