Which countries allow euthanasia? Ethical issues of euthanasia

• November 3, 2019
• Tips for tourists
• Elena Spi

In medical practice, there is such a patient’s right - an unauthorized decision about care, but only a few know in which countries euthanasia is allowed. Switzerland has long attracted tourists not only for its landscapes, but also for its opportunities to die without suffering. This is prohibited in Russia and the UK. Probably, bills are built not only on the basis of the will of the people. Moral standards, ethical and ecclesiastical speculations and arguments are taken into account.

What is euthanasia?

Euthanasia is the act of ending the life of a very sick person to put them out of their suffering. The person who undergoes this procedure usually has a terminal condition. But there are other cases where some patients want their life to end. Therefore, attitudes towards euthanasia vary, but among patients they are predominantly positive, since not everyone is ready to put up with pain and suffering before death.

In many cases this is done at the request of the patient, but there are situations where they may be too ill and the decision is made by relatives, doctors or, in some cases, the court. It would be fair to understand why euthanasia is allowed somewhere, but in other countries it is strictly prohibited for religious reasons:

1. The term is derived from the Greek word euthanatos, which means easy death.
2. Euthanasia is illegal in the UK, where it is illegal to help someone kill themselves.
3. Voluntary euthanasia, or assisted suicide, can lead to imprisonment for up to 14 years.

This issue has been at the center of heated debate for many years and is surrounded by religious, ethical and practical considerations.

Euthanasia in foreign countries: procedure

It is important to know how this procedure occurs in different countries. For example, in Belgium, a patient suffering from a terminal illness must submit a notarized request twice. This application is considered by a special commission for about 3 months. She must check all medical documentation, the progress of treatment, and find out whether there are definitely any other techniques that could improve the patient’s condition. If nothing really can be done, the commission issues a conclusion, which is subsequently reviewed by the judge and other specialists. If the court confirms the decision of the commission, then the patient is informed that his request must be granted. By the way, the patient has the right to refuse.

Interesting: Clinics/facilities for euthanasia

The euthanasia procedure itself is quite simple: the medicine is administered by placing a venous catheter. Lethal injection is common in other countries.

Attitudes towards euthanasia

The procedure raises a number of tantalizing moral dilemmas:

1. Is it ever right to end the life of a terminally ill patient who is experiencing severe pain and suffering?
2. Under what circumstances can euthanasia be justified, if at all?
3. Is there a moral difference between killing someone and letting them die?

These arguments are based on people's different ideas about the meaning and value of human existence. Therefore, patients themselves often ask questions about which countries allow euthanasia. Perhaps this gives them the opportunity to go to a place where the person, in his opinion, will receive help.

Should people have the right to decide matters of life and death? This is an eternal question that will never be firmly and unambiguously resolved. There are also a number of arguments based on practical issues. For example, is euthanasia allowed in Russia or not, and why are people not allowed to resolve such situations on their own?

Some people think that the procedure should not be allowed, even if it was morally right, because it can be abused and used as a cover for murder.

Why Russian officials oppose euthanasia

Russian authorities hold extremely conservative views on euthanasia and have not even begun to develop a bill to legalize it. Only in 2007 did the media report on the possible adoption of euthanasia in Russia, but even then everything was limited to rumors and requests from deputies to medical institutions. After this, euthanasia was discussed in the State Duma exclusively in a condemning tone, judging by the transcripts of the meetings on the parliament website.

The Russian authorities explain their point of view not only by religious dogma, but also by the unpreparedness of society. Thus, former Vice-Speaker of the State Duma Vladimir Katrenko, when the legalization of euthanasia was last seriously discussed in parliament, said that, in fact, this is a permission for suicide and murder.

“We are told that the quality level of medical care in Russia is very low, but this only proves the need to increase this level, and not try to solve the problem by allowing desperate patients to commit suicide. By allowing euthanasia, we are legalizing the right to a death sentence imposed by medicine on a person and a person on himself,” he explained.

Deputy Chairman of the State Duma Committee on Health Protection Nikolai Gerasimenko then stated that euthanasia would become “a weapon in the hands of unscrupulous doctors, lawyers and black realtors” who would “ruin thousands of people for the sake of apartments.” “What the hell is euthanasia? Pensioners are dying of hunger. In our country, the state carries out euthanasia, but no one talks about it,” added Natalya Markova, an expert at the Coordination Council for Social Strategy under the Chairman of the Federation Council.

