RELIGIOUS VIEWS ON EUTHANASIA

Most Buddhists are against involuntary and voluntary euthanasia. Christians believe that life is a gift from God, therefore no human being has the authority to the life of any innocent person, if they want to die. There are two Hindu views on euthanasia. i) By helping to end a painful life, a person is performing a good deed and so fulfilling their moral obligations, ii) By helping to end a life, a person is disturbing the timing of the cycle of death and rebirth. This is a bad thing to do, and those involved in euthanasia will take on the remaining karma of the patient. Muslims are against euthanasia. They believe that human life is sacred because it is given by Allah, and that Allah chooses how long each person will live. Human beings should not interfere in this. Sikhs have a high respect for life which they see as a gift from God. Most Sikhs are against euthanasia, as they believe that the timing of birth and death should be left in God’s hands (www.bbb.co.uk)⁵.

RESEARCH ON ATTITUDES TOWARDS EUTHANASIA

Health professionals

Curlin conducted a National Survey among 2000 practicing US physicians revealed that 31% of them had no objection to PAS, 82% had no objection to terminal sedation and 95% had no objection to withdrawal of life support. In another survey of 3,299 oncologists researchers found that 22.5% supported the use of PAS and 6.5% the use of euthanasia for a terminally ill patient with unremitting pain; 56.2% ‘had requests’ for PAS and 38.2% for euthanasia during their career; and 10.8% had performed PAS and 3.7% had performed euthanasia during their career ⁶.

Several surveys have documented that nurses in diverse geographic and clinical settings receive requests for aid in dying. Asch reported that approximately 17% of the 852 critical care nurses who responded to an anonymous mailed survey said that they had received requests form patients or family members to perform euthanasia or assist in suicide⁷. Matzo and Emanuel mailed anonymous surveys to a random sample of 600 registered nurses who were Oncology Nursing Society members. Thirty percent of the 441 respondents reported that they had received at least 1 request for assisted suicide and 25% indicated that they had received at least 1 request for euthanasia⁸. In Oregon, approximately 40% of hospice nurses responding to a questionnaire stated that they had cared for a patient who had explicitly requested assisted suicide since November 1997 when the death with dignity act went in effect⁹.

Public Opinion Polls / Surveys

In a public opinion poll on euthanasia conducted by Gall up organization between May 8^th–11^th 2006 surveyed 1,002 adults. The results revealed that 69% or the samples believed that doctors should be allowed by law to end patient’s life by some painless means. Helme reported that polls carried out as part of larger surveys, putting the same questions to comparable population samples over a long period of time, demonstrated a definite shift in public attitudes in several countries, with support rising on average from 50% in the 1960s to 80% by the mid-2000s¹⁰.

Survey of terminally ill patients

Emanuel et al (2000) in a survey of 988 terminally ill patients found that a total of 60.2% supported euthanasia or physician-assisted suicide (PAS) in a hypothetical situation, but only 10.6% reported seriously considering euthanasia or PAS for themselves. Patients were more likely to consider euthanasia or PAS if they had depressive symptoms, substantial care giving needs or pain¹¹. Wilson (2007) conducted a study with 379 patients across Canada receiving palliative care for cancer on their desire for physician-assisted suicide and found that 63% of participants believed that euthanasia or PAS should be legalized and 10% of participants believed that had the option been legally available, they would have requested PAS¹².

FACTORS WHICH MAY INFLUENCE A REQUEST FOR EUTHANASIA¹³

Patient Factors

Pain is not the only reason for terminally ill people to wish to hasten their deaths. Symptoms which may make the patient’s life unbearable and may not respond to palliative care, such as persistent nausea, vomiting, double incontinence, fatigue, discomfort and paralysis, may also influence a request for assisted death. Helme asserted that a wish to die is often the result of mental illness. Psychiatric disorder such as depression, anxiety disorder, delirium or adjustment disorder can affect decision making.

Carer Factors

Unrecognized and untreated psychiatric morbidity in carers, family members or health providers. Carer and professional fatigue, anxiety, depression or despair may also impact on the patient.

Other Factors

A request for euthanasia may follow a failure of one or more parts of the health system to provide adequate care. Inadequate medical, palliative or psychiatric care or support may significantly influence a request for premature death.

Research on reasons for terminally ill patients to request euthanasia:

Studies by various researchers proved that euthanasia strongly correlated with pain, low family support and depression (Chochinov et al)¹⁴; pain, fatigue, loss of appetite and feeling sad (Mystakidou etal)¹⁵; loss of independence, concerns about future pain and poor quality of life (Ganzini et al)¹⁶; heavy burden on their families (Saurez – Almrzor et al)⁶; and depressed mood (Vander Ke et al)¹⁷.

