Physician-Assisted Death in the US vs. Euthanasia in the Netherlands, Belgium, Canada
The concepts of assisted death and euthanasia are often confused by some scholars, but there underlies an elaborate difference between the two. For decades now, the two ideas have been controversial and emotive topics regarding the underlying frameworks of biomedical ethics. A report from the World Health Organization (WHO) states that over half a million people commit suicide every year in the low and middle-income nations. In all these deaths, the physician-assisted deaths account for less than half of the total deaths, and the procedure is limited to a few wealthy jurisdictions. Euthanasia, on the other hand, also account for most deaths in countries like the Netherlands, Belgium, and Canada, where the practices are legal. Euthanasia is the act only undertaken by physicians to intentionally end the life of a person at his or her request. Upon the request, the physician then administers a lethal substance to terminate life. Euthanasia is often confused to Physician-assisted Suicide/Death (PAS). In PAS, a person applies the lethal subsistence on himself upon the recommendation by a physician. Even though countries such as US, Belgium, Netherlands, and Canada legalize or ban euthanasia or PAS for different reasons, both PAS and euthanasia are necessary if the underlying ethical frameworks and procedures are followed to the latter as seen in these countries.
Physician-Assisted Death in the US
The Physician-Assisted Death is legalized in only five of the fifty states in the US. The five states include Oregon, Vermont, Montana, Washington, and California. In New Mexico, the legislation was passed in 2014 consistent with the underlying practice but was reversed following an appeal in August 2015 (Nordqvist, 2016). On the other hand, euthanasia is banned in all states in the US. Oregon became the first state to legalize PAS in October 1997 following the approval of “Death with Dignity Act.” This act allows competent adults from the age of 18 with a life expectancy of fewer than six months and terminal illness to receive medications, through voluntary self-administration of lethal doses to end life (Castro et al, 2016). The doctor must prescribe this dose only for this purpose. Any other provision breaches the ethical considerations of PAS. According to the act, the self-administration of such prescriptions is not considered suicide, but death with dignity. Nevertheless, many Catholic hospitals opted out of this practice.
The statistics from the Center for Disease Control (CDC) asserts that since the enactment of the law in 1997, close to 1,500 people had received a prescription of the lethal doses by the onset of 2015. Some patients for whom the procedure was accredited died before the actual administration of the lethal drugs. About 850 who received the prescription died after the self-administration (Castro et al, 2016). Among the 850 individuals, 52.7 percent were men predominantly in the age bracket of between 65 and 74 years with higher education levels or postgraduates. Seventy-eight percent of the cases, cancer was the leading disease that prompted PAS, followed by amyotrophic lateral sclerosis (ALS), which had 8.3 percent. Most patients were subjected to palliative care and died at home (Boudreau & Somerville, 2014). According to the reports from the American Cancer Center, the main concern among these people was the loss of autonomy as mentioned by 91.5 percent of these patients, and the loss of ability to predicate in fascinating life activities at 88.5 percent (Nordqvist, 2016). Loss of dignity accounted for 79.3 percent.
The state of Washington approved the “Death with Dignity Act” in 2009 identical to the one from Oregon State. From 2009 to 2015, 724 people received the prescription of the lethal drug where 712 patients died in the aftermath. In Washington, the predominant underlying disease was cancer just as it was in Oregon, followed by neurodegenerative diseases (Nordqvist, 2016). In Montana State, on 31st December 2009, the Supreme Court ruled that assisted suicide was not illegal. This followed the case of Robert Baxter, a 76-year-old truck driver who retired while having a terminal form of lymphocytic leukemia. According to the court’s deliberation of the case, a patient has to be an adult who is mentally competent and is suffering from terminal illness to request for the lethal medication.
In Vermont, PAS was legalized on 20th May 2013 regarding section 39 of the Act concerning the patient’s choice and control of life. The life expectancy that would guarantee PAS was that shorter than six months after which a Vermont resident can voluntarily request for the self-administration of the lethal dose (Nordqvist, 2016). On 5th October 2015, the Governor of California Jerry Brown signed the Assembly Bill No. 15 called the “End of Life Option Act” thereby allowing assisted death for only competent adults.
