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American Medical Association Code of Ethics Euthanasia is the administration of a lethal agent by another person to a patient for the

purpose of relieving the patients intolerable and incurable suffering. It is understandable, though tragic, that some patients in extreme duress--such as those suffering from a terminal, painful, debilitating illness--may come to decide that death is preferable to life. However, permitting physicians to engage in euthanasia would ultimately cause more harm than good. Euthanasia is fundamentally incompatible with the physicians role as healer, would be difficult or impossible to control, and would pose serious societal risks. The involvement of physicians in euthanasia heightens the significance of its ethical prohibition. The physician who performs euthanasia assumes unique responsibility for the act of ending the patients life. Euthanasia could also readily be extended to incompetent patients and other vulnerable populations. Instead of engaging in euthanasia, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication. (I, IV) For those who advocate euthanasia as a solution providing a death with dignity [which I strongly challenge as completely unfounded], I provide some expert opinion by physicians who have studied the subject in depth: Carlos Gomez, MD, Ph.D., wrote in his book, Regulating Death - Euthanasia and the case of the Netherlands, the following: p. 138: "...I remain unconvinced that under current regulations the practice [of euthanasia] is not abused those in the United States who point to the Netherlands as a public policy model for assistance with suicide have not, I would suggest, looked carefully enough. If the Netherlands with its generous social services and universal health coverage - has problems controlling euthansasia, it takes little effort to imagine what would happen in the United States, with a medical system groaning under the strain of too many demands on too few resources." Herbert Hendin, MD, Executive Director of the American Suicide Foundation and Professor of Psychiatry at New York Medical College has written the following in his authoritative analysis of euthanasia in the Netherlands: Seduced By Death - Doctors, Patients and the Dutch Cure: "The doctors who help set Dutch euthanasia policies are aware that euthanasia is basically out of control in the Netherlands. They admitted this to me privately. Yet in their public statements and articles they maintain there are no serious problems...." p. 14 "The experience of the Dutch people makes it clear that legalization of assisted suicide and euthanasia is not the answer to the problems of people who are terminally ill. The Netherlands

has moved from assisted suicide to euthanasia, from euthanasia for people who are terminally ill to euthanasia for those who are chronically ill, from euthanasia for physical illneses to euthanasai for psychological distress, and from voluntary euthanasia to involuntary euthanasia (called "termination of the patient without explicit request"). The Dutch government's own commissioned research has documented that in more than one thousand cases a year, doctors actively cause or hasten death without the patient's request." p. 23 "Virtually every guideline established by the Dutch to regulate euthanasia has been modified or violated with impunity." [emphasis added] p. 23 "In the selling of assisted suicide and euthanasia, words like "empowerment" and "dignity" are associated only with the choice for dying. But who is being empowered? The more one knows about individual cases, the more apparent it becomes that needs other than those of the patient often prevail. Empowerment flows toward the relatives, the doctor who offers a speedy way out if he cannot offer a cure, or the activists who have found in death a cause the gives meaning to their own lives. The patient, who may have asked to die in the hope of receiving emotional reasusurance that all around her want her to live, may find that like Louise she has set in motion a process whose momentum she cannot control. p. 43-44 "Euthanasia advocates are arguing that if there are ten cases in which euthanasia might be appropriate, we should legalize a practice that may wrongly kill thousands." p. 44 " The alarming statistics in the Remmelink Report indicate that in thousands of cases, decisions that might or were intended to end a fully competent patient's life were made without consulting the patient." p. 77 "The Dutch seem reluctant to acknowledge that the doctor's role in euthanasia is more than that of a neutral observer responding to a patient's needs. This is particularly evident when families pressure patients to request euthanasia .... more requests for euthanasia came from families than from patients themselves." [emphasis added] p. 93 Speaking about how doctors make decisions to implement euthanasia, even when the patient does not request it himself, "The Dutch courts have implicitly encouraged physicians to make such value decisions. Originally the courts interpreted force majeure as applying if virtually anyone in the doctor's situation would have acted as he did, essentially saying that basic human decency and compassion compelled such action. Subsequently the courts have interepreted it as applying if merely any other member of the medical profession would have acted as did the doctor, which is quite a different standard. Jos Welie, an ethicist formerly at the University of Nijmegen, points out that this ruling elevates physicians to a superior moral status, making their judgments on life and death always just." [emphasis added] p. 94

That is an extremely relevant observation, when considering so-called safeguards some suggest to put in place to prevent abuse of euthanasia and/or physician assisted suicide. A physician advocate of euthanasia, when working with a prospective euthanasia candidate, could refer the patient to a known physician supporter of euthanasia for a second opinion, and both being advocates of euthanasia, would of course come to the conclusion that euthanasia was appropriate, even if many other physicians would strongly disagree. This type of reasoning has resulted in the medical killings of depressed patients, chronically ill and others. "Dr. Richard Fenigsen, ... was a strong critic of involuntary euthanasia, which he considers to be widespread. [in the Netherlands] ...his contentions concerning the prevalence of involuntary euthanasia, ... were supported by the Remmelink Report." p. 100 "Chris Rutenfrans, a strong secular critic of euthanasia in the Netherlands, has a doctorate in law and criminology. Together with Caterina Dessaur, writer and professor of criminology at the University of Nijmegen, he had written a book suggesting the ambivalence of most requests for euthanasia, stressing the coercion of the patient that often accompanied the decision to perform it, and indicating how frequently it took place without the consent of patients." [emphasis added] p. 106 Excellent palliative care provided in hospice settings, either in the home or a facility is the preferred and truly compassionate way to provide a death with dignity. Pain relief modalities must be taught more in medical and nursing schools and put into practice using the latest medications and treatments for pain and relief of other distressing symptoms.

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