Category: Euthanasia

Abstract

The ongoing discussion of euthanasia has its supporters and foes. It is already somewhat legal in few places in the world, but still strictly monitored and followed where it is available. Advocates fight for the cause stating that assisted-suicide provides an peaceful end to lives hindered by old age, terminal illness, and empty meaning of life. Those against euthanasia suggest that it is unethical to assist in any type of suicide and that human life should be lived to its fullest to the point that the life naturally ends. Doctors find themselves within the debate citing their own pledge of honor as a moral guide against euthanasia while others are determined to help their patients in anyway possible. Public opinion seems to be growing in favor of euthanasia as the debate goes on. The legalization of assisted-suicide if passed must be done with the most extreme caution and meticulous detail in ensuring that the system will not be abused.

Requested Euthanasia

Death is the final stage of life where the individual completes his or her arduous and fulfilling life and moves on to the unknown afterlife. The right to choose when to end one’s own life in a reasonable manner should not be taken because the individual has full responsibility to do what they want to themselves. At a certain point in life a person may deem that he or she has lived to the fullest extent that makes the individual feel complete. Usually when this occurs, people are at an elderly age of around 85 where numerous diseases and conditions could be hindering their daily lives with the only end in sight being death.

In particular, David Goodall experienced a similar situation towards the end of his life. A somewhat renown Australian scientist, Goodall was 104 years old suffering from deteriorated health that hindered his life to the point of stopping him from partaking in most activities such as working at the University of Melbourne where Goodall was asked to leave his position due to his frailty and to cease driving, performing in theatre, and using public transport. Losing all this left his left empty with little to do according to his daughter which stated, “His work is his hobby, as well as his passion, and without his work, I don’t think that there would be a purpose for him any more” (Joseph, Y. 2018, May 03). Due to these complications from his diminished health, he decided to go through with euthanasia. When asked if Goodall had any hesitation leading up to the procedure he sadd, “No, none whatever,” Goodall said. “I no longer want to continue life, and I’m happy to have a chance tomorrow to end it” (Joseph, Y., & Magra, I. 2018, May 10). To have this whole procedure done Goodall and his invited family members had to fly from Australia to Switzerland for the euthanasia to be legal. This is a costly price to pay especially for those who do not have an excessive amount of money to pay for travel. Due to the price, some of his grandchildren and children could not be present at the time of his dead. As an advocate for euthanasia, Goodall hoped his actions would incite changes in Australia’s laws regarding the issue. Finally after spending a final day with his present family members, he was able to die on his own terms accompanied by his final song of choice “Ode to Joy” by Beethoven.

Advocates like Goodall try to convince the public to further pursue legislation to allow for euthanasia worldwide. Euthanasia is to an extent permitted in Belgium, Canada, Colombia, Luxembourg, Netherland, and certain states in the U.S.. However, Switzerland is the only place that offers euthanasia to foreigners if the assistant is not benefitting from the person’s death. Public opinion has been slowly growing towards being in favor of allowing euthanasia according to Gallup’s annual Values and Beliefs poll done during May 3rd to 7th in 2017. This poll questioned through telephone interviews done with a random sample of 1,011 adults of at least 18 and older, living in all 50 U.S. states and the District of Columbia. In general 73% of Americans support euthanasia according to Gallup, Inc. on 2017, June 12. Of churchgoers that attend church weekly 55% believe in allowing euthanasia while 87% of those who seldom attend are in favor. On a moral basis 57% of Americans say that it is morally acceptable for a doctor to assist a patient in suicide. Due to recent polls showing public opinion increasingly moving towards favoring euthanasia, legislation in the states. States such as California and Colorado along with the District of Columbia most recently voted for death in favor of dignity in death. However, states such as Nevada and Maine still complicate passing more legislation by voting down any euthanasia or assisted-suicide movement. In conclusion, Americans have steadily grown support for euthanasia with it becoming increasingly morally acceptable for doctors perform the procedure leading to a rising movement for passing legislation in the U.S..

Doctors find themselves at the forefront of the euthanasia discussion. Among doctors euthanasia is a divisive issue of ethics in medical practice. One side opposes assisted-suicide because they enter the field with the intention of healing or curing people of their maladies while the other side advocates that doctors must take up the responsibility of granting the wish of euthanasia for the elderly and terminally ill. The side opposing euthanasia cites the Physician’s Pledge as why the practice of assisted-suicide should not be done by doctors. The pledge from The World Medical Association states:

AS A MEMBER OF THE MEDICAL PROFESSION:

• I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
• THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
• I WILL RESPECT the autonomy and dignity of my patient;
• I WILL MAINTAIN the utmost respect for human life;
• I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
• I WILL RESPECT the secrets that are confided in me, even after the patient has died;
• I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
• I WILL FOSTER the honour and noble traditions of the medical profession;
• I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
• I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
• I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
• I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
• I MAKE THESE PROMISES solemnly, freely, and upon my honour.

This pledge states that the doctor will not use their medical knowledge to violate any human rights or civil liberties. This can go both ways in the doctor’s argument of euthanasia. Rejecting a patient’s request could be upholding human rights, yet supporting it can also be violating the civil liberty of the patient. However, the pledge has already been questioned and considered somewhat out of date. David Warriner, a clinical fellow at the Academy of Medical Royal Colleges, uses the oath as a moral compass saying that, “It helps you with circumstances you face where you’re not sure what to do,” (Oxtoby, K. 2016, December 14). In contrast to Warriner, Clare Gerada, a GP partner in London, argues, “We are not royalty or priests, but health professionals doing a job, regulated by law and the GMC. That should be enough” (Oxtoby, K. 2016, December 14). In total the oath may provide medical practitioners a set of moral guidelines, but it proved to be out of date due to changing attitudes from modern ideas. Even with discussions advocating for a change of attitude on assisted-suicide the World Medical Association’s Declaration on euthanasia stands strong in their stance stating that ‘Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically” (WMA Resolution on Euthanasia. 2002, October 06). This statement seems to give doctors on the border of assisted-suicide a direct push towards avoiding the practice or supporting it. In conclusion doctors tend to be split on the issue of euthanasia with certain ideas becoming out of date with modern idea, yet major organizations in the medical field stand cemented in their stance against assisted-suicide.

The dignity of the patient is one of the utmost concerns in the discussion over assisted-suicide. Barring a suffering patient from their choice of euthanasia could be a somewhat spit in the face to the subject. When a patient chooses euthanasia, he or she has complete control on exactly how the final moments leading up to death will happen. The ability to die on one’s own terms gives the person a sense of peace because everything is occurring the way the individual expects. A patient that is diagnosed with a terminal cancer that only gives about 6 months left to live may choose to end the gnawing suspense of the imminent death. In no way does offering the choice of euthanasia force or incline the patient to choose it, but it gives the patient the freedom that. If he or she wish for euthanasia, it will be granted. Even if euthanasia became widely legal, in the instances that it the request is still denied because doctors and hospitals are not obligated to perform the procedure: “Across California, and in the five other states where medical aid-in-dying is now allowed, access is not guaranteed, advocates say. Hospitals, health systems and individual doctors are not obligated to prescribe or dispense drugs to induce death, and many choose not to” (Aleccia, J. 2017, January 25). It may take hospitals or clinics that specialize in assisted-suicide to be founded so that patients have somewhere to go for the method. Over time, as it has been recorded by studies, the overall public opinion on euthanasia will probably grow in favor leading to eventual more widespread practices of the procedure.

Achieving the legislation for assisted-suicide to become legal throughout the world would not be the final stage of this issue. First of all in determining if assisted-suicide should be legalized, having legislation passed against euthanasia may be found unconstitutional. In a situation from a Michigan court that created a law specifically prohibiting assisted-suicide a new issue arose. A journal from Yale about the law in question wrote that

A week later, the American Civil Liberties Union of Michigan brought a lawsuit on behalf of two cancer patients and several health care professionals who specialize in the care of the terminally ill, attacking the law’s constitutionality. The essence of the challenge is that insofar as the law prohibits a health professional, family member, or friend from assisting a competent, terminally ill person who wishes to hasten her death, the law violates the due process clauses of the state and federal constitutions and the “Right to Privacy Guarantee” of the state constitution (1993, May 01).

