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At the present time, voluntary
euthanasia is taken to mean the deliberate ending of life by a doctor
delivering a lethal injection directly to the patient. It is a physical
action by the doctor that directly causes the requested death.
The term physician (or medically)
assisted suicide is sometimes used loosely as an alternative description
of the above, but in reality it describes a different situation. Suicide
means that a person takes their own life, that is, they act (or
fail to act) in a way that deliberately, directly or indirectly,
causes their own death.
Suicide is usually seen as
the taking of an action, such as shooting, gassing or hanging oneself,
but it can also be a lack of action, such as failing to take a
life-preserving medication, with the deliberate intention that the
inaction will lead to death. A good illustration of the difference
is to consider an insulin dependent diabetic, who requires regular
doses of insulin to stay alive. She could deliberately inject a
massive dose of insulin that would cause her death rapidly by hypoglycaemia
(low blood sugar), or refrain from injecting insulin, and die more
slowly by hyperglycaemia (high blood sugar). Either way, she has
deliberately caused her own death.
Physician assisted suicide
is generally considered to involve the prescription of lethal medication
(such as barbiturates) that the patient can take by mouth to end
her life. Thus the doctor is an indirect agent in the suicide, the
prescription achieving nothing unless the person makes a conscious
decision to act. Whilst oral medication is the principal route for
suicide by drugs, Dr. Jack Kevorkian's original assistance to Janet
Adkins, and the assistance given by Dr. Philip Nitschke in the Northern
Territory, was by injection controlled by the patient. In these
instances, although the doctors inserted a needle and attached lethal
drugs, the delivery of the drugs was completely controlled by the
patient. As such, many feel that these are examples of physician-assisted
suicide.
None of the above actions
is considered acceptable by 'voluntary euthanasia' advocates unless
strict conditions exist (such that the person is rational, fully-informed,
makes a durable request, is hopelessly ill and has unrelievable
suffering). All the above actions are taken for the relief of suffering,
and it is clear that the distinction between them is one of method,
not of principle. The same could also be said of other actions such
as refusal of treatment, withdrawal of treatment, and terminal sedation,
where the patient's intention is to use the situation to deliberately
bring about their death.
Therefore, the use of the
term 'voluntary euthanasia' to describe a singular method, which
is not different in principle from other methods, is not sensible.
In VESV's view, voluntary euthanasia should be used to describe
a broad principle which may be achieved in a number of ways.
The key elements of voluntary
euthanasia are :- (1) it is an action initiated or requested by
a rational, fully-informed person; (2) it is action taken for the
relief of otherwise unrelievable suffering; (3) it is accepted that
it will result in the hastening of death; and (4) the death will
occur in a dignified manner, with calmness and certainty. For these
criteria to be met, it almost certainly will require the assistance
of a doctor. Thus DWDV's definition of voluntary euthanasia
is:
An action taken by,
or at the request of, a rational, fully informed, hopelessly
ill person, whose intention is to relieve their unrelievable
suffering, by hastening death in a dignified manner.
Previous definitions have
been very restrictive and focused on the intention of the doctor.
Thus, the Dutch definition (most commonly used as it was for many
years the only country where euthanasia could be openly practiced)
said that euthanasia was "the administration of drugs with
the explicit intention of ending the patient's life, at the patient's
request". Unfortunately, this definition makes no reference
to hopeless illness or unrelievable suffering, and could apply to
anyone in any state of health. It also focuses on the intent of
the doctor rather than on the intention of the patient. It was meant
to describe direct injection euthanasia and was readily equated
with killing, which carried immoral overtones.
The DWDV definition would
include death by refusal or withdrawal of treatment (with sedation
if necessary), terminal sedation, physician assisted suicide, or
direct lethal injection, provided that it was the patient's intention
to hasten their death to relieve unrelievable suffering. The particular
method used is only the means to the end.
The vast majority of patients who desire voluntary euthanasia are
able to use the oral route for lethal drug ingestion. For those
few for whom the oral route is impossible, a patient activated lethal
infusion is possible for all but those who are totally paralysed
(even they, with modern technology, could activate an infusion,
using eye or tongue movements). The necessity for doctors to personally
deliver lethal injections to patients should be virtually nil.
The advantages of voluntary
euthanasia by physician assisted suicide are that (1) the death
cannot occur without the explicit action of the suffering person,
(2) the doctor is involved indirectly to validate the criteria,
to support the patient, and to provide advice and the prescription
only when the suffering is intolerable to the patient, and (3) the
responsibility for the action resides where it should, with the
patient.
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public education · medically assisted suicide
