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Euthanasia

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Originally euthanasia ( gr : - , refers to the act terminating the life of another person to prevent him dying , euthanasia is described as a practice (or omission) to cause the death of an individual suffering from a disease that causes the incurable suffering moral and / or physical intolerable, especially by a physician or under his control .

Summary

Current definitions

The life expectancy has increased in some industrialized countries together with scientific and technological modernization of medicine , the part played by the medical decision in deaths has increased correspondingly to the increase. The acceleration of the end of life can encompass many different forms, the interruption of medical treatment to the injection of lethal, to stop nutrition and hydration or administration of sedatives in large doses. It is estimated that in Europe, the proportion of deaths in medical decision affects 40 to 50% of deaths . But these practices can not all be grouped under the term "euthanasia", to the extent the goal is not the end of life itself. Moreover, certain practices are accepted by the legislation, others not.

It uses the word assisted suicide to describe the act of providing an environment and facilities to a person to commit suicide, whatever the motives. In this case, the "patient" itself that triggers his death and not a third party. Assisted suicide requires a clear expression and freedom of the will to die, what distinguishes the incitement to suicide.

Another misuse of the word is its application to palliative care , which does not seek to hasten death and prevent the prolongation of dying patients even if, to relieve pain, sometimes for caregivers to use doses of analgesics or painkillers that might bring the time of death.

The aggressive treatment means "an unreasonable obstinacy, refusing to recognize reasoning encountered a man is doomed to death and it is not curable" .

The "euthanasia" animal

Main article: Animal euthanasia.

Long applied to practices intended solely human, the word is now used for other species, and then we talk of animal euthanasia , carried out in the supposed interest of an animal or group of animals, as opposed to the slaughter , carried out in the interest of humans .

Typology

Classification by the means employed

It is customary to separate the active euthanasia, which means a deliberate act to shorten the patient's life of passive euthanasia, which is to stop a cure or stop the use of instruments or products now a patient alive. In the latter case, it does not use any means hastening the patient's death.

Several associations and commentators reject the distinction between active and passive euthanasia, that seems inessential. They accuse him of hiding the fundamental question of purpose that characterizes euthanasia, to the detriment of the question means, which arises purely in terms of practical expediency . For some, there is no ethical difference between active euthanasia and passive . The insistence on the distinction between active and passive euthanasia could also cause confusion about the status of palliative care .

Classification by type of consent

  1. Voluntary euthanasia: When a person has the mental and physical capacity to request assistance to die and so requests;
  2. Involuntary euthanasia, meaning 1: when an individual no longer has the mental and physical capacity to request assistance to die but has previously expressed such a wish;
  3. Involuntary euthanasia, meaning 2: when an individual no longer has the mental and physical capacity to ask for help to die or to oppose it and we do not know what would have been his will .

Etymology and history of the term

The word euthanasia is composed of two elements from the Greek, the prefix was "good" and the word thanatos, "death" so it literally means good death, that is to say death under good conditions.

The word was coined by the philosopher English Francis Bacon ( one thousand five hundred sixty-one - one thousand six hundred and twenty-six ), and appears in a text of 1605 :

"The doctor's office not only restore health but also to soften the pain and suffering attached to disease, and this not only as the softening of pain, considered a dangerous symptom, helps and leads to recovery, but also to provide the patient, when there is more hope, a gentle and peaceful death, for it is not the least part of the happiness that euthanasia . "

It is defined as "happy death" in the dictionary Trvoux (ed. 1771 ), attesting to its use in French from this century. Until the late nineteenth century , he has the job of "softening of death" ("Euthanasia or medical treatment to provide an easy and painless death" William Munk 1888 , translation 1889 ).

In nineteenth-century sense bends, first under the influence of eugenics in the sense of eliminating "soft" people "not desirable", then elimination of these people without the sense "good death" be retained. As such it integrates all the means envisaged by the eugenics scientific or ideological to prevent or limit the existence of these populations: sterilizations and forced abortions, imprisonment, deportation, separation of sexes.

The culmination of these practices euthanasia is their first large-scale implementation of the Third Reich : the Aktion T4 program. This program led to the systematic murder of over 100 000 "insane" and disabled. It is part of the broader program of racial hygiene of the Nazis, in parallel with the final solution , the planned elimination of the Jews first and foremost, but also Gypsies and other people considered undesirable. Some .

