Ruwan M Jayatunge M.D.

You don’t need to kill the patient to kill the pain –Dr. Andre Bourque University of Montréal

Euthanasia or assisted suicide is a controversial topic that is defined as deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering. Today several countries have legalized euthanasia and some view it as a human right. Those who support euthanasia point out that the importance of personal autonomy and self-determination, the right of every human being to have his / her wishes respected in decisions involving his / her own body and the recognition of every human being is in principle, master of his/ her own destiny.

In 2002 Holland became the first country in the world to legalize euthanasia and in 2003, 1626 cases were officially reported from Holland. The Dutch euthanasia law gives doctors immunity from prosecution if they help to kill patients over the age of 12 who are suffering unbearably from incurable conditions and who have repeatedly requested euthanasia.

Euthanasia Guidelines in Holland

The Dutch laid out narrow guidelines for doctors: The patient, who must be suffering unbearably and have no hope of improvement, must ask to die. The patient must clearly understand the condition and prognosis and a second doctor must agree with the decision to help the patient die.

Euthanasia in Belgium

Belgium legalized euthanasia in 2002, but the laws seem to encompass assisted suicide as well. Since its legalization eight years ago, euthanasia now accounts for 2 per cent of deaths in Belgium – or around 2,000 a year. Two doctors must be involved, as well as a psychologist if the patient’s   competency is in doubt. The doctor and patient negotiate whether death is to be by lethal injection or prescribed overdose.

Oregon Death with Dignity law

In 1994, voters in the state of Oregon approved a ballot measure that would have legalized euthanasia under limited conditions. Under the Death with Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria. In order to qualify for physician-assisted suicide, a person must be an Oregon resident, 18 years of age or older, must have decision-making capacity, and must be suffering from a terminal disease that will lead to death within six months.

Forced Euthanasia

A number of reports indicate that some medical practitioners have abused the legal privilege of euthanasiaand reinforced depressive patients to select euthanasia as an option. A study found that a high proportion of deaths classed as euthanasia in Belgium involved patients who did not ask for their lives to be ended. In 1990 government sponsored surveys found that 0.8% of all deaths in the Netherlands were euthanasiadeaths that occurred without a request from the patient. In a 1995 study, Dutch doctors reported ending the lives of 948 patients without their request.

Passive Euthanasia

Although euthanasia is illegal in many countries passive euthanasia (withhold treatment and allow a patient to die) is being practiced. This is unethical and described as a malpractice. The American Medical Association emphasizes that the intentional termination of the life of one human being by another is contrary to that for which the medical profession stands. Human life has an absolute value and it is inhuman for a medical practitioner to terminate it.

Mrs. H a resident from North York Ontario Canada witnessed the agonizing death of her grandmother who suffered a stroke. When she was admitted to the …….hospital the doctors said that she would not recover. After several days the nasal feeding was discontinued. Mrs. H was near her semi-conscious grandmother all the time and the grandmother responded to her time to time by blinking the eyes. After removal of nasal feeding tube she was starving and I could see tears in my grandmother’s eyes. She was dying but the process was accelerated by discontinuing nasal feeding that led to an agonizing death says Mrs. H

Mrs. VXXX   a resident from Colombo Sri Lanka  underwent the same experience when her 92 year old mother was admitted to the ……… hospital. She was diagnosed with a benign ovarian tumor and had numerous age related complications. During her stay at the hospital she was only given Brufen  and Vitamin B. Doctors and Nurses often said that she had lived her years and taken no significant efforts to improve her condition. She was prematurely discharged and after two weeks she died at home. What worries me is not my mother’s medical condition but the attitude of the medical staff says Mrs. VXXX.  

Mr. XXX a resident from Negombo   met with a road traffic accident and admitted to the ……………….. Hospital- Intensive Care Unit. He was unconscious throughout and was on a life support. By the 8^th  day his condition remained unchanged.  The medical staff decided to remove him from the life support system in order to accommodate another patient who was diagnosed with Guillain–Barré syndrome. After removing Mr. XXX from the life support system less than 24 hours he passed away. His son who is a doctor now believes that his father was not given a fair chance at the hospital to recover.

Passive Euthanasia: My Personal Experiences in the Sri Lankan Hospitals

Unfortunately I observed passive euthanasia in a number of Sri Lankan Hospitals. The first experience I witnessed was in 1994 during my internship appointment at the Matale   Base Hospital.

A 10 year old school boy was brought to the surgical ward following head injury that was caused by a road traffic accident on the Palapathwala road.  I was the house officer who gave primary care for this unconscious child. I immediately realized trepanation of the skull had to be done to evacuate the intracranial hemorrhage that was pressing the vital centers in the brain. The Senior House Officer too agreed with me. This operation is called performing a Burr Hole and had to be done by a Consultant Surgeon. I immediately called the Operation Theater and said we may need the theater facilities to treat a boy with a head injury.  

Then I called my Consultant Surgeon who had just finished the evening ward round. The time was about 3.40 pm and he was preparing to go home.  The Consultant Surgeon was annoyed that I called the operation theater. He ordered me to give diazepam 5 mg intravenous to the child even without seeing the patient. Again I asked Sir are we going to do a Burr Hole to stop the subdural hematoma. This time he responded to me in very dry language and asked me to give diazepam and monitor the child and maintain the head injury chart. I was powerless and did exactly what he ordered. Then the Consultant Surgeon left for home.