At the same time, officials emphasized: the idea of ​​legalizing euthanasia will not find widespread support in Russian society. Their opinion is partially confirmed by the fact that the fight for the legalization of euthanasia in Russia is now limited to posts in specialized communities for terminally ill patients on social networks and the creation of petitions on the website Change.org. They don’t get more than 200–300 signatures.

" Paper " talked to the creator of one of these petitions. He turned out to be a 37-year-old unemployed man who is not sick with any fatal diseases, and advocates the legalization of euthanasia, as he considers “life is too expensive, dangerous and immoral to seriously live and leave offspring.”

— Humanity is, in fact, an absurd biosect with the commandment of copulation and reproduction and with the inevitable end of overpopulation. This is a merciless parasitic monster on the face of the Earth, with no morality, no purpose, no meaning. I realized this at the age of 15. I don’t want to live and I don’t want to persuade anyone to do anything, to judge anyone. So I'm just promoting the petition and trying to make society free. “I seek complete freedom for a citizen to manage his life, not to be anyone’s slave,” he explained, emphasizing that he is not taking any other steps to legalize euthanasia due to the lack of “legal and effective ways” to solve the problem in Russia.

However, it recently became clear that such ways may appear, because among the Russian authorities there are also open supporters of euthanasia. For example, the new Commissioner for Human Rights, Tatyana Moskalkova, announced her position. “It seems to me that this is very humane if the person himself wants to die and his life has no chance of living, if he suffers, and if his loved ones and relatives in one harmony came to end this suffering,” the ombudsman said . The matter has not yet progressed beyond this statement.

At the same time, not only terminally ill people dream of introducing euthanasia in Russia, but also those who suffer from mental illness.

Suicide or the right to care?

Most people believe that unbearable pain is the main reason why people agree to euthanasia, but some studies in the US and the Netherlands found that less than a third of requests for euthanasia were due to severe pain.

In terminally ill people, quality of life may be seriously impaired by physical conditions such as:

• incontinence;
• nausea and vomiting;
• dyspnea;
• paralysis;
• difficulty swallowing.

Psychological factors that make people consider the procedure include depression, fear of loss of control or dignity, feelings of burden, or aversion to dependency. Where euthanasia is permitted, such situations are not considered murder.

The term “mercy killing” is distinguished and used in situations where the patient suffers greatly. Killing is stopping the taking of measures that would allow a person to survive.

The following are not euthanasia:

1. Discontinuation of medically futile treatment when the burden of such treatment outweighs the benefit.
2. Providing treatment aimed at relieving pain and other symptoms, even though the treatment very rarely may result in some predictable risk of shortening life, known as the "double effect," when the doctor reduces pain rather than ending life processes.
3. When a mentally competent person decides to refuse treatment. Doctors cannot force patients to undergo treatment against their will, and it is legal for a patient to refuse treatment. If the patient dies, it is not euthanasia.

Arguments for the procedure may be as follows:

1. It does not include stopping or starting medically futile treatment, alleviating pain when the goal is to eliminate the pain but not the patient, or withholding medical treatment from a competent patient. Euthanasia is illegal in the UK under the common law crime of murder.
2. Voluntary euthanasia is when a competent patient agrees but does not commit to making a decision to end his life.
3. Assisted suicide is when someone helps another person commit suicide. In the UK it is illegal under the Suicide Act 1961, which states that a person "who aids, abets, counsels or procures the suicide of another person or the attempt of another to commit suicide is liable on indictment."

If such actions are not self-interested, then this is the norm for both parties. They also introduce the definition of a person's living will: a document prepared by a mentally competent person in which a person states that he does not want to receive medical treatment and care if he becomes incompetent in the future and can no longer express his wishes himself.

USA

In the USA the situation is ambiguous, because each state can make its own laws. Therefore, injecting terminally ill people is allowed only in a few states: Vermont, Oregon, California, Montana, and the District of Columbia. True, to go to the next world, you will have to go a long way. Two independent doctors must confirm the fatal illness and the fact that the person will die in six months. The patient must voluntarily express his desire to give up his life and be mentally healthy. In Oregon, the patient must administer the fatal injection themselves.