Ironically, laws prohibiting euthanasia can possibly be found unconstitutional while those legalizing it would not. As a civil liberty the freedom to choose assisted-suicide can fall under one of the inherited rights under the Constitution. Either way if euthanasia becomes legal and therefore normalized it may lead to a snowball effect. At first it may still seem unacceptable but with the passing of time euthanasia would become more and more practiced. Without descriptive laws detailing how a patient can apply or qualify for an assisted-suicide, the system may become abused by those who are not in need of it due to the possible lax nature that could build around it writer Ross Douthat says,“Once legalized, euthanasia would become routine. Over time doctors would become comfortable giving injections to end life and Americans would become comfortable having euthanasia as an option” (Douthat, R. 2009, September 07). Ways to combat the issue would be passing detailed legislation on the matter, however throughout history numerous loopholes have been found in countless laws passed by the U.S.. Another way to prevent the problem is to have close monitoring of any doctors that administers euthanasia on a somewhat common basis. In summary the effects of the legalization of assisted-suicide can be society becoming normalized to it, the system is abused by those who do not need it, and society’s view on doctors shifting from healing to killing.

As such in other issues, the world is transitioning away from past ideas and practices towards new modern ideals. It is important to not barr but provide all freedoms an individual may request. For those who suffer from old age effects on the body, terminal illness, or having no meaning left after a complete life euthanasia can offer a peaceful controlled method to end one’s life course. Global attitudes seem shifting towards acceptance of this freedom, yet there are still copious amounts of people that disapprove it. A general consensus on the matter seems plausible with hopefully a reasonable agreement between both sides of the euthanasia discussion.

References

1. WMA – The World Medical Association-WMA Declaration of Geneva. (2018, July 9). Retrieved from https://www.wma.net/policies-post/wma-declaration-of-geneva/
2. Joseph, Y. (2018, May 03). Why David Goodall, 104, Renowned Australian Scientist, Wants to Die. Retrieved from https://www.nytimes.com/2018/05/03/world/australia/david-goodall-right-to-die.html?action=click&module=inline&pgtype=Article
3. Joseph, Y., & Magra, I. (2018, May 10). David Goodall, 104, Scientist Who Fought to Die on His Terms, Ends His Life. Retrieved from https://www.nytimes.com/2018/05/10/world/europe/david-goodall-australia-scientist-dead.html
4. Gallup, Inc. (2017, June 12). Majority of Americans Remain Supportive of Euthanasia. Retrieved from https://news.gallup.com/poll/211928/majority-americans-remain-supportive-euthanasia.aspx
5. WMA Home Logo. (2002, October 06). Retrieved from https://web.archive.org/web/20151124001332/http://www.wma.net/en/30publications/10policies/e13b/
6. Aleccia, J. (2017, January 25). Legalizing Aid In Dying Doesn’t Mean Patients Have Access To It. Retrieved from https://www.npr.org/sections/health-shots/2017/01/25/511456109/legalizing-aid-in-dying-doesnt-mean-patients-have-access-to-it
7. Douthat, R. (2009, September 07). A More Perfect Death. Retrieved from https://www.nytimes.com/2009/09/07/opinion/07douthat.html
8. Yale. (1993, May 01). Are Laws against Assisted Suicide Unconstitutional? Retrieved from https://www.questia.com/library/journal/1G1-13931599/are-laws-against-assisted-suicide-unconstitutional
9. Oxtoby, K. (2016, December 14). Is the Hippocratic oath still relevant to practising doctors today? Retrieved from https://doi.org/10.1136/bmj.i6629

Suicide is when someone willingly ends their own life. Euthanasia is when a physician assists in ending a person’s life. Reasons for suicide include Post-Traumatic Stress Disorder (PTSD), bullying, mental illness, and substance abuse (alcohol, drugs, etc.). The reason for euthanasia is usually terminal illnesses or old age. The morality of dying in either of these ways is a heavily discussed topic. Some people who discuss the morality of suicide and euthanasia are John Hardwig, Richard Brandt, Carl B. Becker, and Kathrine young. In addition to these people, there are also groups of people such as the Samurai and Pure Land Buddhist that also discuss the morality of suicide and euthanasia.

John Hardwig talks about how we have a duty to die and that we should die well all of which is part of the quality of life. He states that euthanasia can be part of dying well and therefore is also part of the quality of life. In addition to this Hardwig also discusses how relying on technology to extend your life is not part of dying well. Hardwig also doesn’t think that it is unrealistic for elderly people and people who are terminally ill to consider euthanasia. He feels that it is selfish to try and stay alive when it’s not a life worth living. Willingly choosing to die in old age helps to lift the burden of ongoing care from loved ones. There are also financial and psychological costs associated with caring for the elderly and terminally ill people that can become too much for loved ones to bear. Hardwig also takes into consideration some possible objections such as how God forbids killing yourself, that ending your life goes against human dignity, and that death could bear a greater burden than illness. Overall, John Hardwig argues that voluntarily ending your life is better than any pleasure found in living miserably. So, therefore, he states that willingly choosing to die is more meaningful.

Richard Brandt argues that not all suicides are morally wrong but that it may be intrinsically wrong. However, there are times that it needs to be acceptable to commit suicide. When looking at the morality of someone committing suicide, we need to look at the reasoning behind the decision to end your life. There are two perspectives on suicide: One perspective argues that no matter what the situation is, suicide is wrong; The second perspective argues that there are some situations in which suicide is right which is what Brandt argues for. Brandt also considers other arguments such as Augustine’s theological argument and Aquinas’s natural argument. He also states that when we examine what the confines of this subject are suicide can be considered rational. For example, according to Brandt, suicide can be considered rational when distortion of thought or perception is avoided. These distortions of thought and perception are often caused by depression.

Carl B. Becker argues from the Buddhist ethical perspective which states that life doesn’t end at death but that it is instead a transition from this world to a different world. Therefore, from this perspective suicide is not the end nor is it an escape from anything but rather a transition to another world. Also, Japanese Buddhist view suicide as heroic and therefore not morally wrong. While on the other hand, Katherine Young argues from traditional Hindu ethical perspective which leans towards favoring a long life that is only acceptably shortened by a natural death.

The samurai argue that suicide is honorable as they often commit suicide to avoid dying while in the hands of others and or to avoid extensive and unnecessary suffering. This approach to suicide comes from the basic idea of being pure and simple, unconditionally serving a master, while also taking on full responsibility for fulfilling one’s duty. Though on the other hand Pure Land Buddhist aren’t concerned about the morality of suicide but rather the readiness of an individual to reach Pure Land. This Pure Land is the Buddhist equivalent of paradise.

Suicidal thoughts and suicide are a legitimate issue that people struggle with and almost everyone’s life has been impacted by suicide in one way or another whether its friends, family, or your own personal struggle with it. Therefore, suicide needs to be dealt with carefully because if we’re too hard against it we could end up making it even more difficult for people who struggle with it to deal with it. However, if we’re too relaxed or accepting of it there could be an increase in suicides which could possibly lead to the slippery slope effect. Overall, the morality of suicide is a hard thing to determine and really can vary from one individual to another individual.

I personally don’t feel like somebody should end their life just because they feel done with living but that instead there should be a sound logical reason for such an extreme decision. For example, if someone who is elderly or terminally ill chooses euthanasia than that could be an acceptable decision and way to end your life.

Under the current law, the treatment of mercy killing at the point of conviction and at the point of sentencing are considerably different and must be examined separately.

Mercy killing at the point of conviction

In convicting a defendant, there is no direct leniency given to those who have acted in the course of a mercy killing. R v Inglis makes this point apparent per Judge LJ: “The law of murder does not distinguish between murder committed for malevolent reasons and murder motivated by familial love. Subject to well established partial defences, like provocation or diminished responsibility, mercy killing is murder.” This judgement established the cornerstone of the stance that the law would take to mercy killing and were echoed in McCombe LJ’s judgement in R v Douglas. These decisions make it apparent that the courts are not willing to consider ‘mercy killing’ as a defence in itself when convicting although the expressed sentiments of regret may well indicate a willingness to accommodate such a thing.

