Euthanasia: a Challenge to Medical Ethics Rui Nunes*And Guilhermina Rego Centre of Bioethics, Faculty of Medicine of the University of Porto, Alameda Prof

l Rese ca arc ni h li & C f B o i o l e Journal of a t h n Nunes et al., J Clin Res Bioeth 2016, 7:4 r i c u s o J DOI: 10.4172/2155-9627.1000282 ISSN: 2155-9627 Clinical Research & Bioethics Commentary Open Access Euthanasia: A Challenge to Medical Ethics Rui Nunes*and Guilhermina Rego Centre of Bioethics, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal *Corresponding author: Rui Nunes, Centre of Bioethics, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal, Tel: + 351-225513625; Fax: +351 225513697; E-mail: [email protected] Received date: July 31, 2016; Accepted date: August 18, 2016; Published date: August 20, 2016 Copyright: © 2016 Nunes R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Introduction Euthanasia and the Right to Choose For many decades the euthanasia debate is particularly controversial Although there is a strong debate in modern societies over the in modern societies. Indeed, in the northern European tradition, as legalisation of physician-assisted suicide, many ethicists of different well as in countries of Anglo-American influence, euthanasia, philosophical backgrounds are comfortable with voluntary euthanasia physician-assisted suicide and other end-of-life decisions are an and the right to die with dignity [4]. For instance, it is well known that important source of social debate. It is well known that in many libertarians, such as Tristram Engelhardt Jr., contend that there is no circumstances, medical decision-making often contributes to hasten ethical difference between killing and letting dye as long as the mutual the death of a particular patient and different societies have different consent of involved parties is obtained [5]. Also, from a utilitarian understandings with regard to the specific role of health professionals perspective, James Rachels in his book “The Elements of Moral in this setting. Moreover, death usually happens in the hospital, far Philosophy” [6] suggested that “euthanasia may be morally right” and away from family and friends, at an environment more prone to that “the argument can be summarized as this: loneliness and abandonment. The rise of the hospice movement in the a) “The morally right thing to do, on any occasion, is whatever sixties and, more recently of palliative care as a new philosophical and would bring about the greatest balance of happiness over unhappiness; practical approach to death and dying, is also a sign that this issue should be properly addressed as a major cultural transition. Indeed, as b) On at least some occasions, the greatest balance of happiness suggested by John Keown in his book Euthanasia, Ethics and Public over unhappiness may be brought about by mercy killing; Policy “whether the law should permit voluntary euthanasia or c) Therefore, on at least some occasions, mercy killing may be physician-assisted suicide is one of the most vital questions facing all morally right”. modern societies” [1]. This evolution happened primarily in northern Europe and in There have been many attempts to legalize euthanasia in the western countries of Anglo-American tradition. However, even in southern world, but only a few have succeeded. There are plenty of good reasons European countries, as well as in countries that share common why euthanasia should or should not be legalized. Traditionally, in traditions and cultural backgrounds, such as Latin America countries, most countries with a Christian tradition, euthanasia and physician- there is evidence available that shows a similar evolution regarding the assisted suicide was a morally condemned practice due to the sanctity practice of euthanasia. Although in Mediterranean countries there is a of human life. However, the emergence of secular pluralistic societies longstanding tradition of respecting the sanctity of human life, gave a different meaning to the concept of personal autonomy, and the legalisation of assisted death is now also in the political agenda. right to self-determination is a progressively recognized value of Indeed, in the last decades the sociological background of many modern societies. Both as a negative right as a positive one meaning southern European countries has changed dramatically, namely due to that the “realization of an ideal of a more perfect humanity as an increase in life expectancy, a decreased influence of the Roman conceived by reason” [2]. Therefore, western countries are not so prone Catholic Church, as well as a different role of the family as an informal in condemning voluntary euthanasia and physician-assisted suicide, carer. The nuclear family is smaller, with a substantial decrease of the and are now faced with contradictory political and social evidences birth rate and, consequently, there are fewer members to take care of with regards to these practices. Indeed, although there should exist