Which countries allow euthanasia? Ethical issues of euthanasia

November 3, 2019
Tips for tourists
Elena Spi

In medical practice, there is such a patient’s right - an unauthorized decision about care, but only a few know in which countries euthanasia is allowed. Switzerland has long attracted tourists not only for its landscapes, but also for its opportunities to die without suffering. This is prohibited in Russia and the UK. Probably, bills are built not only on the basis of the will of the people. Moral standards, ethical and ecclesiastical speculations and arguments are taken into account.

What is euthanasia?

Euthanasia is the act of ending the life of a very sick person to put them out of their suffering. The person who undergoes this procedure usually has a terminal condition. But there are other cases where some patients want their life to end. Therefore, attitudes towards euthanasia vary, but among patients they are predominantly positive, since not everyone is ready to put up with pain and suffering before death.

In many cases this is done at the request of the patient, but there are situations where they may be too ill and the decision is made by relatives, doctors or, in some cases, the court. It would be fair to understand why euthanasia is allowed somewhere, but in other countries it is strictly prohibited for religious reasons:

The term is derived from the Greek word euthanatos, which means easy death.
Euthanasia is illegal in the UK, where it is illegal to help someone kill themselves.
Voluntary euthanasia, or assisted suicide, can lead to imprisonment for up to 14 years.

This issue has been at the center of heated debate for many years and is surrounded by religious, ethical and practical considerations.

Attitudes towards euthanasia

The procedure raises a number of tantalizing moral dilemmas:

Is it ever right to end the life of a terminally ill patient who is experiencing severe pain and suffering?
Under what circumstances can euthanasia be justified, if at all?
Is there a moral difference between killing someone and letting them die?

These arguments are based on people's different ideas about the meaning and value of human existence. Therefore, patients themselves often ask questions about which countries allow euthanasia. Perhaps this gives them the opportunity to go to a place where the person, in his opinion, will receive help.

Should people have the right to decide matters of life and death? This is an eternal question that will never be firmly and unambiguously resolved. There are also a number of arguments based on practical issues. For example, is euthanasia allowed in Russia or not, and why are people not allowed to resolve such situations on their own?

Some people think that the procedure should not be allowed, even if it was morally right, because it can be abused and used as a cover for murder.

Suicide tourism

You can obtain the right to assisted death only in a few states. In this regard, a service such as medical or suicide tourism has appeared. Seriously ill people who cannot undergo euthanasia in their own country come specifically for this purpose to places where it is permitted. So far, only Sweden and Zurich (Switzerland) officially accept “tourists”. There are clinics in these countries that provide this service to both local residents and foreigners.

The scientific publication Journal of Medical Ethics claims that over the past 5 years the number of foreigners who came to Zurich for an “easy death” has doubled. In May 2011, a referendum was held in which Zurich residents had to vote for or against the abolition of suicide tourism. 84.5% of respondents voted for euthanasia to remain legal.

Suicide or the right to care?

Most people believe that unbearable pain is the main reason why people agree to euthanasia, but some studies in the US and the Netherlands found that less than a third of requests for euthanasia were due to severe pain.

In terminally ill people, quality of life may be seriously impaired by physical conditions such as:

incontinence;
nausea and vomiting;
dyspnea;
paralysis;
difficulty swallowing.

Psychological factors that make people consider the procedure include depression, fear of loss of control or dignity, feelings of burden, or aversion to dependency. Where euthanasia is permitted, such situations are not considered murder.

The term “mercy killing” is distinguished and used in situations where the patient suffers greatly. Killing is stopping the taking of measures that would allow a person to survive.

The following are not euthanasia:

Discontinuation of medically futile treatment when the burden of such treatment outweighs the benefit.
Providing treatment aimed at relieving pain and other symptoms, even though the treatment very rarely may result in some predictable risk of shortening life, known as the "double effect," when the doctor reduces pain rather than ending life processes.
When a mentally competent person decides to refuse treatment. Doctors cannot force patients to undergo treatment against their will, and it is legal for a patient to refuse treatment. If the patient dies, it is not euthanasia.

