{"id":106470,"date":"2020-09-10T14:06:52","date_gmt":"2020-09-10T21:06:52","guid":{"rendered":"http:\/\/www.lankaweb.com\/news\/items\/?p=106470"},"modified":"2020-09-10T14:06:52","modified_gmt":"2020-09-10T21:06:52","slug":"euthanasia-political-social-and-health-dilemmas","status":"publish","type":"post","link":"https:\/\/www.lankaweb.com\/news\/items\/2020\/09\/10\/euthanasia-political-social-and-health-dilemmas\/","title":{"rendered":"Euthanasia: Political, Social and Health Dilemmas"},"content":{"rendered":"

Ruwan\u00a0M Jayatunge M.D.<\/strong><\/em><\/span><\/h2>\n\n\n

You don\u2019t need to kill the patient to kill the pain \u2013Dr. Andre Bourque University of Montr\u00e9al<\/em><\/strong><\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

Euthanasia or assisted suicide is a controversial topic that is\ndefined as deliberate intervention undertaken with the express intention of\nending a life, to relieve intractable suffering. Today several countries have\nlegalized euthanasia and some view it as a\nhuman right. Those who support euthanasia point\nout that the importance of personal autonomy and self-determination, the right\nof every human being to have his \/ her wishes respected in decisions involving\nhis \/ her own body and the recognition of every human being is in principle,\nmaster of his\/ her own destiny.
\n
\nIn 2002 Holland became the first country in the world to legalize euthanasia and in 2003, 1626 cases were officially\nreported from Holland. The Dutch euthanasia law\ngives doctors immunity from prosecution if they help to kill patients over the\nage of 12 who are suffering unbearably from incurable conditions and who have\nrepeatedly requested euthanasia.<\/p>\n\n\n\n


\n
\nEuthanasia<\/strong> Guidelines in\nHolland<\/strong><\/p>\n\n\n\n

The Dutch laid out narrow guidelines for doctors: The\npatient, who must be suffering unbearably and have no hope of improvement, must\nask to die. The patient must clearly understand the condition and prognosis and\na second doctor must agree with the decision to help the patient die.<\/p>\n\n\n\n


\n
\nEuthanasia<\/strong> in Belgium<\/strong><\/p>\n\n\n\n

Belgium legalized euthanasia in\n2002, but the laws seem to encompass assisted suicide as well. Since its\nlegalization eight years ago, euthanasia now\naccounts for 2 per cent of deaths in Belgium – or around 2,000 a year. Two\ndoctors must be involved, as well as a psychologist if the patient\u2019s \n competency is in doubt. The doctor and patient negotiate whether death is\nto be by lethal injection or prescribed overdose.<\/p>\n\n\n\n


\nOregon Death with Dignity law<\/strong><\/p>\n\n\n\n

In 1994, voters in the state of Oregon approved a ballot\nmeasure that would have legalized euthanasia under\nlimited conditions. Under the Death with Dignity law, a person who sought\nphysician-assisted suicide would have to meet certain criteria. In order to\nqualify for physician-assisted suicide, a person must be an Oregon resident, 18\nyears of age or older, must have decision-making capacity, and must be\nsuffering from a terminal disease that will lead to death within six months.<\/p>\n\n\n\n

Forced Euthanasia<\/strong><\/p>\n\n\n\n

A number of reports indicate that some\nmedical practitioners have abused the legal privilege of euthanasiaand reinforced depressive patients to\nselect euthanasia as an option. A study\nfound that a high proportion of deaths classed as euthanasia in\nBelgium involved patients who did not ask for their lives to be ended. In 1990\ngovernment sponsored surveys found that 0.8% of all deaths in the Netherlands\nwere euthanasiadeaths that occurred without a\nrequest from the patient. In a 1995 study, Dutch doctors reported ending the\nlives of 948 patients without their request.<\/p>\n\n\n\n

Passive Euthanasia<\/strong><\/p>\n\n\n\n

Although euthanasia is\nillegal in many countries passive euthanasia (withhold\ntreatment and allow a patient to die) is being practiced. This is unethical and\ndescribed as a malpractice. The American Medical Association emphasizes that\nthe intentional termination of the life of one human being by another is\ncontrary to that for which the medical profession stands. Human life has an\nabsolute value and it is inhuman for a medical practitioner to terminate it.<\/p>\n\n\n\n


\nMrs. H a resident from North York Ontario Canada witnessed the agonizing death\nof her grandmother who suffered a stroke. When she was admitted to the\n\u2026\u2026.hospital the doctors said that she would not recover. After several days the\nnasal feeding was discontinued. Mrs. H was near her semi-conscious grandmother\nall the time and the grandmother responded to her time to time by blinking the\neyes. After removal of nasal feeding tube she was starving and I could see tears\nin my grandmother\u2019s eyes. She was dying but the process was accelerated by\ndiscontinuing nasal feeding that led to an agonizing death says Mrs. H
\n
\nMrs. VXXX   a resident from Colombo Sri Lanka  underwent the\nsame experience when her 92 year old mother was admitted to the \u2026\u2026\u2026 hospital.\nShe was diagnosed with a benign ovarian tumor and had numerous age related\ncomplications. During her stay at the hospital she was only given Brufen\n and Vitamin B. Doctors and Nurses often said that she had lived her years\nand taken no significant efforts to improve her condition. She was prematurely\ndischarged and after two weeks she died at home. What worries me is not my\nmother\u2019s medical condition but the attitude of the medical staff says Mrs.\nVXXX.  <\/p>\n\n\n\n


