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Friday 01 August 2014

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Definitions and terminology

Euthanasia means the act of bringing about a good death, i.e. one that is quick, peaceful and in the interests of the person concerned.

Voluntary euthanasia thus means a quick and peaceful death brought about at the express wish of that person. VES NSW advocates voluntary euthanasia only by a doctor acting in accordance with prescribed safeguards. Consequently VES NSW defines voluntary euthanasia as follows: A quick and peaceful death brought about under medical supervision at the request of and in the interests of a patient in which prescribed safeguards are followed. The definition applies to a person who is hopelessly ill with no other prospect of relief from suffering which that person finds intolerable.

Active Voluntary Euthanasia - administration by a doctor of medication designed to bring about a quick and peaceful death at the request of a patient.

The various ways in which death may be hastened are different in practical terms and may well be perceived differently by different people. However, they are morally equivalent when the purpose or foreseen and accepted effect is to bring about death as the only means of relieving serious suffering while respecting the patient's wishes. They all involve positive actions by the doctor and the same safeguards should apply in their practice.

Passive (Voluntary/non-voluntary) Euthanasia - withholding or withdrawing life sustaining treatment either because it is unduly burdensome and/or medically futile, or in order to bring about a quick and peaceful death.

Neither is properly described as passive because both require a positive decision. Neither will necessarily result in a good death nor necessarily reflect the wishes of the patient. Passive (voluntary) euthanasia is thus a confusing term. Its use is best avoided.

Double Effect - a term used to deny responsibility where death is foreseen but claimed to be the unintended consequence of treatment to relieve pain or other symptoms. Reliance on intention in the mind of the doctor provides no sure guide in public policy. Moral responsibility cannot be reasonably denied where the outcome is foreseen.

Withdrawal of treatment is a hugely controversial area. Also known as passive euthanasia, it is where the doctor withholds life-sustaining treatment. Many doctors would argue there reaches a point in the care of a patient where treatment is no longer of any help. Since the 1989 Bland ruling*, basic nutrition and hydration count as treatment.  See also the The Principle of Double Effect.

* Bland ruling refers to the case of Anthony Bland. A victim of the Hillsborough stadium tragedy, he was left in a persistent vegetative state – and hence was not legally dead. His parents believed their son would not want to be kept in such a condition. They petitioned the court to sanction the withdrawal of hydration and artificial nutrition, which it did.

Medical/Physician Assisted Suicide (PAS or PAD) - provision of medication to enable a patient to bring about his or her own death quickly and peacefully under medical supervision;

Sound Medical Practice requires that medical aid in dying, in common with all medical treatment, is, as far as practicable, only provided with the informed consent of, and in the interests of the patient. When the patient is unable to provide informed consent, sound medical practice requires reference to an advance directive (living will) if one exists, and to the enduring guardian(s)–those appointed the legal right to make substitute decisions on the patient's behalf. Go here for more information about the Guardianship Board and Tribunal. Ph: 02 9556 7600

The term medical aid in dying covers all situations in which a hopelessly or terminally ill person may receive help in dying from a medical practitioner. The full range of medical aid in dying comprises:
Item (a) is legal and recognised as sound medical practice. Items (b) and (c) are also recognised as sound medical practice but are forms of voluntary euthanasia and illegal if the doctor intends to hasten death. Item (d) (medically assisted suicide) and (e) (medically induced death) are also forms of voluntary euthanasia and illegal. Many doctors and other professionals as well as a majority of the general public believe that hopelessly and terminally ill patients should be free to choose from the full range of medical aid in dying.

Palliative Care:
Why it doesn't provide all the answers.

AND:

Emphasis on autonomy and quality of life is common to both palliative care and voluntary euthanasia.