EUTHANASIA AN ACTIVE AREA OF RESEARCH

IN CONTEMPORARY BIOETHICS

Major RN, PhD Maria MALLIAROU, 404 Military Hospital

Major RN, Konstantinia Karathanasi, EUFOR RCA
Major RN, Eleni Moustaka3, Non Commissioned Officer Academy
Ass. Prof Sofia Zyga, University of Peloponnese, Nursing Department
Ass. Prof Pavlos Sarafis Technological institution of Sterea Ellada, Nursing
Department
 EUTHANASIA

Euthanasia is a deliberate act or

omission, undertaken with the
intention of ending a person’s life.

13/04/2024 20th BMMC 2

Voluntary Euthanasia – Assisted suicide

Voluntary euthanasia is defined as intervention by one person to end the life

of another person with that person’s informed consent and with the primary
intent of relieving pain and suffering and causing death. It is a complex social
issue which continues to be debated by the community.

Those contributing to the debate include: providers of medical, nursing and

midwifery care; those seeking to end their lives due to pain and illness;
advocates for voluntary euthanasia; ethicists; religious organizations; and
the broader community.

It has become an issue for a range of reasons including: the advent of

modern medical technology which makes it possible to artificially prolong
life; cases which have arisen where existing laws have been challenged, and
the growing population of older people and those with terminal illnesses.

13/04/2024 20th BMMC 3

 Aim:

of this review is to present

different views and arguments
about euthanasia.

13/04/2024 20th BMMC 4

 Material – Method:

A literature review was

conducted on google scholar for
recent articles (5 years old) about
the theme using as key words:
euthanasia, ethical issues in
nursing.
13/04/2024 20th BMMC 5
 Euthanasia is a controversial subject,
not only because there are many moral
dilemmas associated with it, but also in
what constitutes its definition.

 At the extreme ends of disagreement, some

school of thoughts is of the opinion that
euthanasia, also
known as physician assisted suicide or
physician aid in dying, is a merciful act of
dying.

 At the other end, there are opponents of

euthanasia who believe that this method is a
form of murder.
 EUTHANASIA

Euthanasia stems from the Greek ‘eu’ = good, and

‘thanatos’ = death. Thus it means a good death.
Accordingly, a patient dying peacefully from
natural causes would be a case of euthanasia –
meaning euthanasia is widespread throughout the
world. In fact, it might mean most people’s deaths
are instances of euthanasia. But surely this is not
what a position paper on euthanasia would be
about. So what would it be about?

13/04/2024 20th BMMC 7

 Review
Review (History)
• According to the historian N. D. A. Kemp, the origin of the contemporary
debate on euthanasia started in 1870. Nevertheless, euthanasia was
debated and practiced long before that date --
• Hippocrates (ca. 460 BC - ca. 370 BC)- Euthanasia was practiced in Ancient
Greece and Roman civilizations as they opined that there was no
need to preserve the life of a person who had no interest in living, or who
thought life as a burden.
1300s- According to the English jurisdiction of the suicide as well as helping
people to kill themselves were considered as a criminal act. Mercy killing was
also not supported by the ascendancy of Christianity (12th till 15th century).

1828- The first law against assisted killing, known as anti-euthanasia was passed
in New York.

1870- In this year, Samuel Williams suggested the use of morphine and
analgesic medications for assisting quick and painless death.

1885- Exactly 15 years after Samuel Williams raised the proposal, the American
Medical Association strongly denied the use of analgesic for euthanasia.

Beginning of 20th century - mercy killing and assisted killing already entered the
minds of the public.
1905- A bill for making it legal was circulated in Ohio, but it failed. A similar bill was
introduced in the next year, which also failed.

1935- The first group for legalization of euthanasia, called Voluntary Euthanasia Legislation
Society (VELS), was founded by a group of doctors in London.

1938- A similar organization, known as National Society for the Legalization of Euthanasia
(NSLE) came into existence. Till date, many cases of physician-assisted suicide have been
fought in the court.

1940- Non-voluntary euthanasia was practiced for the first time by German physicians, to
eliminate the diseased and disabled Germans in closed gas chambers. The main purpose of
the program was to get rid of handicapped children and people with psychiatric problems.

1945- It was estimated that 300,000 Germans had been killed.

20th century- Marked the formation of several organizations for addressing the concerns
regarding euthanasia.
1986- Doctor Joseph Hassman was charged guilty for
administering a lethal dose of Demerol to his mother-in-law.
He was fined and sentenced to two years imprisonment for
the act.

