Derived from the Greek word, meaning good death is euthanasia (Math & Chaturvedi, 2012). It can vary from active to passive former by induction and later in which supportive measures are withheld; it can be voluntary to involuntary former in which patient gives consent and later in which the consent is obtained by the guardians and it can be physician-assisted (Verkissen et al., 2018). Since it has been introduced in the field of medicine it has faced a lot of debate about the intention and credibility of the people involved. Euthanasia is a practice that is done when the patients are in life-limiting chronic disease conditions where living is causing more pain and discomfort for example in a case where a patient is suffering from cancer and they are undergoing palliative care (Gibson, 2018). Euthanasia is also called mercy killing so that the person can be relieved of his suffering and can leave painlessly (Gibson, 2018). Human rights organizations at times view this as a violation of human rights as it is viewed equivalent to suicide and according to judiciary systems it is a punishable crime. At the same time prolonging the inevitable in case of chronic disease patients is not killing or suicide and also the burden on healthcare can be reduced. The aim of the present debate is for the motion “Euthanasia Should be Legalized Nationally” while highlighting the ethical implication of doing so.
One of the most common factors in chronic illness is pain and one of the most common diseases which cause chronic and severe pain in patients is cancer which is a long battle where patients lose hope and sight of living (Slightam et al., 2018). The pain such a case is nociceptive in nature which is caused due to the main tumor or at the site of cancer and due to the metastasis which can be seen in advance stages of cancer (Thorp, 2018). Due to the invasion of cancer cells in the adjacent tissue, it can also invade bone where it causes an inflammatory response and which is the most common cause of pain. Cancer treatment often causes taste change in patients, some patients during the last stages of cancer are not able to swallow and all these factors together drive the patients towards the thought of ending their life (Thorp, 2018). The other diseases which are life-limiting which causes disability in the patients like meeting with accident, stroke, congenital defect like ALS, spinal muscular dystrophy where the patient is not in control of their bodies (Ripamonti, De Campos & McCosker, 2018). This is depressing for the patients and for the family members who have to take care of the patients.
The demographic profile of the population is shifting toward the aging population and the people who suffer from and require healthcare facilities are the ones who are extremely old (Wand et al., 2016). There are a few diseases that are specifically for the old age population which often require palliative care. The most important aspect of palliative care is to manage the constant, chronic and severe pain which the patients face and often they get suicidal tendencies and would want their suffering to end (Nabati & Abrahm, 2020). Patients have the support of the families who want their family members to live with them as long as possible and it is the reason that often there is a conflict of interest that may lead to ethical conflict. There are other reasons also for the tendency of suicidal which may be projected into a medical condition which may be seen as a chronic condition like depression, social isolation, inhibition, anxiety, pain, disability and being institutionalized (Karp, 2017). At this point, it is seen that the patients often feel that it is better to end their life than to prolonging living in pain. Taking into consideration the perspective of the patient the suicidal tendency is rationalized as they have information on their condition, its prognosis, have a realistic outlook and their interest is at the priority. Though it cannot be justified in all the conditions like if there is any condition that affects the cognition of the patient like in case of Alzheimer's the judgment of the patient cannot be used.
Euthanasia is not a novel concept and has been described in the Hippocratic Oath but in recent times it has gained more popularity. Since then many countries have debated along the length and breadth of the topic to legalize the act of mercy killing in healthcare. Due to the nature of the work in the present times, it is considered a public health problem. The first-ever medically documented case of euthanasia is Debbie who is an anonymous patient and the documentation of this "It's over, Debbie" started the opposition to medically assisted suicide (Lewis, 2018). The main goal of the medicine is to provide relief to the patient but the medical authorities across the globe have debated that killing patients for the achievement of this cannot be expected. In palliative care which is to be provided to the patients who suffer from chronic and painful illness with a goal to relieve them of the pain, it is documented that there is underuse of analgesics (Clark, 2017). There are a few countries where euthanasia has been legalized like in the Netherlands where the government is liberal and it could defend the context of euthanasia in healthcare.
There are less qualitative studies in the Australian context as euthanasia is not legalized nationally and the examples of the cases in the Netherlands show that most of the euthanasia requests occur in older people where there is the absence of mood disorder. The physicians estimated that they on an average 17% of requests to end life comes from patients who are tired of living. In a study conducted by Wand et al. (2016) where the cases are shown related to euthanasia, it was seen that the patients wanted to end their lives because one of them was scared of living in institutions and were in too much pain to live with. Meanwhile, the driving factor for the other patient was the loss of autonomy and not being able to things on his own due to disability. The author explains that these were rational choices for the decision and requests for euthanasia from people who are terminally ill can be a cry for help as they cannot bear or the pain or cannot see their family cope with their illness (Wand et al., 2016).
The legalization of euthanasia across the nation will reduce the suffering of the patients at the same time decrease the disease burden and money spent on healthcare by the patients and their family members (Watson, 2019). There are some intangible costs that cannot be accounted for but are an integral part of the disease process. This will also fall in the category of person-centric approach where the patient is at the center of the care provided and everything is done for the betterment of the patient. This will give patients the choice to decide how they want to spend the remaining short time of the life they have.
The argument against euthanasia has always revolved around the fact that it is against the natural order. The human rights show that if the patient chooses to end his life if there is a rationalization to that decision medically provision to the same should be provided. The ethical conflict can occur for the healthcare professional if the patient requests for euthanasia and the family members want the patient to live as long as possible (Pesut et al., 2019). According to medical ethics, there should be no harm incurred to the patient as a process of treatment and euthanasia is against no malevolence. Also, one of the principles of medical ethics, that is, beneficence states that only good should be done to the patient and euthanasia is for this ethical principle (Pesut et al., 2019). The conflict arises when the patients and family members want their will to take place at discretion with each other and as the medical ethics states the confidentiality of the patient’s condition should be maintained. In order to do so, there can be legal implications for the healthcare providers as they cannot refuse treatment to any patients but when the patient requests to end their life it becomes an ethical issue (Pesut et al., 2019). The other medical ethical principle should also be followed while considering the decision such as autonomy of the patient where the patient has the right to decide for himself till the time there is no arm incurred to others by the decision (Pesut et al., 2019). These ethical principles hold good when there is no cognitive function defect and the patient is lucid, but in case there is cognitive function defect the decision lies in the hands of medical proxy or guardians. Healthcare professionals are expected to act as advocates in such cases to make sure that there is no injustice that can occur in such a case.
Euthanasia also can be called mercy killing is the practice in which the patients who find living in chronic illness conditions difficult can opt to end their life. There are many ways in which euthanasia can be done active or passive, medically assisted, and voluntary and involuntary. The patient who suffers from chronic illness consists of old age people who have chronic illness coupled with ageism, depression and the fear of living alone or being institutionalized. There are very few countries across the globe who have legalized euthanasia and Australia is not one of them. This debate was made in favor of the legalization of the practice in the nation as the patients should have the choice as to how they want to spend the remaining short life they have. There are always ethical implications with such practices as the principles of medical ethics state that the decision should be in favor of the patient such that the decision-making capacity is given to him. There should be no harm that is incurred to the patient and the medical decision or the treatment should be beneficial to the patient and not following these can have legal implications for the healthcare professional.
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