After the Second World War , the word is mainly associated with its use euphemistic and misleading to the first half of the century, and as such a negative connotation. Only in the 1970s, and in the fight against what is coming to be called aggressive therapy , which is tantamount to a job closer to the original meaning, while adding new senses.

Since the medical advances in the preservation and extension of life have been breakthroughs, has raised the question of limits to be put to practice "life support". The public debate on this subject led the medical profession, philosophers and theologians to discuss the issue of quality of life, and rights for a human to determine when the quality has deteriorated so much that it becomes acceptable and lawful means to end his agony and suffering, and ultimately has led states to legislate on these matters within the legislative known in France as laws of bioethics.

Another major factor that gave rise to the political debate on euthanasia is the gradual abandonment of medical paternalism (where the physician knew what was good for the patient, and thus alone make medical decisions) for respect of the autonomy of the citizen, who must decide his own fate.

Euthanasia as a practice and concept

The practice of euthanasia is not a new problem. It suffices to be seriously ill to be asking this question. Euthanasia is a persistent problem in which clash of ideologies from different backgrounds.

In ancient Greece , the principle does not usually give rise to moral problems: the prevailing view was that a bad life is not worth living, that is why eugenics (exposure) and euthanasia were in general not not be shocking.

But some, like Hippocrates , had a different conception of things and, in the Hippocratic Oath , doctors are prohibited all forms of assisted suicide:

"I will abstain from all evil and injustice. I will not give poison to anyone, if asked, nor will the initiative of such a suggestion "

In France, this oath was updated in 1996 by Professor Bernard Hoerni to reflect developments in technology, particularly as regards the concept of aggressive treatment :

"I'll do anything to relieve suffering. I do not unduly prolong agony. I never causes death deliberately. "

Euthanasia was also practiced by the Celts. In Gaul , it is "the god with the mallet," Sucellos who was, according to the beliefs, the owner of such practices. In Britain Armorican, especially in Vannes, a "mallet blessed" (Mel Bniguet) was used until the early twentieth century to complete those whose death dragged on the request of the family and under the authority of priest and some notables of the parish. The use of "Mel Bniguet" was attested to Guenin, Locmariaquer, Carnac, Guern or Brec'h.

The concept is defended by Thomas More in his Utopia ( Utopia , 1516), where he spoke of death's Voluntary, when, for incurable ailments join excruciating pain that nothing can soften or suspend .

Legislation and Judicial Practice

Status of national legislation

The majority of states do not recognize or prohibits euthanasia and other forms of aid at the end of life, but in many countries, notably in Europe and North America, there is an implicit or explicit tolerance against such practices, provided that they operate in a regulated environment.

  • Euthanasia is allowed, under certain conditions in some European countries like Belgium. The Netherlands , where euthanasia remains a crime, a law of 1 April 2002 releases from prosecution doctors who have (or have) made an assisted suicide under very precise conditions: the Ministry of Health says that this practice "allows a person to end his life in dignity after having received all palliative care available." Read the discussion on euthanasia (in English) on the website of the Dutch Ministry of Health, Welfare and Sports.
  • In Luxembourg , after a gestation tortuous, the draft law on euthanasia was approved in final route March 17, 2009. Euthanasia and assisted suicide are now totally legal.
  • In Switzerland , where euthanasia remains forbidden, the assisted suicide , however, is authorized under the same conditions as for the two countries mentioned, through the association Exit Switzerland. (Other Associations: Exit International, Dignitas, ...)
  • In France , it is a murder or a premeditated poisoning theoretically punishable of life imprisonment . If the law punishes formally euthanasia and assisted suicide, between 1998 and 2005 legislative and regulatory texts, however, have expanded opportunities for cessation of aggressive treatment and extended the patient's rights "to a dignified end," and in the judicial practice, most cases belonging to such questions provide the most appropriate, since the early 2000s, to non-places or token sentences. In the case of a person not to be seriously ill, the mere knowledge of the project without suicidal rescue may warrant prosecution for "criminal failure to rescue people in danger .
According to a 2000 survey, 70% of French medical report is favorable or very favorable with the exception of euthanasia (an act intended by the patient or his representative, in accordance with the care team) . In another survey, conducted by INSERM , 45% of French GPs are in favor of legalizing euthanasia comparable to the Netherlands.

