GENERAL OBJECTIVES: AFTER 1 HOUR OF VARIED LECTURE-TEACHING, THE BSN 3-F WILL BE ABLE TO ACQUIRE BASIC KNOWLEDGE, DEVELOP

SKILLS AND POSITIVE ATTITUDE IN THE CONCEPT OF EUTHANASIA.

SPECIFIC OBJECTIVES Specifically, the students will be able to: 1. Define Euthanasia

CONTENT

TIME ALLOTMENT

METHODOLOG Y

RESOURCES

EVALUATION

Euthanasia (from the Greek meaning "good death": eu- (well or good) + thanatos (death)) refers to the practice of ending a life in a painless manner. According to the House of Lords Select Committee on Medical Ethics,the precise definition of euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering

2. Trace the Euthanasia

history

of About 400 B.C. - The Hippocratic Oath (By the "Father of Medicine' Greek physician Hippocrates).According to Hippocrates, I will give no deadly medicine to any one if asked, nor suggest any such counsel. 14th through 20th Century English Common Law (Excerpt is from the U. S. Supreme Court ruling in the 1997 Washington v. Glucksberg - opinion written by Chief Justice Rehnquist.) -"More specifically, for over 700 years, the Anglo American common law tradition has punished or otherwise disapproved of both suicide and assisting suicide." 19th Century United States (Excerpt is from the U.

S. Supreme Court ruling in the 1997 Washington v. Glucksberg - opinion written by Chief Justice Rehnquist.) That suicide remained a grievous, though nonfelonious, wrong is confirmed by the fact that colonial and early state legislatures and courts did not retreat from prohibiting assisting suicide. Swift, in his early 19th century treatise on the laws of Connecticut, stated that "[i]f one counsels another to commit suicide, and the other by reason of the advice kills himself, the advisor is guilty of murder as principal." 2 Z. Swift, A Digest of the Laws of the State of Connecticut 270 (1823). This was the well established common law view, see In re Joseph G., 34 Cal. 3d 429, 434-435, 667 P. 2d 1176, 1179 (1983); Commonwealth v. Mink, 123 Mass. 422, 428 (1877) ("`Now if the murder of one's self is felony, the accessory is equally guilty as if he had aided and abetted in the murder'") (quoting Chief Justice Parker's charge to the jury in Commonwealth v. Bowen, 13 Mass. 356 (1816)), as was the similar principle that the consent of a homicide victim is "wholly immaterial to the guilt of the person who cause[d] [his death]," 3 J. Stephen, A History of the Criminal Law of England 16 (1883); see 1 F. Wharton, Criminal Law 451-452 (9th ed. 1885); Martin v. Commonwealth, 184 Va. 1009, 1018-1019, 37 S. E. 2d 43, 47 (1946) (" `The right to life and to personal security is not only sacred in the estimation of the common law, but it is inalienable' "). And the prohibitions against assisting suicide never contained exceptions for those who were near death. Rather, "[t]he life of those to whom life ha[d] become a burden--of those who [were] hopelessly diseased or fatally wounded--nay, even the lives of criminals condemned to death, [were] under the protection of law, equally as the lives of those who [were] in the full tide of life's enjoyment, and anxious to continue to live." Blackburn v. State, 23 Ohio St. 146, 163 (1872). See Bowen, supra, at 360 (prisoner who persuaded

another to commit suicide could be tried for murder, even though victim was scheduled shortly to be executed). 1828 - Earliest American statute explicitly to outlaw assisting suicide (Excerpt is from the U. S. Supreme Court ruling in the 1997 Washington v. Glucksberg - opinion written by Chief Justice Rehnquist.) The earliest American statute explicitly to outlaw assisting suicide was enacted in New York in 1828, Act of Dec. 10, 1828, ch. 20, 4, 1828 N. Y. Laws 19 (codified at 2 N. Y. Rev. Stat. pt. 4, ch. 1, tit. 2, art. 1, 7, p. 661 (1829)), and many of the new States and Territories followed New York's example. Marzen 73-74. Between 1857 and 1865, a New York commission led by Dudley Field drafted a criminal code that prohibited "aiding" a suicide and, specifically, "furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life." Id., at 76-77. 20th Century United States (Excerpt is from the U. S. Supreme Court ruling in the 1997 Washington v. Glucksberg - opinion written by Chief Justice Rehnquist.) Though deeply rooted, the States' assisted suicide bans have in recent years been reexamined and, generally, reaffirmed. Because of advances in medicine and technology, Americans today are increasingly likely to die in institutions, from chronic illnesses. President's Comm'n for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life Sustaining Treatment 16-18 (1983). Public concern and democratic action are therefore sharply focused on how best to protect dignity and independence at the end of life, with the result that there have been many significant changes in state laws and in the attitudes these laws reflect. Many States, for example, now permit "living wills," surrogate health care decision-making, and the withdrawal or refusal of life sustaining medical

