Helping patients - to die? |
In
Austria (population: 8.000.000), about 1.500 people are murdered each
year (i.e. killed intentionally), and more than 90% of them are killed
- by themselves. Similar statistics exist for most countries in the
world (Schmidtke et al 1999). Suicides may be motivated by various
reasons: By (1) acute negative emotions; (2) psychiatric diseases
(mostly depression); or (3) the threat of inescapable suffering. |
As life
expectancy in developed countries approaches the 9th decade, a
gradually increasing fraction of the population suffers from
age-related diseases, either degenerative ones affecting the joints,
the heart, and the brain; or neoplastic diseases of various types.
Disabling physical or mental conditions of advanced age have become
the reason No 1 for suicide. In an increasing number of countries, it
is legal for physicians to provide patients suffering from incurable
terminal diseases with drugs (mostly barbiturates) to end their lives
by their own free decision. Examples are the Netherlands and
Switzerland in Europe, and Oregon in the U.S. |
This
development touches one of the oldest taboos of mankind, best
summarized in the 5th commandment: "Thou shalt not kill." Principally,
the function of such rules has always been to protect the weak and poor
against infringement by the strong and mighty. Nevertheless, the 5th
commandment has been taken by its words by various activist groups
including those fighting death penalty, abortion, and the alimentary
use of animals. The same argument has been brought forward against
dying-with-dignity programs. To make it short: I do not recommend the
literal observation of rules written in very old books. |
The
last society implementing euthanasia programs against the disabled was
Nazi-Germany from 1933 to 1945, no good company for ideas like these,
although in 1942 even the prestigious American Journal of Psychiatry
advocated the killing of 'feebleminded' people (Joseph 2005).
Fortunately, our priority today is the will of the patient and not the
will of the society. If it were up to society to decide, who
knows where it would lead us? Maybe an immoderate society would even
try to improve its economy by getting rid of long-term unemployed with
an elegant barbiturate overdose? |
Many
troubles might be solved, just by choosing the right poison. We do it
with our old dog, if we get tired of him. Why don't we do it with
humans, if we get tired of them? What a wonderful world, if we would
meet only charming people, and if we simply could eliminate the boring
and the troublesome. The real trouble, however, begins if we ourselves
are assessed as being boring and troublesome. Nobody must have the
right to decide who is allowed to live, and who has to die. A
dying-in-dignity program will not relieve us from supporting our
disabled and handicapped; but it may provide for each of us personally
an emergency exit when we really need it for ourselves, and might spare
us from choosing another, less decent one. |
J. Joseph (2005) The 1942 'euthanasia' debate in the American Journal of Psychiatry. History of Psychiatry 16: 171-179. A. Schmidtke, B. Weinacker, A. Apter et al (1999) Suicide rates in the world (update). Arch. Suicide Res. 5: 81-89. |
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freedom & society |