Euthanasia (from the Greek “eu” and “thanatos” meaning “good death”) 1 It is the act or omission that accelerates the death of a terminally ill patient , with his consent, with the intention of avoiding suffering and pain . Euthanasia is associated with the end of life without suffering. This does not include unconscious people, as is the case of the coma. 2
According to the Royal Spanish Academy (RAE) euthanasia aims to avoid unbearable suffering or artificial prolongation of the life of a patient. Euthanasia can be performed with or without the consent of the patient. 2
For the World Medical Association (WMA):
Euthanasia, that is, the deliberate act of ending the life of a patient, even if it is by his own volition or at the request of his relatives, is contrary to ethics. This does not prevent the doctor from respecting the patient’s desire to let the natural process of death take its course in the terminal phase of his illness. 3
The World Health Organization (WHO) states, in relation to active euthanasia as follows: 4
The definitions of euthanasia are not exact and may vary from person to person, but they have several elements in common. Most commentators restrict their description to direct or ‘active’ euthanasia, which can be divided into three categories:
1) The intentional killing of those who have freely and fully expressed the desire to be helped to die;
2) Suicide assisted professionally; And
3) The intentional death of newborns with congenital anomalies that may or may not be life threatening.
Classifications of euthanasia
In the Anglo-Saxon context, we distinguish between euthanasia as action and euthanasia as omission (letting die). Their equivalent would be active euthanasia and passive euthanasia, respectively. Also, in almost synonymous form, the qualifications of positive and negative respectively, are used.
However, the Spanish Collegiate Medical Organization and other institutions do not accept the terminological distinction between ‘active’ and ‘passive’. They consider that euthanasia is always deontologically condemnable, and that it is different from the medical act of suspending a useless treatment. 5
- Direct euthanasia : To advance the hour of death in case of an incurable disease.This in turn has two forms:
- Active : Consists of causing death directly. It is possible to use drugs that in overdose generate deadly effects.
- Passive : The treatment of a certain nosological process (for example a bronchopneumonia) is omitted or suspended, or feeding by any means, which precipitates the end of life. It is a death by omission.
- Indirect euthanasia : This is the one that occurs when, with therapeutic intent, procedures that can produce death as a side effect are performed. For example, the administration of narcotic analgesics to calm the pain. They, as an indirect and unintended effect, cause a decrease in the state of consciousness and possible shortening of the survival period. Here the intention, no doubt, is not to shorten life but to alleviate suffering, and the other is a foreseeable but not persecuted consequence. It thus enters into what has been called a double-effect problem since Aquinas .
Other related concepts
- Assisted suicide : Means intentionally and knowingly providing a person with the means or procedures or both necessary for committing suicide, including advice on lethal doses of medications, prescription of such lethal medications or their delivery. It arises as a desire for the extinction of imminent death, because life has lost its raison d’être or has become painfully hopeless. It should be noted that in this case it is the patient who voluntarily and actively ends with his life, hence the concept of suicide.
- Cacotanasia : Euthanasia that is imposed without the consent of the affected. The word points to a ‘bad death’ (being kakós: ‘bad’) 6
- Ortotanasia : It is to let die in time without using disproportionate and extraordinary means for the maintenance of life. It has been replaced in practical terminology by “dignified death”, to focus the concept on the condition (dignity) of the terminally ill and not on the will to die.
- Dysthanasia : It consists of therapeutic “biting” or “cruelty”, which seeks to postpone the moment of death by resorting to any artificial means, although there is certainty that there is no option to recover health, in order to Of prolonging the life of the patient at all costs, arriving at the death in inhuman conditions. It is usually done according to the wishes of others (family, doctors) and not according to the true good and interest of the patient.
- Adistanasia or antidistanasia : cessation of the artificial prolongation of life leaving the pathological process to end with the existence of the patient.
- Palliative medicine : reaffirms the importance of life and considers death as the final stage of a normal process. The attention it provides does not accelerate or postpone death, it provides relief from pain and other distressing symptoms and integrates the psychological and spiritual aspects of the patient’s treatment. It offers support so that you can lead a life as active as possible to death, and the family so that you can deal with your loved one’s illness and mourning.
- Suffering : Having or suffering physical or moral damage or pain. Usually suffer from an illness or a physical or mental disorder.
Euthanasia is not something new: it is linked to the development of modern medicine. The mere fact that the human being is seriously ill has caused the question to arise in different societies. Euthanasia is a persistent problem in the history of humanity in which diverse ideologies are faced.
Euthanasia posed no moral problems in ancient Greece : the conception of life was different. A bad life was not worth living, and therefore neither eugenics nor euthanasia aroused much discussion. Hippocrates was a notable exception: it banned physicians from active euthanasia and aid to commit suicide.
