مطالب انگلیسی و پزشکی برای مطالعه شخصی
موضوعات امانتی از دنیای طب
Topics covered in this page are: The Verbal Battle over Euthanasia Giving gays and lesbians a choice in whether to marry; All are emotionally laden questions. Discussions about euthanasia often get mired in a mountain of emotional accusations, such as charges that the "most vulnerable" of humans are "besieged by euthanasia practitioners" and that families must fight "anti-life assaults on their loved ones" which "threaten the lives of those who are medically vulnerable". In reality, the basic question posed by euthanasia/assisted suicide is: should a person: who is terminally ill, and be given assistance in dying? Euthanasia is not: Whether a person should be free to ask a physician for assistance in dying. A patient can ask any question of their doctor. Ultimately, euthanasia is a question of choice: empowering people to have control over their own bodies. As of 1999-MAR, unless a person lives in Colombia, Japan, the Netherlands or the state of Oregon, the only lawful option is to remain alive, sometimes in intractable pain, until their body finally collapses. The main opposition comes from some: conservative religious groups. They are often the same organizations which oppose access to abortion. Groups that promote access to assisted suicide seem publicize cases where people have a terminal illness, are in intractable pain, and want to end their life. Although such cases do exist, they are in small minority. Many dying patients who are in serious pain have adequate access to pain-controlling medication. Most of those who would ask for assistance in dying may well be individuals concerned with quality of life or dignity issues. Unfortunately, groups on all sides have resorted to scare tactics. They do not tackle the issue directly, but create false scenarios to alarm the public. These methods may work on the short term, but will only serve to eventually alienate the public: Some groups in the pro-choice faction have described horrendous cases of terminally ill individuals, suffering terribly, in intractable pain, even though such cases are not the norm. Ethical aspects of Euthanasia: Some terminally ill patients are in intractable pain and/or experience an intolerably poor quality of life. They would prefer to end their life rather than continue until their body finally gives up. Does the state have a right to deny them their wish?
The verbal battle over euthanasia
Ethical aspects of euthanasia
Religious aspects of euthanasia
Public opinion on euthanasia
Many hotly debated social questions revolve around choice:
Allowing women the freedom to choose an abortion;
Giving people access to assistance in dying.
who feels that their life is not worth living because of intractable pain, and/or loss of dignity, and/or loss of capability and
who repeatedly and actively asks for help in committing suicide and
who is of sound mind and not suffering from depression
Whether a particular physician should take the initiative to kill a patient. The dying person must be the person to take the initiative.
Whether a person should be allowed to commit suicide. In most jurisdictions, suicide is a legal act, and has been so for decades.
Whether an otherwise healthy person who is going through a period of depression should be given help in committing suicide. They would not be given such assistance under any proposed legislation. Instead, their depression would be treated.
Whether a person's family should be allowed to initiate euthanasia; a request for aid in dying would have to come from the terminally ill person.
Whether death squads should periodically visit hospitals and nursing homes in order to kill people who are no longer contributing to society. This is a red herring created to scare people.
Whether everyone should select physician assisted suicide. Even if it were generally available, only a small percentage of people would request it.
medical associations whose members are dedicated to saving and extending life, and feel uncomfortable helping people end their lives.
groups concerned with disabilities, who fear that euthanasia is the first step towards a society that will kill disabled people against their will.
Some groups in the pro-life faction have been implying that "physician initiated murder" is the topic being debated, not physician assisted suicide. They have been raising the specter that the Oregon law would permit roving gangs of bureaucrats to visit nursing homes and decide which residents deserve to live and which to die; then they will kill all of the residents who they consider to be not worthy of life.
Even Focus on the Family, a Fundamentalist Christian group who has a reasonably good record of accuracy on social questions, appears to have misrepresented the question under debate. In an end-of-the-year review for 1997, their founder and president, Dr. Dobson, wrote: "By a sizable margin of 60-40 percent, Oregnonians [sic] have authorized their doctors to administer lethal doses of poison to willing patients...For the moment, if you are elderly and ill, Oregon is the last place you should want to be." 1 Dr. Dobson seems to have implied that elderly, ill residents of Oregon are at risk of being murdered against their will.