Arguments for the procedure may be as follows:

It does not include stopping or starting medically futile treatment, alleviating pain when the goal is to eliminate the pain but not the patient, or withholding medical treatment from a competent patient. Euthanasia is illegal in the UK under the common law crime of murder.
Voluntary euthanasia is when a competent patient agrees but does not commit to making a decision to end his life.
Assisted suicide is when someone helps another person commit suicide. In the UK it is illegal under the Suicide Act 1961, which states that a person "who aids, abets, counsels or procures the suicide of another person or the attempt of another to commit suicide is liable on indictment."

If such actions are not self-interested, then this is the norm for both parties. They also introduce the definition of a person's living will: a document prepared by a mentally competent person in which a person states that he does not want to receive medical treatment and care if he becomes incompetent in the future and can no longer express his wishes himself.

Ethical norm of euthanasia

Palliative care is the comprehensive care of patients with an incurable, progressive illness that is expected to end in death, providing physical measures such as pain control and psychological, social and spiritual support. This guides the management of hospitals in whose countries the act of “help” is allowed. At the same time, ethical problems of euthanasia remain, because some may use such measures for their own purposes. It is no secret that it is enough to pay for the procedure. And different cities have their own prices.

Where is euthanasia allowed?

The following is a list. It helps you find out exactly which countries allow euthanasia.

Netherlands - legally allowed by the Supreme Court since 1984. It began to be used legally and officially in 2002. It is performed exclusively on terminally ill patients.
Belgium - since 2002 you can officially do this. Allowed for everyone who experiences physical pain and suffering. Since 2014, child euthanasia has been legalized.
Switzerland has the most liberal attitude towards the process of dying. In Zurich, up to 200 people die every year from the “injection”.
USA - each state sets its own rules. However, in Oregon, Washington, Montana, Vermont and California, the procedure is officially permitted.
Luxembourg - can be carried out since 2009. The rules are the same as in Belgium. You can only choose a doctor yourself, and relatives can be present.
Colombia - Euthanasia was carried out legally for the first time in 2015. The government allowed a sick 79-year-old man to commit suicide within the walls of the hospital.
Canada, where euthanasia is officially allowed, previously provided for a punishment (until 2015) of 14 years in prison. This provision has now been found to breach the Charter of Human Rights to Care.

Above is a list of countries where euthanasia is allowed. To this day, many cannot understand why such measures were not allowed before. Now children can be given an injection that will ease their suffering, however, if the children themselves want it. Accordingly, parents decide for children under 7 years old.

Modern Application

Today, the practice that the Reich used under the name “euthanasia” is recognized as a crime. Because of this, the perception of easy death in society has been greatly distorted; most states consider it murder. However, in 2001 the Netherlands legalized this procedure. Since then, a fierce debate has begun about the legality of euthanasia for humanitarian reasons. In countries where it is permitted, the “good death” is applied to terminally ill people for whom medicine cannot help. Also, in countries where it is legal, euthanasia can be performed on newborns with brain atrophy. Children and adults who live only with the help of life-supporting equipment are helped to die with the consent of their relatives.

To perform euthanasia, doctors must be completely sure that the patient cannot be saved. For these purposes, the patient undergoes a comprehensive examination, including by a psychiatrist. Even after a personal request to “die with dignity,” the patient needs to make two statements, with long breaks between them. Switzerland has allowed euthanasia for mentally ill people if their illness cannot be cured. The Swiss Federal Tribunal argued its decision by arguing that mental disorders in some cases cause as much suffering as physical ones.

How is the procedure performed?

Knowing which countries have euthanasia, you can inquire about the procedures. The most common prescription is for intravenous injection. The medicine can be purchased for 200-400 dollars (equivalent to the country’s currency). There are also several types of procedures, which are carried out accordingly in different ways.

However, when a patient is denied action or medication for the primary purpose of causing or hastening death, it is passive or indirect euthanasia. These measures may include withholding or eliminating normal measures such as food, water (hydration), and oxygen. To reduce the chance that euthanasia medications will cause vomiting, an antiemetic should be given.

In the Netherlands, the practice involves giving the patient a comatose injection followed by a second injection to stop the heart. Coma is first induced by intravenous barbiturates and then a muscle relaxant. The patient usually dies as a result of muscle relaxant-induced anoxemia. When death is delayed, intravenous potassium chloride also precipitates cardiac arrest.

Types of euthanasia: which path to the next world can you choose?

