ABSTRACT. Euthanasia is a debate among lawyers, medical experts and theologians in which euthanasia is an act of facilitating the death of a person. Euthanasia or assisted suicide—and sometimes both—have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards. Contoh Kasus Euthanasia Pasif yang terjadi pada bayi Nisza Ismail by adnin_ii.
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Euthanasia or assisted suicide—and sometimes both—have been legalized in a small number of countries and states. In all jurisdictions, laws and safeguards were put in place to prevent abuse and misuse of these practices. Prevention measures have included, among others, explicit consent by the person requesting euthanasia, mandatory reporting of all cases, administration only by physicians with the exception of Switzerlandand consultation by a second physician.
The present paper provides evidence that these laws and safeguards are regularly ignored and transgressed in all the jurisdictions and that transgressions are not prosecuted.
Although the initial intent was to limit euthanasia and assisted suicide to a last-resort option for a very small number of terminally ill people, some jurisdictions now extend the practice to newborns, children, and people with dementia.
A terminal illness is no longer a prerequisite. Legalizing euthanasia and assisted suicide therefore places many people at risk, affects the values of society over time, and does not provide controls and safeguards.
Euthanasia is generally defined as the act, undertaken only by a physician, that intentionally ends the life of a person at his or her request 12. The physician therefore administers the lethal substance. In physician-assisted suicide pas on the other hand, a person self-administers a lethal substance prescribed by a physician.
To date, the Netherlands, Belgium, and Luxembourg have legalized euthanasia 12. The laws in the Netherlands and Luxembourg also allow pas. In the United States, the states of Oregon and Washington legalized pas in and respectively, but euthanasia remains illegal 3.
In the Netherlands, euthanasia and pas were formally legalized in after about 30 years of public debate 1. Despite opposition, including that from the Belgian Medical Association, Belgium legalized euthanasia in after about 3 years of public discourse that included government commissions. The law was guided by the Netherlands and Oregon experiences, and the public was assured that any defects in the Dutch law would be addressed in the Belgian law.
Luxembourg legalized euthanasia and pas in Switzerland is an exception, in that assisted suicide, although not formally legalized, is tolerated as a result of a loophole in a law dating back to the early s that decriminalizes suicide. Euthanasia, however, is illegal 4. A person committing suicide may do so with assistance as long as the assistant has no selfish motives and does not stand to gain personally from the death.
Unlike other jurisdictions that require euthanasia or assisted suicide to be performed only by physicians, Switzerland allows non-physicians to assist suicide. In all these jurisdictions, safeguards, criteria, and procedures were put in place to control the practices, to ensure societal oversight, and to prevent euthanasia and pas from being abused or misused 5.
Some criteria and procedures are common across the jurisdictions; others vary from country to country 56. The extent to which these controls and safeguards have been able to control the practices and to avoid abuse merits closer inspection, particularly by jurisdictions contemplating the legalization of euthanasia and pas. In eurhanasia jurisdictions, the request for euthanasia or pas has to be voluntary, well-considered, informed, and persistent over time.
The requesting person must provide explicit written consent and must be competent at the time the request is made. Despite those safeguards, more than people in the Netherlands are euthanized involuntarily every year.
Ina total of deaths by euthanasia or pas were reported, oasif 1.
Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls
More than people 0. For every 5 people euthanized, 1 is euthanized without having given explicit consent. Attempts at bringing those cases to trial have failed, providing evidence that the judicial system has become more tolerant over time of such transgressions 5.
In Belgium, the rate of involuntary and euthanasi euthanasia deaths that is, without explicit consent is 3 times higher than it is in the Netherlands 89. Those findings accord with the results of a previous study in which 25 passif non-sudden deaths had been the result of euthanasia without explicit consent 8. Some proponents of euthanasia contend that the foregoing figures are misrepresentative, because many people may have paslf some time in their lives expressed a wish for or support of euthanasia, albeit not formally.
The counterargument is that the legal requirement of explicit written consent is important if abuse and misuse are to be avoided. After all, written consent has become essential in medical research when participants are to be subjected to an intervention, many of which pose far lesser mortality risks.
Recent history is euthanazia with examples of abuse of medical research in the absence of explicit informed consent. Reporting is mandatory in all the jurisdictions, but this requirement is often ignored 11 In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee Legal requirements were more frequently not met in unreported cases than in reported cases: The involvement of nurses gives cause for concern because all the jurisdictions, with the exception of Switzerland, require that the acts be performed only by physicians.
In a recent study in Flanders, nurses reported having cared for a patient who received life-ending drugs without explicit request In many instances, the physicians were absent. Factors significantly associated with a nurse administering the life-ending drugs included the nurse being a male working in a hospital and the patient being over 80 years of age. All jurisdictions except for Switzerland require a consultation by a second physician to ensure that all criteria have been met before proceeding with euthanasia or pas.
euthanasia: Topics by
The consultant must be independent not connected with the care of the patient or with the care provider and must provide an objective assessment. However, there is evidence from Belgium, the Netherlands, and Oregon that this process is not universally applied 10 Moreover, non-reporting seems to be associated with a lack of consultation by a second doctor In Oregon, a physician member of a pro-assisted-suicide lobby group provided the consultation in 58 of 61 consecutive cases of patients receiving pas in Oregon This raises concerns about the objectivity of the process and the safety of the patients, and raises questions about the influence of bias on the part of these physicians on the process.
Networks of physicians trained to provide the consultation role when euthanasia is sought have been established in the Netherlands Support and Consultation on Euthanasia in the Netherlands and Belgium [Life End Information Forum leif ] Their role includes ensuring that the person is informed of all options, including palliative care. However, most leif physicians have simply followed a hour theoretical course, of which only 3 hours are related to palliative care, hardly sufficient to enable a leif member to provide adequate advice on complex palliative care needs The development of expertise in palliative care, as in any other specialty, requires a considerable amount of time.
