Joe.Chamberlain@f302.n141.z1.fidonet.org (Joe Chamberlain) (03/23/90)
Index Number: 7267
PG> I wanted to put this in a separate message. I think your
PG> message about euthanasia is very important, and I want to
{The following was taken from the October 8th "Sunday News
Journal" and was written by Harris Meyer for the Health & Fitness
News Service.}
Euthanasia: Old dilemma for our time
Maria Barendregt, 94 years old and of sound mind but helpless
body, pointed to her physician of five years, Dr. P.L.
Schoonheim. Barely able to speak, she told her son and daughter,
"Always honor this doctor."
Then Schoonheim, under an agreement reached with Barendregt
in a series of talks, and after hearing her say once again that
she wished to die, gave her three deadly injections in short
succession. The old woman expired quickly.
Unlike most physicians around the world who perform
euthanasia, Schoonheim told the police of his actions, which
occurred in 1981 in the Netherlands. Three years later, the
Netherlands' highest court ruled for the first time that medical
doctors performing euthanasia cannot be convicted of a crime if
it is shown that they acted out of a professional duty to their
patients higher than the law.
Dutch medical doctors now are the only physicians in the
world who can perform mercy killings -- under limited
circumstances -- with the reasonable assurance that they won't be
criminally prosecuted. Polls show two-thirds of the Dutch
support euthanasia, and the Royal Dutch Medical Association (KNMG
in its Dutch acronym) stands alone among the the world's medical
societies in favoring it.
But pending legislation that would bring the Dutch criminal
code (which outlaws euthanasia) into line with the courts and
with what has become accepted medical practice is under fire from
some doctors and politicians. The legislation would sanction
euthanasia as allowed by the courts but leave penalties in place
for cases not meeting the prescribed guidelines.
Across the West German border in Bavaria, Dr. Julius
Hackethal also participated in killing a patient who urgently
sought to die. He obtained cyanide for the patient, who suffered
from facial cancer, at her request. As a result he might lose
his license. But his acquittal on manslaughter charges after a
celebrated three-year trail established the legal permissibility
of assisted suicide in West Germany. The rules of the German
medical profession still forbid it.
American doctors are watching the Europeans closely because
the euthanasia issue has drawn growing attention here. The issue
has become more pressing as medical advances enable sicker
patients to live longer lives of dubious quality. Experts say
data showing a rising elderly suicide rate in the United States
might indicate dissatisfaction through new medical means.
There have been some signs of movement on the issue recently
in the United States, although organized medicine and most
politicians still shun the concept. Referenda to legalize
euthanasia are planned for next year in three states -- including
California, where the first such referendum there failed last
year. In March, a distinguished group of medical doctors writing
in the New England Journal of Medicine declared that it is not
immoral for doctors to assist in the suicide of a rational
terminally ill patients. They also recommended aggressive pain
relief in terminal patients even if it shortens their lives.
The attitude in West Germany toward euthanasia is very
different from that in the Netherlands. The dreadful shadow of
the Third Reich's mandatory euthanasia program for the old and
disabled during the 1930s, performed by Nazi doctors, chills
discussion of the practice, said Martin Pfaff, staff analyst for
a legislative commission on reforming the West German health
system.
Even so, the attitude toward letting terminal patients die
without treatment is more tolerant than in the United States,
said Uwe Reinhardt, a health policy professor at Princeton, whose
father died in his native West Germany not long ago. His
father's doctor told him bluntly that his father would die of
pancreatic cancer within a month and that it would be cruel to do
anything than keep him comfortable.
"That was in some ways an assisted departure." Reinhardt
said. In the United States, the doctors probably would have tried
to do a lot for him, and he would have lived maybe a month longer
in a lot of pain. There, they do it in an elegant way."
But Hackethal believes German doctors must do even more.
"Without a readiness to perform mercy killing, the medical
profession loses the human quality that would justify the title
of humane physician-caregiver," Hackethal wrote in his new book,
Humane Euthanasia, in which he laid out guidelines similar to
those in Holland.
The Royal Dutch Medical Society, which claims 85 percent of
the country's 30,000 doctors as members, agrees with him. "We
believe in letting a physician administer euthanasia to a patient
in unbearable suffering with a clear mind who asks the physician
to end his life," said Dr. M.G. Van Berkestijn, the KNMG's full-
time secretary.
The KNMG estimates that, in a nation of 15 million, Dutch
medical doctors perform 500 to 1,000 acts of euthanasia every
year. Most, but not all, are terminal-stage patients. Van
Berkestijn said Holland's general practitioners, who do most
euthanasias, get as many as 2.500 requests a year but act only on
a portion of them. There are no reliable data, he said, on
euthanasia in hospitals and nursing homes.
But there are both the proponents and critics of euthanasia
who believe the actual total is as much as 10 times higher than
the KNMG figure. Dr. Peter Admiraal, a euthanasia advocate who
is senior anesthesiologist at Reinier de Graff Hospital in the
Netherlands, said 4 percent of the nation's 128,000 deaths
annually result from euthanasia.
"Six thousand patients were murdered by doctors in Holland in
1986," said Dr. G.F.A. Van Ren, vice president of the Netherlands
Union of Physicians, a sanctity-of-life group claiming 2,000
members and originally formed to oppose abortion. The union is
fighting strenuously to scuttle the pending legislation to
recognize euthanasia.
"It's against all the laws of man. Patients are undergoing
euthanasia against their will because of pressure from the
family, from society and from doctors. They are not free to
choose euthanasia if they are dying."
To prevent euthanasia under duress, the KNMG, a Dutch
government commission, and the Dutch courts have laid down
separate but similar guidelines for the practice.
The KNMG guidelines define euthanasia as all actions aimed at
terminating a person's life at his or her request, including
assisted suicide. The guidelines specify that:
* Only doctors may perform euthanasia, because only they
know what is wrong with the patient and what are the realistic
for improvement, and only they can be held professionally
accountable for their actions.
* The patient must make a well-informed, persistent and
completely voluntary request for euthanasia. The doctor must
ascertain that the request is not due to inadequate care.
* The patient cannot be a child or be mentally impaired
when making the request.
* The doctor must explore the patient's motives, making
sure the patient understands the medical situation, and must try
to alleviate the patient's fears about continuing to live.
* The doctor must determine that the patient's physical
or mental suffering is unbearable and without hope of
improvement, although the doctor might be unable to verify
objectively the degree of suffering. A small number of patients
who are not dying, such as multiple sclerosis patients, may be
eligible under the criterion.
* The doctor must consult, first informally with a
colleague experienced in the field of caring for the dying, than
with an official panel of doctors appointed for the purpose of
discussing such cases.
* The doctor must report the act of euthanasia to
authorities.
* The doctor who personally objects to the practice of
euthanasia should refer any patient who requests it to a
colleague as soon as possible.
For physicians following the guidelines, Dutch prosecutors
generally have refrained from enforcing the criminal code's
prohibition on euthanasia. But most Dutch doctors who practice
it, Van Berkestijn said, don't report it for fear of being
treated like criminals.
But Van Ren said the KNMG's guidelines "are exactly the same
as Hitler's."
Despite the sharp differences between the KNMG and Van Ren's
union, the two organizations agreed to publish jointly a booklet,
soon to be released, on how to treat dying patients without
euthanasia.
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