J Ayub Med Coll Abbottabad 2002; 14(1) p 1
Euthanasia – at a moment of truth
A paraplegic infant due to
meningomyelocele, a terminal cancer case in severe distress due to pains and a
post traumatic comatose patient on life support equipment with minimal hopes
of revival are some of the obvious examples in common medical practice today
posing serious question of management plan specially regarding continuing
efforts to sustain the life.
answer is not simple. All above like situations concerns whether or not a
physician assists the patient for a merciful ending of the life to relieve
him/her of sufferings and to cause a dignified death. EUTHANASIA is a term
coined to do this job. This Greek word means ‘ good death’. The practice
of intentional mercy killing was customary in Greek and Roman times. In city
of Sparta the newborns with sever birth defects and elderly were put to
religions including, Islam, Christianity or Judaism prohibit intentional mercy
killing (ACTIVE EUTHANASIA). However, in comatose patient with brain death the
situation could be different. The patient may have short life if left alone or
may carry on living for years if assisted with respirator etc. Many relatives
insist to remove patient from life support equipment in this situation. This ‘not
doing something’ in preventing
death is known as ‘ PASSIVE EUTHANASIA’.
another scenario the physician is perplexed where for good reasons a person is
asking for an assistance of some sort in causing euthanasia i.e. ‘ VOLUNTARY
EUTHANASIA’. There is only one state ‘Oregon’ of USA in the world, which
allows prescription but not actually administering lethal drug, on person’s
request in certain medical situations. At present in United States and some
other countries, under a legal Act, people make ‘Living Wills’ in which
they may give advanced directives allowing doctors for passive euthanasia. A
recent development in this regard was witnessed in Holland where the court
allowed euthanasia in a special case.
on the justification or otherwise of the Euthanasia is a complex issue
involving legal, religious and cultural implications. Books on Jurisprudence
mention it sparingly without coating any legal authority, but most probably
the practice of passive euthanasia may be going on.
situation in our circumstances in the developing world
(regarding passive euthanasia) is that the attendants willfully take a
number of seriously ill patients away. The respirators are switched off on
relative’s request or even on doctor’s decision. At times the only
available life support equipment is transferred to another but better
candidate for survival. Many patients cannot be facilitated to prolong their
life because of non-availability of the equipment, expertise or funding etc.
Finally terminal patients are commonly being used as donors for organ
transplants, which is considered as a very noble cause.
& Head, Department of Surgery,
Medical College, Abbottabad.