ST.

PAUL HOSPITAL MELLINIUM MEDICAL COLLEGE

School of nursing: medical surgical department

ETHICO-LEGAL NURSING

EUTHANESIA

Group Assignment

Submitted to: Getahun F {Bsc, Msc, MPH, Ass. Professor{

Submission date: December 25/2022

 Acknowledgment

We would like to express our sincere gratitude to Instructor Getahun F for the
guidance he provided us to properly prepare this paper. We would also like to thank
the different authors whose articles helped us to organize this paper.
Table of contents

Contents pages
Introduction …………………………………………………….1
Purpose of burn-out concept analysis …………………………..1
Literature review………………………………………………...
Definition on attributes …………………………………………
Case identification ………………………………………………
Model case ………………………………………………......
Borderline case ………………………………………………
Related case …………………………………………………
Contrary case ………………………………………………..
Burn-out Antecedents ……………………………………………
Consequences of Burn-out………………………………………
Empirical referents ………………………………………………
Conclusion/summary …………………………………………….
References ………………………………………………………..
Summary
 Introduction
The word ‘euthanasia’ comes from the Greek – “euthanatos,” derived from the words ‘eu’
meaning good and ‘thanatos,’ meaning death. It has been defined as – mercy killing of the
hopelessly ill, injured or incapacitated. It is the intentional killing, by an act or omission, of a
dependent human being for his or her alleged benefit. It is “deliberate intervention undertaken
with the express intention of ending life to relieve intractable suffering.”

Euthanasia is controversial due to the involvement of special populations like pregnant women,
children, terminally ill patients, feeding and hydration, brain death and the persistent vegetative
state and those who are mentally ill. Every Person has the right to life. This is outlined under
article 6 (1) of the International Covenant on Civil and Political Rights: “Every human being has
the inherent right to life. The right shall be protected by law. No one shall be arbitrarily deprived
of his life.”[1]
 Objectives

The majore objectives of this paper is to

1. To explore the history of Euthanasia

2. ssess the challenges of euthanasia practice in Ethiopia.

3. To describe the future fate of euthanasia practice in Ethiopia

 History of Euthansia
The word ‘euthanasia’ comes from the Greek – “euthanatos,” derived from the
words ‘eu’ meaning good and ‘thanatos,’ meaning death. It has been defined as –
mercy killing of the hopelessly ill, injured or incapacitated [1].
Debates about the ethics of euthanasia and physician-assisted suicide date from
ancient Greece and Rome. In the 4th Century BC,
The term “Euthanasia” was coined long after it was practiced by the Philosopher
Francis Bacon in the Seventeenth century.
For 2400 years, physicians made these solemn promises. Until very recently (the
last 30 years or so) the Hippocratic Oath was taken by all new physicians. It was a
rite of passage.
The following history lesson will explain why most physicians do not swear the
Hippocratic Oath today—which is very dangerous for their patients.
In 1938: Euthanasia Society of America (ESA) was founded in New York.Goal: to
gain social and legal acceptance for the “right” to kill vulnerable human beings
(people the organization called “mental defectives” and “incurables”).
1939: Euthanasia Society of America {ESA} made its first attempt to legalize
euthanasia.

Legislative proposal for “voluntary” euthanasia—ESA believed the public was

“readier to recognize the right to die than the right to kill, even though the latter be
in mercy.” (ESA pamphlet Merciful Release.)

ESA hoped eventually to legalize the “putting to death of ‘non-volunteers’ beyond

the help of medical science.” (Charles Nixdorff, attorney and ESA treasurer)

After many failed attempts to legalize euthanasia, followed by a period of little

activity, ESA changed tactics.
In 1967: ESA leaders realized that, to be successful, they first had to change both
medical ethics and public morals. They launched a massive educational campaign.
Established the Euthanasia Educational Council.
Introduced the Living Will (first Advance Directive form) as the “foot in the door”
for social and legal acceptance of euthanasia.
1968 and 1973: Rep. Walter S. Sackett, MD, introduced unsuccessful “right to
die” legislation in Florida.
Cost-saving measure which Dr. Sackett said would save billions of dollars “if the
state’s mongoloids [people with Down syndrome] were permitted to succumb to
pneumonia.”
Opposed by advocates for mentally retarded children and the FL Catholic
Conference [2].