treatment. See Vacco v. Quill, post, at 9-11; 79 F. 3d, at 818-820; People v. Kevorkian, 447 Mich. 436, 478-480, and nn. 53-56, 527 N. W. 2d 714, 731-732, and nn. 53-56 (1994). At the same time, however, voters and legislators continue for the most part to reaffirm their States' prohibitions on assisting suicide. 1920 - The book "Permitting the Destruction of Life not Worthy of Life" was published. In this book, authors Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig, argued that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician. This book helped support involuntary euthanasia by Nazi Germany. 1935 - The Euthanasia Society of England was formed to promote euthanasia. 1939 Nazi Germany - "In October of 1939 amid the turmoil of the outbreak of war Hitler ordered widespread "mercy killing" of the sick and disabled. Code named "Aktion T 4," the Nazi euthanasia program to eliminate "life unworthy of life" at first focused on newborns and very young children. Midwives and doctors were required to register children up to age three who showed symptoms of mental retardation, physical deformity, or other symptoms included on a questionnaire from the Reich Health Ministry." "The Nazi euthanasia program quickly expanded to include older disabled children and adults. Hitler's decree of October, 1939, typed on his personal stationery and back dated to Sept. 1, enlarged 'the authority of certain physicians to be designated by name in such manner that persons who, according to human judgment, are incurable can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death.'"

1995 Australia's Northern Territory approved a euthanasia bill - It went into effect in 1996 and was overturned by the Australian Parliament in 1997. 1998 U.S. state of Oregon legalizes assisted suicide. 1999 Dr. Jack Kevorkian sentenced to a 1025 year prison term for giving a lethal injection to Thomas Youk whose death was shown on the "60 Minutes" television program. 2000 The Netherlands legalizes euthanasia. 2002 Belgium legalizes euthanasia. 2008 U.S. state of Washington legalizes assisted suicide Philippines considers euthanasia bill (Claire Wallerstein, Manila) The Philippine Senate is considering a controversial bill that could make the staunchly Catholic country the first in the world to legalise euthanasia. The billpart of a 16 point bill of patients rightshas already undergone its first reading and the second reading will start after the Senate session resumes in late July. It must pass three readings with a two thirds majority and then be ratified by President Fidel Ramos before it can be incorporated into law. Senate health committee secretary John Basa said: It is proposing the legalisation of passive, rather than active, euthanasiabut obviously it is still very contentious. It would make us the first country in the world to legalise so called mercy killing. He added: If it becomes law, this bill will make a big difference to doctors here. At the moment, if they help a patient to die, they can be charged with malpractice and are liable to imprisonment. However, the bills chances of success in its current form may be slim. Its biggest stumbling block is the Catholic church, which has enormous power in the 85% Catholic country. Monsignor Pedzro Quitorio, spokesman for the Catholic Bishops Conference of the Philippines, said: An act or omission which, of itself or by

3. Enumerate the
classifications of Euthanasia

intention, causes death in order to eliminate suffering, constitutes murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The church has been seen as a hindrance to health policymakers and medical workers in many cases over the years. Public immunisation schemes have had only intermittent success since Catholic groups denounced a mass tetanus vaccination programme in the early 1990s, claiming that the toxoid could cause spontaneous abortion in pregnant women. It is feared this has caused a widespread suspicion of immunisation, particularly in the slums and far flung rural areas where such treatment is most needed. Meanwhile, Manilas archbishop, Cardinal Sin, caused uproar last month after publicly announcing that condoms wereonly fit for animals. And in asurvey among medical students, more than half said that AIDS was a punishment from God. Another proposal in the patients rights bill is that patients should be allowed to leave hospital before they have paid in full for their treatment. Virtually all hospitals in the Philippines are privately run, and many owners are worried that patients will abscond without paying.

Classifications of Euthanasia: Voluntary euthanasia: When the person who is killed has requested to be killed. Non-voluntary: When the person who is killed made no request and gave no consent. Involuntary euthanasia: When the person who is killed made an expressed wish to the contrary. Assisted suicide: Someone provides an individual with the information, guidance, and means to take

4. Identify the reasons for implementing Euthanasia

his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called "physician assisted suicide." Euthanasia By Action: Intentionally causing a person's death by performing an action such as by giving a lethal injection. Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water. Both voluntary and involuntary euthanasia can be conducted passively or actively Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors' consciences, it is usually regarded as a passive measure Active euthanasia entails the use of lethal substances or forces to kill and is the most controversial means. An individual may use a euthanasia machine to perform active voluntary euthanasia on himself / herself.

