Euthanasia is the act of deliberately ending a person's life to relieve suffering.

For example, a doctor who gives a patient with terminal cancer an overdose of muscle relaxants to
end their life would be considered to have carried out euthanasia.
Assisted suicide is the act of deliberately assisting or encouraging another person to kill
themselves.
If a relative of a person with a terminal illness were to obtain powerful sedatives, knowing that the
person intended to take an overdose of sedatives to kill themselves, they may be considered to be
assisting suicide.
Legal position
Both euthanasia and assisted suicide are illegal under English law.
Depending on the circumstances, euthanasia is regarded as either manslaughter or murder and is
punishable by law, with a maximum penalty of up to life imprisonment.
Assisted suicide is illegal under the terms of the Suicide Act (1961) and is punishable by up to 14
years' imprisonment. Attempting to kill yourself is not a criminal act in itself.
Types of euthanasia
Euthanasia can be classified in different ways, including:
active euthanasia where a person deliberately intervenes to end someones life for
example, by injecting them with a large dose of sedatives
passive euthanasia where a person causes death by withholding or withdrawing treatment that
is necessary to maintain life, such as withholding antibiotics from someone with pneumonia
Euthanasia can also be classified as:
voluntary euthanasia where a person makes a conscious decision to die and asks for help to do
this
non-voluntary euthanasia where a person is unable to give their consent (for example, because
they are in a coma or are severely brain damaged) and another person takes the decision on their
behalf, often because the ill person previously expressed a wish for their life to be ended in such
circumstances
involuntary euthanasia where a person is killed against their expressed wishes
Depending on the circumstances, voluntary and non-voluntary euthanasia could be regarded as
either voluntary manslaughter (where someone kills another person, but circumstances can partly
justify their actions) or murder.
Involuntary euthanasia is almost always regarded as murder.

There are arguments used by both supporters and opponents of euthanasia and assisted suicide.
Read more about the arguments for and against euthanasia and assisted suicide.
End of life care
If you are approaching the end of life, you have a right to good palliative care to control pain
and other symptoms as well as psychological, social and spiritual support.
You're also entitled to have a say in the treatments you receive at this stage.
For example, under English law, all adults have the right to refuse medical treatment, as long as
they have sufficient capacity (the ability to use and understand information to make a decision).
If you know that your capacity to consent may be affected in the future, you can arrange a legally
binding advance decision (previously known as an advance directive).
An advance decision sets out the procedures and treatments that you consent to and those that you
do not consent to. This means that the healthcare professionals treating you cannot perform certain
procedures or treatments against your wishes.

Legalisasi Euthanasia di Indonesia merupakan perbincangan yang pernah hangat di kalangan

aparat hukum dan kedokteran.
Dalam praktik kedokteran, Euthanasia adalah pencabutan kehidupan manusia atau hewan melalui
cara yang dianggap tidak menimbulkan rasa sakit atau menimbulkan rasa sakit yang minimal,
biasanya dilakukan dengan cara memberikan suntikan yang mematikan.
Sampai saat ini belum ada payung hukum yang membolehkan tindakan euthanasia. Justru yang
masih berlaku saat ini adalah KUHP yang melarang orang menghilangkan nyawa orang lain meski
atas permintaan orang tersebut.
Pasal 344 KUHP: "Barang siapa menghilangkan jiwa orang lain atas permintaan orang itu sendiri,
yang disebutkannya dengan nyata dan sunguh-sunguh, dihukum penjara selama-lamanya dua
belas tahun."
Begitu juga dalam Kode Etik Kedokteran yang ditetapkan Menteri Kesehatan Nomor:
434/Men.Kes./SK/X/1983. Pada Pasal 10 disebutkan: "Setiap dokter harus senantiasa mengingat
akan kewajibannya melindungi hidup makhluk insani." Pada bagian penjelasan dengan tegas
disebutkan bahwa naluri yang kuat pada setiap makhluk yang bernyawa, termasuk manusia ialah
mempertahankan hidupnya. Usaha untuk itu merupakan tugas seorang dokter. Dokter harus
berusaha memelihara dan mempertahankan hidup makhluk insani, berarti bahwa baik menurut
agama dan undang-undang Negara, maupun menurut Etika Kedokteran, seorang dokter tidak

dibolehkan:
Oleh karenanya, berdasarkan peraturan perundang-undangan maupun kode etik kedokteran,
seorang dokter bisa dituntut penegak hukum, apabila ia melakukan euthanasia, tak peduli jika itu
adalah permintaan pasien atau keluarganya.

Abstract
The key to the euthanasia debate lies in how best to regulate what doctors do. Opponents of
euthanasia frequently warn of the possible negative consequences of legalising physician assisted
suicide and active euthanasia (PAS/AE) while ignoring the covert practice of PAS/AE by doctors
and other health professionals. Against the background of survey studies suggesting that anything
from 4% to 10% of doctors have intentionally assisted a patient to die, and interview evidence of
the unregulated, idiosyncratic nature of underground PAS/AE, this paper assesses three
alternatives to the current policy of prohibition. It argues that although legalisation may never
succeed in making euthanasia perfectly safe, legalising PAS/AE may nevertheless be safer, and
therefore a preferable policy alternative, to prohibition. At a minimum, debate about harm
minimisation and the regulation of euthanasia needs to take account of PAS/AE wherever it is
practised, both above and below ground.
HIV/AIDS assisted suicide euthanasia harm minimisation policy
On 22 May 2002, Nancy Crick, a 69 year old grandmother living on Australias Gold Coast
committed suicide by drinking a lethal cocktail of barbiturates.1 For months previously, Nancy
had advertised her intention to do so on her website, <nancycrick.com>. With 21 family members
and friends present to witness the death, Cricks suicide all but guaranteed the police
investigation that followed. According to her doctor, Philip Nitschke, the manner of Cricks
dying was evidence of a new radicalism within the voluntary euthanasia movement, and was
intended to force a precedent for the right not to die alone.2,3 Putting the short, sharp media feast
to one side, however, Cricks death appears to have achieved little in political terms. Queensland
Premier Peter Beattie immediately ruled out legal change,4 while days later, the Australian
Medical Association voted 79 to 34 against a motion to move towards a neutral position on
voluntary euthanasia.5 In retrospect, Cricks death was seen as a public relations disaster when a
postmortem revealed that Crick had an inoperable twisted bowel, rather than bowel cancer, when
she died.6,7 On 6 August 2002, detectives swooped on Nitschkes home outside Darwin,
confiscating computers, files, and disks.8 Recently, the investigations concluded, with no changes
laid.9
Two years on, who remembers Nancy Crick? And in another year from now, what will mark her
death out from the slow parade of personal tragedies and suicides that seem to fuel public debate
about euthanasia in the pages of newspapers and even academic journals? Significantly, each new
case is seen as a defining moment in the debate: the case that could tip the balance in favour of
legalisation. The usual participants weigh in to do battle over the same old questions, but nothing
ever seems to change.
If the euthanasia debate has reached something of a stalemate, these questions may be part of the
problem. We have assumed for too long that it is Nancy Crick, or Dianne Pretty, celebrity