Ethical norm of euthanasia

Palliative care is the comprehensive care of patients with an incurable, progressive illness that is expected to end in death, providing physical measures such as pain control and psychological, social and spiritual support. This guides the management of hospitals in whose countries the act of “help” is allowed. At the same time, ethical problems of euthanasia remain, because some may use such measures for their own purposes. It is no secret that it is enough to pay for the procedure. And different cities have their own prices.

Where is euthanasia allowed?

The following is a list. It helps you find out exactly which countries allow euthanasia.

1. Netherlands - legally allowed by the Supreme Court since 1984. It began to be used legally and officially in 2002. It is performed exclusively on terminally ill patients.
2. Belgium - since 2002 you can officially do this. Allowed for everyone who experiences physical pain and suffering. Since 2014, child euthanasia has been legalized.
3. Switzerland has the most liberal attitude towards the process of dying. In Zurich, up to 200 people die every year from the “injection”.
4. USA - each state sets its own rules. However, in Oregon, Washington, Montana, Vermont and California, the procedure is officially permitted.
5. Luxembourg - can be carried out since 2009. The rules are the same as in Belgium. You can only choose a doctor yourself, and relatives can be present.
6. Colombia - Euthanasia was carried out legally for the first time in 2015. The government allowed a sick 79-year-old man to commit suicide within the walls of the hospital.
7. Canada, where euthanasia is officially allowed, previously provided for a punishment (until 2015) of 14 years in prison. This provision has now been found to breach the Charter of Human Rights to Care.

Above is a list of countries where euthanasia is allowed. To this day, many cannot understand why such measures were not allowed before. Now children can be given an injection that will ease their suffering, however, if the children themselves want it. Accordingly, parents decide for children under 7 years old.

Opinion of the public and doctors about the problem

Despite the fact that public figures, politicians, and the medical world deny euthanasia in the vast majority of countries, the public as a whole is not opposed to such an idea. Thus, according to a survey of Russian Internet users, 50 percent of respondents do not see anything terrible in euthanasia and consider it one of the human rights to freedom of choice.

Psychologists believe that this is due to the personal attitudes of most people, who, in the event of an incurable illness, would not want to become a burden to relatives and experience torment.

Surveys of medical portals conducted among young doctors show a similar division in the professional sphere - only half of those surveyed are generally in favor of the use of euthanasia, including in Russia.

How is the procedure performed?

Knowing which countries have euthanasia, you can inquire about the procedures. The most common prescription is for intravenous injection. The medicine can be purchased for 200-400 dollars (equivalent to the country’s currency). There are also several types of procedures, which are carried out accordingly in different ways.

However, when a patient is denied action or medication for the primary purpose of causing or hastening death, it is passive or indirect euthanasia. These measures may include withholding or eliminating normal measures such as food, water (hydration), and oxygen. To reduce the chance that euthanasia medications will cause vomiting, an antiemetic should be given.

In the Netherlands, the practice involves giving the patient a comatose injection followed by a second injection to stop the heart. Coma is first induced by intravenous barbiturates and then a muscle relaxant. The patient usually dies as a result of muscle relaxant-induced anoxemia. When death is delayed, intravenous potassium chloride also precipitates cardiac arrest.

Types of euthanasia: which path to the next world can you choose?

Assistance is provided by a specialist doctor after a positive decision of the commission. Measures are being taken to help decide on such an action. They are distinguished not by the composition of the substance introduced orally, but by the procedure that ultimately leads to death:

1. Injections - a lethal drug is injected that affects the respiratory tract, the person dies due to the concentration of poison in the blood.
2. Disconnection from the artificial respiration apparatus only after biological death has been established.
3. A person who is in a comatose state (less than 4 weeks) cannot be disconnected from mechanical ventilation, accordingly, the injection can be administered if he regains consciousness and measures are taken to euthanize him.
4. When a person voluntarily stops taking medications because they do not want to continue treatment that may or may not help them get better (voluntary drug withdrawal).
5. The right to euthanasia can be obtained if the patient is in pain - painkillers do not help, and the patient cannot endure it without permission.