\n
\nMr. XXX a resident from Negombo   met with a road traffic accident\nand admitted to the \u2026\u2026\u2026\u2026\u2026\u2026.. Hospital- Intensive Care Unit. He was unconscious\nthroughout and was on a life support. By the 8th<\/sup>  day his\ncondition remained unchanged.  The medical staff decided to remove him\nfrom the life support system in order to accommodate another patient who was\ndiagnosed with Guillain\u2013Barr\u00e9 syndrome. After removing Mr. XXX from the life\nsupport system less than 24 hours he passed away. His son who is a doctor now\nbelieves that his father was not given a fair chance at the hospital to\nrecover.<\/p>\n\n\n\n

Passive Euthanasia: My\nPersonal Experiences in the Sri Lankan Hospitals<\/strong><\/p>\n\n\n\n

Unfortunately I observed passive euthanasia in\na number of Sri Lankan Hospitals. The first experience I witnessed was in 1994\nduring my internship appointment at the Matale   Base Hospital.<\/p>\n\n\n\n

A 10 year old school boy was brought to the surgical ward\nfollowing head injury that was caused by a road traffic accident on the\nPalapathwala road.  I was the house officer who gave primary care for this\nunconscious child. I immediately realized trepanation of the skull had to be\ndone to evacuate the intracranial hemorrhage that was pressing the\nvital centers in the brain. The Senior House Officer too agreed with me. This\noperation is called performing a Burr Hole and had to be done by\na Consultant Surgeon. I immediately called the Operation Theater and said we\nmay need the theater facilities to treat a boy with a head injury.  <\/p>\n\n\n\n

Then I called my Consultant Surgeon who had just finished\nthe evening ward round. The time was about 3.40 pm and he was preparing to go\nhome.  The Consultant Surgeon was annoyed that I called the operation\ntheater. He ordered me to give diazepam 5 mg intravenous to the child even\nwithout seeing the patient. Again I asked Sir are we going to do a Burr Hole to\nstop the subdural hematoma. This time he responded to me in very dry language\nand asked me to give diazepam and monitor the child and maintain the head\ninjury chart. I was powerless and did exactly what he ordered. Then the\nConsultant Surgeon left for home.<\/p>\n\n\n\n

I observed the poor child until midnight. Several times he\nwent in to seizures. Since we were given unofficial instructions not to\ntransfer patients to the Kandy hospital at night, by the Surgeon we\nhad no way of sending the child to the Kandy Teaching hospital for special\nmanagement.  The Surgeon did not respond to our calls that night. So we\nwaited and prayed for his life. At around 1.30 am the child died. According to\nmy opinion we could have saved this child if the Surgeon did the surgery or\nallowed us to transfer the child to the Kandy Hospital. When I look\nback at this incident after 18 years I feel that the Consultant Surgeon who was\nsupposed to give us knowledge, ethics, and leadership did nothing but forced us\nto perform passive euthanasia.<\/p>\n\n\n\n

I was trained in Anesthesia by Dr.\nPriyangani Ariyarathne – Consultant Anesthetist at the North Colombo Teaching\nHospital in 1999. I worked in the ICU and in the operation theaters at the\nNorth Colombo Teaching Hospital for about a year and observed that when the\nmedical staff get new acute patients to the ICU they sometimes remove the life\nsupport systems of the old patients and fix it to the new patients. Due to lack\nof beds at the ICU the medical staff was compelled to do it. But still I had\nmixed feelings about this unorthodox practice.<\/p>\n\n\n\n

When the Ja Ela bomb exploded on the December\n18, 1999, that killed General Lucky Algama, hundreds of patients were\nbrought to the Colombo North Teaching Hospital. The individuals who were\ncritically injured were admitted to the ICU. There was a young man who was on\nthe life support system following organophosphate poisoning and the medical\nstaff removed him from the life support system and his bed was given to a bomb\nvictim. Without the ventilator and other life support system the young man died\nthe following day. One can always argue that the first patient became ill\nas a result of self-induced poisoning and the second patient became a victim of\na terrorist act. But my question was who are we to decide their fate and the\nduration of their life span.<\/p>\n\n\n\n

When I was working at the Chilaw   hospital I had\nthe opportunity of working at the ICU and I saw this life support removal\noccurring there too. Once we had a snake bite case and in order to accommodate\nhim the doctors removed another patient who was in the ventilator with Dengue\nhemorrhagic fever.  The snake bite case survived and the dengue\npatient died. Again it became a dilemma for me. So instead of working at the\nICU I decided to work in the Operation Theater.<\/p>\n\n\n\n