dissidents like Jack Kevorkian and Philip Nitschke, or prosecuted doctors like Nigel Cox and
Timothy Quill who illustrate what is at stake in the euthanasia debate. We need a change of focus.
For every death, and every dissident doctor who makes it into the medias spotlight, there are
thousands who do not. Intentionally assisting a patient to die, whether by physician assisted
suicide (PAS) or active euthanasia (AE) carries enormous risks, both for patients and society
generally. If we are concerned about the risks of euthanasia, the issue we should be confronting is
how best to regulate underground euthanasia, rather than whether the law should regularise an
unlawful practice that happens anyway.
Concepts of public health, patient safety, and harm reduction are evident in the euthanasia debate,
but they feature overwhelmingly in the context of arguments opposing the legalisation of
euthanasia. Commentators speculate about the impact that a legal right to die would have upon the
physicianpatient relationship,10 or upon the broader, moral fabric of society,11 and warn about
the risks of a slippery slope. [O]nce we agree to the principle of doctors performing voluntary
euthanasia by what effort of societal will, on what rock of ethical principle, can we resist its
extension to ever new categories of sufferers? asks Robert Manne.12 There is no such will:
no such fixed and reliable principle, he argues. To legalise euthanasia is to set in motion a
subtle transformation of ethical sensibility. Over time we become blind to how we once
thought.12 In Mannes view, the criminal law functions as a kind of moral dyke: to
breach that dyke, even for the sake of competent, suffering patients is ultimately to put other
vulnerable classes of patient at risk.
The assumption that the risks all lie with legalisation is rarely contested. In this paper, I will not
argue that legalisation could ever be perfectly safe, but rather that the debate about harm
minimisation is more difficult than opponents of euthanasia admit, mostly because they are silent
about the risks posed by underground PAS/AE. I will begin by drawing on my own interview
based research into covert assisted death to illustrate what underground euthanasia is really like,
before suggesting how covert euthanasia invites a reassessment of euthanasia policy.
UNDERGROUND EUTHANASIASURVEY EVIDENCE
At the empirical level, the existence of a euthanasia underground is difficult to deny. Surveys
consistently demonstrate that a significant percentage of doctors comply with patients requests
to take active steps to hasten death: up to 12.3%, for example, in Baume and OMalleys
survey of 1268 doctors in New South Wales and the Australian Capital Territory.13 In a more
recent survey of Australian general surgeons, 5.3% reported administering a bolus lethal injection,
while 36.2% reported giving an overdose of drugs with the intention of hastening death (more than
half, or 20.4% of respondents, did so without a clear request by the patient).14 In a 1994 study of
312 British doctors, Ward and Tate reported that 124 of 273 doctors answering the relevant
question (45%) had been requested by a patient to hasten death; 12% of these respondents
complied.15 A survey of 1000 Scottish healthcare workers found that 4% had assisted suicide
either by providing drugs or advice.16
A similar picture emerges from the USA. A national survey of 1902 American physicists found
that 3.3% had written at least one lethal prescription, while 4.7% had provided at least one lethal
injection.17 A survey of American oncologists found that 3.7% had performed euthanasia, while
10.8% had assisted suicide.18 American surveys, like those elsewhere, show that medical opinion
is fragmented over the question of assisted death. In a random sample of American physicians,

44.5% favoured the legalisation of PAS (33.9% were opposed).19

These and dozens of similar studies suggest that we have passed the point where it is reasonable to
deny evidence of underground PAS/AE by asserting that the wrong questions were asked, or that
doctors failed to distinguish between actions taken with the intention of hastening the patients
death, and pain relief involving the lawful administration of analgesics. No-one suggests that the
majority of doctors have participated in assisted death; many doctors, of course, come nowhere
near death in their daily practice. But the weight of survey evidence demands a response:
wherever you turn, somewhere between 4% and 10+% of doctors have illegally assisted a patient
to die. Perhaps doctors themselves feel quite comfortable with this, but should we? Where is the
outcry from euthanasia opponents if each of these deaths is best understood as murder by the
physician?
Two recent, thought provoking books illustrate this point. John Keowns Euthanasia, Ethics and
Public Policy, published in 2002, runs to 291 pages and contains a five chapter critique of Dutch
euthanasia practice, but just four paragraphs on the implications of surveys into the illicit practice
of PAS/AE.16 Margaret Somervilles Death Talk contains 348 pages of text, but (on my
reckoning) just four pages on the illicit practice of euthanasia.20 It is time opponents of
legalisation balanced their concerns about what might happen if euthanasia is legalised with the
reality of what doctors already do.
WHAT IS UNDERGROUND EUTHANASIA REALLY LIKE?
Despite the growing body of statistical evidence, remarkably little is known about the
circumstances in which doctors provide covert assistance to die, whether these attempts result in
what was perceived to be a good death for the patient, and the long term impact of involvement on
health carers themselves. In Angels of Death: Exploring the Euthanasia Underground,21 I reported
on 49 detailed, yet pseudonymous interviews with doctors, nurses, and therapists working in
HIV/AIDS health care, principally in Sydney, Melbourne, and San Francisco. Half of the
interviewees volunteered to be interviewed by identifying themselves to me following seminars I
gave to doctor groups, while the other half were referred by interviewees, and other contacts.
Certain interviewees played a pivotal role in referring me to key players within the informal
euthanasia networks whichI discoveredhad grown up around involvement in HIV
medicine and in the gay community, particularly up until the mid-1990s when protease inhibitors
became available and dramatically slowed the number of AIDS deaths.
Despite their mostly good intentions, interviewees painted a troubling picture of covert PAS/AE. It
is true that many deaths were peaceful and were reported as being positive occasions for all
concerned. For example, an eminent physician, Joseph, was asked by his hairdresser to prescribe a
lethal dosage of drugs to assist the death of the hairdressers lover, who was dying from AIDS.
Joseph had heard about the mans deterioration second-hand, during haircuts, but Joseph had
never met him. He admits that there was no assessment involved whatsoever. Joseph recalls:
I wrote a prescription to a patient who I had never seen and I sent it to him in the mail. I heard that
next time I went in to get my hair cut that it was the most beautiful experience that my stylist had
ever had. It was [St] Valentines Day and they had a lovely meal with champagne and they
held each other and then his partner took his pills and was released.
Not all deaths end as sweetly as this. Take Stanley, a therapist and former priest, who presided
over the death of a patient who swallowed 15 Seconal tablets (a barbiturate), but who failed to

take an antiemetic. It was only after the patient had swallowed his own vomit that the drug took
effect. In many cases doctors and nurses miscalculated the dosages required to achieve death and
resorted in panic to suffocation, strangulation, and injections of air. Of the 88 detailed narratives
that interviewees gave to illustrate their euthanasia credentials, nearly 20% involved botched
attempts. Suffocations were referred to euphemistically as pillow jobs by several
interviewees:
It was horrible, said one doctor (now head of a large community organisation). It took four
or five hours. It was like Rasputin, we just couldnt finish him off. I tried insulin, I tried just
about everything else that I [had] around and it just took forever [It was] very hard for his
lover. So I um sort of shooed the lover out of the room at one stage and put a pillow over his head,
that seemed to work in the end [laughs, nervously] That was one of the worst [clearing throat]
one of the most horrible things Ive ever done.
Another doctor, Tony, reflected:
I think the ultimate obscenity was one of my patients who helped a friend of his to die at
home by helping him take a large quantity of sleeping pills and then holding a garbage bag over
his head until he died, and I think that is absolutely appalling and barbaric, and primitive.
It was incidents like this that cemented Tonys decision to assess patients who requested PAS/AE
with the help of a trusted psychiatrist. In his case, assistance to die took the form of building up
his patients dependence upon cortisone, and then suddenly withdrawing it while administering
morphine, or simply administering massive doses of liquid morphine and Largactil
(chlorpromazine): you can just keep on pumping it into the stomach until they die.
For me, the most striking feature of these accounts was the way they betrayed the absence of
norms or principles for deciding when it was appropriate to proceed. One doctor injected a young
man on the first occasion they met, despite concerns from close friends that the patient was
depressed. The doctor had a chat with a hospital physician who had been involved in the
patients care who seemed to think that death would be a nice thing. It later emerged from a
community nurse I interviewed, who was involved in the same incident, that the patient had only
told his parents the week before that he was HIV positive. Even those closest to the patient were
concerned about depression.
In another case, a patient brought his death forward by a week so as not to interfere with the
doctors holiday plans. The doctor supplied a palatable mixture of barbiturates ground up by a
pharmacist, but absented herself during the death itself. Absent doctors were a feature of several
accounts, attending briefly to inject the patient, before fleeing the scene for personal and legal
reasons. Annoyed at having to fit in a home visit a few hours before her scheduled flight, the
doctor was also irritated to find that the patients friends had failed to lay him out straight before
rigor mortis set in. The grieving friends also left the organisation of the funeral to her (she
narrowly avoided paying for it herself).
On another occasion, a doctor injected the entire contents of his doctors bag into a comatose
patient after a failed overdose, reflecting that I realised he [was] not going to survive this I
might as well speed it along. I think also because it was four oclock in the morning, I had a cold
and I felt dreadful and I just wanted to get out of there.
Underground euthanasia has spawned a culture of deception. Deceit is all-pervasive. It
encompasses the methods used to procure euthanasia drugs, the planning of the death itself, and
the disposal of the body and associated paperwork. Prior to death, doctors admitted to fabricating

