Chapter 3

Euthanasia

Weiwei Liu (Vivian)

Public Health and Management
Department
Euthanasia is stop to treat the in
curable patients,such as severe
mental patients, severely disable
d and the vegetable in irreversibl
e coma ,and use humane metho
ds to let them die without any pai
ns.
It root in Greece ,which including two
meanings
Active euthanasia:Use drugs or other
methods urge patients go die. that is end the
patients‘ life ahead of time.
Passive euthanasia: Stop to treat the
patients when it is useless and relieve his pains,app
roved by most of the people.
A
fa
m
ou
s fil
m
ab
ou
te
ut
ha
na
s ia
 The First Case of Euthanasia in
China
 Wang mingcheng require the doctor to implement
euthanasia for his dying mother who suffers from a
terrible illness, and cause the China’s first
euthanasia case.
 He request euthanasia for himself seventeen
years later and become a central figure again,
attract the attention of community to euthanasia.
 in China
 The problem of euthanasia has not been
discussed formally yet.
 Many examples of active euthanasia have
been reported.
 China still does not have the conditions to
legislate for euthanasia.
 The Present Situation of
Euthanasia around the World
 Holland—the first country in the
world where euthanasia is openly
practiced
The Dutch House passed the euthanasia
bill on April 10, 2001,so the Holland be
come the first country of legalizing the
euthanasia. Doctors as long as strictly in a
ccordance with the relevant rules of the ac
t for euthanasia, will not suffer criminal inv
estigation.
 in Belgium

 Belgium began to adopt euthanasia officially

on September 23,2002, so it become the
second country that allow euthanasia in law.
 In Belgium ， incurable adult patients who in
their right senses can end their lives with the
help of doctors.
 in Britain
 Euthanasia is a crime, but two medical events
caused controversy again in 2002.
 In Britain ,the debate on euthanasia always
revolves around gravely ill adults who want to
die.
 A new study says two-thirds of British doctors
against active euthanasia.
 in America
—the debate continues
 68% of Americans tend to support
euthanasia. But only the Oregon allows
euthanasia.
 The Hawaii House allowed terminally
patients to require doctor prescribing some
oral deadly medicine, but banned injecting
or reached euthanasia with the help of
others.
 the present situation of other
countries
 Switzerland: euthanasia is legal in individual cities.
 Australia: euthanasia began legalized in 1995, but
it be overthrew nine months later.
 Germany: passive euthanasia is legal.

 France: euthanasia is a kind of crime.

 Greece and Poland : euthanasia is banned in the

two countries.
 The argument about the mercy
killing
What shall we do to a person when he is
seriously ill and the hope of his keeping
alive is very slight?
 Should we try every means to prolong his
life in pain or should we just stop trying to do
anything useful and inject some kind of
drugs into his body so that this person may
no longer suffer?
 Support

 Euthanasia is humane because it can hasten the

death of the incurable patients and relieving them
from the endless pain.
 The mercy killing can lessen the family
economic burden.
 They are wasting medical resources that can
reasonably be used on patients who really need
them to recover.
 Oppose
 Those who object to euthanasia think it is immoral
to give up treatment for the doctors.
 Euthanasia is nothing else than murdering, and it
will bring more law cases.
 Life fist, nothing can be more cruelty than taking
away human life.
 Workshop:
 Choose euthanasia situation in the world to
discuss (you may choose some countries
cases as an example)
 Clarify your opinions of euthanasia (support
or oppose? why?)
 How do you think the difference between
euthanasia and hospice care?
1. When do patients ask
for euthanasia?
 When?
•uncontrolled, severe problems (pain, dyspnoea,
nausea… ）
•fear for intolerable pain
•fear of a long deterioration over many months
•fear of being kept alive with machines and tubes…
 When?
•demoralization (hopelessness...)
•depression (not just sadness…)
•feeling of burden on one’s family
•feeling of being unwanted by the family, friends
Natural process of dying
Phase 1

Phase 2

phase 3
 Phase 1
 frequently lack of acceptance of dying
 “trial and error” in the treatment of
symptoms
 disappointment, disbelief, lack of
confidence, anxiety and fear of the future
 frequent requests of euthanasia
Will to live versus pain

Chochinov. Lancet Oncol 2001

 Phase 2
 the (physical) symptoms are not prominent
 confidence is restored

 the patient experiences a space for his

adaptation process
 requests of euthanasia are withdrawn (not
always)
 Phase 3
 each day a new symptom emerges
 some symptoms are again prominent
(pain, dyspnoea, dry mouth)
 drugs are not working properly any more

 the patient is confused and incompetent

 in case of intractable suffering terminal

sedation can be considered
2. Why do patients ask for
euthanasia? --- patients
 Patients who want to die earlier

 A (Afraid), 80%
 B (Burn-out) 5%
 C (Control-oriented) 1%
 D (Depressed) 10%
 E (Extreme) 4%
 A (afraid)
 Poor experience with death and symptom
control
 afraid of things that never happen

 afraid to be a burden
 B (burn-out)
 significant damage and mutilation
 no hope for quick death
 existential suffering
 C (control-oriented)
 sometimes no medical reasons or only
potential suffering
 self-oriented, make a deal with their GP
 D (depressed)
 history of depression in the past

 suicidal thoughts as part of depression

 E (extreme)
 Not only pain can be extreme and
untreatable
 sometimes symptoms untreatable
because of lack of cooperation with the
patient
 many failures and disappointments in the
past
 do not intend to undergo just another trial
3. Possible interventions
--- Doctors
 A (afraid)
 Explain the alterantives

 establish good communication

 non-abandonment

 safe environment

 give patient rest not boredom

 B (burn-out)
 Prevent over-treatment!
 be prepared to share the suffering
 sometimes heavy sedation necessary in
case of existential suffering
 C (control-oriented)
 make clear where are your limits

 make patient clear that other people are

suffering with him/her
 D (depressed)
 recognize differences between exhaustion
and depression
 what if patient refuses treatment?
 newer antidepressants more rapid effect
 pharmacology & psychotherapy
 E (extreme)
 look for other solutions (creativity!)
 in extreme situations extreme measures
are possible
 evaluate with whole team
 Conclusions
 Euthanasia requests are frequent

 most patients express their wish during

phase 1 and belong to the group A (afraid)
 look for alternatives/consult colleagues

 heavy sedation sometimes necessary