Assistance is provided by a specialist doctor after a positive decision of the commission. Measures are being taken to help decide on such an action. They are distinguished not by the composition of the substance introduced orally, but by the procedure that ultimately leads to death:

Injections - a lethal drug is injected that affects the respiratory tract, the person dies due to the concentration of poison in the blood.
Disconnection from the artificial respiration apparatus only after biological death has been established.
A person who is in a comatose state (less than 4 weeks) cannot be disconnected from mechanical ventilation, accordingly, the injection can be administered if he regains consciousness and measures are taken to euthanize him.
When a person voluntarily stops taking medications because they do not want to continue treatment that may or may not help them get better (voluntary drug withdrawal).
The right to euthanasia can be obtained if the patient is in pain - painkillers do not help, and the patient cannot endure it without permission.

However, there is an important nuance! Euthanasia or deliberate poisoning with lethal substances is not euthanasia, since only those substances that help to pass painlessly into another world should be used for the procedure.

Opinions of doctors and experts

Above we have already given a list with a reminder about which countries allow euthanasia. In Russia, this procedure is prohibited by law. Moreover, any refusal of resuscitation or treatment prescribed by a doctor after emergency hospitalization is considered a refusal to live. After all, it is specific measures that help save a person, and if you do not adhere to this, the patient voluntarily dooms himself to death. In such cases, people should not be allowed to leave hospitals or be discharged at their request or at the request of their parents.

Incurable patients can resort to killing substances if they have drawn up a notarized request in advance, which specifies how and how to proceed in the event of a fatal illness. At the same time, they often bequeath their organs to other people, if this is possible in their situation. Do not confuse resuscitation with euthanasia - these are different things, since no one can say at what point the heart will stop.

Other cases: prescribing painkillers to patients. The illustrative story with Dr. Khorinyak caused a flurry of bewilderment, because the doctor helped a terminally ill patient not feel pain, relieving him of suffering. Lawyers stated in the media that the drugs had no effect on the speed of death; on the contrary, they helped the patient fight for 3 years to preserve his life:

The hopelessly ill are those who cannot be cured. We can only hope for a miracle, which is not excluded in medical practice. Sometimes cancer patients recover when doctors give no chance.
Hospice and palliative care are the only option for patients doomed to die.
But the hospice in Zheleznogorsk is not ready to provide assistance and use the euthanasia procedure. The doctors turned out to be unprepared for such actions - this would mean taking responsibility for the death of the patient.

Some people resort to the help of Swiss colleagues. Tourists come there for euthanasia, paying for treatment, procedure and stay in the ward. The cost of services can vary between 4-8 thousand euros.

List of used literature:

Akopov V.I. Collection of reports from the first international conference “Society, Medicine, Law” / V.I. Akopov, A.A. Bova. – Kislovodsk, 1999. 5 p.
Zubris G. Eitanasia is illegal / G. Zubris // Medical newspaper No. 3. - 1997.
International Code of Medical Ethics.
Millard D.W. The problem of euthanasia / D.U. Millard and clinical psychiatry. No. 4. – 1996. 101 p.
Sudo Jacques. Euthanasia / Jacques Sudo – M. 1987.
Uranova V.N. Medical associations. Collection of official documents / V.N. Uranova. – M. 1995.
Foot Philip Euthanasia / Philip Foot // Philosophical Sciences No. 6.– 1990.62 p.
Yarovinsky M.Ya. Good death / M.Ya. Yarovinsky // Medical assistance No. 9. –1996. 35 s.

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The attitude of the church towards euthanasia

Many argue that the right to choose when to die is a basic human right. At the same time, the ban on euthanasia is a punishment, because it is the Lord who decides the fate of a person. A mortal does not have the right to be born and die where he wants.

While those who belong to the Christian religion may argue that the time, place and manner of death should be left in the hands of God. But there are other religions that believe that dying in an act of religious fanaticism is a fundamental right and leads to an afterlife in heaven.

All this may be "true" in the eyes of believers, but whenever a question of procedure arises, the argument almost immediately turns into "suicide", defined as death by one's own hand. Similar opinions on euthanasia have been documented. However, there remain countries that fully support human rights.