symptoms to create a plausible clinical basis for the prescription or administration of escalating
dosages of drugs. The following example is drawn from the interview with Merril, a devout
Christian who acknowledged the tension between his faith and participation in euthanasia:
Interviewer: [But] what if, for example, the patient isnt in chronic pain and so Demoral [a
barbiturate] is not really medically indicated?Merril: probably in that instance I would develop
some chronic pain [very quiet]Interviewer: [so] youre hoping to fudge the system to some
extent?Merril: To protect me and the patients.
Other interviewees depended less on creating a plausible scenario for administering very high
dosages of drugs, and more on the trust of the patients family and loved ones. Josh, for
example, had used a veterinary drug called Lethabarb (pentobarbitone), sourced from a friendly
vet, in two successful episodes. Josh felt that Lethabarb was incredibly humane because
you dont have the agonal respirations all that awful stuff. Several interviewees admitted
to the outright theft of drugs. Othersparticularly in hospitalhoarded the excess morphine left
in the vials after the charted dose had been given.
While euthanasia is easier to carry out in community settings, there were examples of hospital and
hospice euthanasia. A variety of social processes made hospital euthanasia possible. These ranged
from cooperative overdosing carried out by one or two functionaries acting at considerable
personal risk, to whole hospital units staffed by people of like mind that fostered, to a greater or
lesser degree, a culture of euthanasia.
One nurse interviewee, Liz, saw herself as the odd person out in a hospital unit that apparently
used to book in patients to receive a lethal infusion of drugs. Although Liz had participated in
voluntary euthanasia on previous occasions, she drew the line when the unit physician instructed
her to send the mother of a dementing patient home to get a shower, and to administer a fatal
infusion to the patient in her absence. The physicians words to her were: Get it up and get
him [the patient] out of here by sundown. What came across most strongly in the interview was
Lizs sense of isolation and bewilderment: it was like I was the only person there [who] could
see clearly what was happening, she said. It was murder. The doctor played God, he thought
he was God hed decided this was the time for this patient.
In Angels of Death, I argue that these actions add up to more than the random misdeeds of doctors
and nurses acting in isolation. Collaborative euthanasia takes may forms: referring a patient to an
activist doctor for assessment, writing a lethal prescription, charting a lethal infusion,
accessing the patients vein, administering a lethal injection or infusion, directing the procedure
in a non-specific capacity, as well as being on call should anything go wrong, signing the death
certificate, and countersigning cremation forms. Lying on death certificates was universal.
Cremation is usually favoured over burial. You sit in sweat waiting for cremation to occur,
said Peter, a community nurse. All the people you speak to, if theyre being honest, will say
the same thing: were all waiting for the smoke to go up in the crematorium.
In summing up the overall impression gained from the interviews, it is difficult to disagree with
Edmund Pellegrinoa long-standing opponent of euthanasiawho points to the risks of doctors
acting outside of the established professional framework. To exalt compassion over traditional
professional obligations is seductive but dangerous. Danger lurks behind the benign face of
compassion so flexibly interpreted.22
RESPONDING TO UNDERGROUND EUTHANASIA

How, then, should we respond to the absence of professionalism that characterises illicit, covert
PAS/AE? How can we best minimise the risks for patients? In terms of policy choices, there
would appear to be three major alternatives to the status quo:
Protect patients by keeping euthanasia illegal, while actively investigating breaches and enforcing
the law rigorously.
Legalise, in order to re-regulate the practice of PAS/AE. Clearly, this option covers a range of
more specific options.
Educate and influence those who will nevertheless continue to participate in illicit euthanasia.
Option 1: keep euthanasia illegal and try to prosecute the offenders
The first optionattractive to moral conservativesis to prosecute the offenders in the
hopes of wiping out underground practices. In practical terms, however, any such policy is bound
to fail. Callahan and White argue that ensuring full compliance with the criteria forming part of
any statutory regime that permitted euthanasia is impossible, since it would require an intrusion
into the legally protected privacy of the doctorpatient relationship.23 As a factual claim, this
may or may not be true, although legally it is not a satisfying objection, since medical
confidentiality is not absolute and can not be used to cloak blatant criminality. What the privacy of
the clinical relationship does do, however, is camouflage illicit PAS/AE. The interviewees I spoke
to were generally concerned about exposure and careful with whom they shared details of their
involvement. To all outward appearances they were trustworthy, law abiding professionals. Aside
from the occasional show trial, or Kevorkian-style admission, there is no realistic chance of
purging the health professions of those who participate in assisted death.
Any attempt to suppress the covert practice of euthanasia by actively investigating suspicions and
prosecuting offenders would also require a massive commitment to policing clinical functions.
The most common euthanasia recipes consist of overdoses of relatively accessible, therapeutic
drugs.24 A more aggressive policing of analgesics, sedatives, and antidepressants would have a
disastrous impact on pain relief and symptom management. The resulting climate of defensive
medicine would seriously undermine palliative care. Doctors would fear giving adequate levels
of pain relief, and chronically ill and dying patients would suffer because of it. It seems plausible
to argue that a policy of aggressive policing would not only fail, but because of its effect on
patients, could also lead to renewed calls for PAS/AE to be legalised.
Option 2: legalise, in an effort to re-regulate euthanasia
A second response to the illicit practice of PAS/AEattractive to libertariansis to legalise
euthanasia. The argument is that a statutory regime creates space for law to re-regulate euthanasia
and to protect vulnerable patients by including safeguards in the statutory protocol that doctors
would be obliged to follow when providing lawful assistance. Opponents of euthanasia typically
respond by questioning the overall efficacy of a statutory regime and by shooting holes in the
safeguards it would contain. Opponents claim that legalisation will fail to reduce underground
euthanasia, that legalisation will fail to ensure that above ground assessments are safe, and
that legalisation will result in more unsafe killing, both above and below ground.
These arguments deserve careful scrutiny. However, if we are to talk sensibly about legalisation as
a harm minimisation strategy, we need to be clear on what the criteria for success of any statutory
regime would be. If a statutory procedure worked effectively, according to the safeguards
embodied within it, people would use it and they would die. It is difficult to guess how
popular a PAS/AE statute might be. If the Oregon experience is any guide, surprisingly few