In the United Kingdom, it involves a 4-year residency program, and in Australia and the United States, 3 years. Innone of the people who died by lethal ingestion in Oregon had been evaluated by a psychiatrist or a psychologist 20despite considerable evidence that, compared with non-depressed patients, patients who are depressed are more likely to request euthanasia and that treatment for depression will often result in the patient rescinding the request 21 — Despite that finding, many health professionals and family members of patients in Oregon who pursue pas generally do not believe that depression influences the choice for hastened death A recent Oregon-based study demonstrated that some depressed patients are slipping through the cracks Among terminally ill patients who received a prescription for a lethal drug, 1 in 6 had clinical depression.
Of the 18 patients in the study who received a prescription for the lethal drug, 3 had major depression, and all of them went on to die by lethal ingestion, but had been assessed by a mental health specialist.
Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls
There is evidence, therefore, that safeguards are ineffective and that many people who should not be euthanized or receive pas are dying by those means. Of concern, too, is the fact that transgressions of the laws are not prosecuted and that the tolerance level for transgressions of the laws has increased. The interpretations proposed by Keown in 27 appear very relevant, however. The first interpretation postulates that acceptance of one sort of euthanasia will lead to other, even less acceptable, forms of euthanasia.
The second contends that euthanasia and paswhich originally would be regulated as a last-resort option in only very select situations, could, over time, become less of a last resort and be sought more quickly, even becoming a first choice in some cases.
The circumvention of safeguards and laws, with little if any prosecution, provides some evidence of the social slippery slope phenomenon described by Keown 5 Till now, no cases of euthanasia have been sent to the judicial authorities for further investigation in Belgium. In the Netherlands, 16 cases 0. In one case, a counsellor who provided advice to a non-terminally ill person on how to commit suicide was acquitted There has therefore been an increasing tolerance toward transgressions of the law, indicating a change in societal values after legalization of euthanasia and assisted suicide.
However, basing a request on an advance directive or living will may be ethically problematic because the request is not contemporaneous with the act and may not be evidence of the will of the patient at the time euthanasia is carried out.
Initially, in the s and s, euthanasia and pas advocates in the Netherlands made the case that these acts would be limited to a small number of terminally ill patients experiencing intolerable suffering and that the practices would be considered last-resort options only.
That change is most concerning in light of evidence of elder abuse in many societies, including Canada 33and evidence that a large number of frail elderly people and terminally ill patients already feel a sense of being burden on their families and society, and a sense of isolation.
The concern that these people may feel obliged to access euthanasia or pas if it were to become available is therefore not unreasonable, although evidence to verify that concern is not currently available. This definition enables physicians to assist in suicide without inquiring into the source of the medical, psychological, social, and existential concerns that usually underlie requests for assisted suicide.
Physicians are required to indicate that palliative care is a feasible alternative, but are not required to be knowledgeable about how to relieve physical or emotional suffering.
Untilthe Netherlands allowed only adults access to euthanasia or pas. However, the law allowed for children aged 12—16 years to be euthanized if consent is provided by their parents, even though this age group is generally not considered capable of making such decisions 5. The law even allows physicians to proceed with euthanasia if there is disagreement between the parents.
Inlegislators in Belgium announced their intention to change the euthanasia law to include infants, teenagers, and people with dementia or Alzheimer disease In Belgium, some critical care specialists have opted to ignore the requirement that, in the case of non-terminally-ill patients, an interval of 1 month is required from the time of a first request until the time that euthanasia is performed.
Beneficence, this specialist argued, was the overriding principle. Initially, euthanasia in the Netherlands was to be a last-resort option in the absence of other treatment options.
Surprisingly, however, palliative care consultations are not mandatory in the jurisdictions that allow euthanasia or assisted suicide, even though uncontrolled pain and symptoms remain among the reasons for requesting pasfi or pas Moreover, the rates of palliative care involvement ehthanasia been decreasing.
That finding contradicts claims that in Belgium, legalization has been accompanied by significant improvements in palliative care in the country Other studies have reported even lower palliative care involvement 8 It must be noted that legalization of euthanasia or pas has not been required in other countries such as the United Kingdom, Australia, Ireland, France, and Spain, in which palliative care has developed more than it has in Belgium and the Netherlands.
The usefulness of a single palliative care assessment has been challenged—even when it is an obligatory requirement, as is the case at the University Hospital of the Canton of Vaud, Lausanne, Switzerland the first hospital to allow, inassisted suicide in Switzerland 40 A similar number of U.
Originally, it was the view of the Supreme Court of the Netherlands, the Royal Dutch Medical Association, and the ministers of Justice and Health that euthanasia would not be an option in situations in which alternative treatments were available but the patient had refused them.
When this view conflicted with the accepted ethical principle that patients are allowed to refuse a treatment option, the law was altered to allow access to euthanasia even if the person refused another available option such as palliative or psychiatric care.
One consequence of the change is that, the appropriateness of suicide prevention programs may begin to be questioned, because people wanting to commit suicide should, on the basis of autonomy and choice, have the same rights as those requesting euthanasia. In Switzerland inthe university hospital in Geneva reduced its already limited palliative care staff to 1. There is evidence that attracting doctors to train in and provide palliative care was made more difficult because of access to euthanasia and pasperceived by some to present easier solutions, because providing palliative care requires competencies and emotional and time commitments on the part of the clinician 47 Compared with euthanasia cases, cases without an explicit request were more likely to have a shorter length of treatment of the terminal illness However, there is evidence that challenges those assertion.
The number of deaths by euthanasia in Flanders has doubled since Of the total deaths in this Flemish-speaking part of Belgium population 6 million1.