by Rooptaz Singh Sibia, Medical Student , Medical College, University, Miami, FL

continued from last issue

Defining Euthanasia

Through major advances in science and biomedical technology “It is now possible to keep coma lose and seriously incapacitated patients alive for years” (Parakh and Slesnick 46). Patients can be kept alive by respirators, can be fed intravenously and by tubes through the nose and esophagus to the stomach. Numerous procedures such as dialysis, organ and tissue transplants, and blood transfusion can greatly extend the life expectancy (Parakh and Slesnick 46). “While these and other life sustaining measures can often re~ store or prolong functioning lives, they can also prolong patients’ lives beyond the point at which they desire continued life support or gain any benefit by it” (Veatch 331).

“About three quarters of all deaths in 1987 occurred in hospitals or Jong term care institutions” (Council 2229) which represents a dramatic increase from previous years. This move from the privacy of the home to medical institutions has increased concern about medical decisions near the end of life. These decisions near the end of life include the withholding or withdrawing of life sustaining treatment, forms of active euthanasia, and assisted suicide.

First, some of the terms associated with euthanasia must be de fined. The term passive euthanasia at one time was used to de scribe withholding or withdrawing life sustaining treatment. Life sustaining treatment is “any medical treatment that serves to pro long life without reversing the underlying medical condition” (Council 2229), some treatments which are considered life sustaining include mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration (Council 2229). The term passive euthanasia is no longer used by experts because euthanasia is now commonly de fined as “the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for rea sons of mercy” (Council 2229), The withholding or discontinuance of treatment is typically de fined as an act of omission in cases where a terminally ill or seriously injured patient dies due to disease or injury (Parakh and Slesnick 46).

Active voluntary euthanasia is defined by some ethicists as “the intentional killing of a patient by a physician, with the patients con sent” (Pellegrino 95), It is also defined as “any action to terminate a patient’s life when that life is not already supported by extraordinary measures” (Hunter 3074), Non voluntary euthanasia is a situation in which decisions are made by surrogates on behalf of an incompetent person (Council 2229). Involuntary euthanasia is euthanasia performed without a competent person’s consent. Assisted suicide is a situation in which @ patient is provided at his or her request with sufficient medication or other means to end life, with an understanding that the patient intends to use the medication for the purpose of ending life (Quill 1381). Assisted suicide is different from active euthanasia in the extent to which the physician participates in the process. In assisted suicide, the patient performs the life ending act under the physician’s guidance, in active euthanasia, the physician actually administers the death causing agent. (Orentlicher 1844),

Killing and Letting Die

The distinction between killing and letting die is imperative in analyzing the moral status of euthanasia (Misbin 1308). Daniel Callahan of the Hasting’s Center argues that there is a major difference between stopping life sustaining treatment and active euthanasia. The acts of omission and commission are significantly different When a physician stops treatment of a patient with a lethal disease the “physician’s omission can only bring about death on the condition that the patient’s disease will kill him in the absence of treatment” (Callahan 53). The Omission does not directly cause the death. An example that proves this point is a lethal injection will kill both a sick and a healthy per son, an act of omission will have no effect on a healthy person. Turning off the machine on a healthy person will cause nothing to hap pen. Turning off the machine of a sick person will bring his life to an end because of the underlying fatal disease (Callahan 53). “It is a misuse of the word killing to use it to use it when a doctor stops a treatment he believes will no longer benefit the patient” (Callahan 53). The doctor 1s basically allowing an inevitable death to occur now rather than later. People will die of some disease no matter what for “death will have dominion over all of us” (Callahan 53). A doctor kills a patient when he or she omits treatment that should have been provided. A le that injection causes death and the administrator of the injection is responsible for the death. Thus to reiterate, when treatment is dis continued, the disease kills the patient. The treatment is withheld because it is no longer beneficial and continued treatment would be futile and not in the patient’s best interests (Pellegrino 96). James Rachel, a utilitarian philosopher, argues that it isn’t relevant that one cause of death is a lethal injection and the other cause of death is for example, respiratory failure due to the withholding of a respirator (Pellegrino 96).

Withdrawing and withholding Treatment

Another issue which arises is whether there is a difference between withdrawing and withholding treatment. Withdrawing of life support may be more difficult than withholding life support because an action is performed which has tens death, When life sustaining treatment is withheld, death occurs because of an Omission rather than an action. To many bioethicists this distinction lacks Significance because ethical relevance lies with the motivations and obligations of a Physician not between omissions and acts (Council 2230).

to be continued in a future issue

Article extracted from this publication >>  October 22, 1993