TABLE-1: LEGALISATION OF EUTHANASIA/PAS IN DIFFERENT COUNTRIES¹⁸

Country	Euthanasia	PAS
Belgium	Legal in Sep, 2002	Legal since 2002
Colombia	Unclear	Illegal
Germany	Illegal	Legal since 1751
Switzerland	Illegal	Legal since Jan, 1, 1992
Netherlands	Legal since 2001	Legal since 2001
United States	Illegal	Legal in Oregon, Vermont, Washington, Montana
Luxembourg	Legal since 2005	Legal since 2005
India	Legal since 2011	Legal since 2011

Table I describes the legalization status of different countries in the world. In April 2001, Netherlands charted out a new chapter in the history of legalizing euthanasia when the Upper House of the country passed the Bill by a vote of 46-28. In 1996, the Northern Territory of Australia became the first jurisdiction to explicitly legalize voluntary active euthanasia when it passed the Rights of the Terminally III Act, 1996. The Federal Parliament of Australia had subsequently passed the Euthanasia Laws Act, 1997 repealing the Northern Territory legislation. In England, following a series of decisions of the House of Lords it is now settled that a person has the right to refuse life-sustaining treatment as part of his rights of autonomy and self-determination. The House of Lords has also permitted non-voluntary euthanasia in case of patients in a persistent vegetative state. While active euthanasia is prohibited, the courts have ruled that physicians should not be legally punished if they withhold or withdraw a life-sustaining treatment at the request of a patient or the patient’s authorized representative. Patients in Canada have rights similar to those in the United States to refuse life-sustaining treatments and formulate advanced directives. However, they do not have the right to demand assisted suicide or active euthanasia. As of mid-1999, only one U.S. State, Oregon, had enacted a law allowing physicians to actively assist patients who wish to end their lives. On November 4, 2008 Washington becomes Second US State to legalize physician assisted suicide. On December 5, 2008 – State of Montana, 3^rd State in US to legalize PAS. One more state that legalized PAS in the US is the state of Vermont. On February 19, 2008 Luxemburg legalizes physician – Assisted suicide and euthanasia. In 2002, Belgium legalizes euthanasia. The practice of assisted suicide in Switzerland had led many people to believe that the practice has been legalized in that country. That is not the case. There is an important distinction between the Swiss situation and that of Oregon, the Netherlands and Belgium where the law considers euthanasia and/or assisted suicide to be “medical treatment”

REALITY OF EUTHANASIA IN INDIA:

In India, euthanasia is a crime. Section 309 of the Indian Penal Code (IPC) deals with the attempt to commit suicide and Section 306 of the IPC deals with abetment of suicide-both actions are punishable. Only those who are brain dead can be taken off life support with the help of family members. Likewise, the Honorable Supreme Court is also of the view that the right to life guaranteed by Article 21 of the constitution does not include the right to die. The court held that Article 21 is a provision guaranteeing protection of life and personal liberty and by no stretch of imagination can extinction of life be read into it. However, various pro-euthanasia organizations, the most prominent among them being the Death with Dignity Foundation, keep on fighting for legalization of an individual’s right to choose his own death.

A major development took place in this field on 7 March 2011. The Supreme Court, in a landmark judgment, allowed passive euthanasia. Refusing mercy killing of Aruna Shaunbag, lying in a vegetative state in a Mumbai Hospital for 37 years, a two-judge bench laid down a set of tough guidelines under which passive euthanasia can be legalized through a high-court monitored mechanism. The court further stated that parents, spouses, or close relatives of the patient can make such a plea to the high court. The chief justices of the high courts, on receipt of such a plea, would constitute a bench to decide it. The bench in turn would appoint a committee of at least three renowned doctors to advise them on the matter (Sinha, Basu and Sarkhel, 2012)¹⁹.

NURSES ROLE IN EUTHANASIA AND ASSISTED DEATH

Nurses play key roles in caring for people at the end of life. These roles involve assessing and managing pain and other symptoms, addressing psycho-spiritual needs, assisting patients and families in articulating their values goals and beliefs that influence the decisions made at the end of life, discussing treatment choices, and helping patients and families communicate their needs and wishes for care of the end of life. Unfortunately, there are fewer resources to provide direction regarding euthanasia and assisted death. One reason for the dearth of information is that much of the literature focuses on the role of physician in assisted death.

Scanlon²⁰ was one of the first nurses to address this important issue. In several publications, she elucidated 6 key actions in responding to patient’s requests.

Nursing actions in euthanasia

· Dialoguing with patients and families about treatment options and patient goals

· Assessing the patients decisional capacity including cognitive functioning and presence of depression and spiritual distress

· Evaluating the integrity of the informed consent process

· Witnessing and documenting a formal request for assisted suicide

· Remaining physically and emotionally present when a patient chooses assisted suicide.

