Euthanasia is an artificial interruption of the life of a terminally ill person. It is called "decent" or "good death", since the purpose of the procedure is to stop the patient's torment by his consent or with the permission of loved ones. The practice of voluntary retirement was welcomed in ancient Greece, when the suicide of old people and people with disabilities was encouraged. Today, this procedure causes heated debates: in 5 countries it is legalized, 5 more states reflect on the legality of "voluntary killing".
For the first time the term "euthanasia" was used in the XVI century by the philosopher Francis Bacon to define the act of easy death. The idea, then and now, is to help a patient who is terminally ill to die. With an incurable disease, a person at will can ask a doctor about a lethal injection to die without pain and suffering. Since the twentieth century, euthanasia has received particular popularity. But the criminal and distorted use of this practice by the Nazis completely discredited the idea itself.
At the dawn of the last century, eugenics was gaining momentum in Europe - the science of human species selection. In the 1920s Germany, she was obsessed with people promoting the idea of the purity of the Aryan race. A thought took root in society that the nation needed to be cleansed of the "defective". Patients with mental disorders, hereditary diseases, and congenital pathologies fell into this category. Over time, the list of objectionables expanded, and everyone who was not able to work or simply did not like the authorities began to fall into it. On the topic of sterilization and disposal of patients, books and scientific works were published.
In 1923, the work "Permission to destroy life unworthy of life" fell into the hands of Adolf Hitler. The work belonged to two professors - the psychiatrist Alfred Gohe and the lawyer Carl Binding. It was about the legality of the physical destruction of mentally retarded, criminals and seriously ill people. These ideas will form the basis of future "death camps." Informal mass use of forced euthanasia in Germany began in 1939, before that it was considered murder. The Knower family appealed to the Führer for permission to put their son to sleep, since he was a deep cripple. The boy was put to sleep at the clinic in Leipzig, and in the same year they set up an office for conducting such cases.
All children under 3 years old had to undergo an “expert assessment,” during which they calculated the terminally ill. Those who could not become full-fledged workers in the future were put to sleep. Adults with severe pathologies and mental disorders were sterilized. By 1940, the term "children" in the documents began to spread to persons under 17 years of age, and a little later, "child euthanasia" began to be applied to all age groups. There were discussions about the way of killing in the circles of responsible persons, the injections were considered an economically unprofitable way. Criminologist Albert Widman proposed a quick and affordable option - carbon monoxide.
In the "gas chambers" fell:
- people with mental disorders;
- disabled people;
- Gypsies, Jews and Poles;
- patients who have been treated for more than 5 years.
Euthanasia procedures were called only because of the sonority of the term, in the documents such murders were sometimes called "disinfection" and the code name "T-4". By 1941, the mass disappearance of people caused outrage among the clergy, the aristocracy and some politicians. By the end of the same year, Hitler issued an official decree on the termination of "disinfection", but the program was unofficially stopped only after World War II. In the course of military operations, soldiers with injuries, children and adults, non-Aryan prisoners were also subjected to "euthanasia".
The trials of the perpetrators and those responsible for the T-4 began only in 1950. In the process, punishment was given to units, most psychiatrists who advocated killing continued their medical practice, and their trials did not take place. Falkenhauser, the head physician of one of the mental hospitals who practiced hunger as "euthanasia", was sentenced to 3 years in prison for hundreds of starvation. Only in 2001, the German Society of Psychiatry admitted its guilt and asked for forgiveness from the relatives of the victims.
Today, the practice that the Reich used under the name "euthanasia" is recognized as a crime. Because of this, the perception of an easy death in society has been greatly distorted, most of the states consider it a murder. However, in 2001 the Netherlands legalized this procedure. Since then, a vivid discussion has begun on the legality of euthanasia from humane considerations. In countries where it is permitted, the "good death" is applied to the terminally ill, whom medicine can not help. Also in countries where it is legal, euthanasia can be performed on a newborn with an atrophied brain. Children and adults who live only with the help of life-supporting equipment help to die from the agreement of relatives.
To carry out euthanasia, doctors must be completely sure that the patient cannot be saved. To this end, the patient undergoes a thorough examination, including that of a psychiatrist. Even after a personal request to “die out with dignity,” the ill person needs to make two statements, between which they take long breaks. In Switzerland, allowed euthanasia for mentally ill people, if their disease can not be cured. The Swiss Federal Tribunal argued that mental disorders in some cases bring as much suffering as physical.
