EUTHANASIA – THE “GOOD DEATH” CONTROVERSY IN HUMANS AND ANIMALS Edited by Josef Kuře Euthanasia – The “Good Death” Controversy in Humans and Animals Edited by Josef Kuře Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. 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ISBN 978-953-307-260-9 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Defining the Issue 1 Chapter 1 Good Death Within Its Historical Context and as a Contemporary Challenge: A Philosophical Clarification of the Concept of “Euthanasia” 3 Josef Kuře Chapter 2 Euthanasia: A Confounding and Intricate Issue 45 Isabelle Marcoux Part 2 Argumentation 63 Chapter 3 Voluntary Active Euthanasia: The Debate 65 Louis-Jacques van Bogaert Chapter 4 Euthanasia: Between Personal Moral and Civic Ethics 81 Begoña Román Chapter 5 Handling End-of-Life Care in Medical Decision Making: On a Bioethical View 93 Maribel Bont-Paredes, Carmen Malpica-Gracian and Carlos Rojas-Malpica Chapter 6 Euthanasia, Dignity, Autonomy - A Reflection on Medicine 117 Dominique A. Lossignol and Cristina Dumitrescu Chapter 7 Everything Under Control: How and When to Die - A Critical Analysis of the Arguments for Euthanasia 127 Josef Kuře VI Contents Part 3 Policy and Attitude 165 Chapter 8 The Impact of the Dutch Euthanasia Act on the Number of Requests for Euthanasia and Physician Assisted Suicide - A Cohort Study in General Practice Between 1977 and 2007 167 G.A. Donker and J.E. van Alphen Chapter 9 Turkish Health Professional’s Attitudes Towards Euthanasia 175 Gulten Kaptan, Lecturer Ozden Dedeli and Levent Önen Part 4 Euthanasia of Animals 189 Chapter 10 Medical and Bioethical Issues in Laboratory Animal 191 Matilde Jiménez-Coello, Karla Y. Acosta-Viana, Antonio Ortega-Pacheco and Eugenia Guzmán-Marín Chapter 11 Euthanasia for the Zoonosis Control Program 219 Márcia Dalastra Laurenti and Marcio Antônio Batistela Moreira Chapter 12 Debate For and Against Euthanasia in the Control of Dog Populations 233 Antonio Ortega-Pacheco and Matilde Jiménez-Coello Preface Few issues in contemporary health care arouse so much controversy as does the problem of euthanasia. We appear to have quite different understandings of what a “good death” is, based on diverse value judgments. Euthanasia, however, does not tolerate moral indifference. The concept of euthanasia does not allow it to be glossed over apathetically. Regardless of the way it is used, the word euthanasia always evokes strong emotions. The source of such powerful emotions and the need to draw up potent rational arguments are derived from the heart of the matter: euthanasia is about life and death. In such an arena, the fight for liberty, dignity, autonomy and individual rights does not allow for passivity and a detached view, and tends to affect both sides of the controversy to the same degree. For both proponents and opponents alike it therefore becomes a matter of principle to decriminalize euthanasia on one hand and to halt its encroachment through restrictive legislation on the other hand. The root of the dilemma is that autonomy and individual rights have to be promoted so that an individual can make the choice about his/her own life and death while the right to life has to be strongly protected. For opponents of euthanasia, there exist some similarities between the present-day debates on euthanasia as a matter of life or choice (being a compassionate choice in the case of non-voluntary euthanasia) and the debates on abortion in the 1960s and 1970s as a matter of life (pro-life) or choice (pro- choice). In both contexts “the issue” appears as a “matter of principle” and for those taking up such a stance, based on the fundamental sanctity of life, it is morally wrong to contaminate the principle itself; the principle has to be defended without any moral compromise. In contrast, as some people argue, dragging out a person’s death process so that it conforms to the value system of others, which he/she believes to be a terrible contradiction of his/her life values or aspirations, is a devastating and odious form of tyranny. While for some people euthanasia is a manifestation of the individual’s autonomy at par with a responsible control of one’s destiny, a compassionate responsiveness to someone’s immense suffering or a clinical imperative to act in the patient’s best interest, for other people euthanasia is tantamount to or merely a euphemism for killing, the violation of human life and an infringement of the human right to life, being contradictory to the sanctity of life doctrine and facilitating the abuse of vulnerable persons. Specific terms and arguments are used in euthanasia debates which have an immediate, universal appeal about them and seem to be desired, in X Preface great demand and strike a chord with our sentiments. Human dignity, humaneness and compassion belong to the first order of such terms. Nobody would doubt that people who are terminally ill, who are dying or who want to die should be treated with compassion and with respect to their (human) dignity. At a closer look, however, there are diverse semantics rooted in these terms, allowing them to be used as both arguments for and against euthanasia – depending on the individual’s view. One could say that euthanasia is contrary to human dignity because the conduct of euthanasia would violate human dignity (of both persons involved), whereas one could also conclude that dying under horrible suffering would violate human dignity and therefore a request for euthanasia and its fulfilment are an expression of respect for human dignity and for a dignified death. As a result many euthanasia discussions lack a clear semantic common ground to serve as a rational starting point. Since there is no universally agreed upon definition of “euthanasia” per se, it is essential to clarify how the word is used with regard to a particular context. Otherwise confusion dominates the debate. Both in academic literature and in public debates euthanasia is often associated with “physician assisted dying” and mixed with “(physician) assisted suicide”. In some contexts euthanasia is simply assumed to refer to very general terms like “assisted death”, under which assisted suicide is also subsumed. Particularly in recent years, the term “euthanasia” is used more and more in the context of that as defined by Dutch and Belgian legislation, whereby