On November 24, 2009, French legislators have rejected a bill submitted by the Socialist deputy Manuel Valls to legalize euthanasia under certain conditions (by 326 votes against 202).

  • The United States by the referendum of 4 November 2008 , the District of Columbia ( Washington DC ) has authorized the use of euthanasia for terminally ill patients .
  • In Canada, where euthanasia is a reprehensible act, December 12, 2008, a jury of Alma in the Saguenay-Lac-Saint-Jean Stphan Dufour acquitted on charges of helping his sick uncle to suicide .

Cases relating to euthanasia

Justice is subject to the confidentiality of investigations and the definition of euthanasia is difficult, it will be here, individuals claiming to authors of this practice and expressed concern for justice for this reason.

  • In 2009 , Italy, the case Eluana Englaro , in a coma for seventeen years, justice has not approved its power to help him die.
  • In 2008 , France's suicide Rmy Salvat , aged 24, revived the debate on euthanasia. The young man was suffering from an incurable degenerative disease. He killed himself Aug. 10, 2008. Like Chantal Sbire he had sent a letter to the President of the Republic. He read on camera by director Marie-Pierre Raimbault for the show "Crisis" that aired on France 2 in September 2008.
  • In 2008 , in France , the case of Chantal Sbire , 52 years old, disfigured by a Esthesioneuroblastoma and asked the president, Nicolas Sarkozy , the right to die with dignity without having to visit a foreign country accepting euthanasia. She was unable to obtain satisfaction.
  • On 15 March 2007 in France, the jury sitting in the Dordogne condemned Dr. Laurence Tramois a one-year suspended sentence, and acquitted the nurse Chantal Chanel. In 2003, the doctor had prescribed and the nurse had administered a lethal injection of potassium Ms Druais, 65, a patient with pancreatic cancer in terminal phase. Since they were accused of poisoning. Judges and jurors did not fully follow the Advocate General Yves Squercioni who demanded heavier sentences principles: one year suspended sentence against the nurse and two years suspended sentence against the doctor. The defense had argued the payment by asking jurors to end "hypocrisy" surrounding this debate in her company. The Crown wanted for his symbolic penalties for either recalled the principle of law that prohibits a doctor to death.
  • In 2006 , Piergiorgio Welby was at his request, disconnected the respirator that did survive. The doctor was acquitted by the court after the Italian Association of Italian doctors had approved its attitude.
  • In 2005 , the case of Christine Malevri , French nurse convicted;
  • In 2003 , the case Vincent Humbert , who died in France (which has also accelerated in France the process of legislation on end of life and palliative care).
  • In 1993 , Canada faced one of the most controversial cases, that of Robert Latimer. The latter has killed his daughter, Tracy, disabled and aged only twelve. He has placed in the cab of his truck and by passing the gas engine exhaust. Tracy had a severe cerebral palsy, could neither speak nor walk nor feed herself. He was sentenced to life imprisonment with possibility of parole after ten years .
  • The case of Terri Schiavo in the United States , after which, the doctors decided not to reintubation and die of dehydration, only legal alternative in accordance with state law.
  • The case of Karen Ann Quinlan in the United States.
  • At European level, the European Court of Human Rights is very reluctant regarding euthanasia. It can be seen especially in the case of Diane Pretty v United Kingdom 29 April 2002 in which the Court refused to recognize any "right to die" through art .2 ECHR enshrines the right to life. Indeed, for the Court, it can not be interpreted without distortion of language in a negative way, that is to say, as conferring the diametrically opposite right, namely a right to die. Nor can confer a right to self-determination in the sense that he would give every individual the right to choose death rather than life. Accordingly, it is not possible to deduce from the art. 2 ECHR right to die, either from the hand of another person or with the assistance of a public authority.
  • Yves Bonniec business, one of the authors of the book Suicide, user manual , sentenced to 2 times for "criminal failure to rescue persons in danger" for not having rescued from desperate readers who wrote before committing suicide. In one case, the crime has been constituted by the mere knowledge of the project without the unfortunate suicide of his rescue, response to the player laying Yves Bonniec knew the suicidal intent of that person.

