Euthanasia

1. 2011 Marek Vácha Euthanasia

2. Euthanasia • eu = good, right; thanatos = death • "Passive euthanasia" = withdrawing (=stopping) medical treatment with the deliberate intention of causing the patient's death • „Activeeuthanasia“ = A deliberate act to end another person's life on patient´s request • the difference between "active" and "passive" is that in active euthanasia, something is done to end the patient's life; in passive euthanasia, something is not done that would have preserved the patient's life. • there is differencebetween „lettingdie“ and „killing“

3. Euthanasia • Euthanasiameansknowingly and intentionallyperforminganactthat is clearlyintended to end another person´s life and thatincludes the followingelements: • the subject is a competentinformed person with anincurableillnesswho has voluntarilyaskedforhis or her life to beended; • the agent knows about the person´s condition and desire to die and commits the actwith the primaryintention of ending the life of that person • the act is undertaken with compassion and withoutpersonalgain

4. Assistence in Suicide • Assistance in suicide means knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counseling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs

5. NaziGermany 1939 - 1941

6. Karl Brandt Philipp Bouhler

7. Nazi physician Karl Brandt, director of the Euthanasia Program. August 27, 1942.

8. Program T4 • 1000 : 10 : 5 : 1 Tiergartenstraße 4

9. This image originates from a film produced by the Reich Propaganda Ministry. It is captioned: "A moral and religious conception of life demands the prevention of hereditarily ill offspring." Nazi propaganda aimed to create public support for the compulsory sterilization effort.

10. Sixplaces, where euthanasia were performed Brandenburg near Berlin (January 1940 - September 1940),Grafeneck near Stuttgart (January 1940 - December 1940),Hartheim near Linz in Austria (January 1940 - December 1944),Sonnenstein/Pirna near Dresden (April 1940 - August 1943),Bernburg near Magdeburg (September 1940 - April 1943),Hadamar near Koblenz (January 1941 - August 1941).

11. Buses used to transport patients to Hadamar euthanasia center. The windows were painted to prevent people from seeing those inside. Germany, between May and September 1941.

12. 1936

13. 'This person suffering from hereditary defects costs the community 60,000 reichsmark during his lifetime. Fellow German, that is your money too.'

14. Nazi poster bearing the phrase, translated from German, "A strong and healthy nurse is there only to give care to a dangerous madman. Shouldn't we be ashamed?"

15. ClemensvonGalenLebensunwertesLeben ? • “We must expect, therefore, that the poor defenceless patients are, sooner or later, going to be killed. Why? . . . because in the judgement of some official body, on the decision of some committee, they have become “unworthy to live", because they are classed as “unproductive members of the national community". The judgment is that they can no longer produce any goods: they are like an old piece of machinery which no longer works, like an old horse which has become incurably lame, like a cow which no longer gives any milk. What happens to an old piece of machinery? It is thrown on the scrap heap. What happens to a lame horse, an unproductive cow? I will not pursue the comparison to the end — so fearful is its appropriateness and its illuminating power . . . • If it is once admitted that men have the right to kill “unproductive" fellow­men — even though it is at present applied only to poor and defenceless mentally ill patients — then the way is open for the murder of all unproductive men and women: the incurably ill, those disabled in industry or war. The way is open, indeed, for the murder of all of us, when we become old and infirm and therefore unproductive".

16. “For some months we have been heating reports that inmates of establishments for the care of the mentally ill who have been ill for a long period and perhaps appear incurable have been forcibly removed from these establishments on orders from Berlin. • Regularly the relatives receive soon afterwards an intimation that the patient is dead, that the patient's body has been cremated and that they can collect the ashes. There is a general suspicion, verging on certainty, that these numerous unexpected deaths of the mentally ill do not occur naturally but are intentionally brought about in accordance with the doctrine that it is legitimate to destroy a so-called “worthless life” — in other words to kill innocent men and women, if it is thought that their lives are of no further value to the people and the state. A terrible doctrine which seeks to justify the murder of innocent people, which legitimises the violent killing of disabled persons who are no longer capable of work, of cripples, the incurably ill and the aged and infirm!”

