Euthanasia

My presentation consists of 4 topics:

Euthanasia
Physician-Assisted Suicide
Palliative Sedation
Do Not Resuscitate (DNR)
Euthanasia
 Definition:

Greek word consist of eu "well" thanasia

"death"

Euthanasia is "inducing the painless death

of a person for reasons assumed to be
merciful”
Reasons for requesting euthanasia
Pain
Poor quality of life
Loss of dignity
Terminal illness
Social and economic burden
There are four types of euthanasia
 Direct & voluntary
 Direct & involuntary
 Indirect & voluntary
 Indirect & involuntary
 Direct (ACTIVE)

Intentional taking of another human's

life By administering a lethal injection of
drugs e.g. morphine, rapid IV Ca or
muscle relaxant e.g., curare.
 Indirect (passive):
➢ Withdrawal or withholding of a life
sustaining medicine or device
➢ Withholding foods and fluids.
 Withdrawal of treatment is more justified
than withholding as withdrawal gives the
chance to experience the benefit of the
treatment before deciding not to use
 Withholding food and fluids not only
shortens the life but it causes
additional days of great suffering.
Some of the effects are nausea,
vomiting, muscle pain, cough, heart
problems and shortness of breath.
 Voluntary: means with the patients
competence consent

 Involuntary: means without the patients

consent
Who is competent?
 Competent persons “those with decision making
capability”
 The common law permits competent adults to
refuse any form of medical treatment.
What about the incompetent?
Persons not able to make a decision e.g.
➢ Comatose patient
➢ In some Psychiatric disorders
➢ Children
 Incompetent

Coma
 Subjective judgment

 Substitutive judgment

 Best of interest standard

 Incompetent

Psychiatric patients

➢Severely psychotic patient

➢Suicide “behavior of incompetence”

➢Mentally ill with loss of intellectual functions

Remember: not all psychiatric
patients are considered
incompetent
 Incompetent

Children
Non urgent non essential treatment?
Essential non urgent treatment?
Urgent live saving treatment ?
Controversy concerning
euthanasia
1. Physician role
 with

1.1st purpose of medicine is restoration of

health, If this can't be achieved, doctor still
have the duty to relieve pain and suffering
even if by means that might shorten life or
accelerate death.
 with

Health care extend over all

phase of patient's life and into
his death so, good death is a
part of good health care.
against

1.The backbone of ethics is

respect of human life whatever
the cost and for as long as
possible.
against

Doctors should only extend life never

shorten it and the patient must be in no
doubt about this.
The doctor shouldn't seek good death by
bringing premature death
against

Hippocratic oath is that the

doctor will exercise his art solely
for the care of the patient and will
give no drug, perform no operation
for criminal purpose
against

So, even if euthanasia is legalized,

physician should refuse to participate
in it and other professional
organization can perform it.
with

2.There is no differences between

withholding life sustaining care and
active euthanasia. This is like the
difference between omission and act
but the result is the same.
against

2.There is no doubt that active

euthanasia is a murder "deliberate
killing of someone" that threaten
the moral integrity of the medical
Profession
2.Autonomy
 with
Patient's autonomy should be
respected, we must permit him to
refuse treatment, end his life when
this treatment seems to conflict with
his vision of good life.
 with

Dying person should have the right to

choose whether he is to be helped to die or
to live according his own estimate of good
quality of life. He has the right to die
with dignity.
 against

Autonomy has limits. Not every thing we

want, we have legal right to do. Social and
religious issues are strongly implicated.
against

Patients are allowed to choose passive

euthanasia but can not choose active
euthanasia.
3. Beneficence
with

It's claimed that in some

circumstances, continuing life
inflict pain and suffering that
contradict with the patients
beneficence.
against

Withholding food and fluids not

only shortens the life but it causes
additional days of great suffering.
Abuse of euthanasia
 Abuse of euthanasia

1.Involuntary euthanasia may

occur through encouraging or
pressuring dying patients to choose
euthanasia to spare their families
financial or emotional stain or for the
prospect of inheritance.
 Abuse of euthanasia

2.Crypthanasia = secret euthanasia

the patient may be euthanized

without their consent against their
wish
 Abuse of euthanasia

3.Discriminatory euthanasia:
patient belonging to vulnerable groups
in society might be involuntary
euthanized.
My presentation consists of 4 topics:
Euthanasia
Physician-Assisted Suicide
Palliative Sedation
Do Not Resuscitate (DNR)
Physician-Assisted Suicide
Assisted suicide is the act of providing
medical means or knowledge that
allows others to take their lives.
In assisting suicide, a facilitator, usually
a physician, provides drugs that can
end life and instruction in their use.
The patient then administers the lethal
dose.
My presentation consists of 4 topics:
Euthanasia
Physician-Assisted Suicide
Palliative Sedation
Do Not Resuscitate (DNR)
Palliative sedation
Palliative sedation allows physicians to
relieve extreme pain, agitation;
delirium, or breathing difficulty by
sedating dying patients into
unconsciousness. Sedated into coma,
the patient often dies within days.
The double-effect doctrine states that
one may not deliberately cause harm in
order to promote some good. But one
may promote some good even if serious
harm comes from a foreseeable side
effect.
Physicians thus prescribe controlled
substances to relieve pain, agitation,
delirium, or breathing difficulty in the
terminally ill, even if doing so
foreseeably hastens the patient's death.
My presentation consists of 4 topics:
Euthanasia
Physician-Assisted Suicide
Palliative Sedation
Do Not Resuscitate (DNR)
Do Not Resuscitate (DNR)
DNR seeks to allow natural process of
dying to take its course without
interference. It gives people the right to
die in peace
It's decided that CPR should be
routinely undertaken in all patient
with cardiac or resp. arrest except:
➢Where the patients condition indicate that CPR
is unlikely to be successful
➢When CPR isn't in the recorded sustained
whished of competent patient.
➢When CPR is likely to be followed by a length,
quality of life which isn't acceptable to the patient
➢DNR decision is taken by the
consultant in charge after
appropriate consultation and with
consideration of all aspects of the
patient condition.
Golden rules
 Patients are allowed to choose passive
euthanasia but can not choose active
euthanasia.

 Parents cannot withhold life saving treatment

to their children

 Patient autonomy should be respected

 Treatment is a patient not a doctor decision
THANK YOU