1999- Euthanasia became a public issue, with the

imprisonment of Dr. Jack Kevorkian for conducting voluntary
euthanasia on Thomas Youk (52), who was in the final stage of
ALS (amyotrophic lateral sclerosis). Kevorkian was charged
with second-degree murder, and he served eight years in
prison (from 1999 to 2007). It was claimed that he had
exercised euthanasia for at least 130 other patients (in this
case, patients took lethal injections themselves).
 FORMS OF EUTHANASIA

Active euthanasia means ending life of a suffering person on his own request by
another person, mostly by a doctor, and most of the time by lethal injection.

This form has two varieties: non-voluntary and involuntary.

Passive euthanasia means acceleration of death by letting the patient die

naturally.

Assisted suicide – the suffering person dies with another person’s help.
Main Difference between Active Euthanasia And Passive Euthanasia

In active euthanasia the doctor takes an action with the intention that it will cause the
patient's death where in passive euthanasia the doctor lets the patient die

Active euthanasia is a positive act of commission, such as a lethal injection where passive
euthanasia implies an act of omission, such as the withholding or withdrawal of
treatment.

Active is usually a quicker means of causing death. All forms of active euthanasia are
illegal. However, active euthanasia should be treated differently from passive euthanasia.
Where Passive is usually slower and more uncomfortable than active.

There is a moral difference based on the fact that active euthanasia leaves no room for a
miracle, is outwardly similar to murder and so would be more difficult to distinguish from
murder than passive, and does not require the patient to be as ill as passive.

In active euthanasia, something is done to end the patient's life; in passive euthanasia,
something is not done that would have preserved the patient's life.
EUROPEAN PERSPECTIVEpPrhON
ysiciaEUTHANASIA
n-assisted su
icide: AND
the physicia
ovides the n
PHYSICIAN ASSISTED SUICIDE
necessary, bu
t
knowledge
a n d m ea n s
the act is com
patient ! from pleted by the
the physician
is a deliber ’s standpoint,
ate act wit it
intention of e h the expre
nding life and ss
ethically distin s hould not be
guished from
euthanasia

The European perspective includes quite different laws on euthanasia and PAS, and most states
uphold a ban – despite the fact that in 2002, euthanasia and PAS were legalized in the
Netherlands and euthanasia was legalized in Belgium.

In 2003, the Council of Europe issued a controversial report on euthanasia in the light
of Article 2 (which concerns ‘right to life’) of the European Convention on Human
Rights.
In the UK, a House of Lords Select Committee recently reviewed the evidence that has been
submitted following a private bill on assisted dying for the terminally ill that would legalize both
euthanasia and PAS, providing certain criteria were met. In November 2005, an amended Bill was
introduced to allow PAS only. It is worth neutral position. There is mounting pressure towards
legalization in other European countries too.

13/04/2024 20th BMMC 14

European Association for Palliative Care (EAPC)

In the first issue of the European Journal of Palliative Care (EJPC) in 1994, the
European Association for Palliative Care (EAPC) published a paper stating its
position on euthanasia.

In the March 2003 issues of Palliative Medicine and the EJPC, the task force
published a new paper on the subject. Until this day, the 2003 article that was
published in Palliative Medicine still represents the official view of the EAPC:
euthanasia and physician-assisted suicide should not be part of palliative care.

However, after ten years new and ongoing developments this paper necessitates
a revision. A EAPC working Group is preparing this revision to the 2003 EAPC
position statement and a new one is anticipated to be published this year.

13/04/2024 20th BMMC 15

American Nurses Association
(ANA) position

Historically, nurses have played a key role in caring for patients at end-of-life across
healthcare settings.

The American Nurses Association (ANA) prohibits nurses’ participation in assisted

suicide and euthanasia because these acts are in direct violation of Code of Ethics for
Nurses with Interpretive Statements (ANA, 2001; herein referred to as The Code), the
ethical traditions and goals of the profession, and its covenant with society.

Nurses have an obligation to provide humane, comprehensive, and compassionate

care that respects the rights of patients but upholds the standards of the profession
in the presence of chronic, debilitating illness and at end-of-life.

13/04/2024 20th BMMC 16

Australian nursing federation position on euthanasia

Euthanasia is not legal in Australia.

Adult patients with decision-making capacity have a common law right to

consent to or refuse medical treatment which is offered to them. Refusal of
medical treatment is not voluntary euthanasia and is not illegal.

Australian membership comes from diverse cultural, religious, and ethnic

backgrounds, and that members hold a range of ethical views on the subject
of voluntary euthanasia. Nurses, midwives and assistants in nursing have the
right to hold their own opinion and for their opinion to be respected.

