BIOETIKA PADA PASIEN

EUTHANASIA
Ms. Y is 32 years old and has advanced gastric cancer that has
resulted in constant severe pain and poorly controlled vomiting.
Despite steady increases in her morphine dose, her pain has
worsened greatly over the last 2 days. Death is imminent, but the
patient pleads incessantly with the hospital staff to “put her out of
her misery.”
Mr. Z is a 39-year-old injection drug user with a history of
alcoholism and depression. He presents at an emergency
department, insisting that he nolonger wishes to live. He
repeatedly requests euthanasia on the grounds that he is no longer
able to bear his suffering (although he is not in any physical
pain). A psychiatrist rules out clinical depression.
What are euthanasia
and assisted suicide?
• Euthanasia as “a deliberate act undertaken by
one person with the intention of ending the life of
another person to relieve that person’s suffering where
the act is the cause of death.”
• Euthanasia may be “voluntary,” “involuntary” or
“nonvoluntary,” depending on
(a) the competence of the recipient,
(b) whether or not the act is consistent with his or her
wishes (if these are known) and
(c) whether or not the recipient is aware that euthanasia
is to be performed.
• Assisted suicide was defined by the Senate
committee as “the act of intentionally killing
oneself with the assistance of another who
deliberately provides the knowledge, means,
or both
• In “physician-assisted suicide” a physician
provides the assistance.
• Euthanasia sudah dilakukan sejak dulu
• Euthanasia dapat dibagi atas :
- euthanasia pasif
- euthanasia aktif
 The brain-dead patient and the family's dilemma

• Physician: There is a patient in the ward who is on ventilator. He is

around 40-45 years. He suffered major injuries is now brain dead. The
family members have been explained everything. They are in a dazed
state and don't know what to do. Probably, their heart does not allow
them to let their loved one go and take the responsibility of switching off
the ventilator.
• Interviewer: So what do your colleagues have to say on that?
• Physician: We cannot do anything. We may discuss it among ourselves
but it is pointless. Switching off the ventilator is euthanasia which is not
permitted. It also depends upon the family. If they are well educated and
reconciled to the idea, then some of them do decide that, OK, you can
switch off the support system. But it can go on for days or weeks. In the
past, whenever this situation came up, it has gone on like this. Ultimately,
when the patient's heart failed, Nature took the final decision.
 The terminal patient who did not die
• Physician: We had a patient with chronic obstructive airway disease who
developed pneumothorax and she was put on a ventilator. She was in
her early sixties and able to communicate. We managed her on the
ventilator, but it was very difficult to wean her away from the ventilator.
Ultimately we discussed with the patient's relatives that she may not
make it. If the relatives agreed, we could switch off the ventilator. The
husband of the patient said: "You see, she is going to die if you switch off
the ventilator. But I will not be able to excuse myself if I let you remove
the life support. For my whole life I will feel guilt. So please, continue the
ventilator till she improves or dies." To my surprise she recovered very
well and I have subsequently discharged her.
• This case is a good example of a conflict between limited resources and
the nature of the disease itself. We can say that we cannot waste our
resources by pulling on with a patient for a long time. This was a
collective decision. All involved staff thought that it was wise to switch
off the ventilator, but, retrospectively, I can see that it would have been
a wrong decision.
HUMAN