The only potential relief a defendant can achieve at the point of conviction is through the manipulation of another potential, partial defence to reduce their conviction from murder to manslaughter: necessity, diminished responsibility and loss of control. The former has been denied as a potential defence to mercy killers, however, and so it falls to the latter two to protect such defendants. Prior to the 2010 reform of the Homicide Act 1957, the defence of diminished responsibility was often interpreted wide enough to allow for mercy killers to fit the criteria but this has become more difficult post-reform due to the supplementation of ‘an abnormality of the mind’ with the need for a ‘recognise medical condition’, a criterion that many mercy killers cannot satisfy. The narrowing of this defence further obstructs mercy killers from reducing their conviction to manslaughter and so the current law takes a notably harsh approach (although it should be noted that it does not completely preclude the defence). The loss of control defence has a similarly narrow test. The base requirement of a ‘loss of control’ may not be compatible with the facts of a mercy killing and the need for a qualifying trigger only exacerbates the slender applicability of the defence. Many mercy killers do not lose control, instead acting in a considered and measured way. It could even be said that they act because of their control over the situation; their ability to control the suffering of their loved one and control themselves in such a way as to end it would suggest this defence is inappropriate to use, even if applicable as it may not reflect the level of responsibility that such actors possess. As such, at the point of conviction, the current law provides very little, if any, relief to mercy killers.

Mercy killing at the point of sentencing

There is more potential for the courts to take into account mercy killing as a mitigating point when sentencing. Schedule 21, paragraph 11, section (f) of the Criminal Justice Act 2003 allows the courts to take into account the defendant’s belief that the murder was an act of mercy when setting the minimum term to be served. This has no definitive effect on the existence of a mandatory life sentence but does allow the courts to recognise that mercy killers are not culpable to the same degree as other murderers and deserve some degree of leniency.

In comparison to maintaining the status quo

Maintaining the status quo, although the most practically attractive option is normatively questionable. The advantages of following such a policy are not overwhelming although do have some weight.

The largest advantages in maintaining the status quo over introducing a partial defence are those that arise from continuity and consistency. By continuing to impose the mandatory life sentence in cases of mercy killing, the practical considerations regarding passing and enacting legislation as well as the repercussions of it upon the development of the common law need not be confronted and is the option that will cause the least disruption or undermining of the current law. This, however, does not address the issue of culpability as it cannot be held that those who ‘killed compassionately in order to relieve the victim’s suffering’ are as culpable as those who kill maliciously. The argument that diminished responsibility already provides a way for mercy killers to reduce their conviction to manslaughter and so address the culpability issue has been suggested by some, despite its aforementioned narrowness: Mathew Gibson believes “Creative use of diminished responsibility is still achievable,” and the partial defence may still allow mercy killers to be convicted of manslaughter rather than murder. The accuracy of this claim is debatable as the reformed diminished responsibility plea significantly narrowed its availability to mercy killers, Hughes LJ in R v Dowds noted that the presence of a recognised medical condition was a ‘necessary, but not always…sufficient condition, to raise the issue of diminished responsibility’ and illustrates how the medicalisation of diminished responsibility has reduced its applicability to mercy killers who suffer from no such condition. If the defence is completely unavailable, maintaining the status quo becomes significantly less attractive but if Gibson is correct in saying that the defence is still open, if reduced, there may still be an argument in it.

Even if this is the case, there is still the question of if maintaining the status and using the diminished responsibility defence is normatively appropriate. The law ought to be consistently applied and maintain its own integrity and yet a ‘creative use’ of it could easily be seen to undermine this. It is preferable to introduce a new partial defence than to manipulate and misconstrue an existing one.

It could be equally argued that the mandatory life sentence, even in cases of mercy killing, has a greater normative importance. The taking of another human being’s life is one of the most reprehensible possible acts and it could well be considered that to allow anything to alter the seriousness with which the law views such a thing is to undermine the law’s protectory and punitive nature. When the Government announced a review of the law of murder, the terms of reference made explicit that the review was to “Take into account of the continuing existence of the mandatory life sentence for murder.” This suggest an inherent normative importance in the concept of the sentence and so its dismissal in the context of mercy killers cannot be so simple. The flaw in this argument, however, is that this was only a concern regarding the law of murder. If a partial defence for mercy killing was introduced that downgraded the offence from murder to manslaughter, the issue of a mandatory life sentence would cease to exist. Similarly, this argument could be applied to all of the existing defences for murder, and their existence would be brought into question. Imposing a mandatory life sentence may be undeniable for murder, it is not the be all and end all for all homicide offences.

There is the related issue of fair-labelling that must also be addressed. It is unlikely to be controversial to claim that mercy killers ought not be held as culpable as ordinary murderers and so the manslaughter label is more appropriate than murder. However, this is not an argument specifically in favour of the creation of a new partial defence for mercy killing as, if Gibson’s claim regarding diminished responsibility is correct, it could easily be achieved this way.

It ought to also be noted that public support appears to be in favour of leniency in regard to mercy killers. 79% of the public are in favour of only up to 9 years imprisonment for defendants in mercy killing situations and only 4% are in favour of the mandatory life sentence. As such, maintaining the status quo would not be in the public interest, although such data is simply indicative of acceptance, rather than active desire.

Practically, introducing no new partial or full defence would be the easiest option but this is not enough of a justification in itself. The other considerations mentioned above appear to outweigh practical considerations

In comparison to creating a separate criminal offence

The creation of a separate criminal offence is a practically cumbersome choice in comparison to a partial defence although it may provide more normative advantages.

The practicality of introducing a separate offence for mercy killings is two-fold. First, in passing the appropriate legislation, second in the effect of said legislation. In regard to the former, drafting and enacting such extreme reform, even if it had overwhelming support, would be inherently complex, as it is with any bill whereas introducing a partial defence would be significantly simpler. In regard to the second, the introduction of a completely separate offence could easily obfuscate and undermine the clarity of the law, as well as disrupt the development and continuity of the common law. It could be said that such issues are equally likely to result from the introduction of a partial defence but it would be to a considerable lesser extent, particularly in terms of effect on the common law. This is due to the fact that the partial defence would be incorporated into the existing law of murder and would not have to be recognised under the more general category of homicide. There is also the fact that if the effect of the separate criminal offence on a defendant’s conviction is the same as a partial defence then the former appears to lose any of its advantages bar the fair label.

It may be possible to claim the converse, that the introduction of a separate offence would actually aid the clarity of the law as providing another partial defence, in addition to loss of control and diminished responsibility, to murder may only add to its complexity and wide scope. Although, it could equally be said that encompassing mercy killing as a partial defence and so maintaining the singular categorisation of homicide would be just as practically beneficial, if not more so, by maintaining a streamlined and efficient murder charge.

The normative disadvantages of maintaining the status quo are addressed by creating a separate criminal offence. The fair-labelling issue would be addressed to an even greater degree than a partial defence and the lesser degree of culpability in mercy killing offences would be addressed. Similarly, the normatively and practically troubling use of diminished responsibility would no longer be necessary. The public preference for a lesser sentence would also be satisfied through this reform although it would also be done, if not as explicitly, through the introduction of a partial defence.

The Law Commission also noted the distinction between a justificatory and excusatory offence and emphasised its importance, claiming that the creation of a separate criminal offence would rely too greatly on justification, preferring instead to view any possible approach to mercy killing as solely reliant on an excusatory legal philosophy. Although a notably legal and theoretical question, it ought to be considered by the Secretary as by allowing mercy killing to be justified would be to condone the act itself whereas to excuse it, as would be achieved through a partial defence, would condemn the act whilst understanding its motive. The latter is likely to be a more suitable approach to mercy killing as it maintains the law’s purpose of discouraging the taking of another human life whilst incorporating moral and principled considerations for the specific act of mercy killing.

Many of the advantages of the creation of a sperate criminal offence for mercy killing are also present if introducing a partial defence. Practically, the two options are similar although a partial defence is less disruptive and easier to implement but theoretically, a separate offence would guarantee closely tailored and appropriate treatment for mercy killers.

In comparison to introducing a full defence

The advantages and disadvantages of a full defence for mercy killers in comparison to a partial defence are similar to that of the creation of a separate offence.

Primarily, a full defence would acknowledge the lesser degree of culpability of mercy killers in comparison to murderers. However, a complete acquittal could be too lenient. The 79% of the public in favour of leniency for mercy killers are not necessarily in favour of full acquittal, especially not in cases with a non-terminally ill victim, and to do so would be to fail to reflect the seriousness of taking another’s life. This latter consideration is inherent in both governmental reasoning behind the murder offence A partial defence would manage to meet both needs, by reducing the sentence whilst still imposing an appropriate degree of punishment. However, the full defence of necessity arguably allow equally culpable defendants to be acquitted and so there is little reason to object to allowing a full defence for mercy killers. In regard to mercy killers, there is a greater degree of control and choice than in necessity cases and so they may be considered more deserving of conviction than acquittal.