Types of euthanasia
Depending on whether the doctor participates directly in the process, there are two forms of the “act of easy death”: active and passive. Also, on the part of the patient, the process may be voluntary or involuntary (from an aesthetic point of view, it is not called “forced”).
This type of life interruption is also called the “deferred syringe method”. They say about the passive form when treatment does not help the patient. In this case, medical assistance aimed at prolonging life is terminated. The patient receives only symptomatic therapy, for example, anesthesia. This type of procedure allows a person to leave naturally and without suffering. Some supporters of this idea doubt that such a process can be called “euthanasia” in general.
More controversy and doubt causes an active form of the process. It implies the direct participation of the health worker in the death of a person. Use it only in case cases. In Switzerland, anyone can demand it, including healthy relatives or spouses of a deceased person. To carry out the act, the doctor must introduce or give the patient a substance that gently stops the body. As a rule, this is a large dose of painkillers that lead to death in a dream.
The controversy surrounding this form of euthanasia is due to the fact that not every health worker is willing to take on such responsibility. Even in countries where the service is legalized, only some specialists are ready to carry out the procedure.
Supporters of euthanasia call the voluntary death of the realization of the right to death. Everyone has the right to independently manage their lives, and decent care is part of this right. A voluntary procedure occurs when the patient himself asks the doctor to interrupt his life. To implement the idea requires a long period and the test of all possible methods of treatment. The patient also undergoes work with a psychiatrist. For people with mental disorders to confirm the desire to die is quite difficult. Therefore, this possibility is only in Switzerland.
Involuntary euthanasia is a very controversial issue for doctors and relatives of the patient. It occurs when the patient cannot express his desire to leave on his own. At the same time, it must be precisely proved that there is no chance to return him a full life. An additional factor to make a decision is the pain that a person may experience. Without the consent of the patient himself, euthanasia can be applied only in countries where it is permitted and after a unanimous decision of the council of doctors and relatives.
In each state, legalized euthanasia, has its own regulation of its implementation. Legislation clearly controls the criminal law aspect of the issue. Medicine is responsible for the accuracy of the arguments about the incurability of man.
General factors for the procedure:
- The patient must be terminally ill, feel a desire to die and declare it at least 2 times.
- If the patient is conscious, he must sign a statement of the procedure himself.
- For euthanasia of a person in an unconscious position requires the application of relatives.
- The process is possible only if the quality of life of the patient is too low and there is no chance of his recovery.
- The application is reviewed by a council of doctors and legal authorities.
If a decision is made to conduct an active "act worthy of death", the process takes place in two stages. First, painkillers are intravenously injected into the patient, for half an hour the person is immersed in anesthesia. After this, barbiturate-based substances are injected that stop respiratory function. The procedure is followed by the doctor to make sure that the person really leaves without pain.
Passive form may take an indefinite period of time. A person receives all the medications so that his condition does not bring pain. However, the patient, without receiving drugs to prolong life, dies from the very cause of his condition. Also, euthanasia is carried out at the request of relatives, if a person finds a long time on life support hardware and there is no chance of recovery. In such cases, the authorities must ensure that the relatives have no material benefit in the death of the patient.
What does man feel
The question of what the patient feels during the process is very theoretical. Doctors also argue about him, among whom some support the idea and others do not. It has been suggested that the patient may feel choking. The author of this theory remains unknown, but he has a lot of followers. This is argued by the fact that barbiturates slowly depress the central nervous system, stopping breathing. The "opposition" of this assumption believes that this is unjustified, since the person is in a state of deep anesthesia by this point. To answer unequivocally the question of what a person feels when euthanasia is as impossible as the question: what happens after death.
Legislative regulation in the world
Such a controversial procedure requires a solid legislative framework. In countries where it is legalized, doctors operate within the law. In some countries, only passive form of conduct is permitted. However, even where it is considered murder, passive euthanasia is still used, although it is not submitted for general discussion.
Only a small part of the states abroad is ready to give a person the right to make an independent decision about death. Fully legitimized "easy death" in:
- The Netherlands;
In the USA, this service is legal only in California, Oregon, Montana, Vermont. In Washington, euthanasia was legalized, but since 2012 it has been banned. In some European countries, passive form is permitted. There is no clear prohibition on assisting death in:
On March 9, 2018, the Indian Constitutional Chamber only legalized passive euthanasia. In countries where the procedure is allowed, it can be applied to citizens from 18 years. The main requirement for the euthanasia of the child is his awareness of what is happening. In 2014, Belgium allowed small children to carry out a "good death", if there are all legal and medical justifications for this. Also in Belgium, the attending doctor may prescribe a kit for the procedure if the patient has asked for it. Forced suicide the patient conducts himself with the help of a set of drugs and instructions.