Euthanasia in the Netherlands, Belgium, and Canada
The Netherlands
Both Euthanasia and PAS were adopted in the Netherlands in 2002. The laws of the Netherlands regulated the two activities such that they were not punishable by law. In Belgium, Luxemburg, and the Netherlands, the process of PAS and euthanasia is quite different from the US (Diehl-Schmid et al, 2016). Let alone the fact that the US does not recognize euthanasia. In these three countries, the patient must carry out the request voluntarily and must be competent, just like in the US. However, the three countries provide that the patient must be having acute, chronic conditions that cause intense psychological or physical suffering (Emanuel, 2017). Together, the patient and the physician must conclude that there are no reasonable alternatives.
In the Netherlands, people with dementia as well as children are eligible for euthanasia and PAS, unlike in the US. In the US, only adults aged 18 years and above are eligible for PAS unlike in the Netherlands where the age bracket caters for children aged between 12 and 17 years with mental capacities. According to the “Groningen Protocol,” regulations, euthanasia may apply to newborn children (Emanuel, 2017). Between 2002 and 2007, about 10,320 cases were reported. 54% were male while 43 percent were females aged between 60 and 79 years old, unlike the age bracket in the US (64 and 74 years). Eighty-seven percent of these patients were diagnosed with cancer, making the most significant percentage of the predominant disease, just like the case of the US.
Belgium
Belgium allowed the use of voluntary euthanasia in 2002 just like the Netherlands for competent people with incurable diseases. The disease also encompasses incurable mental illness that unbearable physical or psychological conditions (Boudreau & Somerville, 2014). Assisted suicide is not regulated by law in Belgium like it is in the US. However, the cases reported to the Federal Evaluation and Control Commission for Euthanasia (FECCE) are treated as euthanasia. Belgium and the Dutch legislation on euthanasia are similar. Nevertheless, if the patient is not terminal, the doctor is allowed to consult a third party specialist and allow a grace period of one month before the execution of euthanasia.
In 2014, Belgium removed the age restrictions for euthanasia, meaning anybody was now eligible for it despite strong oppositions from the religious groups (Castro et al, 2016). The new legislation provides that children of any age may require euthanasia contrary to the prior legislation they offered the process to be conducted on people more than 15 years old. In Belgium, provided a person understands the consequences of euthanasia, despite the age, the process will be conducted. However, the child’s decision has to be supported by the parents or legal guardians and the decision must be certified by the psychologists or psychiatrists. Between 2010 and 2014, the cases reported almost doubled from 953 to 1,807 (Diehl-Schmid et al, 2016). According to the Federal Commission, an estimate of 44% PAS and euthanasia occur in hospitals, 43% in homes, and 11% in nursing homes.
Canada
Canada suspended the ban on euthanasia and PAS in 2015 after six years of debate in the Supreme Court. The federal and the provincial governments in Canada provided a grace period of one year. This was meant for the healthcare professionals to prepare themselves for the implementation of the law (Boudreau & Somerville, 2014). The deadline for the application of the law was extended in January 2016 by four months. The extension also prolonged the legalization of assisted death in Canada. The provincial governments were given the deadline of sixth June that yare after which if the implementation does not occur, assisted death would be legalized in Canada but would not be regulated in individual provinces. The physicians would thus have the freedom to modify their behaviors.
Quebec became the first province in Canada to legalize euthanasia, unlike the US, which does not recognize it. The act was legalized in line with the “Act Respecting End-of-Life Care” in 2015. According to the act, medical aid in dying is the act where a physician administers a lethal substance to terminate life following a patient’s request, thus fitting the definition of euthanasia. This practice in Canada characterizes voluntary euthanasia. The other territories in Canada also mobilized themselves for the implementation of the act. In 2016, the College of Physicians in Ontario published documents regulating euthanasia and PAS with similar criteria to those adopted in Quebec.