In relation to this, there is, again, the issue of fair-labelling. Imposing the murderer label on a mercy killer may be too far but holding them completely innocent could be equally as troubling for the reasons mentioned above. This, however, is a notably subjective question and reliant upon a definition of what ‘fair’ treatment of mercy killers is. Allowing a full defence in such cases would be adopting an extreme view and so be more likely to incur strong and controversial reactions whereas a partial defence, that encompasses the middle ground of labelling, is a more moderate and so potentially more universally acceptable solution.

The practical advantages of allowing a full defence for mercy killers are in the clarity of the law. A clear, full defence does not require the degree of integration that a partial defence would and is capable of standing on its own, although not to the same extent as a separate offence. However, this advantage is minimal and the clarity that a full defence would provide cannot justifiably outweigh the potential culpability issues that an acquittal would cause. Enacting the legislation itself may also be an issue. The government’s strong desire to maintain the mandatory life sentence may reflect a desire to maintain the current law regarding mercy killings and so the passing of any bill in regard to these defendants may have added obstacles, obstacles that a partial defence, as a less radical reform, would not face.

A full defence for mercy killing may address some of the issues of the current law regarding mercy killing but the practical and theoretical disadvantages are significant in comparison to the potential of a partial defence.

Euthanasia, or assisted dying, is one of the most debated ideas globaly with many views for and against the motion. Euthanasia is the painless killing of a patient who is suffering from an incurable and painful disease or in an irreversible coma. There has been a variety of films made about euthanasia, one of these being the 2016 film, Me Before You. Me Before You is a film which looks at the decision process around Euthansia from the view of Will Traynor, his parents and his love interest. It delves into personal opinions and values and depicts the thought process which is common through most euthansia cases.In Australia, euthanasia is illegal in all states and territories expect Victoria, who legalised it in 2017, and soon Western Australian, to legalise it in 2021. However it is only permitted under specific guidelines and if certain criteria are met. In 2018, India legalized passive euthanasia and alike Victoria, it has to reach specific circumstances strict guidlines. All patients who are wanting to be euthanized must be either in a vegetative state or terminally ill and give consent through a living will. Christianity and Hinduism are two religions that have both similar yet different views on this topic of discussion.

Hinduism is the third largest religion in the world after Christianity and Islam, with around 900 million followers and is the world’s oldests religion, with roots dating back to over 4,000 years. 95% of Hindu followers reside in India. Hindus believe in a single deity known as ‘Brahman”, meaning that they are monotheistic. They believe strongly in the principles that one’s thoughts and actions will directly determine their future and current lives. There is no set text in Hinduism but a variety of sacred writings. The main texts are known as the Vedas which holds hymns and verses that contain revelations received by ancient sages and saints. In Hinduism the meaning of life is achieved in 4 ways; one must achieve Dharma, moral law and duty, righteousness, right conduct, Artha, the pursuit of wealth and prosperity in one’s life, Kama, obtaining enjoyment in life, and Moksha, to obtain enlightenment. There are a number of different views on euthanasia in the Hindu religion. The majority of Hindu followers claim that doctors should refuse a patient’s request to be euthanized as it will affect the body and soul, causing them to separate at an unnatural time, damaging the karma of both the doctor and patient. They also state that it breaches their teaching of Ahimsa, which is doing no harm. There are some hindu’s who do believe that euthanizing someone is beneficial to their life. As they are helping to end a painful life, the person who is administering the drug is performing a good deed towards another, in turn fulfilling their moral obligations and achieving the concept of Dharma. One of the most well known figures in Hinduism, Mahatma Gandhi had voiced his own opinion on what would later be called euthanasia and assisted suicide. Gandhi, who was a lawyer, political activist and anti-colonial nationalist, understood that violence at times was unavoidable but under certain conditions, killing a human may be seen as an expression of non-violence. He stated that in rare cases, it would be better to kill an individual who is in extreme suffering at the end of their life “A calf, having been mained, lay in agony in the ashram and despite all possible treatment and nursing, the surgeon declared the case to be past help and hope… Would I apply to human beings the principle that I have enunciated in connection with the calf?.. My reply is yes..”. However he also believed that if there was care to the dying individual, their suffering could be eased.

Christanity is the largest followed religion in the world with more than 2 billion followers. Christianity is split into 3 different branches; Catholic, Protestant and Orthodox. The Catholic branch is governed by Catholic bishops and the Pope around the world. The Orthodox branch independent subdivisions each of which is governed by the Holy Synod. The Protestant branch has a number of denominations within it, these include Lutheran, Anglican and Baptist. Although they have different views and traditions, their core faith is centered around the teachings of Jesus. Like Hindus, Christians are monothesitic s they believe in one God, who created heaven and earth. The God consists of three entities; the father, God himself, the son, Jesus, his son, and the Holy Spirit. Christianity has one main text, which the bible. The bible consists of two parts and contains Jesus’s teachings, lessons and how Christians should live their day to day lives. Majority of Christian followers are against the idea of euthansia and assisted suicide as they believe strongly, that all life is given by God and no human has the right to take the life of any innocent individual, even if that individual wishes to die. Another popular view is that everyone’s life is equally important, no matter what state they are in, so taking one’s life would be viewed as considering them useless. The Roman Catholic view also agrees with the Christian view in that euthansia is morally wrong and one should not go against the teachings of the ten commandments, one of which states that “You shall not kill”. Pope John Paul II stated in his encyclical the Envangelium Vitae his views on euthanasia “Euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person.”. He stated that humans should always prefer the prospect of life opposed to the idea of death and spoke out against what he described as “a culture of death”.

Both Hinduism and Christainty view euthanisa as the unlawful killing of an innocent person, despite if it is the person’s wish to be euthanized. They agree that by euthanizing someone, it will upset the balance of life and it is not a human’s right to decide when one leaves this earth, but a higher entity. The breach of a teaching is also another common similarity between both religions as euthansia goes against the christian commandment of “You shall not kill” and the Hindu teaching of Ahimsa, doing no harm. Gandhi, who was opposed to the idea of assisted dying did say that if there was no other way to end the suffering, than euthanasia would need to take place however Pope John Paul II was strongly against the idea of euthanasia even if it was used a last resort. The idea of helping someone suffering without the act of euthanizing them was recognised in both religions, more so in Christianity with the full support of Pope John Paul II. Religion has a crucial role in lawmaking throughout the world, as those in power have their own religious values and teachings and this influences them to mold their laws around these specific teachings. In societies that are ruled by Chrisitanity or Hinduism, their laws will be strongly against euthanaisa due to the political and religious stance their of leaders have but there may be some leniency with these laws depending on the circumstances that the event is occurring in.

Christianity and Hinduism are two religions that look at the strong disapproval of euthanaisa in societies. These traditions and values influence others as it is the basis for their own values and beliefs. Religion influences everyone’s lives in ways that some might not even realise. In Australian society, Christaintity is the most dominant religion and through its influence has provided society with many facilities arising out christain culture, for example churches, schools, hospitals and charities. These facilities are used day to day by people of all ethnicities and religions and are open to all. Hinduism is the fastest growing religion in Australian and through its ever growing presence and influence, there are many celebrations, rituals and events that are recognised in the Australian community. Yoga, a spiritual movement that is recognised throughout all of Australia and the world with people of all ethnicities and religions taking part in this event.

Introduction 

In the United States, the right to die is a controversial and often emotional topic. There are two main sides to the argument: those who believe that people have the right to end their lives when they are suffering from a terminal illness or are in pain, and those who believe that this is a decision that should be made by the individual’s family or doctor. 

There are many factors to consider when taking a side on this issue. For example, some people believe that the right to die is a personal choice that should not be taken away by the government. Others believe that the government has a responsibility to protect its citizens, and that allowing people to end their lives could lead to abuse. 

There is no easy answer to this question, and it is one that will likely continue to be debated for many years to come. However, it is important to consider all of the factors involved before taking a side.

The Right to Die is a Fundamental Human Right 

The right to die is a human right. It is a right that every person should have. The right to die should be a person’s choice. It should not be up to the government or anyone else to decide when or how a person can die.

The right to die is a controversial topic. Some people believe that everyone has the right to die when they want to. Others believe that the right to die should only be available to people who are terminally ill or in great pain.

