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The Debate and Arguments Against Euthanasia

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The debate on euthanasia is often polarised. In order to provide an opportunity for in-depth study, and to highlight the knowledge that actually exists in the form of research, the State Medical-Ethics Council has published a knowledge summary. There are many claims in the death aid debate that one can actually test against the facts found in the scientific literature . With the report, the foundation needs to be laid for a common knowledge base for the continued debate on euthanasia. The emphasis in the report is on research from the countries that supports euthanasia, mainly the United States where the so-called Oregon model occurs in a number of states, but also Switzerland and the Benelux countries .

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In Belgium and Netherlands, where euthanasia is allowed and where the basic requirement is not to have a fatal disease without having unbearable suffering, euthanasia is up to ten times as common as in Oregon . There are also clear differences as to which diseases patients suffer from. The increased experience from countries where euthanasia is permitted, and that there is now a significant amount of research and statistics in the area, means that the conditions for assessing which support exists for the arguments have increased. According to Barbetta , there are sustainable arguments on both sides of the debate.

For example, the facts that exist against the fact that euthanasia would have an adverse effect on the expansion of palliative care speak. Nor does it seem that particularly vulnerable groups would be over-represented among those who want to have euthanasia; Oregon experience, on the contrary, shows an overweight of white, younger and highly educated people, as well as an even gender distribution. However, according to Oliver , there is support in the research that patients who request euthanasia are more depressed than other patients. The most common motives for choosing euthanasia are said to be the fear of losing dignity and independence and gaining an unacceptably low quality of life in the final phase of life – not, as is sometimes pointed out in the debate, as a ‘last straw’ if palliative care fails to control difficult symptoms in the final stages of life satisfactorily.

Other factual arguments against euthanasia that Peterson examined are, for example, about the fact that the medical assessments are uncertain. Some point out that data from Oregon and Washington support the existence of some measure of uncertainty in the remaining life expectancy assessments. In individual cases, the assessments deviate quite strongly from the actual outcome.

Regarding the argument that legalisation of euthanasia would lead to a sloping plan where practices will inevitably be extended to more and more patient groups, Battin writes that it is not possible to find data that the legalization of assisted dying in Oregon and Washington has led to an increased incidence of euthanasia outside the framework of the team. The regulatory framework itself has been constant, which contradicts the assumption that a gradual extension of the criteria is inevitable. According to Keown , however, information from Oregon indicates that so-called ‘doctor-shopping’ may occur, that is, patients who have been refused a doctor’s euthanasia are looking for other doctors who are willing to give euthanasia.

As for the argument that euthanasia is a burden on healthcare professionals, Gauthier says that studies from both Oregon and the Netherlands support the assumption that for many doctors, there is a great emotional stress and a heavy sense of responsibility in giving euthanasia or assisting dying. However, there seems to be only a small percentage who regrets afterwards. However, Seale wishes to emphasize that the values made in the report only concern the question of whether the arguments are sustainable, i.e. whether there are data that support them. If these arguments are relevant to the statement of euthanasia.

Euthanasia under certain conditions is legal in the Netherlands, Belgium, Luxembourg and Canada. In Switzerland, assisted suicide is allowed as long as the assistant does not draw personal benefits from the person’s death, and in Germany, assisted suicide is allowed in ‘extreme cases’. Even a state in Australia and Colombia allow euthanasia .

In Netherlands, aid has under certain conditions been allowed since a precedent in 1973. In 1984, the Dutch Medical Association established guidelines for how doctors should act on a request for euthanasia, and doctors who follow these received prosecutions. In 2001, this practice was regulated by law. The patient must have made a voluntary, well-informed and carefully considered request. Suffering must also be judged to be unbearable – no reasonable options for alleviating suffering should be available. Every year, about 10,000 requests for euthanasia are made. In recent years, on average, 2 500 of them have been granted .

In Switzerland, according to the Criminal Code of 1918, it is not allowed to assist suicide if you yourself gain from it. It has come to be interpreted that it is otherwise allowed for anyone to help. There are four organizations that offer the member help to end their life: EXIT Deutsche Schweiz, EXIT ADMD, EX-International and Dignitas. The latter two mainly help foreigners. The patient should suffer from a disease with a visionless prognosis that causes unbearable suffering or is unreasonably life-limiting. According to their own data, Dignitas has helped approximately 950 people commit suicide (of which eleven Swedes) during 1998–2008. In order to curb the ‘suicide tourism’, the Swiss government proposed in October this year that assisted suicide should only be given to terminally ill, or completely banned .

In Belgium, the Belgian Parliament adopted a euthanasia law corresponding to the Dutch one in 2002. In 2007, just under 500 people died through euthanasia.

In Luxembourg, Parliament adopted a euthanasia law similar to that in Belgium and the Netherlands in 2008. The Act came into force on March 17 this year. (The Grand Duchy of Luxembourg refused, for reasons of conscience, to sign the law, which led to a constitutional crisis and that in December last year Parliament decided to deprive the monarch of the last remnants of formal power .)

In the United States, in Oregon, physician-assisted suicide is allowed since 1998, and the law allows doctors to print a lethal dose of medicine for a patient. The patient must be written in Oregon, over the age of 18, deciding and suffering from a fatal disease that is expected to lead to death within six months. Until 2008, 629 prescriptions for lethal doses have been printed, 401 people have completed their lives in this way . In Washington, from March 4 this year, doctor-assisted suicide is allowed. The law is basically identical to the one that applies in neighbouring Oregon .

In Canada, the trend has been very rapid. Two years after euthanasia and assisted suicide were legalized, a relaxation of the age limit of 18 years is already discussed and organ donation after euthanasia occurs regularly. In addition, doctors who do not want to participate in euthanasia, according to a court order taken after the law’s introduction, must refer to a colleague, and in fact have no conscience .  

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