Arguments for and against euthanasia

Arguments for decriminalization or legalization

  • End suffering: If the pain is now well considered and often subsided effectively, particularly in palliative care services, there are still severe suffering that are not in pain. Thus:
    • progressive loss of control over her own body, as in the case of neurodegenerative diseases,
    • the sensation of suffocation,
    • the deformation of his body, and especially his face,
    • permanent loss of autonomy.

Even if they try to also take into account the suffering, palliative care can not always completely calm, and euthanasia is a way out.

  • Perform euthanasia in a medicalized framework avoids hiding and gesture can limit certain abuses.
  • Vision of human dignity (as noted by the philosopher Simon Blackburn , this argument is often cited by activists " pro-life "and opposed to euthanasia, but can equally be turned against them: in his view, it is impossible "to base the prohibition )
    • the disease is perceived as an unacceptable deterioration in the patient;
    • the disease can cause alterations in mental faculties (reason and will in particular) upon which the moral values of the West;
    • dependence very significant or total assistance of others.
    • sense of social uselessness.
  • Vision of the freedom of human beings
    • human being is the sole holder of rights associated with his body, sole master of his life is the simple application of individual freedom. It must be the one to decide what to do with her body but also his spirit, that is to say, so it exists as a human being .
    • freedom of choice of the patient, who knows best what he wants.
  • Designing utilitarian of moral utilitarianism permits, and possibly promotes the sacrifice of some for the benefit of many. In this context, it is considered legitimate to optimize the use of medical resources by focusing on patients whose lives can be saved, and considered a burden on resources for sustaining the lives of people who can not bring anything to society. This design is especially forbidden in Switzerland by the President of the Christian Democratic Party (PDC), Christophe Darbellay .

Arguments against decriminalization

  • Moral grounds: for many people, there is a general prohibition of murder or suicide that applies to euthanasia. It is based on the idea of inviolability of human life , which may be based on religious references. For example, followers of the three monotheistic religions consider human life as a gift from God, which man did not freely available. Thus, for the latter, man is created in the image of God , his life is sacred and do not diminish in dignity in the event of incapacity.
  • Incompatibility with a certain vision of the practice of health workers, as it appears in different versions of the Hippocratic oath.
  • Useless: some doctors believe that progress in the treatment of pain and suffering ( palliative care ) make euthanasia unnecessary. The sharp drop in cases of euthanasia in the Netherlands between 2001 and 2005 is attributed by most doctors to improve palliative care .
  • Gap between the social pressure to legalize euthanasia and the reality experienced by the patients: for certain professionals like Professor Lucien Israel , "euthanasia is a concern, in fact, far more than the healthy patients' and his experience is that they "even if you could not cure does not require euthanasia." .
  • In case of inability to decide (unconsciousness, mental handicap, dementia etc..), The decision must be taken by someone else.
  • Death by poisoning, sometimes very painful, which deprives euthanized and family to experience moments that are considered essential precede natural death .
  • While suicide may be seen as a personal tragedy and a failure to society.
  • Slippery slope:
    • financial pressures on the patient because of the high cost of care for families;
    • financial pressures for the poorest, who may "prefer" to die quickly;
    • financial interest of the patient care is a very sick person is expensive (many diseases, heavy care), the acceleration of the inevitable, therefore, reduces its expenses.
    • moral pressure from relatives or society, what is the real freedom of those who feel "too"? ;
    • difficulty of changing the view from a certain point ( unconsciousness );
    • frequent interference between the concepts of pain and suffering of the patient's entourage;
  • Drift potential:
    • eugenics , selection of individuals in relation to a conception of the good life;
    • consequently, can become an instrument of social domination;
    • Mobile cash (the heirs can take the opportunity to accelerate an inheritance);
    • From the moment you open the door to euthanasia, it is fast becoming a easier, cheaper and faster, and it was found that palliative care are neglected.

Euthanasia and religion

Catholicism

For Catholicism , whose doctrine on this subject has been recalled by the encyclical letter Evangelium Vitae (The Gospel of Life) of Pope John Paul II in 1995, euthanasia is in direct opposition to the 5th commandment : " Thou shalt not kill "( Exodus XX/13). Accordingly, any form of euthanasia is prohibited.

"(...) Euthanasia is a crime that no human law can claim to legitimize. Laws of this nature, not only do not create any obligation on the conscience, but they lead to a grave and clear obligation to oppose them by conscientious objection. "Evangelium Vitae, No. 73 .