a the older family members, especially with chronic and terminal consensus over death and dying, conflict has come to dominate the conditions. debate [3]. In this changing social and cultural settings, it is expected that new However, from a strict medical ethics perspective, international approaches regarding assisted death are steadily developed all over the guidelines following the Hippocratic Oath and the World Medical civilized world, as many people, namely terminal patients, have Association Declaration of Geneva still consider euthanasia and frequent thoughts about death and dying and believe that the practice physician-assisted suicide as a morally forbidden practice. The of euthanasia should be considered as an acceptable public policy. objective of this paper is to determine what might be the consequences Also, and from an ethical perspective, it is well known that some to medical ethics, in a global perspective, with the legalization of terminal patients feel that physician-assisted suicide and euthanasia euthanasia in a growing number of countries. Specifically, how should can be a valid option at the end of life and that this practice is within the medical codes of ethics adapt to such an evolution in an ethical the limits of the right to self-determination. Amongst the various consistent way. motives for requesting assisted death, it is of significance the fact that the person feels alone and has difficulty in self-care. The reasons why a terminal patient has this opinion are, in general, related to feelings of abandonment leading to a collapse of the individual’s life project. Indeed, the inexistence of clear objectives to self-fulfilment may be J Clin Res Bioeth, an open access journal Volume 7 • Issue 4 • 1000282 ISSN:2155-9627 Citation: Nunes R, Rego G (2016) Euthanasia: A Challenge to Medical Ethics. J Clin Res Bioeth 7: 1000282. doi:10.4172/2155-9627.1000282 Page 2 of 5 related to thoughts about dying, leading to the assumption that the euthanasia, are an important argument to be ruled out. A thorough individual’s life project might be perceived as already accomplished [7]. analysis of the empirical evidence gathered from Oregon (were physician-assisted suicide is legalised through the Oregon Death with Also, many patients that request physician-assisted suicide claim Dignity Act), the Australian Northern Territory (where euthanasia and that their reasons are the loss of autonomy and dignity and also the physician-assisted suicide were temporarily legalised through the incapacity to engage in activities that give their life meaning. For Rights of the Terminally Ill Act of 1995), and also the Dutch and Belgic instance, the Dutch law on euthanasia refers to “unbearable suffering” experience, seems to be paramount [11]. In the Netherlands, the first as the criterion to request euthanasia. That is, this law refers to a country to legalise euthanasia, Heide et al. demonstrated that, in 2005, subjective evaluation by the patient, not presenting any feasible 1,7% of all deaths were the result of euthanasia [12]. Also, in Belgium it alternatives to a death with dignity. However “unbearable suffering” is is estimated that about 30 percent of all deaths are preceded by not a technical term but a subjective personal condition that will palliative care and that about 2 percent are through euthanasia [13]. determine the choice for a merciful death [8]. In other countries, the debate over euthanasia is just beginning and Also, it is clear that euthanasia is conceptually different from other issues such as death with dignity will lead necessarily to a balance issues such as withholding and withdrawing life-prolonging medical between autonomy of the patient and his or her best interests from a treatment in terminal patients, namely futile and heroic treatments, societal perspective [14]. Nevertheless, the debate will be more fruitful sedation for refractory symptoms of terminal patients that may hasten if on one hand the access to palliative care becomes universal and on death, or even decisions to forego medical treatment in the persistent the other hand there is an adequate training of healthcare professionals vegetative status [9]. The alleviation of severe symptoms sometimes in end-of-life decision-making [15]. In the long run, however, involves the use of drugs that may be life shortening as a potential side physician-assisted death will be much more accepted if the fears of effect. But, it is beyond the scope of this paper to evaluate the ethics of involuntary and non-voluntary euthanasia are ruled out. Also, withholding or withdrawing of medical treatment [10], namely common conditions such as depression and anxiety should be because in general they are an accepted medical practice. And, detected. But, as Ganzini et al. demonstrated in a cross sectional survey therefore no specific changes are needed in most codes of medical performed with patients requesting physician’s aid in dying in Oregon, ethics.

Load more