might die this way (91 people died with assistance under Oregons PAS statute between 1998
and 2001).25,26 On the one hand, any sudden rise in lawful euthanasia deaths, both initially and
over time, might be seen as evidence that covert practices were being re-regulated and driven
above ground (policy success). Advocates would argue that the policy was working and that those
who died, died better deaths.
On the other hand, for those who see euthanasia as inherently wrong, regardless of the
circumstances, any lawful killing would be grounds for concern, and for suspicion about the
failure of safeguards (policy failure). For these opponents, the only safe euthanasia law is one
whose safeguards are so complex and bureaucratic that no patient could ever qualify for
assistance. (Oddly, no similar plea is made for safeguards when a patient is choosing to forego life
preserving medical treatment, despite the fact that death will result and despite evidence that the
major determinants of decisions to withdraw care are highly idiosyncratic to the healthcare worker
concerned.)27 When PAS/AE becomes visible, however, the temptation for moral conservatives is
to interpret anything other than minimal use of euthanasia statutes as evidence of a dangerous
slide down a slippery slope. Prohibiting all PAS/AE may or may not be the safest policy, but moral
opposition ought not to cloud our assessment of empirical questions including whether legalisation
prompts health professionals to redirect their assistance within lawful boundaries, and whether
health professionals comply with specific safeguards. However, such empirical evidence carries
little weight for those who regard a PAS/AE statute, whatever its safeguards, as the moral
equivalent of guidelines about how to carry out the procedures at death camps.28
What, then, about the frequent claim that the safeguards inserted into any PAS/AE statute would
be manipulated according to the values of the doctor concerned, or simply ignored?2931 This is
an empirical question that deserves research. Several cautionary points, however, should be made.
First, the safer the safeguards inserted into any statute (to protect the vulnerable or to
minimise the number killed), the harder it will be for a patient to access assistance under the
statute, regardless of their circumstances. A PAS/AE statute that is too safe, however, may
fail in its aim of re-regulating illicit practices. Since prohibition has failed to prevent covert
euthanasia, any statutory regime mustif it is to do any betterattract some measure of support
and voluntary compliance from doctors. If the law is too bureaucratic, too intrusive, or gives
insufficient legal shelter to doctors acting in good faith, it will be ignored in practice and will fail
in its objective of re-regulating PAS/AE. The challenge for those interested in minimising harm is
to design a regime that is robust, but which is also more attractive than the stresses and risks of
illicit action. Locating this middle ground is all the more controversial because of the feared
consequences of unsafe law.
Secondly, legislators are unlikely ever to come up with a perfectly safe law. Euthanasia opponents
sometimes try to goad advocates of legalisation to put forward a safe proposal, which can
then be gleefully shot down.31 The underlying problem is that the process of assessing patients,
and interpreting safeguards, calls for judgements, and judgements can be value-laden, difficult,
and uncertain. This is true elsewhere in medicine, and undoubtedly so in end-of-life decision
making. The fact that concepts like unbearable suffering, terminal illness, depression
and competency have fuzzy edges does not mean that they provide no constraints at all.32
Ultimately, however, the safety of a statutory regime rests on a moral commitment from doctors
themselves. A PAS/AE statute will be safest when doctors treat statutory safeguards not as
technical requirements or a tick sheet to be filled in, but as an invitation to engage deeply

with their patients experiences and values, appreciating the complex nature of suicide talk and
the mis-expression of pain and distress in terms of suicide.3336 The function of safeguards is to
give moral pause: to take suffering seriously but also to signal the value of the patient s life, the
interests of loved ones and society generally, within a framework that empowers the doctor to act
in the small number of cases that are most difficult.
But why should doctors be thrown into the role of killers? Opponents of euthanasia frequently
argue that advocates of legalisation seem intent on dragging medicine into what is really a debate
about suicide, to the detriment of patients, and the integrity of the profession.37 This is
misconceived. Euthanasia is not just a stimulating topic for the ethics stream of a medical
conference in the Bahamas. It is fundamentally a regulatory challenge that revolves around what
doctors do. Any attempt to regulate PAS/AE cannot but focus on doctors because it is doctors who
are doing the killing. Regardless of whether PAS/AE remains lawful or unlawful, medicine (and
nursing) have a central role in the debate.
On the whole, despite their assumption that the laws that prohibit PAS/AE work in practice,
opponents of euthanasia tend to be law sceptics. They point to non-compliance with the criteria
required to make out the defence of necessity following PAS/AE under Dutch criminal law as
a basis for the broader claim that if euthanasia were legalised, doctors would ignore the statutory
safeguards and patients would be no better off.15,38,39 van der Wal and colleagues report that
between 1990 and 1995, the reporting of PAS/AE rose from 18% to 41% of cases. In 1995, formal
consultation with a colleague occurred in 94% of reported cases, but in only 11% of unreported
ones.40 In 12% of cases where consultation did take place, however, the consultant never saw the
patient.41 Hendin, among others, has argued that Dutch consultants seemed to be facilitators of
the process rather than independent evaluators of the patients situation .42
It is important to remember that our ability to castigate the Dutch about their rates of noncompliance comes courtesy of the relative transparency created by the Dutch policy of
legalisation. If we wish to make ambit claims about slippery slopes, it is only fair to point out that
the reporting rate for Britain, Australia, and most other countries, is zero.43 Nevertheless, even
partial compliance with statutory safeguards may represent an improvement on the kinds of
clinical decisions that currently occur in secret. As one interviewee said, if euthanasia is to be
practised, it needs as much recognition as a tonsillectomy; if youre going to medicalise it and
give doctors all this power, then it needs to be subject to scrutiny, like a surgical audit, in order
to protect patients from mentally disturbed, impaired, or alcoholic doctors. Whatever the
shortcomings of Dutch policy, it is likely to be very difficult to institutionalise mechanisms that
will protect patients so long as PAS/AE remains illegal.
Option 3: educate and influence the lawbreakers
For the foreseeable future, PAS/AE is likely to remain illegal in many countries. Nevertheless, this
need not rule out strategies to guide, influence, and educate those who will continue to ignore the
criminal laws prohibition on physician assisted suicide and euthanasia. These doctors would
surely do less harm if they had the opportunity to calibrate their actions against some sort of
benchmark, some minimum set of criteria that would flag the issues, risks and pitfalls that are
present when health professionals do provide assistance.
The challenge of influencing covert practices is most acute for professional medical organisations,
who are in the best position to access their membership with information, decision making
pathways, guidelines, and other resources. Perhaps because their memberships are so divided

about the issue, professional medical bodies have little incentive to provide leadership in this area.
Unfortunately, this results in rash and ill-considered practices both by patients and health
professionals. In my study, some interviewees felt compelled to assist their patients because they
felt that this was better than the brutality of amateur suicide. Examples included horrific injuries
caused by patients jumping from bridges, jumping from windows, and in one example, crashing
through hospital windows and severing the jugular vein.44 Doctors participating in PAS/AE also
complained constantly about the way in which the criminal law inhibits frank discussion of hard
cases, nurtures ignorance, leads to desperation, botched attempts, ambiguous doublespeak, deceit and deception, and high levels of distress and burnout.45
The argument that the illicit practice of PAS/AE should be rewarded with professional
guidelines may anger some opponents. These critics may need to separate their private views
about the moral wrongness of euthanasia, from the policy question of how to minimise harm and
to better protect patients interests. Euthanasia policy shares a tension between moralistic and
consequentialist approaches also seen in the context of drugs policy, andat least in Australiain
the debate about clean needle distribution programmes.
CONCLUSION
The euthanasia debate is not about Nancy Crick or Dianne Pretty, as troubling as their cases were.
It is about how best to regulate what doctors have always done, and what they will probably
always do. The choice is not between having euthanasia, and not having it, but letting it stay
underground, and trying to make it visible.
For those who see the world in black and white, and struggle to understand why others see it as
shades of grey, legalising euthanasia because there is an underground is about as morally
compelling as legalising paedophilia (with safeguards) simply because paedophilia also
occurs underground. Adopting a harm minimisation approach does not mean, however, that
we cannot distinguish between degrees of harm. Nor does it mean that, if something is illegal, we
must mindlessly legalise it in order to regulate it. In the case of paedophilia, there is a high degree
of social consensus that paedophilia is not only immoral, but that it causes serious harm to
children. Creating a class of child prostitutes would certainly, in my view, be wrong, even if it
could be shown that, on average, fewer children would be predated upon if paedophilia were
regulated.
In the case of euthanasia, however, there is genuine disagreement about whether or not voluntary
euthanasia to relieve terminal suffering, is morally wrong. This disagreement itself ought to
challenge our assumptions about absolutist prohibitions: there is a distinction, too frequently
forgotten in debate about medical ethics, between the private morality according to which we
might choose to live our own lives, and the public morality of law and public policy. Even
assuming that euthanasia is morally wrong, disagreement persists over the consequences of
legalisation; in particular, whether legalising PAS/AE would cause less harm overall, than
prohibition. A similar argument might be made about the heroin underground. I might
strongly disapprove of non-medical heroin use, but nevertheless believe that it is wiser for society
to operate safe injecting rooms to minimise the risks of overdose and transmission of
HIV/hepatitis C through dirty needles. I would also go further and give serious attention to
programmes supplying free heroin to registered addicts so as to simultaneously reduce the crime
arising from the fact that criminals control supply, while ensuring that addicts can access the

counselling and medical assistance that give them the best chance of beating their addiction. But
the fact that I might take this view on heroin does not commit me to the view that it is right to
legalise all undergrounds, just because they exist.
The debate about the legalisation of euthanasia needs to take account of euthanasia whenever it is
practised, both above and below ground. I do not discount the possibility that in the end, moral
conservatives may be right. Nevertheless, this is a case that opponents need to make in the light of
an honest appreciation of what doctors do, and the risks and harms of euthanasia when it is
practised in secret.
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(www.rug.nl/law/research/programmes/mbpsl/researchprogram/newsletter (accessed 15 July
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See reference21:254.