During the Middle Ages there were changes in the face of death and the act of dying. Euthanasia, suicide and abortion from the standpoint of Christian religious beliefs are considered as “sin”, since the person can not freely dispose of life, which was given to him by God. The art of death (ars moriendi) , in medieval Christianity, is part of the art of life (ars vivendi) ; He who understands life must also know death. The sudden death (mors repentina et improvisa) , was considered like a bad death (bad mors) . You want to be fully aware to say goodbye to family and friends and be able to present yourself in the hereafter with a clear knowledge of the end of life.
The arrival of modernity breaks with medieval thought, the Christian perspective ceases to be the only one and the ideas of classical antiquity are known and discussed . Health can be achieved with the support of technology, natural sciences and medicine.
There are thinkers who justify the active term of life, condemned during the Middle Ages. The English philosopher Francis Bacon , in 1623 , is the first to take up the old name of euthanasia and differentiates two types: “external euthanasia” as the direct term of life and “inner euthanasia” as a spiritual preparation for death. With this, Bacon refers, on the one hand, to the tradition of the “art of dying” as part of the “art of living”, but adds to this tradition something that for the Middle Ages was an unimaginable possibility: the death of a sick Helped by the doctor. Thomas Moro , a saint of the Catholic Church , in Utopia (1516), presents as ideal a society in which the inhabitants justify suicide and also active euthanasia, without using this name.
For Bacon, the patient’s desire is a decisive requirement of active euthanasia; Euthanasia can not take place against the will of the patient or without clarification:
Whoever has been convinced of this, who ends his life, either voluntarily through the abstention of receiving food or is put to sleep and finds salvation without realizing death. No one should be killed against his will, he must be cared for just like any other.Francis Bacon 7
The social Darwinism and eugenics are issues that are also beginning to be discussed. In many European countries societies for euthanasia are founded at the beginning of the 20th century and reports are issued for a legalization of active euthanasia. In the discussions take part doctors, lawyers, philosophers and theologians.
The economic scarcity at the time of the First World War sustains the slaughter of the crippled and the mentally ill. The reality of euthanasia programs has been in opposition to the ideals with which it is defended its implementation . For example, doctors during the regime Nazi made propaganda for euthanasia with arguments such as the indignity of certain lives that were therefore, according to this propaganda, worthy of compassion, [citation needed ] in order to get a favorable public opinion The elimination that was being made of patients, considered disabled and weak ( Aktion T-4 ) according to medical criteria. In the Nuremberg Trials (1946 – 1947) , in the face of the reality of medical crimes during the Nazi regime, all forms of active euthanasia were deemed to be criminal and immoral and, more specifically, Illegal all kinds of therapy and medical examination carried out without clarification and consent or against the will of the affected patients.
At present, different opinions on euthanasia are supported and medical practices and legalities vary in the different countries of the world. In general hospitals, practitioners of palliative medicine in specialized residences in the treatment of terminally ill ( hospice in English), in private homes, and also self – help groups , working for the humanization in dealing with the dying and Want to contribute to overcome the distance between life, death and medical practices.
These are some of the historical facts that occur in a primarily public domain. Little investigated and much less known are the different real practices of people facing the act of dying. It is known that until the end of the 19th century in South America there existed the person of the “scraper” or “scraper”, responsible for making the dying evicted dying at the request of relatives. [ Citation needed ]
On the dignity of human life
The concept of ” human dignity ” is invoked, paradoxically, both to defend euthanasia and to reject it.
Thus, for defenders of euthanasia, the human dignity of the sick person would consist in the right to freely choose the moment of one’s death, avoiding those that were otherwise, inexorable pains and situations that undermine the very humanity of the patient.
To its detractors, the human being does not possess dignity , but is in itself a worthy being, independently of the concrete conditions in which it lives. 8 9 10 11
Death worthy is death with all the proper medical relief and possible human consolations. It is respect for the dignity of the human being until the hour of his natural death. A worthy death is not only the absence of external tribulations, but is born of the greatness of mind of those who face it. Dying with dignity does not mean choosing death, but having the help to accept it when it arrives. 12 13
Pain, at present, can be controlled. Measures capable of neutralizing pain are available. 14 According to some authors, it would be incongruous to continue advocating for euthanasia and assisted suicide for reasons of compassion. 15 16
Arguments in favor
- Doctors have always been involved in decision-making about the end of life and it is now common to suspend or not to establish treatments in certain cases, even if this leads to the death of the patient. However, sometimes doctors decide for their own part whether the patient should die or not and cause their death, quickly and without pain. It is what is known as limitation of therapeutic effort , limitation of treatments or, simply, aggressive euthanasia. Usually euthanasia is carried out with the knowledge and consent of the patient’s relatives and / or healers. 17
- In medicine, respect for the autonomy of the person and the rights of patients are increasingly weighted in medical decision making.