There are many different ways to die. Some people die naturally, while others die by suicide or euthanasia. Natural death is when a person’s body stops working and they die of old age or an illness. Suicide is when a person kills themselves. Euthanasia is when a doctor kills a person who is terminally ill or in great pain.

The right to die is a complex issue. There are many different opinions on it. I believe that everyone has the right to die when they want to. It is a person’s choice and no one else should be able to make that decision for them.

The Right to Die should be Respected by the Government and the Law

In the United States, there is no federal law governing the right to die. However, there are a number of states that have legalized physician-assisted suicide, including Oregon, Washington, Montana, and Vermont. According to government statistics, as of 2016, there were an estimated 1,327 people who had died as a result of physician-assisted suicide.

The right to die is a controversial topic, but I believe that everyone should have the right to make this decision for themselves. No one else can know what a person is going through, and no one else can make this decision for them. It is a very personal choice, and one that should be respected. The government and the law should not get involved in this decision. It is not their place to tell us what we can and cannot do with our own lives. We should be free to make this decision without interference from the government or the law. If you are facing a terminal illness or are in immense pain, you should have the right to end your life on your own terms. No one should have to suffer through a prolonged and painful death. If you are in control of your own life, you should be in control of your death.

The Right to Die should be Protected by the Law

The right to die laws are a set of laws that give people the right to end their lives if they are suffering from a terminal illness or are in a vegetative state. These laws vary from country to country, but they typically allow people to request a doctor to assist them in ending their lives. In some cases, the doctor may be required to provide the person with information about their options and to help them understand the consequences of their decision.

In Canada, the issue of the right to die is governed by the Criminal Code. Section 241 of the Code makes it a criminal offence to assist a person in committing suicide. However, the Supreme Court of Canada has ruled that this section does not apply to physician-assisted suicide, as long as the physician acts in accordance with certain conditions.

In the United Kingdom, assisted suicide is illegal. However, the Crown Prosecution Service has issued guidelines stating that prosecutors should not bring charges against someone who assists a suicide in certain circumstances, such as if the act is carried out with compassion and the intention of relieving suffering.

In Australia, the issue of the right to die is governed by state law. Victoria is the only state that has legalized physician-assisted suicide, while the act remains illegal in all other states.

There is no specific law governing the right to die in New Zealand. However, the New Zealand Medical Association has issued guidelines stating that physicians should not assist in suicides.

In Japan, suicide is not illegal. However, assisting someone to commit suicide is a criminal offence.

Conclusion

I am in favor of the right to die.

Everyone should have the right to end their life if they are suffering from an incurable disease or are in immense pain. It is a fundamental right of an individual to have control over their own body, and this includes the right to end one’s life if they so choose.

The right to die should be carefully regulated in order to prevent abuse. For example, there should be a requirement that the individual seeking to end their life must be of sound mind and must have made the decision voluntarily. There should also be a waiting period to ensure that the individual is not making the decision in a moment of desperation.

The right to die is a humane and compassionate way to end the sufferings of those who are terminally ill or in great pain. It should be carefully regulated in order to prevent abuse, but it is a fundamental right that everyone should have.

Euthanasia is the assisted dying of giving people the right to die peacefully in people who are terminally ill or not experiencing their fullest life. euthanasia is all about letting the ill keep their dignity and having a peaceful death and limiting pain and suffering

During the last century, medicine has improved and the acceptance of these diseases and disabilities “it has become normal”. In saying this there are still many sicknesses that can’t be cured but also cause extreme pain to people who have them. Patients with sickness like this should have the choice of euthanasia because life as everyone should agree should be the most amazing gif of all people should be happy. But still, countries of today believe this is immoral or illegal.

In our world today many sicknesses can give intolerable pain mentally or physically. An example of such disease is the locked-in syndrome people who have locked down can’t move any muscles. One of the people how had to deal with this is, Tony Nicklinson, in 2010 was denied his right to be euthanized by the British High Court. As Tony was unable to even move his tongue or eyeballs let lone kill himself and as the quality of his life worsened, Tony starved himself to death and died in 2012. This is not acceptable by any means of any human decency or compassion to one another people’s rights and wishes its tony life and Tony’s body and he was denied that birth is given right. Tony’s family had to deal with him dying with no dignity also in pain. This is just one in an uncountable number of people with a disease like this and in this position

But the people against euthanasia still argue that this is wrong and in just that a cure could come out even the euthanasia 86% of the time shortens the life of the patient by a mouth or a couple of weeks or hours even

Besides, it is cruel and in just to keep people terminally ill alive. And at the same time, there is no proof that diseases such as locked-in syndrome or brain cancer will be cured in the near further

And as much as it is easy to keep people clinically alive someone being kept alive by a machine is not living. Is it not like torture? Assurances and promises that there will be a cure someday do not deny the fact that doctors (and relatives of an ill person) consciously keep a patient in pain and humiliation for an undetermined period. Doing this violates several individuals’ rights and should not be tolerated.

99% of the cases of euthanasia are justified. Some diseases cause severe suffering; sometimes, a patient might try to commit suicide to end this suffering; life for such patients is worse than death. Euthanasia is not killing; its letting people with there dignity—according to the statistics, patients usually ask for euthanasia a maximum of one week before they would die. Also, keeping a person alive against their will and making him or her withstand pain and suffering is not different from torture, and thus should not be allowed: if a patient wants to die, and his or her condition is truly hopeless, relatives, doctors, and the law should not prevent them from doing so.

Huntington’s disease is a genetic disease that causes progressive damage to cells in the basal ganglia and cerebral cortex which are both found in the brain. These areas control movement and the way one thinks, understands and remembers. The disease was characterized by George Huntington in 1872. People with Huntington’s disease generally develop symptoms between the ages of 30 and 50. These symptoms include:

1. Cognitive: amnesia, delusion, lack of concentration, memory loss, mental confusion, difficulty thinking and understanding.
2. Muscular: abnormality walking, increased muscle activity, involuntary movements, problems with coordination.
3. Behavioural: compulsive behaviour, fidgeting, irritability, lack of restraint.
4. Psychological: delirium, depression, hallucination, paranoia.
5. Mood: anxiety, apathy, mood swings.

Huntington’s disease is caused by an inherited defect in a single gene. The disease is an autosomal dominant disorder, which means that the affected person only needs one copy of the defective gene to develop the disorder. Huntington’s disease is caused by the number of CAG repeats in the Huntingtin gene. If there are 10-35 CAG repeats, the individual does not have Huntington’s disease, whereas if the individual has 36-40+ CAG repeats, the individual will develop Huntington’s disease.

If one does have Huntington’s disease, these are some services that can be contacted: Huntington’s VIC/NSW/QLD, Brain Foundation, Huntington’s Disease Youth Organization, International Huntington Association.

There is currently no treatment for Huntington’s disease, however there are medications available and lifestyle changes that can help delay the onset of the disease and the progression of symptoms.

In December 2017, Ionis pharmaceuticals made a major breakthrough in protein altering technology. Huntington’s disease occurs through the mutation of the DNA sequence, this sequence is then transcribed by the RNA in order to form faulty proteins which cause the disease. These scientists have developed a technology called antisense oligonucleotides or ASOs. These ASOs are custom built, chemically modified sections of DNA that can freely enter cells. Once inside the cell they locate and then destroy the specific piece of RNA that instructs the cells to make the Huntingtin protein. The drug has been cleared that is safe and has no side effects, however the trial conducted was over a period of four months, so it is unknown whether the drug has made the symptoms better. For this technology to come onto the market, a full clinical trial will have to be carried out on individuals with Huntington’s syndrome over the course of their lifetime. Although there is no current cure for Huntington’s disease, new technologies are being developed which makes the future look promising for those with the disease.

While these technologies are being developed, there are systems in place to delay the progression of symptoms. As keeping fit is scientifically proven to help the brain stay healthy, keeping fit is recommended to those with HD. Also, living a healthy lifestyle such as eating and sleeping well as well as being outdoors has shown to keep the brain healthier. Doing puzzles such as Sudoku can exercise the brain and in doing so, keep it healthy and active. As one may experience anxiety and depression when dealing with HD, a specialist doctor may prescribe some anti-depressant medication.

