Should Doctors Be Allowed To Terminate Human Lives?

Active Or Passive Euthanasia

Euthanasia and Hippocratic oath was the title of an article I published not too long ago. Within the context of the discussion, I spoke about medically assisted suicide and how it surely yet controversially fits within the scope of clinical judgment. Today, I would like to revisit the topic by exploring various attitudes and players and how they influence the physician's approach toward such a sensitive subject. However, before we begin, let us bear in mind that there is no perfect answer to the notion of passive or even active euthanasia (also referred to as assisted suicide); neither is there a one-size-fits-all solution.

The Semantics Of Health, Life, Sickness, And Death

Modern medicine has been riddled with health and wellness semantics, as many people have a different concepts of a healthy life, disease, quality of life, and even death. Such semantic variations are expected and perpetually affected by the norms of every given society, which are influenced by the person's lifestyle, belief, religion, faith, culture, and surrounding community.

Some define life as the state of biological functioning. Some may see it as an eternal state of nonphysical existence where the physical body is a temporary tangibility. Some discern health and wellness as the status without the disease, and others see it as the state of complete harmony between physical, psychological, and emotional clarity.

For life and death, the subject gets even more unclear!

The Concept Of Life, Death, And Cultural Perception

A person's culture and collective norms influence how a person sees life and death. For instance, Buddhists reckon- that a person's exit from life is crucial to find a peaceful state of rebirth when they pass away. They see life after death as a prerequisite to "rebirth."

Religion And Death

In the eyes of the major religions, death's perception is diverse. The latter sees the quality of life after death as typically dependent on following a specific set of rules and norms throughout life. In most religions, departure is only permitted through the act of the ultimate power, hence God. The intentional ending of life is sin and punishable through the suffering afterlife. No matter how painful the experience and suffering, most religions prohibit euthanasia. Accordingly, the semantics of death in the eyes and ears of faith is entirely different from a modern perspective.

Laws, ethics, death, and the practice of medicine

Prohibition of death is a political, social phenomenon, and taboo. Law states that dying is illegal, usually specified in an absolute political division or a specific raising.

The earliest prohibition of death occurred in the 5th century BC, on the Greek island of Delos; dying on Delos was prohibited on religious terrains.

Today, the prohibition of death is an ambiguous response to the government's failure to approve the expansion of municipal graveyards. For instance, in Spain, one town has prohibited "death"; in France, several settlements have had death banned, while in Biritiba Mirim, in Brazil, an attempt to prevent death occurred in 2005. The latter suggests how an extreme political realm can dictate hypocrisy over rationale.

Today-Irrespective of the country and jurisdiction, laws around the subject of death and dying are the byproduct of prevailing, Thus norms in society and their political upshot.

A person's norms and values are invariably influenced by faith, views, and knowledge of the constituency. Solid religious groundworks change modern societies, with few exceptions reflecting the openness of exchanging ideas. Specific laws affect the subject of death and dying. It utterly prohibits intentional or direct cause of death. However, some countries like the Netherlands overcome such limitations by admitting medically assisted euthanasia for individual patients under certain circumstances over following due process.

Origin Of Laws Around Death

The narrative of law ties closely to the expansion of civilization. The fundamental law dares back to Ancient Egyptians, as far again as 3000 BC. It was based on the concept of Ma'at and characterized by tradition, rhetorical speech, social equality, and impartiality. By the 22nd century BC, the ancient Sumerian ruler Ur-Nammu had formulated the first law code, which consisted of casuistic statements ("if … then …"). Around 1760 BC, King Hammurabi further refined Babylonian law by codifying and inscribing it in stone.

Ethics Of Death and Dying

Death is a value-burdened word. The term touches our ears uttered in negativity, and to hear the word 'death' halts the time. Even mentioning death can be presumed to incite apprehension as we defeat the anxiety that accompanies it and tries to avoid views of mortality. The thought of dying spirals almost everyone, as the death of others, comes into the individual's viewpoint. When unconsciously becomes our own. We indeed confront death, and we do so with caution, a sense of unreality, and even fear.

Death is a mystery to everyone. That is why we tend to circumvent it- not only for ourselves but also those suffering, thus imprisoned by their medical condition. We reflect on our collective consciousness and even go further and extend the sufferer's heartbeat under the notion of humanity and the wrongfulness of eliciting death.

Medical science has prolonged life in many ways. Medical technologies, advanced life-sustaining treatments, new drug therapeutics, and emergency mediations have contributed to holding death at the window as people face the end of their lives. Seldom do the difficulties girdling end-of-life circumstances come to public attention. The conclusion places physicians and the healthcare communities at the center of a sensitive ethical and legal dilemma regarding where to draw the line between extending life and prolonging the natural process of death and dying.

The mortality of a human being for a medical professional has become a double-edged sword. It is becoming more than ever cumbersome given the progress of technology, politics, bureaucracy, and population health. Indeed, death is a subject of ethical significance, which demands a personalized approach; nonetheless, the latter is easier said than done!

Origin Of Ethics And Its Implications On Euthanasia

The subject of euthanasia invites several complex moral dilemmas, such as if it is appropriate to end the life of a critically ill who is enduring severe pain and suffering. Under what conditions can euthanasia be justified, or is there a moral estrangement between annihilating someone and lapse in peace. At the core of these wiles are people's distinct impressions about the significance and value of human actuality.

