Tuesday, June 20, 2006

Euthanasia (from Greek: ευθανασία -'ευ "good", θανατος "death") is the practice of ending the life of an individual or an animal who is suffering from a terminal disease or a chronically painful condition in a painless or minimally painful way either by lethal injection, drug overdose, or by the withdrawal of medical support. Euthanasia is a controversial issue because of conflicting religious and humanist views.

Euthanasia as a topic is often highly-charged—emotionally, politically, and morally. Terminology and laws shift over time, geographically and globally, causing a great deal of confusion.
There is some debate as to whether euthanasia refers to "letting die" or "allowing to die." In the United States and the Netherlands, "letting die" or "allowing to die" refer to areas which the state consider ethically and legally acceptable and permissible. This includes the withholding and withdrawing of medical treatment such as dialysis, feeding tubes or hydration and nutrition when they no longer prolong the life of the dying person. Sometimes, as a body's major organ systems shut down, a dying person may feel most comfortable without any fluids or food. To provide fluids and nutrition in this situation is like "force feeding" a body that does not "want" or need to be fed or hydrated, and doing so may actually cause physical discomfort and suffering. This is a different situation than when the person is not dying, and whose body can absorb nutrition and fluids.

In most other countries removing or denying treatment without the clear instructions of the patient is usually seen as murder. In a growing number of law cases over the last 20 years, juries have sided with the lawful application of euthanasia.

Following are several summary statements defining what euthanasia can include. These are followed by expanded definitions of each. Euthanasia (assisted dying) may employ methods that are either indirect or direct. Indirect methods of euthanasia are defined by an individual him or herself taking the final step inducing death. Direct methods are defined by the involvement of others (clinicians) who take the final step inducing death. Direct euthanasia can either be voluntary, nonvoluntary or involuntary. (See Karl Binding and Alfred Hoche for one of the first uses of the three types of euthanasia.)

Indirect euthanasia means the involvement of a clinician (e.g. physician, clinical nurse practitioner, pharmacist) as an agent who participates only by providing treatment for symptoms (for example pain) with a known side effect being an early death. This is different from physician-assisted suicide, in which a doctor purposefully provides the means to a patient in the form of drugs and delivery mechanisms to kill oneself. This could mean writing or filling a prescription for medications, or personally giving medications, in a quantity large enough to cause death when taken by the patient. This kind of assistance is currently legal in the American state of Oregon. It became legal in 1997 as a result of the "Death with Dignity Act" which was passed in the state in 1994.

Direct euthanasia means the involvement of a clinician as agent in inducing a patient’s death. (e.g. administering a lethal drug by injection). Direct euthanasia is only legal in one state of the US (Oregon), but both direct and indirect euthanasia are legal in Belgium, Colombia, Japan and the Netherlands. This is an alternative in case the patient, due to their illness, is incapable of physically performing the lethal act themselves (e.g. drinking a poison, when the cup is handed to him or her.)

Voluntary euthanasia occurs with the fully-informed request of a decisionally-competent adult patient or that of their surrogate (proxy). (Example: Thomas Youk with ALS was assisted by Jack Kevorkian.) This should not be confused with death after treatment is stopped on the instructions of the patient himself, either directly or through a do not resuscitate (DNR) order. Enforcing a DNR order has never been considered assisted suicide or suicide of any kind, at least in the eyes of the law. Patients of sound mind have always had a right to refuse treatment.

Nonvoluntary euthanasia occurs without the fully-informed consent and fully-informed request of a decisionally-competent adult patient or that of their surrogate (proxy). An example of this might be if a "patient" has decisional capacity but is not told they will be euthanized; or, if a patient is not conscious or lacks decisional-capacity and their surrogate is not told the patient will be euthanized.

Involuntary euthanasia occurs over the objection of a patient or their surrogate (proxy). An example of this might be if a patient with decisional capacity (or their surrogate) is told what will happen. The patient (or surrogate) refuses yet the patient is euthanized anyway. This is generally considered murder. If a patient slated for euthanasia changes his or her mind at the last minute, the doctor is categorically required by law to honor that wish.

Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment, with the exception of medication for symptom control (such as analgesia). It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care.

In Nazi Germany the term "euthanasia" (Euthanasie) referred to the systematic killing of disabled children and adults under the T-4 Euthanasia Program. Technically, the T-4 Program was not euthanasia, since the word is defined as the merciful ending of a life for terminal or chronically painful conditions. This program was "cancelled", at least officially, after public disapproval was expressed. This has tainted the word especially in German-speaking countries; especially as one of the main advocates of euthanasia in Germany after World War II was Werner Catel, a leading Nazi doctor directly involved in T4. The currently accepted German term is the older "Sterbehilfe" (literally "helping to die"), which is used in contemporary German discussions.

Animal euthanasia is commonly referred to by the euphemism "put to sleep".

In the last 20 years, some states have faced voter ballot initiatives and "legislation bills" attempting to legalize euthanasia and assisted suicide. Some examples include: Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, and Michigan included Proposal B in their ballot in 1998. Public opinion concerning this issue has become increasingly important because widespread support could very well facilitate the legalization of these policies in other states, such as in Oregon.

While many people are aware of the ongoing debates concerning the issue of euthanasia and assisted suicide, it has been unclear where the public opinion stands in the United States. A recent Gallup Poll survey did show that 75% of Americans supported euthanasia, however further research has shown that there are significant differences in levels of support for euthanasia across distinct social groups. Recently, these attitudes have been receiving more attention since they not only could influence the legislation on this topic, but how patients are cared for in the future.

Some of the differences in public attitudes towards the right to die debate stem from the diversity of religion in this country. The United States contains a wide array of religious views, and these views seem to correlate with whether euthanasia was supported. Using the results from past General Social Surveys performed, some patterns can be found. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did.
Of the religious groups that were studied, which were mostly Christian in this particular study, conservative Protestants (including Southern Baptists, Pentecostals, and Evangelicals) were more opposed to euthanasia than non-affiliates and the other religious groups.

Moderate Protestants (including Lutherans and Methodists) and Catholics showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Moderate Protestants are less likely to take a literal interpretation to Bible than their conservative counterparts, and some leaderships tend to take a less oppositional view on the issue. Despite the fact that the Catholic Church has come out in firm opposition to physician-assisted suicide, they share the nearly same level of support as moderate Protestants.

The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive of the groups. In general, they had looser affiliations with religious institutions and their views were similar to those of non-affiliates. Within all these groups, religiosity (identified as being frequency of church attendance and self-evaluation) also affected their level of opposition towards euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed than to those who had a lower level of religiosity [1].

In Theravada Buddhism, a monk can be expelled for praising the advantages of death, even if they simply describe the miseries of life or the bliss of the after-life in a way that might inspire a person to commit suicide or pine away to death. In caring for the terminally ill, one is forbidden to treat a patient so as to bring on death faster than would occur if the disease were allowed to run its natural course.[2]

In Hinduism, death has been referred to both as the ultimate truth and as one of the stages in human life. In the Bhagavad Gita, Lord Krishna urges Arjuna to fulfill his destiny or Karma, and not to worry about consequences as death levels all: whatever you give and take, you do it on this earth. In Hindu mythology, some humans were given the right to choose the time of their deaths. This was awarded to only the most pure in heart, suggesting that Hinduism does not disapprove of euthanasia.


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