As the symptoms of an individual with Huntington’s disease slowly become more progressive, the individual may go into palliative care. This means the person goes into care to optimise their quality of life before they eventually pass away. Services of palliative care differ to suit a patient’s needs; however, some services include:

• Administration of medication to ease symptoms.
• Counselling and grief support
• Support for people to meet cultural obligations
• Support for emotional, spiritual, social concerns
• Links to other services such as home help and financial support
• Assistance for families to talk about sensitive issues
• Resources to aid care at home

This care is necessary to make sure that the times in which families and individuals are most vulnerable can be time spent with their loved ones, and that the quality of life for the person with the disease can be the best it can. In my opinion, there should be more government funding into palliative care, because it is not only expensive but because people are busy grieving over their loved one and should not be worrying about how much the care costs. Palliative Care Victoria is a not for profit organization that provides the services listed above. Although they have $72 million in the budget, it is still not enough to provide the services they should be providing. Their priorities should be to the patients, not to the money they need to ration in order to keep the organization running.

Genetic screening is a type of medical test that identifies changes in chromosomes, genes or proteins. It is used to determine whether a person will develop or is the carrier for a genetic disorder. When screening for Huntington’s disease, doctors look for the number of CAG repeats on the Huntingtin gene. The number of CAG repeats a person has will determine whether they are gene positive or gene negative. Genetic screening for Huntington’s disease must occur when the individual is 18 years or older. They must also want to know if they have Huntington’s disease. The age is 18 so that the person may choose for themselves if they want to know their gene status, rather than having a parent choose for them and then the individual getting told without wanting to know. In fact, 85% of people at risk choose not to be screened. This, however, poses multiple ethical problems, as a child of a parent with Huntington’s disorder has a 50% of inheriting the disorder. By having a child, the parents place their child 50% at risk, however if they don’t, they can look to adopt a child. However, this child will be forced to bear the burden of caring for its parents and bear the emotional stress of having a loved one pass away. By process of adoption, the Huntington’s disorder can be fully eradicated however many individuals with the disease want to have children. If one is screened for Huntington’s disease and are found gene positive, they can then make an informed decision about whether to have a child, adopt or not have a child at all. If the parents do choose to adopt, they will eliminate the allele out of the family line and in doing so save their family from the chance of getting the disorder.

For one person who has Huntington’s disease, to pay for the treatment’s and support for this person costs around $40,500. Over 65% of this cost is for palliative care once the symptoms get progressively worse. In Australia during 2016-17, the Australian government spent $9.1 on mental health-related services. This was roughly $375 per person. 7.4% of government health expenditure was spent on mental health-related services. Although $9.1 billion sounds like a lot of money, 1 in 5 people experience mental illness every year, on top of the people who constantly live with a mental illness. Overall, more funding needs to be invested in genetic mental illness such as Huntington’s disease.

Referring to the map, it is shown that Western Countries such as the U.S, Australia and England as well as parts of Europe and Canada are the most prevalent, as they have 5 or less people with HD. In the Middle East and Asia, it is less prevalent with only 0.5 to 0.1 people having the disorder. If the number of people with HD is unknown, it shows that there must not be many people with HD to make it a concern. As mainly Western countries are prevalent with HD, it means they are going to be more technologically advanced and have greater funding into the disease whereas countries that are less prevalent for the disease are less likely to fund research into something that is not a concern. This is fine, however people with HD in countries where it is not prevalent are more likely to have to spend more on treatment as it is not available in their country. This raises ethical debates around who needs the technology more and why some countries should have access to the technology while others shouldn’t.

Although an individual with Huntington’s disease will try and live as quality a life as possible, sometimes the symptoms become so severe that Euthanasia is an option that may be open to people whose symptoms of HD have progressed to the point where it is better they end the pain rather than live through it. Euthanasia, however, is only legal in five countries: Netherlands, Belgium, Colombia, Luxemburg and Canada. This means that people who do have HD need ongoing counselling as suicidal thoughts are common once they reach the later stages of the condition.

Bibliography

1. Huntington’s disease | Health Information | Bupa UK 2017, Bupa.co.uk.
2. Huntington’s disease – Symptoms and causes 2018, Mayo Clinic.
3. Fritz, NE, Rao, AK, Kegelmeyer, D, Kloos, A, Busse, M, Hartel, L, Carrier, J & Quinn, L 2017, ‘Physical Therapy and Exercise Interventions in Huntington’s Disease: A Mixed Methods Systematic Review’, Journal of Huntington’s Disease, vol. 6, no. 3, pp. 217–235.
4. Huntingtons 2019, Huntingtons.
5. Hdbuzz.net. (2017). Success! ASO drug reduces levels of mutant protein in Huntington’s disease patients – HDBuzz – Huntington’s disease research news. [online] Available at: https://en.hdbuzz.net/249 [Accessed 11 Nov. 2019].
6. What is Palliative Care? – Palliative Care 2016, Palliative Care.
7. Genetics Home Reference 2018, What is genetic testing?, Genetics Home Reference.
8. Australian Institute of Health and Welfare. (2019).
9. Mental health services in Australia, Expenditure on mental health-related services – Australian Institute of Health and Welfare. [online] Available at: https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/expenditure-on-mental-health-related-services.

End-of-life care and practice has evolved over the years. There has been a shift on the attitudes about death in American society. Age, gender, race, and socioeconomic status all contribute to the attitudes toward death. It impacts everyone individually and it is not a universal grief. Many Americans are uncomfortable in speaking about death. Young older adults have a higher anxiety in death compared to older adults. Older adults are not strangers to death and grief and are more accepting of death. What does trigger their anxiety is the thought of their death process. Many older adults have the fear of being institutionalized, pain and suffering, not having closure, and the unknown. Older adults want to be able to make their own decisions with dignity and be respected on their wishes. There have been controversies in end of life care with pain management, the right to die, and with aid in dying. Advance directives are very important for the autonomy of older adults. Many policies have been enacted to help older adults such as the Dying Person’s Bill of Rights, Death and Dignity Laws, the 1990 Patient Self-Determination Act, and the Uniform Health Care Decision Act. Losing a loved one is very traumatic especially losing a spouse. Physical and mental health is declined at times.

The changing context of dying and the attitudes toward death have evolved over time. In preindustrial societies, dying at home was very common. It was normal for the community to be involved with rituals and ceremonies. Now, Americans are very uncomfortable in discussing death. They tend to use vocabulary such as sleep, pass away, and rest and not use the word death as a way of avoidance (Hooyman & Kiyak, 2018). Variations in attitudes toward death may depend on age and gender. The oldest old tend to be more accepting about their own death than younger adults and middle age adults. Younger adults tend to have a higher fear of death anxiety than older adults. This can be for many reasons. One particular view is that younger adults have more to lose and that older adults have already experienced life. Another reason is that older adults have already experienced someone’s death whether it was a family member or friend. Older adults are not strangers to death and grief (Thorson, 2000).

With this being said, what does bring anxiety to older adults is the process of their death. They know death is inevitable. But what they do have a concern in is pain and suffering, autonomy, being institutionalized, and the unknown. For women in particular, death anxiety increases in their 50s. They often report anxiety and fear of dying as they get older (Hooyman & Kiyak, 2018). As for men, they have a higher anxiety towards the unknown. This may be because women tend to be more open with their emotions and are connected more towards religion and spirituality.

As mentioned earlier, older adults are not worried necessarily about death, instead they are worried about the death process. It is important for older adults to be respected and given dignity. They want to be able to be heard and want adequate information in order to better make their own decisions about their death. Older adults want to have a “good death”. But what is considered a good death? For older adults, a good death is knowing the unknown of what is to come, it is to be able to maintain their dignity throughout the process, to have control over the decision making, to have pain management and comfort, to be respected of their wishes and religious customs, and to have enough time to say their goodbyes (Hooyman & Kiyak, 2018).

One of the most important factors is pain management. Even with the technology and medical advancements that are in America today, there is still not an adequate pain management for older adults. Older adults have the most pain in the last days of their lives. In all types of chronic illnesses, pain was the most frequent in the last seven days before death according to Bailey et al. (2012). Other studies have shown that pain increased over their last year of life and by the final month it was 66% felt often or all of the time (Thorson, 2000). This comes to a great concern since older adult’s fear pain the most and want to be able to die comfortably without pain. The Supreme Court has cited two legal methods for a more aggressive pain management for older adults. The first method is a morphine drip that will abolish pain. If this is not effective, the second method is a terminal sedation that will be provided (Hooyman & Kiyak, 2018).