History of Euthanasia in Ethiopia

Ethiopia has a threaded chequered political history, transcending from imperial rule to
military dictatorship and presently a democratic regime. Its laws at every point in time
have been tailored and interpreted to suit the ideology and policies espoused by the extant
political authority. In the era of socialism, for instance, which were spearheaded by a
military ruler, Colonel Mengistu Haile Mariam, between 1974 and 1991, the
interpretation and application of Ethiopian laws were given socialist colouration which
imposed obligation on every man, and in the present context a physician, to do all within
his power to save the life of his patient. Liability for failure to act could be based not only
on the specific requirements of the law, but also on the fundamental propositions of the
constitution [3].

Ethiopian penal code of article 547 during Emperior H/Silassie stated that ‘ whosever
intentionally leaves without help in person in imminent and grave peril of his life, person
or health, when he could have lent him assistance, direct or indirect, without risk to
himself or to the third parties is punishable with imprisonment not exceeding six months
of fine” [4]

Since a democratic regime was established, primacy is accorded to an individual’s

inalienable right to self-determination,59 which enables every individual to live his or her
life as he or she desires within the confines of the law, and to die with dignity.

In relation to the subject of this discussion, article 1 of the Medical Ethics for Physicians
Practicing in Ethiopia provides the following:
No doctor can take life deliberately as an act of mercy even at the request of the patient or
the patient’s family [5].

The only duty imposed on a physician, by the tenure of the provisions set out above, is to
explain to the patient the implication of a particular treatment he intends to administer to
the patient and the consequence of the patient’s decision not to accept particular
treatment. The decision to accept or refuse such treatment is entirely that of the patient
(or the patient’s legal guardian if the patient is unconscious or incapacitated in any way).
Once that decision is made, the physician is absolved of any consequence on the patient
even if fatal. This approach is in accord with the Nigerian Supreme Court decision in
Okonkwo’s case, which gave primacy to the right of the patient to self-determination.
These provisions will readily absolve a physician who allows a patient to die by
withdrawing or withholding treatment at the request of the patient, that is passive
euthanasia. They may not, however, be of much assistance to a physician who positively
administers fatal treatment even at the request of the patient or the patient’s guardian. The
withdrawal or withholding of treatment is at best an act of omission which is informed by
the physician’s respect for the patient’s right to self-determination as provided by law [3].

A strong exculpating provision can be found in article 520 of the Ethiopian Penal Code,
Any doctor or any other person lawfully entitled to render professional attention and care,
who contrary to his duty and without just cause, refuses to provide his services in a case
of serious need, whether from indifference, selfishness, cupidity, hatred or contempt, or
for any other similar motive, is punishable with fine. The first element of the offence
created by this provision is that of omission to act which must be ‘contrary to his duty’ as
a doctor. A doctor cannot be said to have acted contrary to his or her duty when the
patient has declined to accept the administration of particular treatment after being duly
informed of the consequence. The patient’s refusal also negatives the second element of
the offence which is ‘without just cause’ as justification is founded on the patient’s
withholding or withdrawal of consent. Incidentally, the incriminating motives
enumerated in article 520 are all personal to the physician, so that once the reason 61
Incorporated as Appendix 1 to the Medical Ethics. 62 Supra note 45. 63 See Negarit
Gazette – Extraordinary Issue No. 1 of 1957. www.chilot.me 190 Anthony O. Nwafor for
not administering treatment can be attributed to the patient, the physician is completely
exculpated.64 It is apparent from the foregoing discussions that in spite of the provision
of article 1 of the Medical Ethics, which unequivocally forbids euthanasia, the Ethiopian
law, like its Nigerian counterpart, is not likely to hold a physician liable for the death of a
patient simply by withdrawing or withholding treatment in complete deference to the
wish or expressed desire of the patient or that of the patient’s guardian. The blameworthy
element in case of death is on the patient and not on the diligent physician. At best that
provision prohibits active and not passive euthanasia [5].
 Evidences and Practice of Euthanasia in Ethiopia

{The Ethics Of Death And Dying | The Reporter | Latest Ethiopian News

Today (thereporterethiopia.com)}

Article 1 of the Medical Ethics for Physicians Practicing in Ethiopia states that, “No
doctor can take life deliberately as an act of mercy even at the request of the patient or the
patient’s family.

