(Revised with permission from YourDoctorintheFamily.com)
Cardiologists enjoy a specialty in which, thanks to rapid advances in pharmaceuticals and medical technology, they are able to do more and more good for more and more patients. Nonetheless, heart doctors still deal with patients who, because of unrelenting coronary artery disease or heart failure, run out of therapeutic options. These patients often find their final weeks or months to be extremely difficult. And occasionally they ask their cardiologists to put an end to their suffering. So, while cardiologists certainly do not face difficult end-of-life decisions as often as doctors from some other specialties do, many of them follow with great personal interest the continuing controversy over the morality and the legality of helping patients die.
With this in mind, cardiologists and other American physicians today find themselves digesting the latest news from the Netherlands: on November 28, the Netherlands became the first country in the world to legalize euthanasia.
The Dutch have long tolerated the elective termination of life by doctors. Physician-assisted suicide (in which the doctor provides the mechanism of death, but the patient's own hand triggers that mechanism) and voluntary euthanasia (in which, with the patient's consent, the physician actually causes death) have been accepted -if not legal - on an official basis in the Netherlands since 1993. (While these life-ending practices have remained technically illegal in the Netherlands, as long as certain guidelines are met and each case is formally reported, no legal action has is taken.)
The new Dutch law, in essence, merely relieves prosecutors from having to officially review each case of assisted suicide and euthanasia. Over 2200 cases of assisted suicide and/or euthanasia were reported to Dutch officials in 1999, but many more cases are thought to have gone unreported - and the doctors who performed the unreported acts are, in legal terms, guilty of criminal behavior. This has been seen as a problem - not because assisted suicide and euthanasia are felt in the Netherlands to be particularly problematic, but because nobody wants all the doctors to be crooks. Thus, the purpose of the new law, according to officials, is to "take euthanasia out of the criminal arena."
Patients' rights advocates hail the decision as a major step in favor of the patient's right to choose.
DrRich comments:
Most ethicists have been telling us for at least a decade that ethical arguments against physician-assisted suicide and euthanasia (two actions that, according to ethicists, are ethically equivalent) are wrong. Because our society has clearly embraced the notion of individual autonomy, they say, it therefore has also embraced - in principle, at least - assisted suicide and euthanasia. Allowing these actions, after all, is simply a manifestation of the individual's right to choose. The latest move by the Dutch parliament, then, merely formalizes the legitimacy of actions that western society has essentially already embraced.
DrRich is not an ethicist, and would surely lose on points a debate with a real, university-trained ethicist. (I can't follow a lot of their arcane jargon or acrobatic twists of logic.) (By the way, since we're supposed to behave ethically, isn't it unethical for ethicists not to speak plainly?) But to me, the real issue is not purely an ethical one. It's a practical one. For, even if assisted suicide and euthanasia are entirely ethical, what happens when you introduce these practices into a health care system in which the basic underlying operating principle is covert rationing?
In viewing the Dutch record since 1993, proponents of assisted suicide see a shining example of the societal benefits in permitting patients to have autonomy in their end-of-life decisions. Opponents see a series of terrible abuses, including an utter disregard of the prescribed guidelines. To DrRich, however, the most telling feature of the Dutch experience over the past seven years is their admission that thousands of cases of "active involuntary euthanasia" are occurring each year. In other words, patients are being actively killed at the hands of their doctors without their permission. All these patients, it is said, are leading insufferable existences, and all are being euthanized solely for humane reasons.
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