1. Unbearable pain as the reason for euthanasia Probably the major argument in favor of euthanasia is that the person involved is in great pain. Today, advances are constantly being made in the

treatment of pain and, as they advance, the case for euthanasia/assisted-suicide is proportionally weakened. Euthanasia advocates stress the cases of unbearable pain as reasons for euthanasia, but then they soon include a "drugged" state. I guess that is in case virtually no uncontrolled pain cases can be found - then they can say those people are drugged into a no-pain state but they need to be euthanasiaed from such a state because it is not dignified. See the opening for the slippery slope? How do you measure "dignity"? No - it will be euthanasia "on demand". The pro-euthanasia folks have already started down the slope. They are even now not stopping with "unbearable pain" - they are already including this "drugged state" and other circumstances. Nearly all pain can be eliminated and - in those rare cases where it can't be eliminated - it can still be reduced significantly if proper treatment is provided. It is a national and international scandal that so many people do not get adequate pain control. But killing is not the answer to that scandal. The solution is to mandate better education of health care professionals on these crucial issues, to expand access to health care, and to inform patients about their rights as consumers. Everyone - whether it be a person with a life-threatening illness or a chronic condition - has the right to pain relief. With modern advances in pain control, no patient should ever be in excruciating pain. However, most doctors have never had a course in pain management so they're unaware of what to do. If a patient who is under a doctor's care is in excruciating pain, there's definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who will kill the patient. There are board certified specialists in pain management who will not only help alleviate physical pain but are

skilled in providing necessary support to deal with emotional suffering and depression that often accompanies physical pain. 2. Demanding a "right to commit suicide" Probably the second most common point proeuthanasia people bring up is this so-called "right." But what we are talking about is not giving a right to the person who is killed, but to the person who does the killing. In other words, euthanasia is not about the right to die. It's about the right to kill. Euthanasia is not about giving rights to the person who dies but, instead, is about changing the law and public policy so that doctors, relatives and others can directly and intentionally end another person's life. People do have the power to commit suicide. Suicide and attempted suicide are not criminalized. Suicide is a tragic, individual act. Euthanasia is not about a private act. It's about letting one person facilitate the death of another. That is a matter of very public concern since it can lead to tremendous abuse, exploitation and erosion of care for the most vulnerable people among us. 3. Should people be forced to stay alive? No. And neither the law nor medical ethics requires that "everything be done" to keep a person alive. Insistence, against the patient's wishes, that death be postponed by every means available is contrary to law and practice. It would also be cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically sound. That's where hospice, including in-home hospice care, can be of such

5. Differentiate the pros and cons of Euthanasia

help. That is the time when all efforts should be placed on making the patient's remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as to the provision of emotional and spiritual support for both the patient and the patient's loved ones. Arguments For Euthanasia: It provides a way to relieve extreme pain It provides a way of relief when a person's quality of life is low Frees up medical funds to help other people

Arguments against euthanasia

Euthanasia would not only be for people who are "terminally ill."

There are two problems here -- the definition of "terminal" and the changes that have already taken place to extend euthanasia to those who aren't "terminally ill." There are many definitions for the word "terminal." For example, when he spoke to the National Press Club in 1992, Jack Kevorkian said that a terminal illness was "any disease that curtails life even for a day." The co-founder of the Hemlock Society often refers to "terminal old age." Some laws define "terminal" condition as one from which death will occur in a "relatively short time." Others state that "terminal" means that death is expected within six months or less. Even where a specific life expectancy (like six months) is referred to, medical experts acknowledge that it is

virtually impossible to predict the life expectancy of a particular patient. Some people diagnosed as terminally ill don't die for years, if at all, from the diagnosed condition. Increasingly, however, euthanasia activists have dropped references to terminal illness, replacing them with such phrases as "hopelessly ill," "desperately ill," "incurably ill," "hopeless condition," and "meaningless life." An article in the journal, Suicide and Life-Threatening Behavior, described assisted suicide guidelines for those with a hopeless condition. "Hopeless condition" was defined to include terminal illness, severe physical or psychological pain, physical or mental debilitation or deterioration, or a quality of life that is no longer acceptable to the individual. That means just about anybody who has a suicidal impulse. Euthanasia can become a means of health care cost containment "...physician-assisted suicide, if it became widespread, could become a profit-enhancing tool for big HMOs. "...drugs used in assisted suicide cost only about $40, but that it could take $40,000 to treat a patient properly so that they don't want the "choice" of assisted suicide..." ... Wesley J. Smith, senior fellow at the Discovery Institute. Perhaps one of the most important developments in recent years is the increasing emphasis placed on health care providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment. In the United States, thousands of people have no medical insurance; studies have shown that the

