Challenging the Concept of Passive Euthanasia

1. Challenging the Concept of Passive Euthanasia Mogens K. Skadborg, MD., AA. Phil., MEVO, External Lecturer in Medical Philosophy. Aarhus University Hospital. President Danish Society of Clinical Ethics* Introduction and problems Active euthanasia is allowed, legally, in a few countries only, while passive euthanasia on the other hand is usually allowed. Proponents of legal consent for active euthanasia often base their arguments on the equivalence of the ethical consequences between active and passive euthanasia. This means, however, serious ethical problems. It is asked, whether it is possible or not possible to compare the two practical ethical problems. Consequences of the analysis are presented. Through an analysis of medical, historical and philosophical applications of the concepts of active and passive euthanasia, it is shown that confusion and misunderstanding characterize applications of the concepts. It is argued that these confusions can play a crucial role in the ethical problems the medical profession encounter when making considerations regarding decisions at the end of life. It is argued that it can be crucial to the clinical ethical counselling in connection with the end of life decisions that these misconceptions are addressed. Active euthanasia can be unambiguously understood as taking another person's life after this person's explicit request not only at the end of life. However, the concept of passive euthanasia is considered to be an “umbrella term” that covers a myriad of circumstances, only at the end of life. It is argued that these misunderstandings are exacerbated by the ethical and medical euphemisms, contributing to misunderstandings about the medical practice. It is argued that these misconceptions give unnecessary problems also for the Clinical Ethics Committee guidance for ethical considerations when physicians seeks counselling in deciding on treatment discontinuation at the end of life. It is also argued that the use of ordinary everyday language can help to reduce these misunderstandings. A recent executive order from the Danish Health and Medicines Authority regarding advanced directives is presented. Points and arguments in the analysis The ethical equivalence thesis, that “letting die” is ethically equivalent to active euthanasia, meets several problems: The semantic understanding of the concept of "letting die" is an omission of action. But in the medical practice, the concept of "letting die" is linked to thousands of different clinical contexts. Situations where cure is not possible and death due to the disease is predictable. Death is inevitable. A concept which is described in the Danish Health and Medicines Authority as, "death is expected to occur within hours, days or weeks". The concept of "letting die" is a false premise in situations where cure is not possible. It is logical and semantic forgery to use the concept ”letting die” in situations that are unavoidable. When a treatment is futile it is also meaningless. But there may be other reasons why a treatment is meaningless. If legally competent people do not want a particular treatment because they do not accept the consequences of treatment - so that particular treatment is not possible. Both of ethical and legal reasons. Treatment would be inappropriate because it is meaningless. The word euthanasia is a coined word from Greek. A composition of eu (good) and thanatos (Greek god of gentle death). This means that it is already in the word is determined that there must be a, ethically, good action. Therefore, it is a euphemism If one is accepting the ethical equivalence thesis, that “letting die” is ethically equivalent to active euthanasia, one also must accept, that if active euthanasia is illegal, then “letting die” must also be illegal. This is obviously absurd when one considers that it is not possible to avoid the specific patient's death. The concept of euthanasia furthermore implies a legal reference solely referring to the everyday semantic understanding of the word killing (or taking lives). This implies that physician's or others action causes the (immediate) death of the patient. A death that would not necessarily be caused by the disease. When using the concept of passive euthanasia – the phrase euthanasia still refers to and implies killing caused by someone else, which isnot the case when withholding or withdrawing futile or meaningless therapy. Active euthanasia is banned in Denmark. But a recent executive order from the Danish Health and Medicines Authority states: “The doctor in charge assess whether, in the particular [relevant] case, there must be taken a decision to differentiate or limit further diagnostic procedures or treatments either completely (withdrawing treatment) or partial (treatment threshold) in cases where: a) a patient is terminally ill, b) a patient is seriously disable / permanent vegetative, or in the case of c) a non-terminally ill patient, the treatment may lead to survival, but the physical consequences of the disease or the treatment is considered to be very serious and painful”. This establishes legally use of both the concept futile as the concept meaningless treatment in medical practice. Using the phrase euthanasia (passive) in reflections of ethics about the end of life decisions is, due to the above mentioned, completely out of context. Reflections should be carried out in ordinary language terms. Thereby, misunderstandings should be avoided about the cause of death. Other ethically relevant issues, e.g. of palliative care, does not risk to be clouded by the use of irrelevant misconceptions. Conclusion The concept of active euthanasia should be replaced by a concept of “death on request” or other ordinary language expressions and the concept of passive euthanasia should be omitted in the discussions in the context of terminally ill people. The concept of meaningless therapy is introduced as a concept describing the competent patients refusal of a non-futile treatment. Address for correspondence Strandbakkevej 11, DK: 8250 Egaa, Denmark Phone: +45 86222792 or cell phone +45 40385592 E-mail: MK.Skadborg@dadlnet.dk or MKSkadborg@gmail.com Copy of poster and literature. http://www.mk-skadborg.dk/Skadborg poster.ppt Thanatos: greek god of gentle death http://www.theoi.com/Daimon/Thanatos.html *The views presented is not necessarily shared by the Society

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