· Facilitating the death which includes physical assistance in helping the patient take the medications. (e.g. crushing the medication and placing it in apple sauce or placing the medication in the patients mouth or nasogastric tube may also include prescribing (in the case of advanced practice nurses with prescriptive authority) medication or delivering medications to the patients home.

CONCLUSION:

Euthanasia continues to challenge hospice and palliative care professionals. It is an issue that provokes strong emotional responses. Careful, reasoned reflection must inform nurses’ personal convictions. Enduring answers to this issue are elusive and may be altered with the ever-changing socio cultural landscape. What should never alter, however, is our commitment to approach our dying patients with open arms and minds and a willingness to stay with them regardless of the suffering they may endure and that we may witness²¹.

In the end, we also would do well to remember the following words of Mahatma Gandhi:

“Death is our friend, the truest of friends. He delivers us from agony. I do not want to die of a creeping paralysis, of my faculties-a defeated man”.

BIBLIOGRAPHY:

Ersek M. The continuing challenge of assisted death. Journal of Hospice and Palliative Nursing (online) 2004; 6(1). Available from: http://www.medscape. com/viewarticle/4685661.Printer friendly.html.

Holt J. Nurse’s attitudes to euthanasia: the influence of empirical studies and methodological concerns on nursing practice. Nur Phil (online) 2008; 9(4): pp.257-272. Available from: http://www3.interscience.wiley.com/cgi-bin/fulltext/121409689. html. (Accessed 16th November, 2009).

http://www.euthanasia.com/definitions.html (Accessed 14th November, 2009).

Working group of the Directorate of Social Issues. Psychological perspectives on Euthanasia and the terminally ill. The Australian Psychological Society Limited. Melbourne: 2008.

Religion and Euthanasia. Available from: http://www.bbb.co.uk/ ethics/ euthanasia/religion/religion_print. html. (Accessed 23rd November, 2009).

Suarez-Almrzor ME, Newman C, Hanson J, Bruerr E. Attitudes of terminally ill cancer patients about euthanasia and assisted suicide. J Clin Onco 2002; 20(8): pp. 2131-2141.

Asch DA. The role of critical care nurses in euthanasia and assisted suicide. N Engl J Med 1996; 334(21): pp.1374-1379. Available from. http://www.hcbi.hlm.nih.gov/pubmed/8614424. (Accessed on 13th November, 2009.

Matzo ML, Emanuel EJ. Oncology nurse’s practices of assisted suicide and patient requested euthanasia. Oncol Nur For 1997; 24: pp.1725-1732.

Oregon Health Division. Oregon’s death with dignity act. Oregon Department of Human Resources (online) June 16, 1998. Available at http://www.ohd.hr. state.or.US/cdpe/chs/pas.htm. (Accessed 23rd November, 2009).

Surveys of Medical Practitioners and professionals on euthanasia and physician assisted suicide. Available from: http://euthanasia.procon. org./viewresource. asp?resource ID=000133.html. (Accessed on 28th November, 2009.

Emmanuel EJ, Fairclough DL, Emmanuel LL. Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. JAMA 2000; 284: pp.2460-2468.

Wilson K. Desire for physician assisted suicide among patients receiving palliative cancer care: survey results. Science Daily 2007; (Available from: http//www.sciencedaily.com/ releases/2007/06/ 070627142/213.html).

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Chochinov HM, Wilson KG, Enns M, Mowchun N, Lander S, Levitt M et al. Desire for death in the terminally ill. Am J Psy 1995; 152 (8): pp. 1185-1191. Available from: http://lib.bioinfo.p1/meid: 223675. (Accessed on 23rd November, 2009).

Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients. Psycho oncology (online). (Cited 2005, Sep. 26); 15 (4): 355-360. Available from: http:// www3.inter science.Wiley.com /journal/ 112095434/ abstract?

Ganzini L, Goy ER, Dobscha SK. Oregonians reasons from requesting physician aid in dying. Arch Intern Med 2009; 169 (5): 489-492. Available from: http://archinte.ama-assn.org/cgi/content/ abstract/169/5/48. (Accessed on 28th November, 2009).

Vander Lee et al. Risk factors for euthanasia among Dutch Patients. J Clin Onco 2005; 23 (27): pp. 6607-6612.

www.wikipedia.com

Sinha V.K., Basu, S., and Soukhel, S., (2012), Euthanasia: An Indian Perspective, Indian and Psychiatry, 2012 Apr-Jun; 54(2): 177-183, doi:10.4103/--19-5545-99537.

Scanlon C. Euthanasia and nursing practice – right question, wrong answer. N Eng J Med 1996; 334: pp.1401-1402. [PUB MED]

Received on 23.08.2013 Modified on 25.09.2013

Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 56-60