Another concern is where the death will happen. As for today, it is more common for older adults to “want to die at home, without pain, and surrounded by their friends and family’ (Hooyman & Kiyak, 2018 p. 477). Unfortunately, this is not always the case. Sometimes older adults’ opinions are not taken into consideration and will die at a hospital or nursing home.

There are two types of care for end-of-life: palliative care and hospice care. Palliative care focuses on the relief of pain and suffering of older adults by “addressing the patient’s emotional, social, and spiritual needs’ (Hooyman & Kiyak, 2018 p.486). The goal of palliative care is to improve quality of life for both the older adult and their family members (Hallowell, 2014). Hospice care provides compassionate comfort care through physical, medical, emotional, and spiritual care for the older adult and their family members in the comfort of their home or place they choose (Hooyman & Kiyak, 2018). Hospice also focuses on the quality of life of the older adults. The service is 24 hours a day and 7 days a week. It is more frequent for families that have informal support to be in hospice care. There are differences and similarities between palliative care and hospice care. Palliative care is provided in any stage of a disease while hospice care is only provided after six months or less prognosis. Palliative care provides curative treatment while hospice care excludes curative treatment. Both reduce stress for the dying adult and their family members while they physical and psychosocial relief to the older adult (Vitas Heatlthcare).

Kubler-Ross had five stages of grief for understanding the dying process. She mentioned that the dying person had to go through each step-in order to move to the next one. These five stages are shock and denial, anger/resentment/guilt, bargaining, depression and withdrawal from others, and adjustment or acceptance. But the dying process is not linear as she mentioned. As Baier and Buechsel suggests, the stages are more as “pinball bumpers” and that one’s grief may bounce in an “unpredictable pattern”. These states are anger, bargaining, denial, depression, shock, and acceptance. The balls in the pinball bumper are labeled as grief and “acceptance is the small opening where the balls fall” (Hooyman & Kiyak, 2018 p. 480).

The loss of a loved one is already very hard, so what happens when one wishes to refuse medical service. An informed consent is when a patient decides to accept or refuse medical treatment based on the benefits and harm (Hooyman & Kiyak, 2018). An informed consent helps an older adult express their own wishes. Euthanasia is referred to a painless or peaceful death. It can be passive or active. Active euthanasia, also known as causing death, is when a lethal injection is administered voluntarily or involuntarily. This is not legal in any states. Aid in dying is another term used when it is a physician-assisted death. A physician will provide a medication by which an older may or may not take it to end their life. According to Hooyman and Kiyak (2018) California, Oregon, Washington, and Vermont all have Death with Dignity Laws that have authorized aid in dying.

Advance directives are very important in end of life care. Advance directives, also known as a living will, is a written statement that shows the older adult to have made medical decisions or appoints someone to make a decision for them. Thankfully, all of 50 states have approved laws for the use of advanced directives. One law that was passed to help is the 1990 Patient Self-Determination Act which requires “Medicaid-participating hospitals, nursing homes, home health agencies, hospices, and health maintenance organizations to provide information to patients on their rights to make advance directives” (Thorson, 2000 p. 295). Unfortunately, the majority of the American population still does not have a written document for such preferences.

The loss of a loved one can be very traumatic. It affects their whole world around them Bereavement, grief, and mourning are used in conjunction with each other, but all have different meanings. Grief is the reaction to the loss. Bereavement is when grief is experienced, and mourning occurs (The Fisher Center for Alzheimer’s Research Foundation, 2019). Mourning is the process in which the survivor adapts to the loss. As social workers, it is important to be respectful or the cultures and traditions one may mourn the death of a loved one. Grief is a like a roller coaster and is not linear. There are many emotions brought up and it is normal for someone not to know how to deal with them. In order to prepare someone to grieve, a social worker may prepare the family members with interventions.

Right to Die

Which is referred In Gian Kaur’s case, is whether a ‘right to die with dignity as part of a ‘right to live with dignity in the context of article 21? The court observed:

A question may arise, in the context of a dying man who is terminally ill or in a PVS THAT HE MAY BE PERMITTED to terminate it by a premature extinction of his life in those circumstances. This category of cases may fall within the ambit of the ‘right to die with dignity as a part of the right to live with dignity when death due to termination of natural life is certain and imminent and the process of natural death has commenced.

From the above passages, it is clear that the supreme court accepted the statement of law by the house of lords in Airedale that ‘euthanasia’ is unlawful and can be permitted only by the legislature i.e., the act of killing a patient painlessly for relieving his suffering from an incurable illness. Otherwise, it is not legal. ‘Assisted suicide is where a doctor is requested by a patient suffering from pain and he helps the patient by medicine to put an end to his life. This is also not permissible in law.

But where a patient is terminally ill or is in a persistent vegetative state (PVS), a premature extinction of his life in those circumstances, by withholding or withdrawal of life support, is part of the right to live with dignity and, is permissible, when death due to natural termination of life is certain and imminent and the process of natural death has commenced.

Thus, there is a crucial distinction between in which (a) a physician decides not to provide or continue to provide treatment or case which can or may prolong his life, and (b) where physician decides, for example, to administer a lethal drug, actively to bring an end to the patient’s life. The former is permissible but the latter is not.

Section 87,88 and 92 of the Indian penal code, 1860

These sections of the penal code are also relevant. Section 87 of the IPC deals with ‘act likely to cause harm, but done without criminal intention to prevent other harm.’

It reads as:

Act not intended and not known to be likely to cause death or grievous hurt, done by consent – nothing which I not intended to cause death, or grievous hurt, and which is not known by the doer to be likely to cause death or grievous hurt, is an offense by reason of any harm which it may cause, or be intended by the doer to cause, to any person, above 18 years of age, who has given consent, whether express or implied, to suffer that harm; or by reason of any harm which it may be known by the doer to be likely to cause any such person who has consented to take the risk of that harm.

Illustration:

A and Z agree to fence with each other for amusement. This agreement implies the consent of each to suffer any harm which in the course of such fencing, may be caused without foul play; and if A, while playing fairly, hurts Z, A commits no offense.

Section 88 deals with ‘act are done in good faith for benefit of a person with consent? It reads as follows: “act intended to cause death, done by consent in good faith for person’s benefit – nothing, which is not intended to cause death, is an offense by reason of any harm which it may cause or be intended by the doer to cause or be known by the doer to be likely to cause, to any person for whose benefit it is done in good faith, and who has given a consent, whether express or implied, to suffer that harm, or to take the risk of that harm.

Illustration:

A, a surgeon, knowing that a particular operation is likely to cause the death of Z, who suffers under a painful complaint but not intending to cause Z’s death, and intending, in good faith, Z’s benefit, performs that operation on Z with Z’s consent. A has committed no offense”.

Section 92 deals with ‘act is done in good faith for benefit of a person without consent.’ It reads as follows:

An act has been done in good faith for benefit of a person without consent. – nothing is an offense by reason of any harm which it may cause to a person for whose benefit it is done in good faith, even without that person’s consent. If the circumstances are such that it is impossible for that person to signify consent, or if that person is incapable of giving consent, and has no guardian or the other person in lawful charge of him from whom it is possible to obtain consent in time for the thing to be done with benefit:

Provided –

• First – that this exception shall not extend to the intentional causing of death, or the attempting to cause death;
• Secondly – that this exception shall not extend to the doing of anything which the person doing it knows to be likely to cause death, for any purpose other than the preventing of death or grievous hurt or the curing of any grievous disease or infirmity;
• Thirdly – that this exception shall not extend to the voluntary causing of hurt, or to the attempting to cause hurt, for any purpose other than preventing of death or hurt;
• Fourthly – that this exception shall not extend to the abetment of any offense, to the committing of which offense it would not extend.

Illustrations:

• (a) Z is thrown from his horse and is insensible. A, a surgeon, finds that Z requires to be trepanned. A, not intending Z’s death, but in good faith, for Z’s benefit, performs the trepan before Z recovers his power of judging for himself. A has committed no offense.
• (b) Z is carried off by a tiger. A fire at the tiger knowing it to be likely that the shot may kill Z, but not intending to kill, Z and in good faith intending Z’s benefit. A’s ball gives Z a mortal wound. A has committed no offense.
• Thus, from the above sections, it is concluded that mere pecuniary benefit is not benefited within the meaning of sections 88,89, and 92.
• c) Section 81 of the Indian penal code, 1860

Section 81 of the code is also relevant. It deals with ‘act likely to cause harm’ but done without criminal intent and to prevent other harm. It reads as follows:

Act likely to cause harm, but done without criminal intent, and to prevent other harm – nothing is an offense merely by reason of its being done with the knowledge that it is likely to cause harm if it is done without any criminal intention to cause harm, and in good faith for the purpose of preventing or avoiding other harm to person or property.

