The minimal collection of data in the state of Oregon and the glaring lack of rigorous monitoring of assisted suicide undermine any semblance of surveillance or strict regulation. A number of questions make all conclusions based on the data seriously flawed. The Washington State law, which is much more recent, contains equally limited and deeply flawed surveillance provisions. There is therefore evidence that protective measures are ineffective and that many people who should not be euthanized or who should not be given steps die in this way. Another source of concern is the fact that violations of the law are not prosecuted and tolerance for violations of the law has increased. Moreover, in the next section, the boundaries of what constitutes “good” euthanasia and SAP practices continue to change, and some of the current practices would have been considered unacceptable just a few decades ago in jurisdictions that legalized these practices. [29] Dore, Margaret, “Death with Dignity”: What Do We Advice Our Clients? “, King County Bar Association, May 2009 Bar Bulletin, available at What Do We Advice Our Clients? (accessed July 13, 2009). According to the prepared law of the hemlock movement, the doctor should seek the advice of a second doctor. You should both agree that the person dies.
The first doctor could then end the patient`s life with an oral or intravenous overdose without threat of prosecution or prosecution. Our laws also state that the physician may choose not to assist the patient in such an action. All jurisdictions, except Switzerland, require consultation with a second physician to ensure that all criteria are met before euthanasia or SAP is initiated. In Belgium, a third doctor must examine the case if the person`s condition is classified as non-fatal. Also, in the same study, patients who showed suicidal thoughts were much more likely to suffer from depression or anxiety, but not somatic symptoms such as pain. Being critically ill has been described as a “fundamental state of vulnerability.” Physicians can take enforcement action even unintentionally. Regarding the sexual abuse of patients by physicians, a newspaper editorial stated, “Even apparent consent is imposed by the power of the professional in whom the client has placed his trust.” The power imbalance between patient and physician is much greater than is generally believed. Just as a physician`s response can prevent suicide, voluntarily accepting a patient`s request to be killed can promote this outcome and make the patient feel abandoned. Some of the fiercest debates focus on euthanasia of members of vulnerable groups, including people with dementia or chronic mental illness, disabilities, the elderly, minors, minorities, socio-economically vulnerable people or simply “tired of life” (7,35). Much heated debate has recently focused on the complex issue of requests for euthanasia by persons with psychiatric and mental disorders, sometimes through the application of an advance directive on euthanasia (37, 38). Controversy often revolves around whether psychiatric disorders are an indication for euthanasia, what role mental illness plays in motivating requests for euthanasia, the decision-making capacity and competence of applicants, and what is considered “incurable” or “irrecoverable” in the context of psychiatric disorders (37).
The use of euthanasia to relieve intolerable suffering caused by a psychiatric disorder or dementia is currently only permitted in the Netherlands, Belgium and Luxembourg (38). Given that research has shown an increase in euthanasia cases in this group since 2008, there are particular concerns related to the determination of mental capacity and voluntariness of the request and the increased psychological demands placed on health professionals involved in these cases (38). Natural rights were originally understood as the rights of citizens that would protect them from injustice. Respect for autonomy can be considered a true natural right and, as such, it would oblige others to accept it. Autonomy is the right of everyone to decide freely on the course of his or her own life, within the limits set by the competing real rights of others, and obliges him or her to comply with them if he or she respects those rights. That is, autonomy includes both the privilege of choice and the duty to refuse choice when necessary. Difficulties arise with regard to VE when (a) autonomy is not or not properly defined, as clarity is essential when dealing with such a controversial and emotional issue, and (b) when it is generally discussed as if it were only a right to social assistance. Autonomy is now commonly presented and often assumed as a mere expression of an individual preference that is never purported to bind others. In early 1997, the Parliament of Tasmania established a committee to examine the need for voluntary euthanasia legislation in Tasmania. When she released the committee`s final report in 1998, the Speaker revealed that of the five MPs, four, including herself, had initially been in favour of euthanasia.
That committee unanimously concluded that `it would be impossible to formulate a law containing all the necessary safeguards to protect vulnerable, vulnerable and disabled persons` (6). In the Netherlands (euthanasia support and advice in the Netherlands) and Belgium (Life End Information Forum (leif)), networks of doctors trained to assume the advisory role in the search for euthanasia have been set up. Their duties include ensuring that the person is informed of all options, including palliative care. However, most Leif physicians have simply taken a 24-hour theoretical course, of which only 3 hours are related to palliative care, which is barely enough to allow an LEIF member to provide adequate guidance on complex palliative care needs.19 Developing expertise in palliative care, as in any other field, takes a lot of time. In the UK, it includes a 4-year residency program and in Australia and the US 3 years. This fear of disability usually underlies assisted suicide. So far, no case of euthanasia has been submitted to the judicial authorities for further investigation in Belgium. In the Netherlands, 16 cases (0.21% of all reported cases) were referred to judicial authorities in the first 4 years after the entry into force of the euthanasia law; Few have been investigated and none prosecuted.5 In one case, a counselor who counseled a non-terminally ill person on how to commit suicide was acquitted.29 There is therefore a growing tolerance for violations of the law, indicating a shift in social values following the legalization of euthanasia and assisted suicide. While Oregon must have an incurable disease with a prognosis of less than 6 months, unbearable suffering that cannot be relieved is not a prerequisite (again, it is recognized that the concept of “unbearable suffering” is inherently ambiguous). This definition allows physicians to provide assisted suicide without asking questions about the source of the medical, psychological, social and existential concerns that typically underlie requests for assisted suicide.