The ban on the procedure
Active euthanasia is equivalent to murder in those countries where it is not allowed by a separate law. A secretly passive form of the procedure is performed in almost all states. The moment when the patient receives only symptomatic treatment without a prediction of life extension is passive euthanasia. Active in most states is seen as complicity in suicide or premeditated murder.
In Russia, the project "On the Protection of Citizens' Health" prohibits physicians from "satisfying the patient's request to hasten his death." The doctor is criminally responsible for any assistance in the intentional suicide of the patient. According to this law, active euthanasia remains prohibited. In cases where it is impossible to save the patient, the same passive form is used.
In the Australian state of Northern Territory since 1995, there was a bill that allowed death to assist. But in 1997 the law was repealed. In 2017, it became known that another state of Australia - Victoria - would legalize the "right to an easy death" in 2019.
The most controversial attitude towards euthanasia can be found in the laws of Japan. In 1995, a doctor from Yokohama was sentenced to 2 years in prison for killing his patient. The ward was ill with the last stage of cancer and was projected to live for several more days. After the verdict was passed, the court listed the conditions for “helping with dying”:
- The sufferer must have unbearable pains.
- All pain relief methods have already been tried and failed.
- The patient himself expressed a desire to die.
- An early death of the patient is inevitable.
Despite this list of criteria, the Constitution of Japan prohibits any type of euthanasia and is a criminal offense. The controversy about its legalization in the "Land of the Rising Sun" lasts since 1962.
Medical assistance in death is prohibited in all post-Soviet countries. There is a bright negative attitude to such actions in all Islamic states. However, the Sunnah and the Koran - the main religious and legislative writings, allow refusal of treatment. Thus, in Islam, everyone can refuse treatment, thereby obtaining the right to passive form of the procedure.
The right to assisted death is possible only in a few states. In this regard, there was such a service as medical or suicidal tourism. Seriously ill patients who cannot undergo euthanasia in their own country come specifically for this to the place where it is allowed. So far, officially, "tourists" takes only Sweden and Zurich (Switzerland). There are clinics in these countries where they provide this service to both local residents and foreigners.
The scientific publication Journal of Medical Ethics claims that over the past 5 years the number of foreigners who came to Zurich for "easy death" has doubled. In May 2011, a referendum was held in which the inhabitants of Zurich had to vote "for" or "against" the abolition of suicidal tourism. 84.5% of respondents voted for euthanasia to remain legal.
Pros and cons
Such a sensitive topic cannot be ignored by the public. Few people remain neutral in the question of whether euthanasia is permissible in principle, what advantages and disadvantages it may have. Supporters and opponents of this idea, as a rule, repel themselves from different dogmas and aspects.Some rely on religion, others on moral and ethical standards. From here - two essentially different opinions.
The main opponent of the artificial stop of life is religion. Despite completely different tenets, world religions have almost identical attitudes towards euthanasia. In any religion, life is the highest gift and good, something absolutely sacred. From here and bright resistance to euthanasia.
In Christianity, as in many other religions, only God has the right to bestow and take away life. Therefore, suicide or murder is considered the supreme sin, equivalent to a call to God. Only those suicides who were in a state of mental disorder at the time of their unauthorized death are not considered sinners. This position applies to all branches of Christianity: Protestantism, Orthodoxy, Catholicism.
Judaism regards the reduction of life at least for a minute as a mortal sin. The main argument of the Jews is that the body does not belong to man. We use it temporarily as a vessel, but we cannot fully dispose of it ourselves. Even passive euthanasia according to rabbis goes beyond the bounds of Jewish religious principles.
More ambiguously, Hinduism applies to such a procedure, including all its manifestations. This extensive religion is based on the idea of karma - the law of the consequences of actions. If a person has lived a good life and has gone well out of it, benefits await him in rebirth. "Good" care comes when a Hindu:
- is at home (or on the banks of the river Ganges);
- in consciousness and said goodbye to relatives;
- there should be no feces in the form of vomiting, urination, bleeding.
Hence the artificial extension of life in agony and unconsciousness refers to a bad end. Consciously and with dignity to leave with the help of voluntary euthanasia in Hinduism is permissible, if a person does it on his own and does not regret his leaving.