This provision in isolation gives the impression that a patient is denied of his or her
constitutionally guaranteed right to self-determination, which invariably grants a choice
as to the manner of death by a sick person, and as imposing an obligation on the
physician to administer treatment against the patient’s wish. But other provisions in the
Medical Ethics clear this confusion. 

A strong exculpating provision can be found in article 520 of the Ethiopian Penal Code.
The first element of the offence created by this provision is that of omission to act which
must be ‘contrary to his duty’ as a doctor.

A doctor cannot be said to have acted contrary to his or her duty when the patient has
declined to accept the administration of a particular treatment after being duly informed
of the consequence. The patient’s refusal also negates the second element of the offence,
which is ‘without just cause’ as justification is founded on the patient’s withholding or
withdrawal of consent.

Incidentally, the incriminating motives enumerated in article 520 are all personal to the
physician, so that once the reason for not administering treatment can be attributed to the
patient, the physician is completely exculpated.
It is apparent from the above that in spite of the provision of article 1 of the Medical
Ethics, which unequivocally forbids euthanasia, Ethiopian law is not likely to hold a
physician liable for the death of a patient simply by withdrawing or withholding
treatment in complete deference to the wish or expressed desire of the patient or that of
the patient’s guardian. The guilty party in case of death is the patient and not the diligent
physician. [6].
 CHALLENGES {ARGUMENTS} FOR AND AGAINST EUTHANASIA
ARGUMENT FOR EUTHANASIA
The act of bringing about the death of another person is because of the belief that his/her
present existence is so bad that a person would be better off dead. The motive of the person
who commits an act of euthanasia is to benefit the one whose death is brought about.

The argument that someone can be better off dead has been the subject of extensive
philosophical deliberation. Those who claim that a person can be better off dead believe this to
be true when the life that awaits that person has no positive value for him/her.

It was believed that euthanasia has the importance of promoting the well-being of persons.
When someone is suffering an intolerable pain or only has available a life that is unacceptably
burdensome and he/she competently requests medical assistance with dying, his/her well-
being may best be promoted by affording a person that assistance. In this way the individual’s
autonomy and well-being are aligned.

In exercising autonomy, individuals take responsibility for their lives; since dying is a part of life,
choices about the manner of their dying and the timing of their death are, for many people,
part of what is involved in taking responsibility for their lives.

The utilitarian approach argues that euthanasia is morally acceptable because it decreases the
misery of the patient, the caretakers, and the family and friends of the patient and when a
terminally ill patient is kept alive only to die slowly and painfully, suffering is greatly increased
for everyone involved.

Not allowing a patient to decide when his life should end is in fact denying his /her freedom.
Utilitarian John Stuart Mill argued that individuals are, ultimately, the best judges and guardians
of their own interests. The competent patient has the right to refuse or discontinue treatment.

Thus, euthanasia is believed as a compassionate response to the suffering of the terminally ill
and it is an expression of autonomy that a competent individual should have the right to make
self-governing choices.
The other concepts of euthanasia are relating to legal aspects. Proponents of legalized
euthanasia argue that the right to self-determination encompasses the right to choose how and
when to die. They believe that keeping a person alive who wishes to die is not only
infringement of that person’s rights but an irresponsible use of resources.

ARGUMENT AGAINST EUTHANASIA

Opponents of euthanasia claim that we can never have sufficient evidence to be justified in
believing that a dying person’s request to be helped to die is competent, enduring and
genuinely voluntary. It is sometimes claimed that patients who are terminally ill cannot
rationally or autonomously choose euthanasia, because they are liable to be depressed.

The notion that euthanasia is wrong has been supported by a number of arguments.

1. The first is religion or theological perspectives. This perspective argues that our life
belongs to God and merely loaned to us, so we have no right to dispose of our own lives,
even though we have the right to use them within limits.

In this view, we have no more right to kill ourselves than we would have to wreck a rented car.

2. The second argument holds that human life is so precious, to act against it is to act
against the cause of the common good.