13/04/2024 20th BMMC 17

International association for Hospice and Palliative
care

voluntary euthanasia leads to non-voluntary euthanasia Reports from the

Netherlands indicate that as many as a thousand patients a year are subjected to
euthanasia without request, nevermind consent

euthanasia for the terminally ill leads to euthanasia for those not terminally ill
e.g. the Dutch reports of euthanasia for men with early AIDS and life expectancy
measured in years !

euthanasia for the terminally ill leads to euthanasia for persons with potentially
treatable conditions like depression as documented in the Dutch and Australian
reports ! the vulnerable will experience pressure to request euthanasia the aged,
the sick, the disabled and those who feel a burden o as reported from Holland

13/04/2024 20th BMMC 18

Countries which have legitimized euthanasia:

- the Netherlands

- Belgium

- Oregon and Washington in the USA

- Switzerland (only assisted suicide)

Euthanasia in the Netherlands

It is the first country

where euthanasia has
been allowed since 1994.

Criteria of •
•
- the patient has to be competent and the request
voluntary and intentional,
practising •
•
- the patient has to suffer unbearably,
- euthanasia has to be the last choice,
euthanasia: • - euthanasia can be done only by a doctor.
Euthanasia in Belgium

The euthanasia law was adopted in

2001.

This law defines conditions for

doctors to avoid penal punishment.
 Euthanasia in Switzerland

Assisted suicide is legitimized, not euthanasia done directly by patient’s

doctor.

The patient himself commits suicide at special clinics.

The doctor prescribes a poison which causes death – the patient himself has
to drunk the poison, otherwise it is a normal murder, considered as a crime.

“Suicide tourism” – foreigners can come to Switzerland and commit assisted

suicide.
Euthanasia in the USA

Impunity of euthanasia has been

guaranteed in two states – Ohio and
Iowa.

The law of help in dying.

Aruna Shaunbsug was a nurse working at the
KEM Hospital in Mumbai on 27 November 1973
when she was strangled and sodomized by
Sohanlal Walmiki, a sweeper. During the attack
she was strangled with a chain.

The lack of oxygen put her in a vegetative state.

She has been treated at KEM since the incident
and is kept alive by feeding tube.
THE COURT CASE: On behalf of Aruna, her friend Pinki Virani, a social
activist, filed a petition in the Supreme Court arguing that the "continued
existence of Aruna is in violation of her right to live in dignity". The
Supreme Court made its decision on 7 March 2011.

The court rejected the plea to discontinue Aruna's life support but issued
a set of broad guidelines legalising passive euthanasia in India.

The Supreme Court's decision to reject the discontinuation of Aruna's life

support was based on the fact the hospital staff who treat and take care of
her did not support euthanizing her.
 discussion
Arguments that are in favor of euthanasia state that legalizing euthanasia would
help alleviate suffering of terminally ill patients. It would be inhuman and unfair to
make them endure the unbearable pain. In case of individuals suffering from
incurable diseases or in conditions where effective treatment wouldn’t affect their
quality of life; they should be given the liberty to choose induced death.
Assisted suicide is legal in Switzerland and the U.S. states of Oregon, Washington
and Montana.
The results of the literature review came up with its pros and cons of it. Some of
the pros are that it provides a way to relieve extreme pain, a way of relief when a
person's quality of life is low and it is another case of freedom of choice.
The cons of it is that it devalues human life, it has become a means of health care
cost containment. If the patient has the right to discontinue treatment why would
he not have the right to shorten his lifetime to escape the intolerance of the
situation.

13/04/2024 20th BMMC 28

CONCLUSIONS
Overseas experience suggests legislative support for
euthanasia erodes standards of end-of-life care

Euthanasia becomes available to a wider group than those

with terminal cancer

Support for euthanasia fundamentally upsets the doctor-

patient relationship

It is no substitute for better care

 CONCLUSIONS

Views, ideas and laws of euthanasia vary greatly from

country to country and from individual to individual.
Euthanasia has been at the centre for a moral debate
for long. The individual’s right over his/her life and the
value placed on human life by the society seems polar
opposites in this debate. Opponents of euthanasia
maintain that there is a clear moral distinction
between merely allowing dying and actually causing or
deliberately hastening someone's death.

13/04/2024 20th BMMC 30

 Conclusions:

Euthanasia is a very
important issue that every
country’s legal system has
to take action and adjust to
circumstanses.
13/04/2024 20th BMMC 31
mmalliarou@gmail.com

MAJOR RN MALLIAROU MARIA, PhD

404 MILITARY HOSPITAL OF LARISA

13/04/2024 20th BMMC 32