6. Recognize the importance of the concept Euthanasia in relation to Nursing

poor and minorities generally are not given access to available pain control, and managed-care facilities are offering physicians cash bonuses if they don't provide care for patients. With greater and greater emphasis being placed on managed care, many doctors are at financial risk when they provide treatment for their patients. Legalized euthanasia raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled person "chooses" to die rather than receive longterm care. Savings to the government may also become a consideration. This could take place if governments cut back on paying for treatment and care and replace them with the "treatment" of death. For example, immediately after the passage of Measure 16, Oregon's law permitting assisted suicide, Jean Thorne, the state's Medicaid Director, announced that physician-assisted suicide would be paid for as "comfort care" under the Oregon Health Plan which provides medical coverage for about 345,000 poor Oregonians. Within eighteen months of Measure 16's passage, the State of Oregon announced plans to cut back on health care coverage for poor state residents. In Canada, hospital stays are being shortened while, at the same time, funds have not been made available for home care for the sick and elderly. Registered nurses are being replaced with less expensive practical nurses. Patients are forced to endure long waits for many types of needed Euthanasia will only be voluntary

They say emotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Financial considerations, added to

the concern about "being a burden," could serve as powerful forces that would lead a person to "choose" euthanasia or assisted suicide. People for euthanasia say that voluntary euthanasia will not lead to involuntary euthanasia. They look at things as simply black and white. In real life there would be millions of situations each year where cases would not fall clearly into either category. Here are two: Example 1: an elderly person in a nursing home, who can barely understand a breakfast menu, is asked to sign a form consenting to be killed. Is this voluntary or involuntary? Will they be protected by the law? How? Right now the overall prohibition on killing stands in the way. Once one signature can sign away a person's life, what can be as strong a protection as the current absolute prohibition on direct killing? Answer: nothing. Example 2: a woman is suffering from depresssion and asks to be helped to commit suicide. One doctor sets up a practice to "help" such people. She and anyone who wants surgery.

Public and professional sentiment about assisted suicide and euthanasia has led to intense debate, controversy, and confusion. In an era of unprecedented technological progress and postponement of death, considering actions to precipitate death seems almost counterintuitive. Yet it is increasingly apparent that medical advances have not necessarily fostered human dignity, quality of life, personal control, or appropriate care. The increasingly common assertion of a right to

determine the time and manner of death embodied in numerous legislative initiatives and court decisions should serve as a wake-up call to health care providers. It represents not only the ultimate claim to selfdetermination but also a response to the egregious inadequacies and inhumanity that often characterize the care of the dying and critically ill. Along with other professions, the nursing profession and individual nurses have been struggling with the perplexing questions surrounding assisted suicide and euthanasia. For example, what counts as euthanasia? Is assisted suicide ever appropriate? As the largest group of health care professionals, nurses are attempting to deal with the ethical, legal, and social consequences of such practices responsibly and to reaffirm the underlying ethical norms of the profession and the boundaries of practice. Recent position statements on assisted suicide and active euthanasia1, 2 developed by the American Nurses Association and endorsed by other nursing organizations, including the American Association of Critical Care Nurses, hold that nurses should not participate in assisted suicide or active euthanasia. Both statements affirm the indispensable role of nurses in the delivery of appropriate care at the end of life and their primary obligation to provide respectful, competent, supportive, and compassionate care. Although the position statements cannot address all of the complex realities of clinical practice and professional life, they do provide initial guidance for nurses as they consider these issues. Nurses intimately witness the devastation of lifethreatening illness and struggle to provide humane care. Critical care units, with their explicit focus on aggressive treatment and technological triumphs, are environments of promise and peril. In such settings, there can be a

compulsion to "do everything" and "beat" death, with the risk that the patient as a person will disappear while the battle with the body rages. Nurses are frequently caught in the middle as they attempt to comply with medical directives and simultaneously protect patients and act as their advocates. Knowingly participating in care that violates patients' preferences or that is unjustifiably painful and burdensome can create tremendous conflict and a sense of helplessness and despair. A desire to end the patient's suffering and at times their own anguish may prompt nurses to consider euthanasia as a compassionate response. While recognizing the inevitability that some patients suffer profoundly and the existence of intercollegial discord, systemic problems, and a sense of powerlessness to alter these facts, nurses should not conclude that euthanasia is the right response. Such acts violate the social opposition to killing another human being, erode trust, transgress the moral mandates of nursing practice, and undermine the integrity of individual practitioners and the care they render. Nurses, on behalf of the patients entrusted to their care, must advocate the delivery of dignified and humane care at the end of life and protect the integrity of professional practice.

Bibliography: http://www.euthanasia.com/page4.html http://rds.yahoo.com/_ylt=A0oGkjU483tLqUcAMw1XNyoA;_ylu=X3oDMTEyOTRqMTRsBHNlYwNzcgRwb3MDNgRjb2xvA3NrMQ R2dGlkA0Y5NDVfOTQ-/SIG=12e1g6bdi/EXP=1266500792/**http%3a//en.wikipedia.org/wiki/Euthanasia_in_the_Netherlandsm