However, there is an important nuance! Euthanasia or deliberate poisoning with lethal substances is not euthanasia, since only those substances that help to pass painlessly into another world should be used for the procedure.

Opinions of doctors and experts

Above we have already given a list with a reminder about which countries allow euthanasia. In Russia, this procedure is prohibited by law. Moreover, any refusal of resuscitation or treatment prescribed by a doctor after emergency hospitalization is considered a refusal to live. After all, it is specific measures that help save a person, and if you do not adhere to this, the patient voluntarily dooms himself to death. In such cases, people should not be allowed to leave hospitals or be discharged at their request or at the request of their parents.

Incurable patients can resort to killing substances if they have drawn up a notarized request in advance, which specifies how and how to proceed in the event of a fatal illness. At the same time, they often bequeath their organs to other people, if this is possible in their situation. Do not confuse resuscitation with euthanasia - these are different things, since no one can say at what point the heart will stop.

Other cases: prescribing painkillers to patients. The illustrative story with Dr. Khorinyak caused a flurry of bewilderment, because the doctor helped a terminally ill patient not feel pain, relieving him of suffering. Lawyers stated in the media that the drugs had no effect on the speed of death; on the contrary, they helped the patient fight for 3 years to preserve his life:

1. The hopelessly ill are those who cannot be cured. We can only hope for a miracle, which is not excluded in medical practice. Sometimes cancer patients recover when doctors give no chance.
2. Hospice and palliative care are the only option for patients doomed to die.
3. But the hospice in Zheleznogorsk is not ready to provide assistance and use the euthanasia procedure. The doctors turned out to be unprepared for such actions - this would mean taking responsibility for the death of the patient.

Some people resort to the help of Swiss colleagues. Tourists come there for euthanasia, paying for treatment, procedure and stay in the ward. The cost of services can vary between 4-8 thousand euros.

Die in one day

The ending of this uninvented story can be indicated by the final words from the story of Alexander Green, which became a catchphrase: “They lived a long time and died on the same day.” 91-year-old Dutch couple Nick and Tris Elderhorst kissed goodbye, held hands and left this world through double euthanasia, reports the Dutch newspaper Algemeen Dagblad.

Nick and Tris Elderhorst lived a long life together and left it together

Photo: CEN/Familie Elderhorst

The Elderhorsts fulfilled a long-standing wish - according to their daughter, they dreamed of dying together. The couple died surrounded by relatives in their own home in Didan. In 2012, Nick suffered a stroke, as a result of which he lost mobility and experienced constant pain. Tris's health also left much to be desired. Her memory was increasingly failing her, and doctors diagnosed vascular dementia—in other words, dementia. Tris could no longer care for Nick. Despite the help of numerous family and friends, the couple feared that when one of them died, the survivor would have to spend his last days in a nursing home.

The Elderhorsts decided to resort to euthanasia. Voluntary death is allowed in the kingdom, but the couple was forced to go to the Levenseindekliniek (“End of Life”) clinic for six months, where they were examined by two groups of doctors.

Doctors checked whether the elderly spouses met the requirements necessary for euthanasia.

“This is a unique coincidence,” commented Dick Bosscher, a representative of the Dutch Association for Voluntary End of Life, commenting on spousal euthanasia. “They both received permission for euthanasia. Such double requests are extremely rarely granted.”

The attitude of the church towards euthanasia

Many argue that the right to choose when to die is a basic human right. At the same time, the ban on euthanasia is a punishment, because it is the Lord who decides the fate of a person. A mortal does not have the right to be born and die where he wants.

While those who belong to the Christian religion may argue that the time, place and manner of death should be left in the hands of God. But there are other religions that believe that dying in an act of religious fanaticism is a fundamental right and leads to an afterlife in heaven.

All this may be "true" in the eyes of believers, but whenever a question of procedure arises, the argument almost immediately turns into "suicide", defined as death by one's own hand. Similar opinions on euthanasia have been documented. However, there remain countries that fully support human rights.