Buddhism actively supports treatment in the terminal period, that is, palliative care. Active euthanasia in this teaching is unacceptable. Since Buddhism is not centralized, its interpretation varies greatly by region. So, some Buddhists refuse treatment, including pain relief. This allows them to meet death with dignity and in a clear mind.
Islam is also categorically against artificial stopping of life. No one can compare himself with Allah and decide whom to live and who to die. However, patience and submission to the will of God are important qualities for Muslims, therefore arbitrary rejection of therapy is allowed. It is also permitted not to artificially prolong life if the mind has died out. The moral and legal problem is the exact establishment: where the mind has died away, and where not yet.
An integral part of euthanasia is a doctor, even if it is a passive and voluntary form. The medic in this case must either stop rescuing the person, or kill him. Both violate bioethical norms. Any negative action or inaction in saving a person contradicts the Hippocratic oath: "I will not give anyone the lethal means at my disposal and will not show the way for such a plan."
There are not many doctors who fully support this idea. To commit such an act, the doctor must transgress both professional ethics and his own morality. Even more difficult is the situation with seriously ill children or unconscious patients. Not many physicians agree to deliberately stop someone’s life. Some experts view euthanasia as egoism: "I cannot kill myself, so do it instead of me."
WHO, in a declaration of 1987, defines the act of interrupting a patient’s life, even at his request or at the request of relatives, as unethical acts. Nevertheless, this practice has already been legalized in several countries, other states are discussing the possibility of its legalization. And where it is "in law", someone conducts it. This means that even among doctors there is a split in opinions. Someone considers a lethal injection as the only way to help a person avoid suffering.
In 1952, the UN received a petition from doctors, scientists and prominent cultural figures from the UK and the USA. The petition stated that in the Universal Declaration of Human Rights, one must add the right of the incurably ill to demand an easy death for oneself. The appeal collected 2,500 signatures, but was rejected by the UN as anti-human.
A 1994 poll among Russian doctors showed that half of the respondents aged 41 and over "never thought (a) whether euthanasia is permissible." Among doctors aged 21 to 30 years, 49% agree with the procedure. A survey of medical students in 2000 showed that 78.4% were in favor of euthanasia.
The survey described above shows that the majority of young doctors have a positive attitude towards the "act of good death." In the modern world, ideas about the right of a person to choose and responsibility for his own life are increasingly developing. Euthanasia in the XXI century is far from news, but so far remains a revolutionary practice. The trend of gradual legalization suggests that humanity over time will either improve treatment methods or accept the fact of euthanasia.
The UN and WHO do not provide global reports on the development of assisted death. However, statistics of individual countries shows a sad demand for such a service. In the Netherlands and Belgium, the annual increase in euthanasia carried out is 5% each since 2008. Statistics Switzerland has published data for the period from 1998 to 2009. In 1998, 43 deaths were recorded, in 2009, already 300 deaths from euthanasia. In Zurich, 300 foreigners receive this kind of “mercy service” every year, and this number is growing.
Every year the number of people aged 80 and over who have resorted to "easy death" decreases. The number of oncology patients under the age of 40 years and resorted to euthanasia is steadily increasing. Such indicators are associated with an increase in the incidence of malignant tumors and the lack of medication. According to data from Switzerland, 44% of cases of “legal suicide” are cancer patients, 25% are diseases of the cardiovascular system and the central nervous system, and another 3% are due to depression.
Is there an alternative
Opponents of the idea of a "good death" rely on the fact that it is impossible to establish precisely the hopeless position of the patient. A diagnostic error is also not excluded, it is possible that the person is not fatally ill, and there are chances to cure it. The concept of incurability depends on the possibilities that are currently available to medicine. The progress of pharmaceuticals and technology leaves hope that the necessary medicine may appear immediately after the procedure.
A worthy alternative to assisted death is palliative medicine. This direction, created specifically to make life easier for the seriously ill and dying. It includes psychological assistance, full symptomatic therapy, an integrated approach to meet all the needs of the patient. This practice also relieves of torment and aims to ensure that the patient’s life is as full and active as possible.
At the same time, the onset of death is neither delayed nor accelerated.
Euthanasia is a controversial method of ridding a person from suffering. Despite the controversy of scientists and prominent figures about the legality of killing a person out of compassion, the main side of the dispute remains the patients who demand such a right for themselves. After all, people who have never faced such a choice cannot fully appreciate euthanasia as something humane or criminal.