Summing up

There are many people who share Michael Winner's opinion: every year more than 200 tourists, mainly from the UK, Germany and France, come to Switzerland to leave this world. The procedure is as follows: a patient who decides to die must meet for consultation with several clinic staff, as well as with an independent specialist. The commission evaluates the doctor’s documents and then schedules an additional meeting after some time. And directly during the euthanasia procedure, a few minutes before the lethal injection is administered, according to the law, doctors once again remind the patient that the injection will kill him.

So, today the only destination where you can get a lethal injection legally is Switzerland. The idea of euthanasia is slowly conquering country after country, but still remains revolutionary. Most of all, this is due to the fact that it contradicts the Hippocratic Oath:

“I will not give anyone the lethal means they ask from me and I will not show the way for such a plan.” Hippocrates. Selected books.

But at the same time, today in the world medical community the Hippocratic Oath is increasingly opposed to ideas about the quality of life and the patient’s right to die. Which side are doctors choosing today? The results of a survey of Russian doctors are interesting. 51.5% and 44.8% of doctors aged, respectively, from 41 to 50 and from 51 to 65 years old, to the question “Do you consider euthanasia acceptable?” They answered: “I never thought about it.” At the same time, 49% of doctors aged 21 to 30 gave a positive answer. This survey shows that the younger generation of domestic doctors today is thinking about euthanasia and considers this idea acceptable and humane.

Is it allowed among children?

Euthanasia for children is not yet legal in countries where it is performed for adults. However, in Belgium and the Netherlands it is already possible, and Canada is preparing to change laws. Doctors and the government of the Netherlands have arguments in favor of euthanasia among children. But not all citizens are able to accept such arguments as opposed to their conjectures - voluntary death for a child.

There, children under the age of 12 are allowed to be euthanized, with parental permission required until age 17. Infanticide is also openly practiced by Dutch doctors, although it is technically illegal. Indeed, the Groningen Protocol, a bureaucratic checklist published by Dutch pediatricians, outlines which terminally ill and disabled children may have such a right. Let's take a closer look:

The Supreme Court of Canada upheld the right to assisted suicide in 2015, followed by legislation in national and provincial parliaments. The law generally ensures that the procedure is available to adults experiencing intractable suffering—as defined by the patient—in circumstances where death is reasonably foreseeable.
There are currently serious discussions about extending this license to children. This development is especially troubling for the United States, given that Canada is its closest cultural cousin.
The Canadian medical establishment has made its agreement clear. The Pediatric Society previously released a position paper entitled "Medical Assistance in Dying: A Children's Perspective." The document is not at all critical of extending the law on euthanasia to minors.
Moreover, the statement contains recommendations on how to carry out child euthanasia, if the law allows it. By refusing to oppose legalization or even make a single substantive argument against moral propriety, the public is implicitly supporting policies that would allow the killing of sick and disabled children.

A staggering 11.2% of respondents reported that they had already had “preliminary discussions” with parents about killing their seriously ill mature children, while child euthanasia remains illegal in Canada.

What about euthanasia for "never competent children":

Forty-five respondents reported receiving written requests from parents to euthanize their children.
Half of the requests were for children under one year of age. Child suicide, Dutch style.
Thirty-two percent of doctors surveyed said they would approve the procedure for minor children "in rare cases involving terminal illness or intractable pain, as long as the process is closely supervised."

Whether euthanasia will be allowed in Russia or not is still unknown. But the authorities are not yet ready to discuss such disputes within the framework of the law.

Statistics

The UN and WHO do not provide global reports on the development of assisted death. However, statistics from individual countries show a sad demand for such a service. In the Netherlands and Belgium, the annual increase in euthanasia performed has been 5% since 2008. Statistics Switzerland published data for the period 1998 to 2009. In 1998, 43 deaths were registered, in 2009 there were already 300 deaths from euthanasia. In Zurich, 300 foreigners receive this kind of “charity service” every year, and this figure is growing.

Every year the number of people over the age of 80 who have resorted to an “easy death” is decreasing. The number of cancer patients under the age of 40 who have resorted to euthanasia is steadily growing. Such indicators are associated with an increase in cases of malignant tumors and the lack of a cure. According to data from Switzerland, 44% of cases of “legal suicide” are cancer patients, 25% are diseases of the cardiovascular system and central nervous system, and another 3% are depression.