Active euthanasia, passive euthanasia, assisted suicide, early provisions of treatment. There are several “options” for the supporters of the “sweet death”. But when we talk about the end of life we also find expressions such as futile medical care, palliative care, deep sedation. What is it?
Active euthanasia is an action which directly causes the death of the patient by another person, which can be a doctor or a close relative. Basically, a murder.
Passive euthanasia is when the therapies or the nutrition and/or the hydration of the patient are suspended. It has been the case, for example, of Eluana Englaro. In Italy, there is an open debate on the possibility to equate nutrition and hydration to medical therapies.
Assisted suicide is the case of Dj Fabo. The sick person chooses to take his own life with means provided by a third person who, unlike active euthanasia, does not take part directly in the suppression of the patient, that performs the “final” act himself.
Early provisions of treatment as explains Carlo Alberto Defanti, emeritus head physician of the Niguarda Hospital in Milan, member of the Consulta of Bioethics and doctor of Eluana Englaro, “these are statements that the person decides to make when he/she is able to understand, in view of a future situation in which he/she would be in serious condition and no longer able to dispose of himself/herself. Basically, it is an expression of the will concerning therapies that a person will or will not accept in the event that he/she would be in the condition of inability to express their right to agree or not agree with the care proposed, including artificial nutrition and hydration, for diseases or brain traumatic lesions irreversible or incapacitating, requesting permanent treatments”.
Futile Medical Care is an attitude of stubbornness in imparting health treatments that are “disproportionate” in relation to the therapeutic goal and to the specific condition of the patient.
Palliative care are the interventions for the patient (but also for the members of the family) whose clinical course is characterized by an irreversible trend and by a deadly prognosis, that is no longer responding to specific treatments. The aim is to improve as much as possible the quality of life of the incurable person, alleviating the sufferings.
Deep Sedation is a particular aspect of palliative care: the patient who is no longer able to withstand the suffering linked to the disease is put asleep, but death does not occur as a consequence of the sedation. Nothing to do with euthanasia: is the recent case of Dino Bettamin.
But what are the rules on life-ending in the world? In Europe, there are four countries that, according to the latest updates of the Center d’information sur l’Europe, have legalized assisted suicide and active euthanasia. To Switzerland, The Netherlands, Belgium and Luxembourg are added in the rest of the world, China, Colombia and Japan.
THE NETHERLANDS It was the first country in the world to approve the law to legalise euthanasia, in April 2001.
BELGIUM The Euthanasia Act entered into force in September 2002. The Belgian Department has conducted a study to determine how many are the sick people that resorted to euthanasia: in ten years from 2003 to 2013, were recorded 8.752 assisted deaths. The most important growth affects the applicants over eighty, which had not been diagnosed with a tumour and whose death would not have occurred, for natural causes in the short term. Even euthanasia on minors and on new-borns is legal, the only country in the world to allow it.
SWITZERLAND In the Swiss country the law allows the assisted suicide if loaned without “selfish” reasons. A service guaranteed also to foreign citizens, as it has happened for Dj Fabo.
LUXEMBOURG The legislation came into force in March 2009. It provides that it is not a criminal offense and may not give rise to a civil action for damages ”the fact that a doctor responds to a request for euthanasia”.
SWEDEN From April 2010 the passive euthanasia is authorized, while active euthanasia is prohibited.
GERMANY The German Court of Justice in June 2010 gave favourable judgment for passive euthanasia. Although there is no specific law, also active euthanasia is permitted if the will of the patient is clear.
SPAIN Passive euthanasia and assisted suicide are allowed, but not active euthanasia.
DENMARK In Denmark only the early provisions of treatment are accepted.
FRANCE Active euthanasia is prohibited, while the passive one is partially admitted.
GREAT BRITAIN Assisted suicide is banned, prosecuted, like every form of euthanasia, but a judge may authorize it in extreme cases.
THE REST OF THE WORLD Euthanasia is permitted in China in hospitals, while in Colombia is legal from 2015. In the USA, the euthanasia is permitted in some States: the first was the Oregon in 1997, even if the law was opposed until 2006 with the legitimisation of the Supreme Court. The assisted suicide is permitted even to people suffering of depression. Subsequently similar legislation has been adopted by Vermont, Washington and Montana. In Canada, a law to legalise euthanasia was rejected and the situation varies from province to province. Other countries including Australia do not allow euthanasia but allow early provisions of treatment. In Japan when a patient wants to access to the euthanasia is approached by a team that helps him to take a decision.