- In line with the above, the introduction of informed consent into the doctor-patient relationship, and for these situations, the preparation of a document of anticipated intentions would be a good way to regulate the medical actions against hypothetical situations where the person loses total – Or partially – their autonomy to decide, at the moment, on the medical actions pertinent to their state of health.
- The decriminalization of euthanasia does not mean absolute obligatoriness. It is not possible to impose the criterion of a conglomerate to the juridical order of a whole territory, reason why the law should assure the mechanisms to regulate the access to the euthanasia of the interested patients that fulfill legally specified requirements; As well as the legality and transparency of the procedures.
The arguments against it affect the “inviolability” of human life, the defense of its dignity regardless of the conditions of life or the will of the individual involved, and the social repercussions of mistrust that could lead to euthanasia.
The World Medical Association considers it to be contrary to ethics and condemns both medical suicide and euthanasia. 19 Instead, he recommends palliative care . twenty
Euthanasia, that is, the deliberate act of ending the life of a patient, even if it is by his own volition or at the request of his relatives, is contrary to ethics. This does not prevent the doctor from respecting the patient’s desire to let the natural process of death take its course in the terminal phase of his illness.Declaration on Euthanasia adopted by the 38th World Medical Assembly
Madrid (Spain), October 1987 21
The Standing Committee of European Physicians encourages all physicians not to participate in euthanasia, even if it is legal in their country, or is decriminalized in certain circumstances. 22
The Collegiate Medical Organization of Spain considers that “the individual request of euthanasia or assisted suicide should generally be considered as a demand for more attention and may make this request disappear applying the principles and practice of quality palliative care. 2. 3
In the case of the Netherlands , one of the first countries to decriminalize physician who practices euthanasia, Remmelink study 24 revealed that more than a thousand cases the doctor admitted having caused or hastened the death of the patient without this asked, For varying reasons, from the impossibility of treating pain, lack of quality of life or the fact that it took time to die.
The position of the Christian Churches, while at the world level, is mostly contrary to euthanasia and assisted suicide: this is the case of the Catholic Church and of the Evangelical and Pentecostal Churches . The position of the former Pope Benedict XVI was explicitly stated in a letter (from 2004) to several American ecclesiastics:
Not all moral issues have the same moral weight as abortion and euthanasia. For example, if a Catholic disagreed with the Holy Father about the application of the death penalty or the decision to wage war, he would not be considered unworthy to present himself to receive Holy Communion. Although the Church exhorts civil authorities to seek peace, not war, and exercise discretion and mercy in punishing criminals, it would still be lawful to take up arms to repel an aggressor or to resort to capital punishment. There may be a legitimate diversity of opinion among Catholics about going to war and applying the death penalty, but not, however, with respect to abortion and euthanasia.Third point of the letter of Joseph Ratzinger to Cardinal Theodore McCarrick, Archbishop of Washington DC. 25
- Advisory Committee on Bioethics of Catalonia: Report on euthanasia and suicide aid . Spain: Prous Science, 2006. ISBN 84-8124-228-4 .
- Ignacio Carrasco de Paula (2004). Pontifical Council for the Family , ed. Lexicon: Ambiguous and discussed terms about family, life and ethical issues (2nd edition). Word. Pp. 349 fs. ISBN 9788482399904 .
- DWORKIN, Ronald: The domain of life. A discussion about abortion, euthanasia and individual freedom . Spanish version of Ricardo Caracciolo and Víctor Ferreres (Universitat Pompeu Fabra) of the original Life’s Dominion , 1st ed., 1993. Barcelona: Ariel, 1994. ISBN 84-344-1115-6 .
- DWORKIN, Gerald; RG FREY, and Sissela BOK: Euthanasia and medical aid to suicide . Translation of the first edition in Cambridge (1998) by Carmen Francí Ventosa. Madrid: Cambridge University Press, 2000. ISBN 84-8323-109-3
- GARCÍA RIVAS, Nicolás: «Decriminalization of euthanasia in the European Union: autonomy and interest of the patient», in Criminal Review , no. 11, 2003, pags. 15-30, ISSN 1138-9168
- GARRIDO SAN JUAN, Juan Antonio. Shorten death without shortening life . PPC ISBN 84-288-0484-2
- HEATH, Iona (2008). Help die. With a preface and twelve theses by John Berger . Katz Publishers. ISBN 978-987-1283-84-2 .
- HENDIN, Herbert (2009). Seduced by death . Planet. ISBN 978-84-08-08546-1 .
