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1.0 Introduction - What is Euthanasia?

Euthanasia is generally the practice of intentionally ending a life in order to

relieve pain and suffering. Euthanasia, assisted suicide or mercy killing refers to

assisting a person with a terminal illness to die (Gupta et al 2006).

Passive euthanasia is intentionally withdrawing life sustaining technological

treatment or withholding nutrition and hydration with intent to let someone die.

Euthanasia may also be executed by a physician through administration of a lethal

dose, or by providing means to the patient such as lethal medication dose or

knowledge for the purpose of ending a life (Mueller 2010). Voluntary euthanasia is

ending ones life with informed consent. Involuntary euthanasia refers to ending

ones life without informed consent (Mueller 2010).

There are different euthanasia laws in each country. The British House of Lords

(highest legal body in England and Wales). Select Committee on Medical Ethics

defines euthanasia as a deliberate intervention undertaken with the express

intention of ending a life, to relieve intractable suffering. In the Netherlands and

Flanders, euthanasia is understood as "termination of life by a doctor at the request of

a patient".

Euthanasia is categorized in different ways, which include voluntary, non-

voluntary, or involuntary. Voluntary euthanasia is legal in some countries. Non-

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voluntary (patient's consent unavailable) is illegal in all countries. Involuntary

euthanasia (without asking consent or against the patient's will) is also illegal in all

countries and is usually considered murder As of 2006, euthanasia is the most active

area of research in contemporary bioethics.

In some countries there is a divisive public controversy over the moral, ethical,

and legal issues of euthanasia. Those who are against euthanasia may argue for the

sanctity of life, while proponents of euthanasia rights emphasize alleviating suffering,

and preserving bodily integrity, self-determination, and personal autonomy.

Jurisdictions where euthanasia is legal include the Netherlands, Canada, Columbia,

Belgium, and Luxembourg.

2.0 Classification of euthanasia

Euthanasia may be classified according to whether a person gives informed

consent into three types: voluntary, non-voluntary and involuntary.

There is a debate within the medical and bioethics literature about whether or not

the non-voluntary (and by extension, involuntary) killing of patients can be regarded

as euthanasia, irrespective of intent or the patient's circumstances. In the definitions

offered by Beauchamp and Davidson and, later, by Wreen, consent on the part of the

patient was not considered as one of their criteria, although it may have been required

to justify euthanasia. However, others see consent as essential.

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2.1 Voluntary euthanasia

Euthanasia conducted with the consent of the patient is termed voluntary

euthanasia. Active voluntary euthanasia is legal in Belgium, Luxembourg and the

Netherlands. Passive voluntary euthanasia is legal throughout the U.S. per

Cruzan vs Director, Missouri Department of Health. When the patient brings

about his or her own death with the assistance of a physician, the term assisted

suicide is often used instead. Assisted suicide is legal in Switzerland and the U.S.

states of California, Oregon, Washington, Montana and Vermont.

2.2 Non-voluntary euthanasia

Euthanasia conducted when the consent of the patient is unavailable is

termed non-voluntary euthanasia. Examples include child euthanasia, which is

illegal worldwide but decriminalized under certain specific circumstances in the

Netherlands under the Groningen Protocol.

2.3 Involuntary euthanasia

Euthanasia conducted against the will of the patient is termed involuntary

euthanasia, supra.

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2.4 Passive and active euthanasia

Voluntary, non-voluntary and involuntary euthanasia can all be further

divided into passive or active variants. Passive euthanasia entails the withholding

of common treatments, such as antibiotics, necessary for the continuance of life.

Active euthanasia entails the use of lethal substances or forces, such as

administering a lethal injection, to kill and is the most controversial means. A

number of authors consider these terms to be misleading and unhelpful.