I observed the poor child until midnight. Several times he went in to seizures. Since we were given unofficial instructions not to transfer patients to the Kandy hospital at night, by the Surgeon we had no way of sending the child to the Kandy Teaching hospital for special management.  The Surgeon did not respond to our calls that night. So we waited and prayed for his life. At around 1.30 am the child died. According to my opinion we could have saved this child if the Surgeon did the surgery or allowed us to transfer the child to the Kandy Hospital. When I look back at this incident after 18 years I feel that the Consultant Surgeon who was supposed to give us knowledge, ethics, and leadership did nothing but forced us to perform passive euthanasia.

I was trained in Anesthesia by Dr. Priyangani Ariyarathne – Consultant Anesthetist at the North Colombo Teaching Hospital in 1999. I worked in the ICU and in the operation theaters at the North Colombo Teaching Hospital for about a year and observed that when the medical staff get new acute patients to the ICU they sometimes remove the life support systems of the old patients and fix it to the new patients. Due to lack of beds at the ICU the medical staff was compelled to do it. But still I had mixed feelings about this unorthodox practice.

When the Ja Ela bomb exploded on the December 18, 1999, that killed General Lucky Algama, hundreds of patients were brought to the Colombo North Teaching Hospital. The individuals who were critically injured were admitted to the ICU. There was a young man who was on the life support system following organophosphate poisoning and the medical staff removed him from the life support system and his bed was given to a bomb victim. Without the ventilator and other life support system the young man died the following day. One can always argue that the first patient became ill as a result of self-induced poisoning and the second patient became a victim of a terrorist act. But my question was who are we to decide their fate and the duration of their life span.

When I was working at the Chilaw   hospital I had the opportunity of working at the ICU and I saw this life support removal occurring there too. Once we had a snake bite case and in order to accommodate him the doctors removed another patient who was in the ventilator with Dengue hemorrhagic fever.  The snake bite case survived and the dengue patient died. Again it became a dilemma for me. So instead of working at the ICU I decided to work in the Operation Theater.

Over the years I witnessed how some of my colleagues became indifferent to human lives.  I remember one Doctor at the Negombo   hospital who was against giving blood transfusions to the severely anemic alcoholic patients. These people are alcoholics and they deserve to die without wasting medical resources he openly stated. Another PHO (Pediatric House Officer) told me that when he suspects cerebral palsy in newborns he cuts off the oxygen supply to them. I am doing a favor for the child and the parents, so they are free of life long suffering with a disabled child, he told me with confidence. I became so disgusted and replied that it was illegal, a crime and under the Hippocratic Oath he was violating professional ethics. I do not know whether he stopped this unethical practice after my brief lecture.

Euthanasia Declines in the quality of care

Euthanasia devalues human life; in the long run euthanasia can become a means of health care cost containment. In Holland legalized euthanasia has led to a severe decline in the quality of care for terminally-ill patients. Dr. Els Borst, the former Health Minister and Deputy Prime Minister who guided theeuthanasia law through the Dutch parliament recently admitted that medical care for the terminally-ill had declined since the law came into effect.

Euthanasia and Murder

According to the Criminal Code a person commits homicide when, directly or indirectly by any means, he causes the death of a human being. In this context euthanasia is mealy a murder. The main aim of the medical practitioners should be focused on improving and enhancing the care of the patient. Under the Hippocratic Oath, medical practitioner cannot engage in euthanasia.

Dr. Jack Kevorkian alias Dr. Death

Dr. Jack Kevorkian is a pathologist who actively support of voluntary euthanasia. He designed a so called death machine (thanatron) that was used by several terminally ill patients to commit suicide. He had helped more than 130 terminally ill people end their own lives. In 1994, he faced murder charges in the death of Thomas Hyde, who suffered from a terminal nerve illness. He was convicted of second-degree murder. Some experts consider Dr. Jack Kevorkian is highly obsessed with mercy killings and gradually lost the human touch. Instead of promoting health as a doctor Dr. Jack Kevorkian promoted death. 

Harold Shipman

The British doctor Harold Shipman murdered 215 of his patients using the drug Diamorphine over a period of 20 years. He killed an average of one patient a month during his medical career. Young Shipman observed the painful death of his mother who suffered from terminal cancer. In the later years he killed mainly elderly women who were suffering from various illnesses. He was an addictive serial killer who may have believed that he was helping the patients to end their suffering. Shipman hanged himself in January 2004 while in custody.

NAZI Movement and Euthanasia

Those who support euthanasia should study what the NAZI s did in Germany and in their occupied countries. The NAZI s widely used euthanasia as a social cleansing method. First, they exterminated the mentally ill and disabled Germans. Subsequently they extended euthanasia as a political tool. NAZI s used the medical practice to propagate racial supremacy. Dr. Josef Mengele alias the angel of death used to do horrible experiments euthanizing men, women and children. NAZI genocide machine started fromeuthanasia and it ended up with the Final Solution. During the Hitler’s regime, 6 million Jews were terminated.

Conclusion
Before the advances in medical science diseases like leprosy, syphilis etc. were considered as incurable and relatives often performed mercy killings to end the suffering of the patients. Today the doctors are struggling with terminal cancer and sometimes suggest euthanasia as a temporary answer. The future advancements in medical science would bring viable solutions to many incurable diseases andeuthanasia would be considered as an outdated, inhuman and unprofessional form of practice.