17. I will give you an example of what is happening. One of the patients in Marienthal was a man of 55, a farmer from a country parish in the Münster region — I could give you his name — who has suffered for some years from mental disturbance and was therefore admitted to Marienthal hospital. He was not mentally ill in the full sense: he could receive visits and was always happy, when his relatives came to see him. Only a fortnight ago he was visited by his wife and one of his sons, a soldier on home leave from the front. The son is much attached to his father, and the parting was a sad one: no one can tell, whether the soldier will return and see his father again, since he may fall in battle for his country. The son, the soldier, will certainly never again see his father on earth, for he has since then been put on the list of the “unproductive”. A relative, who wanted to visit the father this week in Marienthal, was turned away with the information that the patient had been transferred elsewhere on the instructions of the Council of State for National Defence. No information could be given about where he had been sent, but the relatives would be informed within a few days. What information will they be given? The same as in other cases of the kind? That the man has died, that his body has been cremated, that the ashes will be handed over on payment of a fee? Then the soldier, risking his life in the field for his fellow-countrymen, will not see his father again on earth, because fellow-countrymen at home have killed him.

18. Who could then have any confidence in a doctor? • Then no man will be safe: some committee or other will be able to put him on the list of “unproductive” persons, who in their judgment have become “unworthy to live”. And there will be no police to protect him, no court to avenge his murder and bring his murderers to justice. • Who could then have any confidence in a doctor?

19. Tiergartenstraße 4 today

20. Slipperyslope Baby Knauer dětská "eutanázie" T4: "eutanázie" dospělých Auschwitz

21. …after Auschwitz • How can the progress of modern science and medicine and industry promise to liberate people from ignorance, disease, and brutal, mind-numbing work, yet help create a world where people willingly swallow fascist ideology, knowingly practice deliberate genocide, and energetically develop lethal weapons of mass destruction? • Theodor Adorno

22. Euthanasia(all over the world) 1973 - 2010

23. Euthanasia • we are able to cope with a concrete illnesses... • ...but we are unable to cope with aging

24. Euthanasia • The Netherlands, 1994 • On April 10, 2001, the Dutch Parliament approved the "Termination of Life on Request and Assisted Suicide (Review Procedures) Act."(41) It amended sections of the criminal code, specifically stating that the offenses of euthanasia and assisted suicide are not punishable if they have been "committed by a physician who has met the requirements of due care" that are described in the act and if they have informed the municipal "autopsist" in accordance with the Burial and Cremation Act. • Australia: 1995 – 1997 • Oregon (AS) from 1998, Washington (AS) from 2008 • Belgium from 2002 • Luxembourg from 2008

25. Oregon from 1998 • the patient must • be a capable adult • be an Oregon resident • have a terminal illness, with less than six month to live (!!) • voluntarily request a prescription for lethal drugs • the request must be made both orally and in writing

27. Countries where Euthanasia/AS are allowed

28. Euthanasia„Dutchdefinition of euthanasia“ • =the intentional termination of the life of a patient at his request by someone other than the patient

29. Medischemachtenmedischeethiek • Hippocraticoath • the physician must preserve human life, save it and prolong it, where and wheneverpossible • today, with all the medicalpossibilities: • the physician must preserve human life, save it and prolong it, wherever it is sensible and meaningful to do so. • should the physician consider it no longersensible to proceed, then he should be permitted to end patient´s life. This can be done in two ways: • throughceasing all life-sustainingmeasures • throughactivelyterminating the life of the patient • Sohn, W., Zenz, M., (eds) (2001) Euthanasia in Europe.Schattauer. Stuttgart, New York. p.138

30. The Netherlands • In 1973 Dr. Gertruida Postma, who gave her dying mother a lethal injection, received light sentence in the Netherlands. • The case and its resulting controversy launched the euthanasia movement in that country.

31. Postma Case • Leeuwarden 1973 • Dr. Postma was sentenced to only one week in prison • this remarkably mild sentence was based on the fact, that • the physician´s mother was incurably ill • she experienced her suffering as unbearable • she was already in dying phase • the ending of life was done on her own expressed wish

32. The Netherlands • 1973 Voluntary Euthanasia societies formed in the Netherlands • 1982 A Rotterdam court states conditions under which aiding suicide and administering Voluntary Euthanasia will not lead to prosecution in the Netherlands • 1984 The Supreme Court of the Netherlands declares that V.E. is acceptable subject to ten clearly defined conditions • 1990 Notification procedure agreed between the Royal Dutch Medical Association and the Ministry of Justice • 1994 Amendments under the Burial Act incorporate the notification procedure, giving the latter formal legal status

33. Rotterdam criteria: 1982 • the patient makes a voluntary request • the request must be well considered • the wish for death is durable • the patient is in unacceptable suffering • the physician has consulted a colleague who agrees the proposed course of action

34. The Netherlands • The Penal Code of the Netherlands contains a variety of provisions prohibiting the intentional taking of human life. Two of these provisions specifically relate to physician-assisted suicide and active voluntary euthanasia: • Article 293 of the Penal Code prohibits taking a person's life at that person's 'express and serious request'. This crime, sometimes described as 'the offence of voluntary euthanasia'(133), is punishable by imprisonment for a maximum of 12 years or by a fine. • Article 294 of the Penal Code prohibits assisting suicide. Where a death by suicide has occurred, anyone who helped bring about that death could be prosecuted under article 294 for intentionally inciting another to commit suicide, assisting in the suicide of another, or procuring the means for another to commit suicide. Where a death has occurred, this crime is punishable by imprisonment for a maximum of 3 years or a fine.