3.0 History of Euthanasia

According to the historian N. D. A. Kemp, the origin of the contemporary debate

on euthanasia started in 1870. Euthanasia is known to have been debated and

practiced long before that date. Euthanasia was practiced in Ancient Greece and

Rome: for example, hemlock was employed as a means of hastening death on the

island of Kea, a technique also employed in Marseilles. Euthanasia, in the sense of the

deliberate hastening of a person's death, was supported by Socrates, Plato and Seneca

the Elder in the ancient world, although Hippocrates appears to have spoken against

the practices, writing "I will not prescribe a deadly drug to please someone, nor give

advice that may cause his death" (noting there is some debate in the literature about

whether or not this was intended to encompass euthanasia).

3.1 Early modern period

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The term "euthanasia" in the earlier sense of supporting someone as they died

was used for the first time by Francis Bacon (1561-1626). In his work, Euthanasia

medica, he chose this ancient Greek word and, in doing so, distinguished between

euthanasia interior, the preparation of the soul for death, and euthanasia exterior,

which was intended to make the end of life easier and painless, in exceptional

circumstances by shortening life. That the ancient meaning of an easy death came to

the fore again in the early modern period can be seen from its definition in the 18th

century Zedlers Universal lexikon:

Euthanasia: a very gentle and quiet death, which happens without painful

convulsions. The word comes from , bene, well, and , mors, death.

The concept of euthanasia in the sense of alleviating the process of death goes

back to the medical historian, Karl Friedrich Heinrich Marx, who drew on Bacon's

philosophical ideas. According to Marx, a doctor had a moral duty to ease the

suffering of death through encouragement, support and mitigation using medication.

Such an "alleviation of death" reflected the contemporary Zeitgiest, but was brought

into the medical canon of responsibility for the first time by Marx. Marx also stressed

the distinction between the theological.

In Washington v. Glucksberg, 521 U,S 702 (1997), was a case in which the

Supreme Court of The United States unanimously held that a right to assistance in

committing suicide was not protected by the Due Process Clause.

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The fact of the case was that Dr. Harold Glucksberg, a physician; four other

physicians; three terminally-ill patients; and the non-profit organization, Compassion

in Dying, counseling those considering assisted-suicide, challenged Washington State

ban against assisted suicide in the Natural Death Act 1979. They claimed that assisted

suicide was a liberty interest protected by the Due Process Clause of the 14 th

Amendment of USA Constitution.

The District Court ruled in favor of Glucksberg, but the US Court of Appeal of 9 th

Circuit reversed. Then, after rehearing the case en banc, the Ninth Circuit reversed

the earlier panel and affirmed the District Court's decision. The case was argued

before the United States Supreme Court on January 8, 1997. The question presented

was whether the protection of the Due Process Clause included a right to commit

suicide, and therefore commit suicide with another's assistance

Chief Justice Rehnquist wrote the majority opinion for the court. His decision

reversed a 9th Circuit C.A decision that a ban on physician assisted suicide embodied

in Washington's Natural Death Act of 1979 was a violation of the 14 th Amendment's

Due Process Clause. The Court held that because assisted suicide is not a fundamental

liberty interest, it was not protected under the 14th Amendment. As previously

decided in Moore vs East Cleveland, liberty interests not "deeply rooted in the

nation's history" do not qualify as being a protected liberty interest. Assisted suicide,

the court found, had been frowned upon for centuries and a majority of the States had

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similar bans on assisted suicide. Rehnquist found the English common law penalties

associated with assisted suicide particularly significant. For example, at early

common law the state confiscated the property of a person who committed suicide.

Like Blackmun in Roe vs Wade, Rehnquist used English common law to establish

American tradition as a yardstick for determining what rights were "deeply rooted in

the nation's history." Rehnquist cited Roe v. Wade and Planned Parenthood vs Casey

in the opinion.

The Court felt that the ban was rational in that it furthered such compelling state

interests as the preservation of human life and the protection of the mentally ill and

disabled from medical malpractice and coercion. It also prevented those moved to end

their lives because of financial or psychological complications. The Court also felt

that if the Court declared physician-assisted suicide a constitutionally protected right,

they would start down the path to voluntary and perhaps involuntary euthanasia.

Justice O'Connor concurred. Justices Souter, Ginsburg, Breyer, and Stevens each

wrote opinions concurring in the judgment of the court. In 2008 Washington State

voters approved 58%42% the Washingtom Death with Dignity Act, which

established guidelines for using the services of a physician to terminate one's life.