Dr. Abraham Halpern, an ex-president of the American Association of Psychiatry and the Law, and Dr. Alfred Freedman, ex-president of the American Psychiatric Association, wrote an article in the New York Times, stating that "Oregon’s Death with Dignity Act...should be repealed. It greases the slippery slope and will surely result in undignified and unmerciful killings." 2 The implication is that if we allow some terminally ill patients to die that eventually laws will be created to allow the state to kill anyone that it deems to be worthless. Dr. Dobson agreed, stating: "We will eventually be killing those who aren’t sick, those who don’t ask to die, those who are young and depressed, those who someone considers to have a poor quality of life, and those who feel it is their obligation to 'get out of the way.'" 1 Of course, the future course of legislation cannot be predicted. But the present law that was approved by the voters of Oregon is very specific and narrow in application, and will never be used unless a terminally ill patient, who is of sound mind and not depressed, specifically requests assistance in dying on a repeated basis.
Some considerations:
Suicide is a legal act that is theoretically available to all. But a person who is terminally ill or who is in a hospital setting or is disabled may not be able to exercise this option - either because of mental or physical limitations. In effect, they are being discriminated against because of their disability. Should they be given the same access to the suicide option as able-bodied people have?
Many faith groups within Christian, Muslim, Jewish and other religions believe that God gives life and therefore only God should take it away. Suicide would then be "considered as a rejection of God's sovereignty and loving plan". They feel that we are all stewards of our own lives, but that suicide should never be an option. This is an important belief for a member of one of these religious groups. They would probably never choose suicide (including physician assisted suicide) for themselves. But, for each deeply religious person in North America, there are many nominally religious or secular people. Substantial numbers of adults who have liberal religious beliefs treat euthanasia as a morally desirable option in some cases. There are also many secularists, atheists, agnostics etc. who actively disagree with religiously based arguments. And many of these folks would like to retain suicide as an option in case they develop a terminal illness and life becomes unbearable. Do devout believers have the right to take their own personal beliefs and extend them to the entire population? Should the personal beliefs of some religious folks decide public policy for all adults, including religious liberals, Humanists, Atheists, Agnostics, etc?
Many faith groups believe that human suffering can have a positive value for the terminally ill person and for caregivers. For them, suffering can be "a divinely appointed opportunity for learning or purification". A Roman Catholic document mentions that "some Christians prefer to moderate their use of painkillers, in order to accept voluntarily at least a part of their sufferings and thus associate themselves in a conscious way with the sufferings of Christ crucified". 3 These may be meaningful suggestions to some Christian believers. However, can such arguments justify denying euthanasia to persons who do not share those beliefs?
Many people argue that pain experienced by terminally ill people can be controlled to tolerable levels through proper management. They conclude that there is no need for physician assisted suicide. However, tens of millions of individuals in North America do not have access to adequate pain management. Tens of millions are without healthcare coverage. Many doctors withhold adequate levels of pain killers because they are concerned that their patient may become addicted to the drugs. Anticipated cutbacks to health funding will make this situation worse.
By making assisted suicide and/or euthanasia available, some people will be pressured into accepting assistance in dying by their families. This pressure may sometimes occur in very subtle forms. This is an important argument in favor of strict controls that would confirm that a patient is not being influenced by others. Some feel that the potential for interference is so serious that all assisted suicide should be banned.
Some people wish to die because they are suffering from clinical depression. This is another argument in favor of strict controls to confirm that a patient requesting aid in dying is "of sound mind".
In an age when total medical funding is restricted and being continually reduced, is it ethical to engage in extremely expensive treatment of terminally ill people in order to extend their lives by a few weeks, if it is against their will? The money used in this way is not available for pre-natal care, infant care, etc. where it would save lives, and significantly improve the long-term quality of life for others.
Some people argue that patients would be frightened that their physicians might kill them without permission. This is not a valid concern, since a patient would first have to request assistance in dying. If they did not ask for suicide assistance, their doctor would continue to preserve and extend their patients' lives.
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