euthanasia is understood to be “administration of lethal drugs by someone other than the person concerned with the explicit intention of ending a patient’s life, at the latter’s explicit request”. It is obvious that this definition is in need of some additional criteria specifying the conditions and situations under which euthanasia would be legal. When euthanasia is merged with “assisted death“, then under such a broader notion of “euthanasia” similar but distinct clinical situations such as medical futility, life sustaining treatment, the categorization of therapy, palliative care, and other end-of- life decisions enter into the discussion. Here one should emphasize that the decisions in palliative and intensive care medicine include a much broader spectrum of ethical dilemmas than the issue of euthanasia alone. In order for the euthanasia discussion to be meaningful, clearly accepted concepts of the terminology have to be elaborated and established before any meaningful discussion about the morality and ethics of euthanasia is initiated. Failure to keep such a sequence results in frustration. It is one of the ambitions of this book to contribute to the semantics of euthanasia. This book on euthanasia distinguishes euthanasia from other forms of killing, such as self-killing (with or without assistance) or murder. So physician assisted suicide is not covered by this book. Euthanasia is a very old issue, with its roots in Classical thinking. Throughout the course of history, however, it has been understood differently. In recent times the concept of euthanasia has come increasingly under the spotlight due to the on-going technicization of medicine. There are several other compounding factors making the [...]... without the approbation of the priests and the senate, they give him none of the honours of a decent funeral, but throw his body into a ditch.” (More, 2011) 41 “They starve themselves of their own accord, or take opium, and by that means die without pain.” – Ibidem 16 Euthanasia – The “Good Death” Controversy in Humans and Animals killing.42 More believed that his concept of voluntary and involuntary... means “mild death” or “painless death” but also “famous death” or “glorious death” 6 L A Seneca, Epistulae 67,9 8 Euthanasia – The “Good Death” Controversy in Humans and Animals way: they are “saved” by the god Apollo, who kills them peacefully In this way euthanasia was often perceived as the best gift that one could get from the gods (Mystakidou et al., 2005) In the Classical period, in some regions,... (the death the emperor Augustus died) and 12 Euthanasia – The “Good Death” Controversy in Humans and Animals from (physician) assisted voluntary suicide Euthanasia in Antiquity was associated with peaceful death and with mercy killing as well, despite the fact that mercy killing was not referred to as such Nevertheless the concept of voluntary death as it appears in ancient times and as defined by the. .. euthanasia results in various clinical situations being discussed under the scope of euthanasia Once euthanasia is merged with “assisted death“, then under the term euthanasia similar but distinct clinical situations such as medical futility, life sustaining treatment, 4 Euthanasia – The “Good Death” Controversy in Humans and Animals categorization of therapy, palliative care, and other end-of-life decisions... managed and monitored, than to euthanasia One can expect that the controversy surrounding the moral acceptability of euthanasia and its decriminalization will remain a challenge for our ageing societies in the twenty first century What distinguishes this book from other books on euthanasia is, among others, the inclusion of euthanasia in animals This could be perceived by some people as inappropriate Is the. .. zoonosis control and the euthanasia of laboratory animals Hopefully, the present book will provide some insight and enlightenment into the intricate issue of euthanasia, both human and animal, inspiring readers to think critically about the medical, social, philosophical, cultural and existential aspects of “good death” in our technologized, individualized and ageing society burdened with rising health care... refer to the abuse of the Nazi regime during that period (eugenic euthanasia) , while the term “Sterbehilfe”2 is used in current euthanasia debates This use of unspecified terminology - with the term “good death” being used to subsume many very diverse situations and meanings – and including the use of single terms with diverse connotations (e.g “assisted death” or “dignity”) is quite common in these debates... 14 Euthanasia – The “Good Death” Controversy in Humans and Animals space and time) and the church punishment of “excommunication” applied, which included burial extra murales, (out of the Christian cemetery), the suicide would then be punished by God with the committer excluded from heaven (out of space and time).31 From such criminalization of suicide, moral rigorousness and intransigence follows and. .. imperative to act in the patient’s best interest, for other people, euthanasia is tantamount to or merely a euphemism for killing, the violation of human life and an infringement of the human right to life, being contradictory to the sanctity of life doctrine and facilitating the abuse of vulnerable persons The controversies surrounding the moral acceptability of euthanasia and its decriminalization are... an injury, is of the lowest kind” (Hume, 1985, p 586) Suicide can be in harmony with the interest of the individual and with his/her commitment to him/her 50 “But the physicians contrariwise do make a kind of scruple and religion to stay with the patient after the disease is deplored; whereas in my judgment they ought both to inquire the skill, and to give the attendances, for the facilitating and . EUTHANASIA – THE “GOOD DEATH” CONTROVERSY IN HUMANS AND ANIMALS Edited by Josef Kuře Euthanasia – The “Good Death” Controversy in Humans and Animals Edited. killing, the violation of human life and an infringement of the human right to life, being contradictory to the sanctity of life doctrine and facilitating the abuse of vulnerable persons. The. futility, life sustaining treatment, Euthanasia – The “Good Death” Controversy in Humans and Animals 4 categorization of therapy, palliative care, and other end-of-life decisions are discussed