4.0 Voluntary Society with regard to euthanasia

In Malaysia, we have Palliative care to help the patience. Palliative medicine is a

new service which was formally introduced in the Ministry of Health (MOH) in 1995.
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Palliative Care is clearly defined by the World Health Organization as an approach

that improves the quality of life of patients and their families facing problems

associated with life-threatening illness.

Palliative care is a multidisciplinary approach to specialized medical care for

people with serious illness. It focuses on providing patients with relief from the

symptoms, pain, physical stress, and mental stress of a serious illness-whatever the

diagnosis. The goal of such therapy is to improve quality of life for both the patient

and the family. Palliative care is provided by a team of physicians, nurses, and other

health professionals who work together with the primary care physician and referred

specialist (or, for patients who don't have those, hospital or hospice staff) to provide

an extra layer of support. It is appropriate at any age and at any stage in a serious

illness and can be provided as the main goal of care or along with curative treatment.

Palliative care can be provided across multiple settings including in hospitals, in the

patient's home, as part of community palliative care programs, and in skilled nursing

facilities.

Interdisciplinary palliative care teams work with patients and their families to

clarify goals of care and provide symptom management, psycho-social, and spiritual

support.

Physicians sometimes use the term palliative care in a sense meaning palliative

therapies without curative intent, when no cure can be expected (as often happens in

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late-stage cancers). For example, tumor debunking can continue to reduce pain from

mass effect even when it is no longer curative. A clearer usage is palliative,

noncurative therapy when that is what is meant, because palliative care can be used

along with curative or aggressive therapies.

Starting in 2006 in the United States, palliative medicine is now a board certified

sub-speciality of internal medicine with specialized fellowships for physicians who

are interested in the field. Palliative care utilizes a multidisciplinary approach to

patient care, relying on input from pharmacist, nurses, chaplains, social workers,

psychologists and other allied health professionals in formulating a plan of care to

relieve suffering in all areas of a patient's life. This multidisciplinary approach allows

the palliative care team to address physical, emotional, spiritual and social concerns

that arise with advanced illness.

Medication and treatments are said to have a palliative effect if they relieve

symptoms without having a curative effect on the underlying disease or cause. This

can include treating nausea related to chemotherapy or something as simple as

morphine to treat the pain of broken leg or ibuprofen to treat aching related to an

influenza (flu) infection.

Although the concept of palliative care is not new, most physicians have

traditionally concentrated on trying to cure patients.

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The focus on a person's quality of life has increased greatly since the 1990s. In

the United States today, 55% of hospitals with more than 100 beds offer a palliative-

care program, and nearly one-fifth of community hospitals have palliative-care

programs. A relatively recent development is the palliative-care team, a dedicated

health care team that is entirely geared toward palliative treatment.

5.0 Conclusion and views

The debate over euthanasia has been an issue almost in all societies across times

and space. However, euthanasia has become one of the most controversial topics of

our age. The controversy over euthanasia is fueled by perplexity over the point of

clinical death with can no longer be determined by cessation of blood circulation,

respiratory, and pulsation system as in the past. This is because, assisted with new

medical developments like artificial respirators and technology that provide palliative

care, nutrition and hydration, bodily vital functions and organs can continue to operate

artificially.

The challenge to scholars, health providers, judicial system and religious

institution is that, when does clinical death occur? Are individual on life support

clinically death? If so, should they be assisted to die?

Equally polarizing is the question that, who should make the final end of life

decision?

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REFERENCE

1. http://www.palliativecare.my/
2. https://www.hospismalaysia.org/
3. http://www.thestar.com.my/lifestyle/health/2015/04/12/pushing-for-endoflife-
care-in-malaysia/

4. https://www.oyez.org/cases/1989/88-1503

5. International Journal of Sociology and Social Policy. Vol. 33 No. 3/4, 2013 pp.
203-217 . Dorothy J.N. Kalanzi. The controversy over euthanasia in Uganda: a
case of the Baganda.

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