- LORA, Pablo de; And Marina GASCÓN: Bioethics . Principles, Challenges, Debates , Spain, Editorial Alliance, 2008, ISBN 978-84-206-9125-1
- SERRANO RUIZ-CALDERÓN, José Miguel: Euthanasia . Madrid: International University Editions, 2007, ISBN 84-8469-207-8 .
- SINGER, Peter : Rethinking life and death . Oxford University Press, 1994. ISBN 84-493-0414-8
- THOMASMA, David; And Thomasine KUSHNER: From Life to Death: Science and Bioethics . Spanish translation of the first edition (1999) by Rafael Herrera Bonet. Madrid: Cambridge University Press, 1999. ISBN 84-8323-073-9 .
- Burleigh, Michael (1994). Death and Deliverance: ‘Euthanasia’ in Germany, C.1900 to 1945 . CUP Archive. ISBN 9780521477697 .
- Back to top↑ The Greek wordεὐθανασία [eu-thanasía] , can be separated into two components:
- Εὖ eu- ‘bueno’; Y
- Θάνατος thánatos: ‘ morte ‘.
- ↑ Jump to:a b According to the article “eutanasia” , in the Dictionary of the Spanish language of the Spanish Royal Academy, consulted on April 7, 2012.
- Back to top↑ WMA Statement on Euthanasia (1987-2005).
- Back to top↑ See page 9 for the text in English:
The definitions of euthanasia are not precise and may vary from one person to another, but some agreement is apparent. Most commentators restrict their description to direct or “active” euthanasia, which can be divided into three categories:
1) The intentional killing of those who have expressed a competent, freely-made wish to be killed;
2) Professionally-assisted suicide; And
3) The intentional killing of newborn infants who have congenital abnormalities that may or may not be threatening to life.World Health Organization, WHO. (nineteen ninety five). Ethics of medicine and health. WHO-EM / PHP / 1 / E / G. Technical paper presented at the Forty-second Session of the Regional Committee for the Eastern Mediterranean .
- Back to top↑ Meaning of the expression “passive euthanasia” , on the website of the Collegial Medical Organization.
- Back to top↑ Roa, A .: Ethics and bioethics . Andrés Bello, 1998.
- Back to top↑ Quote of Francis Bacon, in De augmentis ( Works , 4. 387).
- Back to top↑ JLA García (2007): «Health versus harm: euthanasia and physicians’ duties», in Journal of Medicine and Philosophy , 32 (1), pp. 7-24.
- Back to top↑ D. Callahan (2000): “Death and the research imperative,” in New England Journal of Medicine , 342, pp. 654-656.
- Back to top↑ L. Kass (1989): “Neither for love nor money”, in Public Interest , 94, pp. 5-46, Winter 2000.
- Back to top↑ E. Pellegrino (1992): “Doctors must not kill” in Misbin R. (ed.): Euthanasia: The Good of the Patient, The Good of Society . Frederick: University Publishing Group, pp. 27-34.
- Back to top↑ EM Andresen, GA Seecharan, and SS Toce (2004): “Provider perceptions of child deaths” in Arch Pediatr Adolesc Med , 158, pp. 430-435.
- Back to top↑ AC Beal, JP Co, D. Dougherty, et al. (2004): “Quality measures for children’s health care”, in Pediatrics , 113, pp. 199-209.
- Back to top↑ N. Coyle, J. Adelhardt, KM Foley, and RK Portenoy (1990): “Character of terminal illness in the advanced cancer patient: pain and other symptoms during the last four weeks of life”, Journal Pain Symptom Manage , 5 (2), p. 83-93.
- Back to top↑ A. Morgan Capron (1992): “Euthanasia in the Netherlands: american observations”, The Hastings Center Report , 22.
- Back to top↑ World Health Organization (2002): National cancer control programs: policies and managerial guidelines . Geneva (Switzerland): World Health Organization, second edition, 2002.
- Back to top↑ “Euthanasia machine comes to United Kingdom” , article in English in the website BBC News .
- Back to top↑ Euthanasia machine comes to UK (English)
- Back to top↑ WMA Resolution on Euthanasia, Washington 2002
- Back to top↑ Venice Declaration of the WMA on terminal illness, Venice 1983. Revised at Pilanesaberg (South Africa) 2006
- Back to top↑ WMA Resolution on Euthanasia, Washington 2002
- Back to top↑ The Standing Committee of European Doctors makes pronouncements on euthanasia
- Back to top↑ Medical College Organization of Spain: Declaration on medical care at the end of life .
- Back to top↑ Remmelink Report
- Back to top↑ Read article in “Italian Vaticanist publishes letter of Ratzinger to United States bishops on communion” , article on the website Aciprensa, July 3, 2004.