35. Netherland • The most important reasons for the request foreuthanasia were • futile suffering (29%), • avoidance of humiliation(24%) • unbearable suffering (18%). • Although pain was amongthe reasons in 40% of cases, only in 5% of cases was pain mentionedas the most important reason. • Van der Wal G, van Eijk JThM, Leenen HJJ, Spreeuwenberg C. Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently? Family Practice 1992;9:135-40.

36. Remmelink Report • Since 1984 the practice of euthanasia in Holland has been very open, and many claims have been made as to its frequency and its benefits or drawbacks.  To establish the facts on euthanasia, a government-sponsored study was undertaken and the report released September 10, 1991.  This report, Euthanasia and other Medical Decisions Concerning the End of Life, commonly called the Remmelink Report, has revealed disturbing findings.  The population of the Netherlands in 1990 was 15 million.  The study findings indicated the following annual figures: • 2300 cases of active voluntary euthanasia. • 400 cases of assisted suicide (the lethal means for death is provided to the patient for self-administration) • 1040 cases of involuntary euthanasia (.8% of total deaths in Holland).  These cases --averaging almost 3 per day -- were those in which the physician prescribed, provided or administered a medicine with the deliberate aim to hasten the end of life, though the patient had made no explicit request for euthanasia.

37. Remmelink Report • 14% of patients whose lives were ended without their explicit request were fully competent. • 62% of patients whose lives were terminated without their explicit request had never given any indication regarding termination of life. • An additional 8100 patients died after pain medication (morphine) was administered by physicians who intended to shorten life.  The decision to administer the intentional overdose was not discussed with 27% of fully competent patients who died in this manner.

38. Remmelink report: 1991

39. The Netherlands

41. …without specific request… • there is a difference between questions • what would the patient want in this circumstances? • what do you want for the patient?

42. Netherland • The most important reasons for the request foreuthanasia were • futile suffering (29%), • avoidance of humiliation(24%) • unbearable suffering (18%). • Although pain was amongthe reasons in 40% of cases, only in 5% of cases was pain mentionedas the most important reason. • Van der Wal G, van Eijk JThM, Leenen HJJ, Spreeuwenberg C. Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently? Family Practice 1992;9:135-40.

43. The Netherlands • On April 1st 2002, euthanasia became legal in The Netherlands, rather than beingtechnically illegal but not punishable in circumstances of ‘force majeure’ (necessity). • Key points in the new law include the following: • incompetent patients can be killed if they have written a statement in advancerequestingeuthanasia. • teenagers aged 16-18 may receive euthanasia, not necessarily with theagreement of a parent or guardian.

44. The Netherlands • children 12-16 years old may receive euthanasia with the agreement of a parent or guardian. • the doctor must hold the conviction that the patient’s suffering is lasting and unbearable. • all cases will be reviewed after the death of the patient. • the law does not prohibit doctors from administering euthanasia to nonresidents.

45. The Netherlands 2002 • in order for the physician to assist with the euthanasia, the following must occure • the patirnt must request the assistance freely and frequently, after careful consideration • the physician may act on the request only if the patient is terminally ill, with no hope of improvement and in severe pain • the physician must consult with another physician and file a report with the coroner

46. The Netherlands 2002 • the standard process is • to give a large dose of barbiturates to produce com • and then an injection of curare, which stops respiration and heart rate

47. The Netherlands 2002 • types of patient availing themselves for euthanasia option: • women and men are equal in requesting euthanasia • the average age for men is sixty-three and for women sixty-six • requests are rare in people over age seventy-five and even rarer for those over age eighty-five

48. The Netherlands 2002 • The Dutch Patient´s Association: • „We feel our lives are threatened. We realize that we cost the community a lot. Many people think we are useless, often we notice that we are being talked into desiring death. We will find it extremely dangerous and frightening if the new medical legislation includes euthanasia.“

49. Oregon from 1998 • the patient must • be a capable adult • be an Oregon resident • have a terminal illness, with less than six month to live (!!) • voluntarily request a prescription for lethal drugs • the request must be made both orally and in writing

50. Kevorkian case • june 1990 – JanetAdkinsended her life with the assistance of Dr. Jack Kevorkian • by the end of June 1998, Kevorkian had participated in over fiftysimilareventsusing his suicidemachines