3. The third argument is consequentialist, which condemn suicide because it harms the
community. Societies recognized that suicide does affect the rights of others, spouse
and child, for example. If a child’s needs such as food and shelter are not met because of
suicide, the child would likely be a public charge. For this reason, many societies have
made suicide a crime, as an offense against society.
 Yale Kamisar argued that legalizing these acts would have adverse social
consequences that outweigh the benefits. Kamisar thinks that legalization would put many
dying people at risk of losing their lives unjustly, and believes this will overshadow the fewer
cases of dying people for whom legalization would be a godsend.

4. The fourth argument proposes that suicide is wrong because it has substantially harmful
consequences for other individuals. They argue that legalizing euthanasia could lead to
forceful killings of those who do not want to die but who are considered to be socially
undesirable and are outcasts from mainstream society.

John Bonnell, as an opponent of euthanasia, mentions that medical practitioners who

are advocating a bill favoring euthanasia would want to include not only those suffering from
an incurable and painful disease, but also those with mental defects and others incapable of
giving consent, seriously malformed and idiotic children.

Opening the doors to voluntary euthanasia could lead to non-voluntary and

involuntary euthanasia, by giving doctors the power to decide when a patient’s life is not worth
living.

In the Netherlands in 1990, around 1,000 patients were killed without their request.
Undoubtedly, the most widely invoked secular argument against the legalization of voluntary
euthanasia is the slippery slope argument, dramatic spread of suicide that legalizing euthanasia
will lead to vulnerable patients being pressured into consenting when they do not really want it.
Or perhaps, as another version of the argument goes, they will simply be killed without their
consent because they are a nuisance to their families, or because their healthcare provider
wants to save money. Medical homicide has occurred and will continue to occur, but there is no
proof that it is a result of letting terminal patients die peacefully and painlessly.

In addition, alternative treatments are available, such as palliative care and hospices. We do
not have to kill the patient to kill the symptoms. Nearly all pain can be relieved. It is sometimes
said that it is not necessary for people to die while suffering from intolerable or overwhelming
pain because the provision of effective palliative care has improved steadily, and hospice care is
more widely available.

5. The fifth argument is even if, for example, American medical culture is based on
preserving life at any cost, there are finances wasted and technologies used for futile
treatments for terminally ill patients.
 Future Directions of Euthanasia in Ethiopia

Now a days we could not find any article that supports the practice of Euthanasia in

Ethiopia. From the history of Euthanasia in Ethiopia, we understand that there were no

time a which Euthanasia was practiced. The countries Law does not allow the practice of

Euthanasia by any health professionals. In addition to this the religious and sociocultural

practice does not accept the euthanasia to come in to application. So, it is difficult to

guess that Euthanasia will be practiced in Ethiopia.

 CONCLUSION
Ethiopia has a long historical and cultural relationship with Christianity and Islam. They are one
of, if not the most, that contribute to the way we live and our views to life. Religion tells us the
preciousness of life. On the contrary, Euthanasia believes that its allowed to take life if it can be
justifies as one is in too much suffering. This view collides with the law of Ethiopia, so it is not
allowed to be practiced by any physicians. The consequence of Euthanasia on the society is
massive, thus the practice should be avoided.

Generally, the practice of active Euthanasia is impossible in Ethiopia due to the country’s Law,
religion and sociocultural practices.
 References

1. International convenent on civil and political rights, part II, article 6. december 1966.

2. The reporter {2021} The Ethics of Death and Dying.

3. All American life league {2022} Euthanasia History.

https://www.all.org/euthanasia/euthanasia-history

4. Anthony O. Nwafor {2010 } comparative perispectives on Euthanasia in Nigeria and

Ethiopia, pp 1888
https://chilot.me/wp-content/uploads/2011/03/comparative-perspectives-on-euthanasia-
in.pdf

5. The Penal Law of Ethiopia 1957, article 547

6. Medical ethics for doctors in Ethiopia {2010} article 77, pp 15.

https://www.refworld.org/pdfid/49216a0a2.pdf

7. The Ethics Of Death And Dying | The Reporter | Latest Ethiopian News Today
(thereporterethiopia.com)