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Euthanasia and physician-assisted suicide are concepts that are widely debated by both the general public and health care professionals. Some of these debates include “ethics of performing such an act, presumed violation of the Hippocratic oath, religious beliefs, sanctity of life, and the stories of the suffering of patients with an incurable illness” (Herat. All these debates question the ethics around euthanasia, its legitimacy as a part of healthcare, and potential legalization.
Euthanasia is defined as “a deliberate act by a physician to administer drugs with the explicit intention of ending a patient's life”, whereas physician-assisted suicide (PAS) is “where the physician prescribes lethal drugs to the patient on their request, as means to commit suicide, rather than administering it oneself” (Herath et al., 2021). Although the concept of euthanasia is widely known, euthanasia and assisted suicide are currently legalized only in some countries such as the Netherlands (2001), Belgium (2002), and Luxembourg (2009) (Inbadas et al., 2017). In the United States, euthanasia is legalized in certain states such as Oregon, Washington, Montana, Vermont, and California (Inbadas et al., 2017). While more and more countries have started to look favorably toward euthanasia and assisted suicide, legalization has been highly debated for decades due to its controversial nature both morally and medically.
Euthanasia is discussed from various perspectives, and there are many differences in how to approach, it, especially in different countries. For example, there are differences in policies surrounding the age of the patient, and how long a patient must be diagnosed to be considered for euthanasia and physician-assisted suicide. For instance, patients must be at least 18 years old in the United States, Canada, and Luxembourg for them to be considered, whereas in the Netherlands the age is 12 years old [1]. Furthermore, in the US, a patient needs to have a survival time of 6 months or less, with or without pain to be considered. In the Netherlands, Belgium, and Luxembourg, the patients need to have “unbearable physical or mental suffering without prospect of improvement but do not require them to be terminally ill” [1]. In addition, a patient’s condition and potential pain have a tremendous impact on an individual's attitude toward euthanasia. For instance, “cancer accounts for more than 70% of all cases of euthanasia and PAS in the Netherlands and Belgium” [1]. Hence, a patient’s survival rate, and their potential suffering throughout the process play a huge role in their assessment of euthanasia and PAS.
Furthermore, there are also changes to the acceptability of euthanasia in the public. For example, “support for this practice increased from 37% in 1947 to 53% in the early 1970s [and] plateaued in approximately 1990, with two-thirds of the United States population supporting ending a patient’s life” [1]. However, these percentages started to decline by 10% to 15% when terms such as “legalization” and “suicide” were added to surveys [1]. Furthermore, this differs from Europe, where the support for euthanasia increased between 1999 and 2008, resulting in more and more countries starting to legalize the practice [1].
Another major milestone in practicing euthanasia is the attitudes of physicians toward euthanasia and physician-assisted suicide. A Medscape survey that was conducted in 2014 demonstrates that “US physicians were most supportive, with 54% agreeing, while a minority of physicians in Germany (47%), United Kingdom (47%), Italy (42%), France (30%), and Spain (36%) concurred that PAS should be permitted” [1]. From this survey, less than 50% of physicians fully support legalizing euthanasia and PAS. While these numbers have been growing recently, these low percentages may be due to the patient’s current condition, a physician’s individual or religious beliefs, their attitudes toward potentially violating the Hippocratic oath (which prioritizes a patient’s life), and even the mental burden that may come with the practice.
As demonstrated, the involvement of euthanasia and assisted suicide in health care is a widely, continuously debated topic. There are various perspectives depending on countries, states, cultures, the physical state of a patient, and even between individual physicians. Some countries have included euthanasia as part of their health care system such as the Netherlands, whereas it is not legalized in many other countries. If euthanasia was legalized and part of the health care system globally, there are various questions that would need to be addressed prior.
Aside from the moral and ethical questions, there are also medical inquiries that require answers. For example, the first question would be who would euthanasia be permitted to? Would it be permitted only to patients with incurable diseases, or would it be available to all patients? If it is permitted to only some patients, then what would the criteria be to deem an illness as incurable? Are the patient and physician taking potential medical advancements in the next couple of years into consideration prior to making the decision?
This list can be endless and there are many more that need to be addressed for all physicians to follow the same guidelines. Hence, it is necessary to have a protocol, like any other medical procedure, that can address the medical and potential ethical dilemmas and provide physicians with guidance when faced with various situations.
References:
Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA, 316(1), 79–90. https://doi.org/10.1001/jama.2016.8499
Herath, H., Wijayawardhana, K., Wickramarachchi, U. I., & Rodrigo, C. (2021). Attitudes on euthanasia among medical students and doctors in Sri Lanka: a cross-sectional study. BMC medical ethics, 22(1), 162. https://doi.org/10.1186/s12910-021-00731-2
Inbadas, H., Zaman, S., Whitelaw, S., & Clark, D. (2017). Declarations on euthanasia and assisted dying. Death Studies, 41(9), 574–584. https://doi.org/10.1080/07481187.2017.1317300
Contributors:
Author: Bhagya Arikala
Editor: Kayjah Taylor
Health Scientist: Chantelle Moore