There is also several reasoning based on real-world issues. Some people contemplate that euthanasia shouldn't be permissible, even morally right, because it could be mistreated and used as a cover for manslaughter. For some, it is not euthanasia if a patient dies due to refusing extraordinary or burdensome medical treatment. Or a physician gives a drug to reduce pain, even though the drug causes the patient to die sooner. That is because the doctor intended to relieve the pain, not to kill the patient. This argument is seldom known as the double standard doctrine.

Very often, as societies witness the pain and suffering of patients in the face of scientific evolution, people also call euthanasia the 'mercy killing.' Perhaps those who use the term are deeming it for terminally ill and suffering prolonged, intolerable pain.

Ethics is the branch of philosophy that deals with the concept of euthanasia. It examines right and wrong moral behavior, decent concepts such as justice, virtue, duty, and moralistic vocabulary.

Various ethical principles pose numerous answers to the subject, hence the highest good!

Ethics elaborate on a complete set of proper behaviors for individuals and groups based on patients' values and physicians who live in a given society. In other words, — ethical theories are closely related to life forms in various social schemes. The latest is a phenomenon not uncommonly overlooked by the modern medical practice, not necessarily because of physicians' and patients' reluctance. But due to the healthcare system's overwhelming politicization, centralization, and bureaucracy.

Why Do People Support Euthanasia?

Most people think unendurable pain is the foremost reason people seek out euthanasia. Still, some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of intractable pain.

Incurably ill persons can severely damage their quality of life by physical conditions such as incontinence, nausea, vomiting, breathlessness, paralysis, and difficulty swallowing.

Emotional influences that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or aversion to being dependent. Based on this doctrine, more and more societies are embracing Death with Dignity laws.

Supporters of "death with dignity" have accomplished legalizing what is also known as physician-aid-in-dying in five U. S. states by convincing voters, lawmakers, and courts that terminally ill patients have the right to die without suffering intractable pain in their final primes. That opens another chapter for discussion over the physician's role as the healer.

Physician Or Healer And Death

Assisting in dying is contentious precisely because it factors in the many ethical dilemmas our society has wrestled with and concerns of violations that primarily affect the deprived, the need to protect vulnerable populations, and the strains between patient choice and control. That is in contrast to the position of the physician as a healer. Indeed, aid in dying is controversial; because of the potential risk of inquests on physicians' professional integrity as a healer. Physicians are programmed to heal, but the healer's standards plummet when the patient can no longer be physically treated.

Physicians don't do a great job optimizing dying patients' dwindling tranquility, partly because clinicians are often uncomfortable when they can no longer heal the patient. Medical culture often sees death as a failure, and physicians find it challenging to address mortality.

Some also believe aid in dying urges physicians first to defy a professional code, not harm. Yet others can justify not embracing assisted euthanasia as a way of causing damage to the patients.

Another group explains their rationale for not engaging in assisted death based on religious grounds. Some also believe lines have already been blurred between the Hippocratic Oath's mandate and the potential for harm in the treatments we provide. Nevertheless, the Hippocratic oath does not harm principle and sees life as ending in dignity; and health as a state of harmony between "Comfort always, often treat and Heal sometimes!"

Medicine, Life, And Death

Too often, doctors entomb themselves in treating disease based on symptoms and clinical judgment that disconnect them from the realism of life and death. This phenomenon is even more profound when physicians rely more and more on technology and evidence-based medicine.

The dissociation of modern medicine from personalized care is inevitable, given the takeover of the art of healing by revolutionary technologies such as artificial intelligence and machine learning. Therefore, for medicine to familiarize itself with life and death, it must provide physicians the education and autonomy to connect with the patients individually, recognize their needs, and honor them accordingly.

Until healthcare honors personal expectations, it will fall short of delineating between extending quality life and prolonging pain, suffering, and death.

The Bottom Line Of Physician Attitude, Practice Of Medicine, And Death

Medicine is about keeping humans comfortable and devoid of disease, suffering, and pain. Of Course- irrespective of the treatment and efficacy of the rendered care, a physician shall not cause intentional harm. However, whether death stands for injury or the procedure- is a matter of ethical significance and depends on the patient's view of life, health, and objective findings of the doctor; still, euthanasia is a decision that we must observe within the framework of the doctor-patient relationship.

No physician must be obliged to render assisted death, while no patient with debilitating (End stage) ailments such as Amyotrophic Lateral Sclerosis (ALS) should be allowed to live in agony. Legislations must respect individual autonomy but ensure such laws' transparent and accountable execution.

Medicine that ignores pain and suffering in any form is not linctus, mainly when science and technology halt in resolving the upheaval. The latter is the point where euthanasia becomes the optimum treatment.

Despite the overwhelming miss perceptions, extending death is not part of Hippocratic medicine. Hippocratic medicine is about the individual slant to the patient's life, health, and wellness. It is about keeping patients contented without refuting death as part of the human journey. So, let us keep bureaucracy away from medical practice, personalize healthcare, honor patients' needs, and respect the physician's objective and personal beliefs even if it pertains to a choice between life and death.