euthanasia
2.1 Pengertian Euthanasia
Euthanasia berasal dari bahasa Yunani, yaitu eu yang berarti indah, bagus, terhormat atau
gracefully and with dignity, dan thanatos yang berarti mati. Jadi secara etimologis, euthanasia
dapat diartikan sebagai mati dengan baik atau mati dengan tenang. Jadi sebenarnya secara harfiah,
euthanasia tidak bisa diartikan sebagai suatu pembunuhan atau upaya menghilangkan nyawa
seseorang. Menurut Philo (50-20 SM) euthanasia berarti mati dengan tenang dan baik, sedangkan
Suetonis penulis Romawi dalam bukunya yang berjudul Vita Ceasarum mengatakan bahwa
euthanasia berarti mati cepat tanpa derita. Sejak abad 19 terminologi euthanasia dipakai
untuk penghindaran rasa sakit dan peringanan pada umumnya bagi yang sedang menghadapi
kematian dengan pertolongan dokter.
Euthanasia adalah tindakan mengakhiri hidup seseorang secara tidak menyakitkan, ketika tindakan
tersebut dapat dikatakan sebagai bantuan untuk meringankan penderitaan dari individu yang akan
mengakhiri hidupnya.
Euthanasia sering disebut : mercy killing (mati dengan tenang). Euthanasia bisa muncul dari
keinginan pasien sendiri, permintaan dari keluarga dengan persetujuan pasien (bila pasien masih
sadar), atau tanpa persetujuan pasien (bila pasien sudah tidak sadar).
Dari pengertian pengertian di atas maka euthanasia mengandung unsur-unsur sebagai berikut:
Berbuat sesuatu atau tidak berbuat sesuatu.
Mengakhiri hidup, mempercepat kematian, atau tidak memperpanjang hidup pasien.
Pasien menderita suatu penyakit yang sulit untuk disembuhkan.
Atas atau tanpa permintaan pasien dan atau keluarganya.

Demi kepentingan pasien dan atau keluarganya.

Kode Etik Kedokteran Indonesia menggunakan euthanasia dalam tiga arti, yaitu:
Berpindahnya ke alam baka dengan tenang dan aman tanpa penderitaan,
buat yang beriman
dengan nama Allah di bibir.
Waktu hidup akan berakhir, diringankan penderitaan si sakit dengan memberikan obat penenang.
Mengakhiri penderitaan dan hidup seorang sakit dengan sengaja atas permintaan pasien sendiri
dan keluarganya.
2.2 Penyebab Euthanasia
Hal-hal yang menyebabkan seseorang menginginkan tindakan euthanasia antara lain:
Rasa putus asa (terutama pada pasien dengan depresi mayor), ketidakberdayaan, kesepian, letih,
nyeri psikologis yang dirasakan tidak tertangguhkan.
Gangguan psikiatrik
a)
Gangguan mood mayor, gangguan mood mayor khususnya dengan tanda-tanda vegetatif
atau proses fikir menyempit
b)
Alkoholisme, sebagian besar pasien kronis, sebagian besar pria, sering setelah kehilangan
hubungan pribadi dengan orang lain, lebih tinggi lagi apabila terjadi depresi dandukungan sosial
yang kurang,kecanduan obat-obatan
c)
Skizofrenia, skizofrenia khususnya ketika mengalami kesepian, depresi, skizofrenia kronis,
atau disertai dengan halusinasi perintah yang merusak diri sendiri
d)
Lain-lain: Psikosis akibat kondisi organik, gangguan kepribadian (ambang, antisosial),
gangguan panik dengan komorbiditas depresi
Kesehatan yang menurun, bila sebelumnya hidup tidak mandiri, hambatan medis kronis, HIV /
AIDS.
4. Intoksikasi, penggunaan aktif (penyalahgunaan) alkohol dan obat-obatan.
5. Pengendalian inpuls yang terganggu karena alasan apapun, hostilitas.
6. Riwayat percobaan bunuh diri.
7. Duda / janda, bercerai, berpisah, hidup sendiri, pengangguran, pension.
8. Pasien medis yang menjalani dialisis ginjal.
9. Perubahan status sosial naik atau turun.
10. Kehilangan ataupun penolakan yang dialami baru-baru ini.

11. Kematian orang tua selama masa kanak-kanak.

2.3

Syarat Diperbolehkannya Euthanasia

Tentunya dalam melakukan tindakan euthanasia harus melalui prosedur dan persyaratanpersyaratan yang harus dipenuhi agar euthanasia bisa dilakukan.
Ada tiga petunjuk yang dapat digunakan untuk menentukan syarat prasarana luar biasa:
Dari segi medis ada kepastian bahwa penyakit sudah tidak dapat disembuhkan lagi.
Harga obat dan biaya tindakan medis sudah terlalu mahal.
Dibutuhkan usaha ekstra untuk mendapatkan obat atau tindakan medis tersebut.
Dalam kasus-kasus seperti inilah orang sudah tidak diwajibkan lagi untuk mengusahakan obat atau
tindakan medis.
2.4

Pihak yang Berwenang Melakukan Euthanasia

Pihak yang berwenang melakukan euthanasia adalah tenaga medis baik dokter maupun perawat.
Dari sinilah dilema muncul dan menempatkan dokter atau perawat pada posisi yang serba sulit.
Dokter dan perawat merupakan suatu profesi yang mempunyai kode etik sendiri sehingga mereka
dituntut untuk bertindak secara profesional. Pada satu pihak ilmu dan teknologi kedokteran telah
sedemikian maju sehingga mampu mempertahankan hidup seseorang (walaupun istilahnya hidup
secara vegetatif).
Secara formal hukum yang berlaku di negara kita memang tidak mengizinkan tindakan euthanasia
oleh siapapun (termasuk para tenaga paramedis baik dokter maupun perawat), sebagaimana
tercermin dalam pasal-pasal KUHP tersebut. Tersirat dari pasal 334 di atas, yang telah jelas
dilarang oleh KUHP adalah euthanasia aktif, dengan atau tanpa permintaan pasien ataupun
keluarganya. Menariknya, UU No. 23/1992 tentang kesehatan (yang dikenal sebagai UU
Kesehatan) ternyata belum mengakomodasi soal euthanasia ini dalam pasal-pasalnya, sedangkan
di lain pihak beberapa pasal KUHP tadi masih belum memberikan batasan yang tegas dalam hal
euthanasia (Achadiat, 2002).
Dari sudut pandang etika kedokteran, euthanasia sebenarnya bertentangan dengan etika
kedokteran.
2.5

Metode Euthanasia

Ada 4 metode dalam euthanasia, yaitu:

Euthanasia sukarela: ini dilakukan oleh individu yang secara sadar menginginkan kematian.
Euthanasia non sukarela: ini terjadi ketika individu tidak mampu untuk menyetujui karena faktor
umur, ketidak mampuan fisik dan mental. Sebagai contoh dari kasus euthanasia non sukarela ini
adalah menghentikan bantuan makanan dan minuman untuk pasien yang berada di dalam keadaan

vegetatif (koma).
Euthanasia tidak sukarela: ini terjadi ketika pasien yang sedang sekarat dapat ditanyakan
persetujuan, namun hal ini tidak dilakukan. Kasus serupa dapat terjadi ketika permintaan untuk
melanjutkan perawatan ditolak.
Bantuan bunuh diri: ini sering diklasifikasikan sebagai salah satu bentuk euthanasia. Hal ini terjadi
ketika seorang individu diberikan informasi dan wacana untuk membunuh dirinya sendiri.

