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Developments in medicine have increased the possibilities of prolonging life and managing symptoms of terminally ill patients (Rietjens, Van der Heide, Onwuteaka-Philipsen, Van der Maas, & Van der Wal, 2006). Prolonging life, however, may not always be the most appropriate goal for incurably ill patients, and hastening of death may actually be the desired goal of care, for example, in the case of euthanasia. Palermo (1995) defined active euthanasia as “the killing of a patient by a physician who usually believes the patient to be terminally ill and in agonizing pain”. “Physician-assisted suicide is performed to end psychological or physiological suffering to a person who desires to commit suicide” (Worthen & Yeatts, 2000-2001).
End of life decisions, including physician-assisted suicide, have continued to be controversial and have raised many medical, legal, and ethical questions (Kopp, 2008-2009). There is no middle ground or strong consensus because, “Euthanasia is viewed as both an immoral crime and an act of moral compassion” (Proulx & Jacelon, 2004). Interestingly, while members of the medical profession debate the ethics of assisted suicide, public support for legalizing assisted suicide has been growing (Palermo, 1995). One reason why physicians, as compared to the population, are more restrictive may be the burden of responsibility associated with physician-assisted suicide (Lindblad, Lofmark, & Lynoe, 2009).
Additionally, physicians also may have a paternalistic view, not trusting patients to know what is best for them (Lindblad et al., 2009). A common argument against physician-assisted suicide is that it could erode trust in the medical services (Lindblad et al., 2009). However, research by Lindblad et al. (2009) found no evidence for the assumption that trust would be jeopardized if physician-assisted suicide were to be legalized. On the contrary, actions stressing patients’ autonomy would possibly result in an increased trust in the medical services (Lindblad et al., 2009). Another argument against legalizing physician-assisted suicide is that a person who is requesting aid-in dying may be suffering from a mental health disorder that might be impairing their judgment (Werth & Holdwick, 2000). Clinical depression and other mental health illnesses have association with higher rates of suicide, and depression is very common among terminally ill individuals (Werth & Holdwick, 2000). The prevalence of suicidal thoughts is higher among those cancer patients who experience emotional distress (Walker et al., 2008). Before considering assisted suicide as an option, mental health professionals should definitely evaluate and provide treatment for any present mental disorders (Werth & Holdwick, 2000).
Through their interventions they can help improve the quality of life of the dying person, reduce the risk of suicide, and possibly delay the option of euthanasia. (Werth & Holdwick, 2000). In some parts of the world, euthanasia is legal and widely accepted. The Greek roots of euthanasia lead to its meaning of a “good” death (Palermo, 1995). Granda-Cameron & Houldin (2012) suggested that the definition of good death may vary from person to person. To some euthanasia is an acceptable option to achieve the desired characteristics of a good death such as dying without pain, with dignity, and maintaining control. (Granda-Cameron & Houldin, 2012). “Many people are concerned that they might receive burdensome treatments that are not consistent with their preferences” (Rietjens et al. 2006). Results of a study by Proulx & Jacelon (2004) indicated that human dignity is largely lost when the life of a terminally ill person is prolonged by technology. “We cannot know what dying with dignity means for any given individual unless we take the time to ask and listen. In order to experience dignity in death, dying patients must have a voice to choose the circumstances of their death according to what matters most to them”. (Proulx & Jacelon, 2004) Research by Rietjens et al. (2006) indicated that the large majority of the Dutch general public considers dying painlessly important for good death.
Patients with advanced cancer, AIDS and Motor Neurone Disease report a higher likelihood to choose euthanasia as an option when compared to patients with other advanced incurable illnesses (Hudson et al., 2006). Pain is one of the most common symptoms in cancer patients, and it is likely the major reason for patients to want to end their suffering (Mori, Elsayem, Reddy, Bruera & Fadul, 2012). Palliative measures can effectively relieve severe pain (Mori et al. 2012). The number of physician-assisted deaths in the Netherlands has recently decreased probably due to an adequate palliative care (Lindblad et al. 2009).
However, “euthanasia and physician-assisted suicide still account for 1.8% of all deaths in the Netherlands, indicating that there is suffering related to terminal illness that cannot be sufficiently relieved by palliative measures” (Lindblad et al., 2009) Research by Granda-Cameron &Houldin (2012) found that patients still frequently die in hospitals with poor quality of life, poor pain and symptom management. Euthanasia is meant to cause death without feeling pain and to end suffering (Palermo, 1995). “No two people share the same life story and personal values, it is not possible to develop a universal, best way to die that honors and upholds dignity for all” (Proulx & Jacelon 2004). The right-to-die movement prioritizes patient’s autonomy in decision making (Granda-Cameron & Houldin, 2012). While clearly not suitable for all, in the future, euthanasia may become a choice for increasing numbers of dying patients. (Proulx & Jacelon 2004).
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