Handbook of the South Australian Voluntary Euthanasia Society (SAVES)
THE RIGHT TO CHOOSE: THE CASE FOR LEGALISING VOLUNTARY EUTHANASIA
2. DEFINITIONS
Discussion about voluntary euthanasia is often misinformed, due partly
to misunderstanding or misinterpretation of the commonly used words and
phrases. The situation is not helped by the lack of consensus in the literature
over some of the definitions.
The following definitions and notes seek to make clear what we, the
South Australian Voluntary Euthanasia Society (SAVES), are advocating and
to explain the terms and ambiguities that arise in the debate. (See also
Fact Sheets 1, 6, 7 and 23.)
Euthanasia. From the Greek, meaning "good death"; a death which
is peaceful and humane. Also, "the act of inducing a good death". The term
has been wrongly used to refer to inhumane practices in Nazi Germany which
bore no relation to a good death.
Voluntary Euthanasia. A good death brought about at the express
wish of the person concerned - a personal and rational choice.
To ensure that the person seeking euthanasia is fully informed of alternative
treatments and that the procedure is properly carried out, SAVES advocates
voluntary euthanasia as part of medical practice. It would be an option
of last resort for those suffering from an incurable distressing condition
which might include deterioration to the point of being totally dependent
on others. There would be legally prescribed safeguards which would require
an explicit request from the patient leaving no room for doubt that the
patient wished to die (See Appendix A). The doctor's participation would
be equally voluntary, as would that of other health care workers and health
care agencies.
Accordingly, SAVES has adopted the following working definition:
A quick and peaceful death brought about under medical supervision at the request of and in the interests of a patient in which prescribed safeguards are followed.
Non-voluntary Euthanasia. Euthanasia administered to a person
without consent. The term is also wrongly used as equivalent to involuntary
euthanasia.
Non-voluntary euthanasia is not advocated by any voluntary euthanasia
society, since it would violate the basis of the voluntary euthanasia movement
- freedom of choice.
It becomes an issue in the case of dying persons no longer capable of
consent who have not made their wishes known in advance, whose suffering
is evident and cannot be alleviated adequately. There is evidence that
both voluntary and non-voluntary euthanasia are practised in Australia
and elsewhere in the interests of the patient, despite legal prohibition.
If voluntary euthanasia were legal, the dilemma which many doctors currently
face would be resolved if the patient had made an appropriate advance request.
Involuntary Euthanasia. Medical termination of life against a
person's will.
This is morally indefensible and is not, in fact, euthanasia at all.
All voluntary euthanasia societies are firmly and irrevocably opposed to
such measures.
The term is also wrongly used as an equivalent to non-voluntary euthanasia.
Mercy Killing. An act of compassion, ending the life of an incurably
ill suffering person without medical supervision and possibly without consent.
Sometimes wrongly used as a synonym of voluntary euthanasia.
Passive Euthanasia. Also known as "letting die", the term is
used to refer to hastening death by withholding or withdrawing life sustaining
treatment either:
(a) because it is unduly burdensome and/or medically
futile, or
(b) in order to bring about a quick and peaceful
death.
Neither is properly described as passive because each requires a positive
decision. Neither will necessarily result in a good death or necessarily
reflect the wishes of the patient. Furthermore (a) is not actually "euthanasia".
Adding to the confusion, action to bring about death can be claimed to
be avoidance of futile treatment - or the doctor may have a dual purpose.
The practice is unregulated, save in the restricted circumstances allowed
in South Australia, Victoria, NSW, the ACT and the Northern Territory,
and pending in Queensland, for no-longer-competent patients who have completed
an advance or proxy directive. It is otherwise unclear to what extent the
action is requested by the patient (passive voluntary euthanasia) or decided
by the doctor (passive non-voluntary euthanasia).
"Passive euthanasia" (voluntary or non-voluntary) is a confusing term.
Its use is best avoided.
Active Voluntary Euthanasia. The administration by a doctor of
medication designed to bring about a quick and peaceful death at the request
of the patient. This is also a confusing term as it implies a valid distinction
between active and passive forms of voluntary euthanasia.
The absurdity of the distinction is apparent in the following definitions
published by the Parliamentary Research Service [1]:
-
Passive Voluntary Euthanasia is "when medical treatment is withdrawn
or withheld from a patient, at the patient's request, in order to end the
patient's life".
-
Active Voluntary Euthanasia is "when medical intervention takes
place, at the patient's request, in order to end the patient's life'.
Medically Assisted Suicide. Provision of medication to enable a
patient to bring about his or her death quickly and peacefully under medical
supervision. Often referred to as Physician-Assisted Suicide, particularly
in the USA.
SOME COMMENTS ON CLAIMED DISTINCTIONS
-
The debate about voluntary euthanasia has been confused by attempts to
distinguish between "passive" and "active" measures on moral grounds. This
is sometimes equated with "omission" and "commission" when, in fact, both
require a positive decision.
-
Some claim that medically assisted suicide is not a form of voluntary euthanasia,
as the doctor does not administer the medication.
-
The various ways in which death may be hastened at the request of the patient
are different in practical terms and may well be perceived differently
by different people. However, they are morally equivalent when the purpose
or foreseen and accepted effect is to bring about the death of the patient
as the only means of relieving serious suffering while respecting the patient's
wishes. They all involve positive actions by the doctor and the same safeguards
should apply in their practice.
Medical Aid in Dying. Medical care during the last stages of life;
any medical intervention in the dying process. This includes palliative
care, (which may prolong life, shorten it, or have no effect on the life
span); measures which have an intention, or likelihood of hastening death;
and medically assisted or induced death.
Double Effect. A term used when treatment given to relieve pain
or other symptoms has the secondary effect of hastening or causing death.
There is controversy as to whether or not the consequence can be said to
be unintended if it can be foreseen. Whatever the moral significance, intention
in the mind of the doctor is a dubious criterion for the framing of public
policy. If life is deliberately shortened or ended in this way in the guise
of symptom relief, it may be classed as Indirect Euthanasia. This
appears to be resorted to not infrequently by doctors acting from compassion
([2], Fact Sheet 23).
Advance Directive (for Health Care). Sometimes also referred
to as an Advance Declaration, Advance Request, Anticipatory Direction
or Living Will. A document that expresses one's wishes for health care
in the event of becoming no longer competent.
These documents have legal status either through interpretations of
the common law or, in jurisdictions that possess them, statute law. An
example of the latter is an Anticipatory Direction under South Australia's
Consent to Medical Treatment and Palliative Care Act 1995. Advance
Directives may stand alone or may include the appointment of a medical
agent to make decisions and/or interpretations on behalf of the no-longer-competent
person. Also in South Australia, the Guardianship and Administration
Act, 1993 provides for the appointment of an Enduring Guardian whose
powers include consent or refusal of consent to medical treatment.
Medical Power of Attorney. A document appointing a medical
agent or proxy to make medical decisions in accordance with stated
wishes when the person is not competent to make such decisions. Since these
documents record the wishes of the person for health care when no longer
competent, they are a type of
Advance Directive.
Palliative Care/Hospice. Medical care designed to provide comfort
and dignity when curative therapy is no longer appropriate. It offers control
of pain and other symptoms as well as emotional and spiritual support.
This approach has been comprehensively developed within the hospice movement
which provides specialised medical, nursing and support services for terminally
ill patients and their families.
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