Introduction
Euthanasia and physician-assisted suicide are a matter of frequent and divisive public debate. On one side of the argument are those who believe that people, especially those with terminal illnesses, should legally be able to determine the time and manner of their death. On the other side of the argument are those who believe that euthanasia is immoral and should never be legally available, even for those who are terminally ill. To get an idea of what doctors think about this subject, Radbruch et al. (2016) reviewed a 2003 EAPC position paper on assisted suicide and wrote 21 statements based on the paper. They then surveyed seventeen European palliative care professionals and amassed a report detailing which aspects of assisted suicide were unanimously agreed upon, and which aspects remained controversial. Using this information, the authors attempt to describe an ethical framework for physician-assisted suicide. This framework instructs healthcare professionals on how to approach assisted-suicide with their patients as well as how the practice should be carried out.
Literature Review
The position paper by the European Association for Palliative Care (EAPC) was written with the intent of clarifying the stance on physician-assisted suicide and euthanasia that the association should adopt. The paper was based on comments from experts in medicine, philosophy, ethics, and theology. Some of these expert opinions converged, while some of the opinions were divergent. The purpose of the paper was to contribute to the informed and intelligent public dialogue on these issues, and perhaps to find a common ground between the two extremes of opinion. Furthermore, by providing a better understanding of the real-life implications of euthanasia and assisted-suicide, it can help those who are undecided about these issues resolve their stance.
It would take more than ten years for any other U.S. state to pass similar legislation. The first to follow would be the state of Washington in 2008; then Vermont in 2013, and, most recently in 2015, California. The issue is currently being discussed by the New Jersey legislature and may be soon put to a vote. In other states, such as Montana and New Mexico, the constitutionality of legal prohibitions of assisted suicide is under judicial review. These states set specific requirements for the use of PAS and euthanasia, such as the requirement that the patient be suffering from a terminal illness. In contrast, in European countries where these practices are legal, such as Luxembourg, the Netherlands, or Belgium, the law states no such requirements of patients. Thus, PAS and euthanasia appear to be practiced more liberally in Europe than in the United States. In Switzerland, euthanasia is available not only to citizens, but also to foreigners visiting the country for the specific purpose of receiving it.
Euthanasia and PAS are regulated to varying degrees according to country. Different countries have different age requirements for euthanasia, for example; in the Netherlands, patients between 12 and 16 years of age may receive it with parental consent, while in Belgium, it is only available to patients older than 18.
Current Study
The purpose of the current study is to provide an ethical framework for the practice and discussion of euthanasia and physician-assisted suicide. The hypothesis that is tested is whether it will be possible for a diverse group of medical professionals to produce a consensus opinion on the relationship between palliative care, PAS, and euthanasia, despite the broad range of cultural attitudes that they represent. The participants were medical professionals and ethics experts who belonged to various hospice and palliative care associations with membership in the EAPC. The materials used were the 2003 EAPC position paper previously mentioned as well as electronic survey tools, like Survey Monkey©. The described method used was the Delphi process, which is a method for systematically interviewing and receiving feedback from a panel of experts. The experts met in five different sessions to review and refine their draft detailing their consensus opinion.
Discussion
The board of experts produced a paper containing 21 statements on which at least 68 percent of all members were in agreement. (Most of the statements were agreed upon to a higher degree than that.) This EAPC adopted this paper as its official position on euthanasia and PAS in April 2015. Compared to previous studies, this study represented the unification of a professional view on the ethics of euthanasia and PAS. These statements drew upon a medical point of view, as well as theological and philosophical points of view. Some of these statements were decisive, while others were more hesitant in their language. The study also arrived at definitions of terms, including euthanasia, “killing on request,” PAS, and non-treatment decisions (NTD) that were agreed upon unanimously.
Conclusion
The major point of this article was that although the experts included in this study brought a diverse range of cultural perspectives to the table, they were still able to find common ground on certain aspects of the issues of PAS and euthanasia. The significance of this study is that it provides medical organizations with a credible way to take an official stance on these issues. These research findings can be applied in the real world by offering a well-rounded perspective to those who would become the providers of PAS and euthanasia, and helping them decide if these practices are consistent with their own sense of ethics. These results can be generalized to all palliative care providers because they are inclusive of a broad range of cultural, ethical, philosophical, and theological points of view. This study may be further enhanced by a follow-up study that further elaborates the statements that were least-agreed-upon, inviting a different group of people to participate.
Biblical Perspective
There are no direct references to euthanasia in the Bible. However, Corinthians 6: 19-20 states that our bodies are temples of the Holy Spirit and we should use them to honor God; it reads “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your bodies.” My perspective, which I base on this passage, is that physicians should treat their patients’ bodies as temples of the Holy Spirit. Thus, they should do everything within their power to heal them, and only suggest PAS or euthanasia as a last resort option. However, it is up to the individual to decide what they should do, and so I believe it behooves doctors to discuss option honestly with them.
References
Radbruch, L., Leget, C., Bahr, P., Müller-Busch, C., Ellershaw, J., de Conno, F., & Berghe, P. V. (2015). Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative medicine, 0269216315616524.