2.6

Pembagian Euthanasia

Adapun jenis-jenis euthanasia:

Euthanasia aktif : perbuatan yang dilakukan secara aktif oleh dokter untuk mengakhiri hidup
seseorang (pasien) yang dilakukan secara medis.Biasanya dilakukan dengan penggunaan obatobatan yang bekerja dengan cepat dan mematikan.
Euthanasia pasif : perbuatan menghentikan atau mencabut segala tindakan atau pengobatan yang
perlu untuk mempertahankan hidup manusia sehingga pasien diperkirakan akan meninggal setelah
tindakan pertolongan dihentikan.
Euthanasia volunter : penghentian tindakan pengobatan atau mempercepat kematian atas
permintaan pasien.
Euthanasia involunter : jenis euthanasia yang dilakukan pada pasien dalam kedaan tidak sadar di
mana tidak mungkin untuk menyampaikan keinginannya.Dalam hal ini dianggap famili pasien
yang bertanggung jawab atas penghentian bantuan pengobatan. Perbuatan ini sulit dibedakan
dengan pembunuhan kriminal.

2.7

Konsep Tentang Mati

Untuk dapat memahami lebih jauh timbulnya masalah euthanasia, kita perlu memahami tentang
konsep mati yang dianut dari dulu hingga sekarang. Perubahan pengertian ini berkaitan dengan
adanya alat-alat resusitasi, berbagai alat atau mesin-mesin penopang hidup dan kemajuan dalam
perawatan intensive. Dahulu, apabila jantung dan paru-paru sudah tidak bekerja lagi, orang
tersebut sudah dinyatakan mati dan tidak perlu diberikan pertolongan lagi. Kini keadaan sudah
berubah, jantung yang sudah berhenti dapat dipacu untuk bekerja kembali dan paru-paru dapat
dipompa agar kembali kembang kempis. Pada umumnya dikenal beberapa konsep tentang mati :
Mati sebagai berhentinya darah mengalir. Dalam PP No. 18 tahun 1981 dinyatakan bahwa mati
adalah berhentinya fungsi jantung dan paru-paru. Tetapi dalam pengalaman kedokteran teknologi
resusitasi telah memungkinkan jantung dan paru-paru yang semula terhenti adakalanya dapat
dipulihkan kembali. Sehingga dilihat dari perkembangan teknologi kedokteran, kriteria mati ini
sebenarnya sudah ketinggalan zaman.
Mati sebagai saat terlepasnya nyawa dari tubuh. Pada umumnya banyak yang beranggapan bahwa
nyawa terlepas dari tubuh ketika darah berhenti mengalir. Tetapi dikaitkan dengan perkembangan
teknologi yang telah dikemukakan diatas, maka konsep ini tidak tepat lagi.

Hilangnya kemampuan tubuh secara permanen (irreversible loss of ability). Dalam pengertian ini
fungsi organ-organ tubuh yang semula bekerja secara terpadu kini berfungsi sendiri-sendiri tanpa
terkendali otak karena telah rusak.
Hilangnya kemampuan manusia secara permanen untuk kembali sadar dan melakukan interaksi
sosial.
Konsep ini dikembangkan dari konsep ke-3 tetapi dengan penekanan nilai moral yaitu dengan
memperhatikan fungsi manusia sebagai mahluk sosial. Konsep ini tidak lagi melihat apakah
organ-organ tubuh yang lain masih berfungsi atau tidak, tetapi apakah otaknya masih mampu atau
tidak menjalankan fungsi pengendalian, secara jasmani maupun sosial, atau tidak.
Berdasarkan cara terjadinya, kematian dibagi dalam tiga jenis yaitu:
Orthothanasia, yaitu kematian yang terjadi karena proses alamiah.
Dysthanasia, yaitu kematian yang terjadi secara tidak wajar.
Euthanasia, yaitu kematian yang terjadi dengan pertolongan dan tidak dengan pertolongan dokter.

2.8 Aspek Euthanasia

Aspek Etik
Declaration of Geneva 1948 dan Declaration of Sydney 1968 menyebutkan bahwa, Saya akan
membaktikan hidup saya guna kepentingan perikemanusiaan. Saya akan menghormati setiap
hidup insani mulai dari saat pembuahan. Peraturan Pemerintah 1969 tentang lafal sumpah
dokter Indonesia bunyinya juga serupa dengan Declaration of Geneva dan Declaration of Sydney.
Pada Kode Etik Kedokteran Indonesia Bab II tentang kewajiban dokter terhadap pasien, tidak
memperbolehkan mengakhiri penderitaan dan hidup orang sakit, yang menurut pengetahuan dan
pengalaman tidak akan sembuh lagi (euthanasia).
Aspek Hukum
Undang undang yang tertulis dalam KUHP Pidana hanya melihat dari dokter sebagai pelaku utama
euthanasia, khususnya euthanasia aktif dan dianggap sebagai suatu pembunuhan berencana, atau
dengan sengaja menghilangkan nyawa seseorang. Sehingga dalam aspek hukum, dokter selalu
pada pihak yang dipersalahkan dalam tindakan euthanasia, tanpa melihat latar belakang
dilakukannya euthanasia tersebut. Tidak perduli apakah tindakan tersebut atas permintaan pasien
itu sendiri atau keluarganya, untuk mengurangi penderitaan pasien dalam keadaan sekarat atau
rasa sakit yang sangat hebat yang belum diketahui pengobatannya. Di lain pihak hakim dapat
menjatuhkan pidana mati bagi seseorang yang masih segar bugar yang tentunya masih ingin
hidup, dan bukan menghendaki kematiannya seperti pasien yang sangat menderita tersebut, tanpa
dijerat oleh pasal pasal dalam undang undang yang terdapat dalam KUHP Pidana.
Aspek Hak Asasi
Hak asasi manusia selalu dikaitkan dengan hak hidup, damai dan sebagainya. Tapi tidak tercantum

dengan jelas adanya hak seseorang untuk mati. Mati sepertinya justru dihubungkan dengan
pelanggaran hak asasi manusia. Hal ini terbukti dari aspek hukum euthanasia, yang cenderung
menyalahkan tenaga medis dalam euthanasia. Sebetulnya dengan dianutnya hak untuk hidup layak
dan sebagainya, secara tidak langsung seharusnya terbersit adanya hak untuk mati, apabila dipakai
untuk menghindarkan diri dari segala ketidak nyamanan atau lebih tegas lagi dari segala
penderitaan yang hebat.
Aspek Ilmu Pengetahuan
Pengetahuan kedokteran dapat memperkirakan kemungkinan keberhasilan upaya tindakan medis
untuk mencapai kesembuhan atau pengurangan penderitaan pasien. Apabila secara ilmu
kedokteran hampir tidak ada kemungkinan untuk mendapatkan kesembuhan ataupun pengurangan
penderitaan, apakah seseorang tidak boleh mengajukan haknya untuk tidak diperpanjang lagi
hidupnya? Segala upaya yang dilakukan akan sia sia, bahkan sebaliknya dapat dituduhkan suatu
kebohongan, karena di samping tidak membawa kepada kesembuhan, keluarga yang lain akan
terseret dalam pengurasan dana.

