Several weeks ago on November 1, 2014, 29-year-old Brittany Maynard1, who suffered from terminal brain cancer, took drugs to end her life surrounded by her family. This was preceded by months of despair and anguish, but also by love and a lust for life as the young woman describes in several videos she recorded to fight for the right to die with dignity.
Many see it as a natural human right to determine when their own life should end. However, you will look for this notion in vain in the Charter of Human Rights. There are still many different laws all over the world on this subject. This type of suicide always requires the assistance of other people – be it to prescribe the necessary drugs or to administer them. This is why many debates are less about the sick person’s wish to die and more about the legal consequences for the helper.
The topic of euthanasia is currently once again being discussed in the German Parliament. The goal is to finally provide legally binding regulations. However, a decision is not expected until the fall of 2015. Yet it already becomes apparent that active euthanasia, that is the intentional administration of a lethal dose of drugs for instance will remain illegal and regulated by Section 216 of the German Criminal Code (German: Strafgesetzbuch)1. In the orientation debate on November 13, 2014 in the German Parliament, Federal Minister of Health Hermann Gröhe reminded members that people’s fates are at stake in this debate and emphasized that he disapproves of the request to die:”I object to a romanticization of suicide as an act of true human freedom. This is why I want assisted suicide not to become a publically advertised treatment alternative; as a member of parliament I advocate for the criminal liability of organized assisted suicide. “
How do you judge a rendered judgment?
Germany is still debating it, while assisted suicide is already permitted in the Netherlands and in Belgium. There was no subsequent increase in suicide rate. For many sick people, just the prospect alone of being able to end their own life when the pain becomes too overwhelming seems to be a consolation, which lets them persevere until their natural end. Those, who sometimes appear to be neglected in this discussion, are those asked to assist with the suicide. Physicians. It is usually two physicians, who make the decision; this is how it is determined whether a patient receives the lethal drug mix via prescription in Switzerland and the U.S. for example. To do this, the physicians need to identify to what extent the sick person is still able to make decisions and judgments. This isn’t always an easy task. This is why the Ethics Commission of the Swiss Academy of Sciences for instance wants to prepare new principles of treatment. Manuel Trachsel2, Assistant Professor at the Institute for Biomedical Ethics at the University of Zürich, is being quoted in the accompanying press release:“Assessing someone’s decision-making capacity is anything but trivial“ and ”most physicians apply their own rules of thumb to determine whether a patient is capable of making decisions or not.“ Only a few people are familiar with the already existing defined guidelines or they are simply not being applied. The researchers refer to a study called “End of Life“, which surveyed approximately 760 physicians from all over Switzerland. It remains to be seen how comprehensive these worked out principles will be and whether they are actually able to do justice to borderline cases. After all, it is less problematic to verify the decision-making capability of younger, terminally ill patients like Brittany Maynard compared to that of older persons with potential dementia. Moral conflicts for some physicians are inevitable in this case.3
Whatever the outcome of this discussion is going to be, it is clear that the further development of palliative medicine and care must not suffer because of this. After all, aside from dying with dignity, the dignity of life must be respected.
2: Trachsel M, Hermann H, Biller-Andorno N. Cognitive Fluctuations as a Challenge for the Assessment of Decision- Making Capacity in Patients with Dementia. American Journal of Alzheimer’s Disease, 2014. doi: 10.1177/1533317514539377
3: Find out more on this subject in an interview with MD-PhD Ralf Jox