The ban comes in the broader context of the denunciation of " a href = "Culture_de_mort" class = "mw-redirect" title = "Culture of Death"> culture of death "in Western societies in which" a hopelessly impaired life any value. " Instead, for Catholics, the depth of the supernatural vocation reveals the greatness of Man and the cost of his life, even in its temporal phase .

Protestantism

Certain strands of Protestantism does not share the doctrine Catholic on this point. They support the idea that God is not exclusive in the fact of having the right to life. Man participates with God in sustaining life. Thus, historically Protestant countries ( Netherlands , Switzerland , Sweden , Great Britain ), have sometimes given a legal meaning of euthanasia, active euthanasia allowed or assisted suicide.

Indeed, the divine life can not be conceived as purely physiological or biological. It is rather a dynamic of love and from the ties that bind humans together. Also, Jesus says "I am come that they might have life and have it more abundantly" ( John X/10). Human beings can not be reduced to the physical life, but life renewed and carried by the indwelling of the Holy Spirit. When Jesus said "Do not sell there be not two sparrows for a penny? However, it does not fall to the ground without your Father knowing it "( Matthew X/29), this does not mean that God alone has the right to life and death, but He is with the birds in their fall.

Also, God accompanies man in love with its dramas, its sufferings, its waterfalls and acts which sometimes can be dramatic.

Islam

In Islam, man is God's work the most important and most complex. It is the creature who bears the divine imprint, which represents his power on earth.

Active euthanasia is legally prohibited (shar'an) because it is seen as murder, even when acting as requested by the applicant, who intends to shorten his suffering. The doctor could not be more merciful to the patient that God gave him life and who takes him under the conditions it wants. The only thing allowed is to let the person die naturally.

Passive euthanasia can not be prohibited in these cases, the fact that the majority of Muslim jurists does not require medical care even in cases where it is hoped healing. They consider themselves part of the care license (mubh), not out of the obligatory.

Buddhism

In Buddhism, death is not the end of the continuum of the mind of a person and, therefore, suicide is not recommended. In general, Buddhism considers the removal of life as a negative act. By cons, from the perspective of the doctor, euthanasia can be an act of compassion, and his analysis becomes difficult and complex condemnation of euthanasia is not automatic , , .

Great masters of Tibetan Buddhism as Kalu Rinpoche or Dilgo Khyentse Rinpoche are not opposed to passive euthanasia. For cons, the 14th Dalai Lama warns against active euthanasia, saying that in trying to escape the suffering of this life, we may be faced with these same sufferings in a future life in difficult conditions .

The Theravada Buddhism has a similar position: according to the monastic code ( Vinaya ), active euthanasia or assisted suicide are serious faults, whereas passive euthanasia is a slight fault .

Judaism

"Respect for human life is absolute, unconditional. It is God who gives life. The Talmud (a compilation of comments on Mosaic law establishing the teaching of the great rabbinical schools) said: he who destroys a life, even a moment as if it destroyed the entire universe. It is forbidden to do anything that might hasten the end of a dying man. "Rabbi Guggenheim.

"We can alleviate suffering by calming if they do not hasten death for sure." Rabbi Klug.

Jews do make a concession: the renunciation of medical manifestly hopeless (passive euthanasia) should be distinguished from active euthanasia, which is condemned without appeal.

The penalties attached to euthanasia

France

Can I be prosecuted if they commit an act of euthanasia today?

-In a personal case, ie for Yourself: A demand even at the highest charge state can justify this day and a fortiori a legitimate legal active euthanasia, which we recall is the voluntary act and the participation of a third death. By cons, there is no charge for the application of such agreement on euthanasia, as such we can refer to the case of Pretty v. the UK, where the plaintiff had asked security at the RFP does not willing to continue her husband's help in committing suicide.

, Where euthanasia is practiced on a third person:

_en criminal matters:

This active euthanasia knows of several charges in criminal matters:

  • murder: the French Criminal Code contains no direct incriminating text euthanasia. Also, the judges held that the act of euthanasia whether active or passive is a homicide. The article in the penal code is concerned, Article 221-1 of the Penal Code which states that: "The fact of intentional killing is murder to others. He is punished by thirty years' imprisonment."

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