Aspek Agama
Kelahiran dan kematian merupakan hak dari Tuhan sehingga tidak ada seorang pun di dunia ini
yang mempunyai hak untuk memperpanjang atau memperpendek umurnya sendiri. Pernyataan ini
menurut ahli ahli agama secara tegas melarang tindakan euthanasia, apapun alasannya. Dokter
bisa dikategorikan melakukan dosa besar dan melawan kehendak Tuhan yaitu memperpendek
umur. Orang yang menghendaki euthanasia, walaupun dengan penuh penderitaan bahkan kadangkadang dalam keadaan sekarat dapat dikategorikan putus asa, dan putus asa tidak berkenan
dihadapan Tuhan. Tapi putusan hakim dalam pidana mati pada seseorang yang segar bugar, dan
tentunya sangat tidak ingin mati, dan tidak dalam penderitaan apalagi sekarat, tidak pernah
dikaitkan dengan pernyataan agama yang satu ini. Aspek lain dari pernyataan memperpanjang
umur, sebenarnya bila dikaitkan dengan usaha medis bisa menimbulkan masalah lain. Mengapa
orang harus ke dokter dan berobat untuk mengatasi penyakitnya, kalau memang umur mutlak di
tangan Tuhan, kalau belum waktunya, tidak akan mati.
2.9

Hak pasien dan pembatasannya

Penghormatan hak pasien untuk penentuan nasib sendiri masih memerlukan pertimbangan dari
seorang dokter terhadap pengobatannya. Hal ini berarti para dokter harus mendahulukan proses
pembuatan keputusan yang normal dan berusaha bertindak sesuai dengan kemauan pasien
sehingga keputusan dapat diambil berdasarkan pertimbangan yang matang. Pasien harus diberi
kesempatan yang luas untuk memutuskan nasibnya tanpa adanya tekanan dari pihak manapun
setelah diberikan informasi yang cukup sehingga keputusannya diambil melalui pertimbangan
yang jelas. Beberapa pasien tidak dapat menentukan pilihan pengobatan sehingga harus orang lain
yang memutuskan apa tindakan yang terbaik bagi pasien itu. Orang lain disini tentu dimaksudkan
orang yang paling dekat dengan pasien dan dokter harus menghargai pendapat-pendapat tersebut.

2.10Batas-batas Tanggung Jawab Ilmuwan dan Praktisi Ilmu dalam Kasus Euthanasia
Dalam euthanasia, setidaknya terdapat empat macam ilmu yang terlibat didalamnya yaitu hukum,
hak asasi, biologi/kedokteran dan agama, yang pasti masing-masing memiliki standar kebenaran
yang berbeda. Pertanyaannya tentu bagaimana proses keputusan euthanasia harus diambil untuk
dapat dilaksanakan tanpa melanggar kebenaran masing-masing, untuk itu tidak ada jalan lain,
selain mengikuti kebenaran relatif.
Etika, sering lebih terasa digunakan sebagai pijakan oleh praktisi ilmu, dibanding pihak yang
mengembangkan ilmu itu sendiri. Profesi-profesi seperti ahli hukum, dokter dan sebagainya
merupakan praktisi ilmu yang sering dituntut secara kuat etikanya dalam menerapkan ilmunya.
Pertanyaannya adalah etika yang mana yang harus digunakan oleh seorang praktisi ilmu. Lebih
lanjut apabila beberapa ilmu harus berperan secara bersama-sama, maka etika yang harus
digunakan tentu diutamakan etika yang berlaku bagi masyarakat pengguna ilmu tersebut.
Ilmu yang seharusnya menjadikan hidup lebih mudah, lebih nikmat, lebih efisien dan sebagainya,
seringkali justru membelenggu hakekat sebagai
manusia, bahkan dapat secara nyata
menghancurkan kehidupan. Kekecewaan Einstein terhadap penggunaan hukum fisika modern
dalam kasus Hiroshima ; kemajuan teknologi industri di satu pihak dan polusi yang
ditimbulkannya merupakan contoh bahwa kemajuan ilmu memiliki dua sisi yang saling
kontradiktif. Demikian pula penemuan-penemuan dibidang kedokteran seringkali sangat mudah
dilihat sisi positif dan negatifnya, seperti penggunaan bahan dalam anestesi, teknik-teknik
pembedahan, fertilitas, euthanasia dan sebagainya. Kenyataan tersebut menunjukkan semakin
jelas bahwa ilmu bersifat bebas nilai. Disinilah pentingnya norma dan etika dalam penggunaan
ilmu, yang hendaknya menjadi konsensus bagi umat manusia. Klaim-klaim hukum terhadap
tindakan dokter dalam euthanasia merupakan bentuk lain dari sisi negatif dalam penerapan ilmu,
yang terkadang sama sekali tidak terbayangkan oleh dokter yang bersangkutan.
Jadi perkembangan ilmu yang kemudian diujudkan dalam tindakan berkembang dalam
kebudayaan manusia serta sekaligus mempengaruhi kebudayaan manusia melalui dua sisi tersebut,
pada gilirannya tentu dapat berupa manfaat dan atau bencana. Demikian pula euthanasia dapat
hadir diantara manfaat dan bencana.
2.11 Argumen Terhadap Euthanasia
Pro Euthanasia
Kelompok pro euthanasia, yang termasuk juga beberapa orang cacat, berkonsentrasi untuk
mempopulerkan euthanasia dan bantuan bunuh diri. Mereka menekankan bahwa pengambilan
keputusan untuk euthanasia adalah otonomi individu. Jika seseorang memiliki penyakit yang tidak
dapat disembuhkan atau berada dalam kesakitan yang tak tertahankan, mereka harus diberikan
kehormatan untuk memilih cara dan waktu kematian mereka dengan bantuan yang diperlukan.
Mereka mengklaim bahwa perbaikan teknologi kedokteran merupakan cara untuk meningkatkan
jumlah pasien yang sekarat tetap hidup. Dalam beberapa kasus, perpanjangan umur ini melawan

kehendak mereka.
Mereka yang mengadvokasikan euthanasia non sukarela, seperti Peter Singer, berargumentasi
bahwa peradaban manusia berada dalam periode ketika ide tradisional seperti kesucian hidup telah
dijungkir balikkan oleh praktek kedokteran baru yang dapat menjaga pasien tetap hidup dengan
bantuan instrumen. Dia berargumen bahwa dalam kasus kerusakan otak permanen, ada kehilangan
sifat kemanusian pada pasien tersebut, seperti kesadaran, komunikasi, menikmati hidup, dan
seterusnya. Mempertahankan hidup pasien dianggap tidak berguna, karena kehidupan seperti ini
adalah kehidupan tanpa kualitas atau status moral.
Falsafah Utilitarian Singer menekankan bahwa tidak ada perbedaan moral antara membunuh dan
mengizinkan kematian terjadi. Jika konsekuensinya adalah kematian, maka tidak menjadi masalah
jika itu dibantu dokter, bahkan lebih disukai jika kematian terjadi dengan cepat dan bebas rasa
sakit.
Oposisi terhadap Euthanasia
Banyak argumen anti euthanasia bermula dari proposisi, baik secara religius atau sekuler, bahwa
setiap kehidupan manusia memiliki nilai intrinsik dan mengambil hidup seseorang dalam kondisi
normal adalah suatu kesalahan. Advokator hak-hak orang cacat menekankan bahwa jika
euthanasia dilegalisasi, maka hal ini akan memaksa beberapa orang cacat untuk menggunakannya
karena ketiadaan dukungan sosial, kemiskinan, kurangnya perawatan kesehatan, diskriminasi
sosial, dan depresi. Orang cacat sering lebih mudah dihasut dengan provokasi euthanasia, dan
informed consent akan menjadi formalitas belaka dalam kasus ini. Beberapa orang akan merasa
bahwa mereka adalah beban yang harus dihadapi dengan solusi yang jelas. Secara umum, argumen
anti euthanasia adalah kita harus mendukung orang untuk hidup, bukan menciptakan struktur yang
mengizinkan mereka untuk mati.
2.12 Prinsip-Prinsip Pencegahan Euthanasia
1)

Kenali dan obati kondisi-kondisi psikiatrik dan medis

2)

Kembangkan ikatan terapeatik dengan pasien

3)
Pasien yang ingin bunuh diri biasanya bersikap ambivalen tentang kematian itu maka
ungkapan tentang ambivalen tersebut, memperlihatkan bukti-bukti bahwa mereka ingin hidup
4)