Story

In fact, killing sick people and even children has been practiced at all times. The term has Greek roots, since it was the Greeks who first adopted the practice of finishing off wounded comrades on the battlefield so that they would not suffer from incurable injuries. We all remember the ancient Spartans, who threw sick or crippled children off cliffs not only to relieve themselves from worries, but also to stop the child’s suffering. By the way, such practices, according to the research of ethnographers, were also in use among ancient peoples, for example, the Far North or Oceania until the 19th century.

In the modern world, before the Second World War, some European countries did not ban euthanasia, and this did not contradict the moral and ethical principles of society. However, the fascist T4 program, during which the Germans, fighting for the purity of the Aryan race, killed mentally retarded people and even children, as well as patients with mental disorders, discredited these ideas for the next 50 years.

Is it allowed among children?

Euthanasia for children is not yet legal in countries where it is performed for adults. However, in Belgium and the Netherlands it is already possible, and Canada is preparing to change laws. Doctors and the government of the Netherlands have arguments in favor of euthanasia among children. But not all citizens are able to accept such arguments as opposed to their conjectures - voluntary death for a child.

There, children under the age of 12 are allowed to be euthanized, with parental permission required until age 17. Infanticide is also openly practiced by Dutch doctors, although it is technically illegal. Indeed, the Groningen Protocol, a bureaucratic checklist published by Dutch pediatricians, outlines which terminally ill and disabled children may have such a right. Let's take a closer look:

1. The Supreme Court of Canada upheld the right to assisted suicide in 2015, followed by legislation in national and provincial parliaments. The law generally ensures that the procedure is available to adults experiencing intractable suffering—as defined by the patient—in circumstances where death is reasonably foreseeable.
2. There are currently serious discussions about extending this license to children. This development is especially troubling for the United States, given that Canada is its closest cultural cousin.
3. The Canadian medical establishment has made its agreement clear. The Pediatric Society previously released a position paper entitled "Medical Assistance in Dying: A Children's Perspective." The document is not at all critical of extending the law on euthanasia to minors.
4. Moreover, the statement contains recommendations on how to carry out child euthanasia, if the law allows it. By refusing to oppose legalization or even make a single substantive argument against moral propriety, the public is implicitly supporting policies that would allow the killing of sick and disabled children.

A staggering 11.2% of respondents reported that they had already had “preliminary discussions” with parents about killing their seriously ill mature children, while child euthanasia remains illegal in Canada.

What about euthanasia for "never competent children":

1. Forty-five respondents reported receiving written requests from parents to euthanize their children.
2. Half of the requests were for children under one year of age. Child suicide, Dutch style.
3. Thirty-two percent of doctors surveyed said they would approve the procedure for minor children "in rare cases involving terminal illness or intractable pain, as long as the process is closely supervised."

Whether euthanasia will be allowed in Russia or not is still unknown. But the authorities are not yet ready to discuss such disputes within the framework of the law.

Summing up

There are many people who share Michael Winner's opinion: every year more than 200 tourists, mainly from the UK, Germany and France, come to Switzerland to leave this world. The procedure is as follows: a patient who decides to die must meet for consultation with several clinic staff, as well as with an independent specialist. The commission evaluates the doctor’s documents and then schedules an additional meeting after some time. And directly during the euthanasia procedure, a few minutes before the lethal injection is administered, according to the law, doctors once again remind the patient that the injection will kill him.

So, today the only destination where you can get a lethal injection legally is Switzerland. The idea of ​​euthanasia is slowly conquering country after country, but still remains revolutionary. Most of all, this is due to the fact that it contradicts the Hippocratic Oath:

“I will not give anyone the lethal means they ask from me and I will not show the way for such a plan.” Hippocrates. Selected books.

But at the same time, today in the world medical community the Hippocratic Oath is increasingly opposed to ideas about the quality of life and the patient’s right to die. Which side are doctors choosing today? The results of a survey of Russian doctors are interesting. 51.5% and 44.8% of doctors aged, respectively, from 41 to 50 and from 51 to 65 years old, to the question “Do you consider euthanasia acceptable?” They answered: “I never thought about it.” At the same time, 49% of doctors aged 21 to 30 gave a positive answer. This survey shows that the younger generation of domestic doctors today is thinking about euthanasia and considers this idea acceptable and humane.