Euthanasia The central problem of medical ethics

The levels of the problem of euthanasia  When physicians decide to treat their patients they do so under two presuppositions:  They presuppose that the treatment has a reasonable chance of being technically successful;  secondly, they presuppose that the treatment has a reasonable chance of bringing about a desirable, or at least a tolerable state, which is consistent with the patient’s self-determined goals.

The Definition of Death  At the beginning of the 19th century: people realized the possibility of resuscitation => fear of being buried alive.  1967 (Christian Barnard): The first successful heart tranplantation.  1968 The Harvard Committe elaborated the whole brain death definition of death.

Acognitive States  The Death of the Whole Brain: when neural tissues from the spinal cord up irreversibly stop functioning.  Coma: both the Neurocortical Structures and the RAS are unable to function. Brain Stem is intact.  Vegetative State: Neurocortical System is unable to function, RAS and Brain Stem are intact.

The Technical Definition of Euthanasia  ‘Eu’ meant ‘Good’ ‘Thanatos’ meant ‘Death’ in the Ancient Greek language.  Euthanasia: Someone’s contribution to another person’s death with the sole intent of serving that other person’s good.  Or better: Someone’s contribution to another person’s death solely in the interest of that other person.

The Forms of Euthanasia  Voluntary Euthanasia: when the patient expilicitly expresses his or her will to die.  Non-Voluntary Euthanasia: When the patient’s surrogate asks for euthanasia on behalf of the patient.  Non-Voluntary euthanasia is not equal to an intervention, which causes the patient’s death, and which is against the patient’s will. The latter is not euthanasia.

The Forms of Euthanasia II.  Passive Euthanasia: when physicians withhold or withdraw some life-prolonging treatment in order to hasten the patient’s death (in the patient’s interest).  Active Euthanasia: when physicians (in the patient’s interest) do something, which not only causes the patient’s death, but which would cause the patient’s death even if the patient was healthy.

The Forms of Euthanasia III.  Physician Assisted Suicide (PAS): when doctors provide some kind of assistance for the patient to commit suicide, which assistance however may or may not be used by the patient.  The problem: the principle of negative responsibility (Rachels)=> there is no ethical difference between active and passive euthanasia.

Passive Euthanasia and Informed Consent  In Hungary: patients have right to refuse the life- prolonging treatments under specific conditions.  Firstly: the patient has to be terminally ill, which means that the patient’s disease cannot be cured and is expected to lead to death soon.  Secondly: a committee consisting of three physicians has to attest in writing that the patient is really terminally ill and that the patient has made his or her decision by being fully aware of the consequences of the decision.

Euthanasia and the Principle of „Nil Nocere”  „Nil Nocere” => „First do not harm!” (Hypocrates) (Hypocrates)  The doctors’ real task is to work with and support the natural healing mechanisms of the body.  When a doctor cannot really help, when a doctor cannot really support the body’s own healing mechanisms, then the best that a doctor can do is not to do anything, since the nature will do its best.

Euthanasia and the Principle of „Nil Nocere” II.  Euthanasia seemingly contradicts to the principle of no harm.  However harmful actions cannot be defined in universal terms, since it is always the patient, whose own goals and desires determine what is good and what is bad for him or her.  Euthanasia can be consistent with the patient’s goals, so euthanasia is not necessarily a harmful action in medicine.

Euthanasia and the Main Goals of Medicine  Euthanasia seems to contradict to the central task of medicine, because euthanasia leads to the patient’s death and not to the patient’s health.  The traditional goals of medicine: Healing Healing Relieving suffering Relieving suffering  Pain / Suffering

Euthanasia and the Value of Human Life  Being alive / Having a life (Zoe / Biosz)  If we insist on attributing absolute value to the simple biological presence of life, then not only euthanasia, but the killing of any biological being will be ethically wrong.  If we attribute absolute value only to the conscious and meaningful life, then euthanasia under specific conditions can be ethically permissible.