Explanation – it is a question of a fact in such a case whether the harm to be prevented or avoided was of such a nature and so imminent as to justify or excuse the risk of doing the act with the knowledge that it was likely to cause harm.

Illustrations:

• (a) A the captain of a steam vessel, suddenly and without any fault or negligence on his part, finds himself in such a position that, before he can stop his vessel, he must inevitably run down a boat B, with twenty or thirty passengers on board, unless he changes the course of the vessel, and that, by changing his course, he must incur the risk of running down a boat C with only two passengers on board, which he may possibly clear. Here, if A alters his course without any intention to run down the boat C and in good faith for the purpose of avoiding the danger to the passengers on boat B, he is not guilty of an offense, though he may run down the boat C by doing an act with he knew was likely to cause that effect if it is found as a matter of fact that the danger which he intended to avoid was such as to excuse him in incurring the risk of running down the boat C.
• (b) A, in a great fire, pulls down houses in order to prevent the conflagration from spreading. He does this with the intention in good faith of saving human life or property. Here, if it is found that the harm to be prevented was of such a nature and so imminent as to excuse A’s act, A is not guilty of the offence.”

From the above sections, it is revealed that ‘active’ euthanasia is not permitted in India but ‘passive euthanasia’ is permitted on the fulfillment of certain conditions.

However, there is a number of cases where the high courts have rejected the Euthanasia petitions.

In Bangalore, the high court has rejected the euthanasia plea of a 72 years old retired teacher from Devanagere, who sought the court’ permission to die. Justice Ajit Gunjal on Wednesday disposed of H.B. Karibasamma’s petition based on reports by neuro-surgical and psychiatric experts from Nimhans. The reports said karibasamma does not suffer any pain or severe ailment. Her spine is normal and she can get up without any pain. Neither does she suffer from any mental disorder.

“since she is elderly and fears she would become disabled in future due to her multiple ailments, and has no family support, she could be provided psychiatric counseling”, the report suggested, nothing that Karibasamma refused to undergo any further investigation and medication.

Based on the court’s order, doctors examined karibasamma and referred her to experts at Nimhans.

Karibasamma, who claimed to have suffered slip disc and was bed-ridden for 10-11 years, had written to local authorities and even the president and prime minister, seeking permission for euthanasia since 2003. Karibasamma claimed that she was getting only Rs. 8968 as monthly pension in 2010 and it wasn’t enough to meet her medical expenses.

Because of her age, doctors have opted for non-surgical treatment, and the pain she is undergoing is excruciating. However, the high court rejected her plea based on reports by neurosurgical and psychiatric experts from Nimhans that she does not suffer any pain or severe ailment.

Similarly, the Kerala high court in C.A. Thomas Master v. Union of India, dismissed the writ petition filed by a citizen wherein he wanted the government to set up “Mahaprasthan Kendra” (voluntary death clinic) for the purpose of facilitating voluntary death and donation, transplantation of bodily organs.

Euthanasia is totally different from suicide and homicide. Under the Indian penal code, attempting to commit suicide is punishable under section 309 of the Indian penal code and also abetment to suicide is punishable under section 306 of the Indian penal code. A person commits suicide for various reasons like marital discord, dejection of love, failure in the examination, unemployment, etc. But in euthanasia, these reasons are not present. Euthanasia means putting a person to painless death in case of incurable diseases or when life becomes purposeless or hopeless as a result of mental and physical handicaps. It also differs from homicide. In murder, the murderer has the intention to cause harm or cause death in his mind. But in euthanasia, although there is an intention to cause death, such intention is in good faith. A doctor applies euthanasia when the patient, suffering from a terminal disease, is in an irremediable condition or has no chance to recover or survive as he is suffering from painful life or the patient has been in a coma for 20/30 years like Aruna Shanbaug.

Therefore, it is suggested that penal provisions regarding attempts to commit suicide and abetment to suicide should be preserved in the interests of the society as a general rule but euthanasia (voluntary) should be permitted in certain circumstances as an exception to the general rule. Thus, the Indian parliament should enact a law regarding euthanasia that enables a doctor to end the painful life of a patient suffering from an incurable disease with the consent of the patient.

The use of euthanasia in the healthcare field has remained a highly controversial topic and has been widely debated. According to the Merriam-Webster dictionary, the defnition of euthanasia is “the act of practice of killing or permitting the death of hopelessly sick or injured individuals in a realtively painless way for reasons of mercy” (Euthanasia). Some people believe that euthanasia is morally right because it ends a persons suffering and pain that goes along with a terminal illness. Others believe that it is morally wrong and that a patient could potentially be misdiagnosed meaning a death that should not have happened. They also believe that it is unnatural and not the way people should die. There are many theories that go along with the topic of euthanasia. James Rachels points out the theory of utilarianism by Jeremy Betham in his journal, The Morality of Euthanasia. He points out that the theory is morally wrong because it goes against personal choice and that it makes humans and animals morally equal.

Rachels uses the theory of utilitarianism in his article titled The Morality of Euthanasia. The first part of the theory, developed by Jeremy Bentham, explains how morality is based on two elements: happiness and misery. If something is deemed morally wrong, it decreases happiness and increases misery. If something is deemed morally right, it increases happiness and decreases misery. Utilitarianists apply this theory to the topic of euthanasia. If a terminally ill patient wanted to increase his happiness and decrease his misery, it would be morally right to receive euthanasia according to the theory. The second part describes how good and bad are measured by how they are to produce happiness and unhappiness. The final part of the theory states how everyone is equal and that everyone’s happiness is deemed equal. This part of the theory goes along with the argument of Bentham that humans and animals are equal in regards to morality.

In regards to pain and pleasure, when pleasure is removed this can inflict pain on a person. If a person had an intimate relationship with a person with a terminal illness and they passed away, this is going to cause the person a great deal of pain. For example, if a husband was close with his wife that is going to pass away, this is going to cause a great deal of pain on the husband. The couple experienced their whole lives together and he is going to have to deal with living without her. When pain is removed this can cause pleasure for the person. For example, when a patient is in the hospital ill and they get their pain under control, this can give them pleasure.

Rachels explains terminal illness as “requesting to be killed as an alternative to a slow, lingering death”. The two terms of Benthams that have to do with the person “considered by itself” are term numbers one and two. The first term has to do with the intensity of the pleasure or pain. The second term has to do with the duration of the pain. The intensity and duration of the pain and pleasure can only be described by the person who has the terminal illness because people may not know what it feels like to have a terminal illness. The other terms have to do with the action of the pleasure of pain and the outcome. The sixth discusses that pain may be followed by pain. This term is relevant to a patient and their family. The family may see that their loved one is experiencing more pain which is going to be painful for them to see. The seventh term explains the extent of the illness and how many people are afflicted by it. When a patient has a terminal illness, it is going to most likely affect their family, friends, co-workers, and their peers greatly. People who experience terminal illness are experiencing a great amount of pain and suffering that is unimaginable to many.

According to Rachels, he does not believe that animals have a moral status like humans. Humans have more to contribute to society and they serve a purpose. When a person wants to die by a physicians-assisted suicide, it is harder to deal with becuase of the contributions they have made to their communities. When we have animals who are suffering and in great amounts of pain, we simply put them down because it would reduce misery to the animals. Animals are not able to vocalize their pain, so simply putting it down is an easier option than putting a human down that is able to vocalize how they feel about their pain.

In conclusion, James Rachels has explained that the theory of utilitarianism is morally wrong because it goes against personal choice and it makes humans and animals equal in terms of morality. For me, I have always believed in the right for a person to receive euthanasia. If I were a patient who had a terminal illness and was going through immense amounts of pain and suffering, I would want it to be over. It would be hard on my family, but in the end, I was allowed to make that decision for myself. Opponents of euthanasia believe that it is unnatural and that it can cause a patient to be misdiagnosed by a doctor. Euthanasia will always remain a constant debate between people across the world due to its prevalence in the healthcare field. This is a topic that is very sensitive to a lot of people and is a very difficult topic to talk about especially with patients with terminal illnesses. As a future nurse, I am going to have to be the patient’s advocate and accept their wishes.