Hadapkan pasien pada hal-hal realita

5)

Jangan mengucilkan keseriusan pasien dalam usaha bunuh diri

6)

Jangan pernah setuju untuk merahasiakan rencana bunuh diri

7)

Bantulah pasien melewati masa berduka karena kehilangan

8)

Jangan beri alasan untuk membenarkan gejala-gejala yang dialami pasien

9)

Nilailah kembali kondisi fikiran pasien dengan sharing

10) Gunakan sumber daya dari komunitas, misal keluarga, dan orang yang bermakna
dalam pengobatan pasien
11) Jangan kehilangan kontak dengan pasien
12) Bersikap aktif tetapi tetap menuntut pasien untuk bertanggung jawab atas kehidupannya
sendiri.
Contoh kasus euthanasia:
Kasus I :
Kasus euthanasia yang terkenal di Indonesia adalah kasus Ny Agian Isna Nauli Siregar. Ibu Agian
merupakan korban mal praktek di sebuah rumah sakit di Jakarta. Terjadinya kasus mal praktek itu
menyebabkan 86% otak dari Ibu Agian mengalami kerusakan parah. Suami korban, Hasan
Kusuma, sempat mengajukan permohonan euthanasia atau suntik mati untuk istrinya kepada DPR
RI karena harapan hidup Ibu Agian amat kecil dan biaya perawatan yang sangat mahal. Setelah
mengkonsumsi suatu obat herbal kesehatannya berangsur pulih, harapan hidupnya kembali hadir.
Tentu ini perlu disyukuri sebagai rahmat Tuhan Yang Maha Esa.
Tanggapan :
1. Aspek Etik
Pada kasus tersebut jika ditinjau dari aspek etik, seharusnya tugas dokter atau tim medis adalah
menyembuhkan dan merawat pasien dengan baik. Tapi pada kasus ini malah dokter atau tim
medis melakukan malpraktik. Hal ini bertolak belakang dengan etik kedokteran.
2. Aspek Hukum
Menurut kami, pada kasus tersebut jika ditinjau dari aspek hukum, yang bersalah adalah dokter
atau tenaga medis. Karena telah berbuat malpraktik terhadap ibu Agian sebagai pasien.
3. Aspek Hak Asasi
Menurut kami pada kasus tersebut, Ibu Agian berhak untuk hidup. Karena beliau melakukan
pengobatan kepada dokter. Namun, perlakuan medis yang diberikan kepada ibu Again tidak sesuai
yang diharapkan. Apalagi ibu Agian terkena kasus malpraktik, sampai-sampai suaminya meminta
hak untuk mati yang ditujukan untuk istrinya.

4. Aspek Ilmu Pengetahuan

Pada kasus ini, dokter atau tim medis telah salah menangani sakit yang diderita ibu Agian.
Sehingga tejadi malpraktik. Padahal seharusnya dokter atau tim medis harus melakukan
pengobatan yang baik untuk ibu Agian. Karena dokter mamiliki pengetahuan yang luas tentang
berbagai macam penyakit.
5. Aspek Agama
Menurut pendapat kami jika kasus tersebut ditinjau dari segi agama, tidak ada hubungannya.
Karena yang meminta tindakan euthanasia adalah suami dari ibu Agian. Dan hal itu belum
dilaksanakan olaeh dokter. Karena ibu Agian kondisinya mulai membaik dengan mengkomsumsi
obat herbal.
Kasus II :
Dan contoh yang lain adalah Vincent Humbert, pemuda Perancis ini mengalami kecelakaan mobil
pada akhir September 2000. Tiga tahun Vincecnt dirawat di sebuah rumah sakit di kota BercksurMer sembilan bulan pertama dalam keadaan koma. Ketika kesadarannya pulih, Vincent sudah
kehilangan penglihatan dan kemampuan berbicara. Tubuhnya pun lumuh. Cuma jempol tangan
kirinya yang bisa digerakkan. Kondisi tanpa daya ini membuat Vincent tak mau meneruskan
hidupnya. Pada November 2002, ia mengirimkan surat kepada Presiden Perancis, Jacques Chirac,
meminta agar ia diberi hak untuk mati. Chirac membalas surat Vinceent dan menelponnya. ke
rumah sakit, menjelaskan bahwa ia tak bisa memenuhi permintaannya itu. Vincent pun akhirnya
menyusun rencana kematian bersama ibunya, Marie Humbert. Ia juga menulis buku berisi
penjelasan soal kasusnya dibantu seorang wartawan bernama Frederick Veille.
Kemudian tepat tiga tahun setelah kecelakaan, Vincent dan Marie melaksanakan rencana mereka,
Marie menyuntikkan obat penenang dengan dosis berlebih ke pembuluh darah putranya. Hari
berikutnya, buku karya Vincent, FeVous Demande le Droit de Mourir (Saya Meminta Pada Anda
Hak untuk Mati), pun terpajang di rak toko-toko buku di Perancis. Dalam buku itu Vincent
berkata, Saya tidak hidup. Saya dibuat untuk hidup. Saya tetap hidup. Untuk Siapa, untuk apa
yang tak saya ketahui, yang saya tahu saya hanyalah mayat hidup.Jumat 26 September 2003,
Vincent meninggal pada usia 22 tahun,Saya sangat bahagia, akhirnya kakak saya bebas, kata
Laurent Humbert, adik Vincent, kepada LCI TV. Marie, 48 tahun, yang genjar mengkampanyekan
hak putranya untuk mengakhiri hidup, ditahan polisi karena dituduh melakukan pembunuhan
dengan sengaja. Hari berikutnya, Marie dibebaskan dan diperbolehkan menemui putranya sebelum
meninggal. Marie kemudian dimasukkan ke rumah sakit yang dirahasiakan nama dan tempatnya.
Keberadaannya pun sekarang tak diketahui umum.

Tanggapan :

1. Aspek Etik
Pada kasus tersebut jika dilihat dari aspek etik, mungkin tidak ada hubungannya. Karena yang
melakukan tindakan euthanasia disini bukan dokter maupun tim medis. Melainkan Marie Humbert
(ibu Vincent Humbert). Jadi, jika dokter atau tim medis yang melakukan tindakan euthanasia,
maka hal itu melanggar etika kedokteran.

2. Aspek Hukum
Pada kasus tersebut jika ditinjau dari aspek hukum, yang bersalah adalah Ibu Vincent, karena telah
membunuh dengan sengaja putranya. Namun, hal itu didasari karena permintaan Vincent untuk
mati. Vincent sudah meminta permohonan euthanasia kepada Presiden Prancis, tapi ditolak.
Sehingga dia meminta Ibunya sendiri untuk mengakhiri hidupnya.

3. Aspek Hak Asasi

Pada kasus tersebut jika ditinjau dari aspek hak asasi, sebenarnya Vincent Humbert ingin hidup.
Namun, mengalami kecelakaan yang parah. Sehingga dia meminta hak untuk mati/ pemohonan
euthanasia untuk mengakhiri penderitaan hidupnya. Karena Vincent sudah putus asa dalam
menjalani hidup.

4. Aspek Ilmu pengetahuan

Pada kasus tersebut jika ditinjau dari aspek ilmu pengetahuan. Sebenarnya Ibu Vincent kurang
mengetahui tentang metode pelaksanaan euthanasia. Dia hanya melakukan permintaan putranya
untuk menyuntikkan obat penenang dengan dosis yang tinggi. Seharusnya yang tahu tentang
metode pelaksanaan euthanasia adalah dokter atau tim medis.

5. Aspek Agama
Pada kasus ini jika dilihat dari aspek agama, perbuatan Marie Humbert yang tidak lain ialah
ibunya Vincent yang berdosa karena telah mengakhiri hidup putranya sendiri dengan
menyuntikkan obat penenang dengan dosis tinggi. Perbuatan Marie Humbert sangat bertentangan

denagn agama, namun Marie melakukan hal ini karena permintaan putranya. Ia tidak tega melihat
Vincent hidup dalam penderitaan.