Over the years I witnessed how some of my colleagues became\nindifferent to human lives.  I remember one Doctor at the\nNegombo   hospital who was against giving blood transfusions to the\nseverely anemic alcoholic patients. These people are alcoholics and they\ndeserve to die without wasting medical resources he openly stated. Another\nPHO (Pediatric House Officer) told me that when he suspects cerebral palsy\nin newborns he cuts off the oxygen supply to them. I am doing a favor for the\nchild and the parents, so they are free of life long suffering with a disabled\nchild, he told me with confidence. I became so disgusted and replied that it\nwas illegal, a crime and under the Hippocratic Oath he was violating\nprofessional ethics. I do not know whether he stopped this unethical practice\nafter my brief lecture.<\/p>\n\n\n\n

Euthanasia<\/strong> Declines in the quality of care<\/strong><\/p>\n\n\n\n

Euthanasia devalues human life; in the long run euthanasia can become a means of health care cost\ncontainment. In Holland legalized euthanasia has\nled to a severe decline in the quality of care for terminally-ill\npatients. Dr. Els Borst, the former Health\nMinister and Deputy Prime Minister who guided theeuthanasia law\nthrough the Dutch parliament recently admitted that medical care for the\nterminally-ill had declined since the law came into effect.<\/p>\n\n\n\n


\n
\nEuthanasia<\/strong> and Murder<\/strong><\/p>\n\n\n\n

According to the Criminal Code a person commits homicide\nwhen, directly or indirectly by any means, he causes the death of a human\nbeing. In this context euthanasia is mealy\na murder. The main aim of the medical practitioners should be focused on\nimproving and enhancing the care of the patient. Under the Hippocratic Oath,\nmedical practitioner cannot engage in euthanasia.<\/p>\n\n\n\n


\n
\nDr<\/strong>. Jack Kevorkian alias Dr. Death<\/strong><\/p>\n\n\n\n

Dr. Jack\nKevorkian is a pathologist who actively support of voluntary euthanasia. He designed a so called death machine\n(thanatron) that was used by several terminally ill patients to commit suicide.\nHe had helped more than 130 terminally ill people end their own lives. In 1994,\nhe faced murder charges in the death of Thomas Hyde, who suffered from a\nterminal nerve illness. He was convicted of second-degree murder. Some experts\nconsider Dr. Jack Kevorkian is highly obsessed\nwith mercy killings and gradually lost the human touch. Instead of promoting health\nas a doctor Dr. Jack Kevorkian promoted\ndeath. <\/p>\n\n\n\n


\nHarold Shipman<\/strong><\/p>\n\n\n\n

The British doctor Harold Shipman murdered 215 of his\npatients using the drug Diamorphine over a period of 20 years. He killed an\naverage of one patient a month during his medical career. Young Shipman\nobserved the painful death of his mother who suffered from terminal cancer. In\nthe later years he killed mainly elderly women who were suffering from various\nillnesses. He was an addictive serial killer who may have believed that he was\nhelping the patients to end their suffering. Shipman hanged himself in January\n2004 while in custody.<\/p>\n\n\n\n


\n
\nNAZI Movement and Euthanasia<\/strong><\/p>\n\n\n\n

Those who support euthanasia should\nstudy what the NAZI s did in Germany and in their occupied countries. The NAZI\ns widely used euthanasia as a social\ncleansing method. First, they exterminated the mentally ill and disabled\nGermans. Subsequently they extended euthanasia as\na political tool. NAZI s used the medical practice to propagate racial\nsupremacy. Dr. Josef Mengele alias the\nangel of death used to do horrible experiments euthanizing men, women and\nchildren. NAZI genocide machine started fromeuthanasia and\nit ended up with the Final Solution. During the Hitler\u2019s regime, 6 million Jews\nwere terminated.<\/p>\n\n\n\n


\n
\nConclusion<\/strong>
\nBefore the advances in medical science diseases like leprosy, syphilis etc.\nwere considered as incurable and relatives often performed mercy killings to\nend the suffering of the patients. Today the doctors are struggling with\nterminal cancer and sometimes suggest euthanasia as\na temporary answer. The future advancements in medical science would bring\nviable solutions to many incurable diseases andeuthanasia would\nbe considered as an outdated, inhuman and unprofessional form of practice.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ruwan\u00a0M Jayatunge M.D. You don\u2019t need to kill the patient to kill the pain \u2013Dr. Andre Bourque University of Montr\u00e9al Euthanasia or assisted suicide is a controversial topic that is defined as deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering. Today several countries have legalized euthanasia and some view it as […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-106470","post","type-post","status-publish","format-standard","hentry","category-dr-ruwan-m-jayatunge-m-d"],"_links":{"self":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/106470","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/comments?post=106470"}],"version-history":[{"count":0,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/106470\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/media?parent=106470"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/categories?post=106470"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/tags?post=106470"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}