Reasons why Euthanasia and PAS are essential
The right to die among the terminally ill patients is an issue of personal choice. Life is full of personal choices right from the onset of adulthood. In life, we can choose various things, including our lifetime spouses, and the jobs we do (Boudreau & Somerville, 2014). The same level of choice determination should traverse into a situation when somebody is terminally ill or too elderly. Everyone should have a choice about what happens to him or her. If we consider the conditions which warrant euthanasia, then it’s prudent to concur with its legalization. A case in Belgium for example, two deaf twins had extreme emotional suffering, which prompted them to call for euthanasia in 2013 (Diehl-Schmid et al, 2017). They had lived their entire lives, and could not bear any more endurance, never seeing each other due to their condition. In this situation, the victims reached what they might have termed as the end of the road for their lives because they could not put with it anymore, and the condition would not change either. In such cases, euthanasia should be affected, hence the call for its legalization.
Euthanasia and PAS provide equal access to freedom for people who are unable to commit suicide. Therefore euthanasia should be legalized because it is an individual’s private decision, and does not harm others except those performing the act (Nordqvist, 2016). Relatives and friends can be more tormented if their led one commits suicide than when the person asks for euthanasia. In most cases, suicide is also a personal decision where the reasons behind it can be accessed in notices after death or even go missing. All that surrounds the incident will be mere speculations. For euthanasia, the decision may be considered a formal decision involving accredited physicians. Therefore, it is easy to argue out a case on euthanasia than a suicidal case. People who are unable to commit suicide should be given the go-ahead to request for euthanasia from the permitted physicians.
Counterargument
Euthanasia and PAS particularly harm those who perform it. If the governments consider legalizing euthanasia, they must prevent the trauma which befalls euthanizes. Killing a fellow human being, whether they warrant it or not, has tremendous psychological impacts. The trained physicians who perform this procure regularly are at significant risk (Emanuel, 2017). Several studies have linked excessive drinking, and high suicide to the killing of humans. Additionally, from a theological perspective, it is wrong to take a person’s life. Euthanasia is fundamentally incompatible with the roles of the doctors, which is to save a life through treatment.
Conclusion
In PAS, a person administers the lethal subsistence on himself upon the recommendation by a physician. Euthanasia, on the other hand, involves the act only undertaken by physicians to intentionally end the life of a person at his or her request. The United States legalizes PAS only in five of its states but has banned euthanasia in all states. PAS in the US is approved in Oregon, Vermont, Washington, California, and Montana states. All these five states have similar legal frameworks for allowing the practice of PAS. Both PAS and euthanasia are recommended in cases where the underlying legal and ethical frameworks are adhered to. The authority of someone to take his life is a matter of personal choice. Both the process provides access to freedom for people who are unable to commit suicide. Besides, taking the life of the terminally ill people saves on medical costs even though life is incomparable to money.
References
Boudreau, J. D., & Somerville, M. A. (2014). Euthanasia and assisted suicide: a physician’s and ethicist’s perspectives. Medicolegal and Bioethics, 4, 1.
Castro, M. P. R. D., Antunes, G. C., Marcon, L. M. P., Andrade, L. S., Rückl, S., & Andrade, V. L. Â. (2016). Euthanasia and assisted suicide in western countries: a systematic review. Revista Bioética, 24(2), 355-367.
Diehl-Schmid, J., Jox, R., Gauthier, S., Belleville, S., Racine, E., Schüle, C., … & Richard-Devantoy, S. (2017). Suicide and assisted dying in dementia: what we know and what we need to know. A narrative literature review. International psychogeriatrics, 29(8), 1247-1259.
Emanuel, E. (2017). Euthanasia and physician-assisted suicide: focus on the data. The Medical Journal of Australia, 206(8), 1-2e1.
Nordqvist, C. (2016). Euthanasia and assisted suicide. Medical News Today.