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Euthanasia in all its forms!

Posted on 2013/04/02 at 2h28  Categorie Opinion from medical professionals

  • Imprimer

Ethicist and nurse

After working for a decade in a hematology-oncology service and another ten years in a palliative care service, I arrived, in all fairness to the conclusion that euthanasia is not the real answer expected by sick and severe suffering people. If the goal of medicine is "to serve life and promote health," there are other ways, more civilized and more responsible, to get there than to take life away to remove mental suffering or rebel pain.

I am even more appalled today to the proposed extension of decriminalization of euthanasia, concerning the "demented" patients in the early declaration and children suffering from an incurable disease, being in a situation of insatiable suffering.

I ask myself several questions:

What category of people are we putting behind the term "dementia"?

Some scientific literature suggest three types of dementia: dementia acquired (Stroke, complications resulting from alcoholism, some cases of epilepsy, cancer and infectious diseases, etc.), dementia with genetic trait (monogenic diseases such as Huntington's disease, etc.) and multifactorial dementia (Alzheimer's disease, etc.)..

Others distinguish vascular dementia, degenerative dementia and mixed dementia.

In fact, the term "dementia" covers so many different realities that may be perceived in a very subjective manner, according to each, causing confusion and misunderstanding.

I supervise, for 5 years, psychiatric services and I often meet people with dementia who live in "another reality" than ours but they are not in a state of unbearable suffering or anxiety about death. These people, in the vast majority are in "demand of life" and really need to be shown by a verbal and non-verbal language, that they remain worthy and respectable people, and even if we are not on the same rational level, the message of attention that we bring to them is heard and understood on an emotional level.

Finally, what look society does have on these people with dementia?

As of when does one believes a patient with dementia may have recourse to euthanasia?

How to estimate objectively the disease progression? Are we at the beginning, half or at the end? Who will evaluate and according to what criteria?

Isn't there a risk that this proposed extension opens the door to other incapacity, close to insanity, as we know in psychiatry?

Given that over half of the patients arrive in psychiatric unit, with a loss of vitality, suicidal ideas and wholesale disorders self-esteem, risk excesses seem obvious, with or without prior notification.

Are we really convinced that outside pressure will not occur?

Even if we know that the legal definition, as it stands, has once and for all allowed, to eliminate from our vocabulary the expressions euthanasia "passive and active" and "voluntary and involuntary", the danger of external pressure exists and I have met them. I've heard doctors in training, say that they increased doses of morphine with the intention of practicing "euthanasia called passive and involuntary" at the request of the family because it felt that the cognitive state of patients was too corrupt. This kind of euthanasia is not declared as such, of course.

An early statement without time limit, is it not improper, preventing a person to evolve in its deepest desires?

What a person thinks at 50 years old is not necessarily what she will think at 70.

My question is even more fundamental: how to enable "a person who is no longer conscious of their own person" to make a decision of programmed death, even if ten years ago, she wrote a forward declaration? Is this statement still reliable? Could the person may not have acquired with age, another vision of the world, and the fragility of the disease? Perhaps the person is not so unhappy that she feared?

Therefore, is it another person who will validate this early statement? Are we going to rehabilitate this very unhealthy expression "called involuntary euthanasia", which resemble so much to a murder?

As for seriously ill children living in great distress, the proposal is even more worrying. We no longer have to prove that over 90% of all pain can be relieved and the remaining 10%, we can induce an occasional or intermittent sedation for patients, especially younger ones. We also know how the family environment is necessary and essential to their quality of life. Are we going to ask the parents permission to "kill" their child or are we going to "kill" them regardless of their will?

What is "child capable of discerning"?

This expression, highly subjective, can open the door to any demand, regardless of age. There are children capable of discernment at 12 years and others who are 50 and are still in a failure of discernment. How to evaluate the capacity of discernment, in a rational and objective way?

Should we inform the child about the possibility to be euthanized?

How the child on the top of its 12 or 15 years, knows that euthanasia exists and is decriminalized under certain conditions? Who will tell them? The parents? The doctors? And how?

Could it be this way: "You know, my boy, if you wish, you can request euthanasia ... "? How else to say it anyway? But besides the fact that such a proposal is of great violence, aren't we at risk in this way to induce such a request?

During my ten years of onco-hematology, we received in consultation once a week, children of all ages suffering from diseases of varying severity. I have never read in a single one of their faces, resignation and fatalism. Instead, I've always been moved by their courage and love of life ...

Imagine how to introduce the concept of euthanasia in this area where life is in bud, even if it is ill?

What happens to family members who may feel complicit of this euthanasia?

I really think that we'll talk soon about the "survivor syndrome" which is already present in many adults taking badly the death of a loved one by euthanasia.

Allowing a child to ask for euthanasia, knowing that the parents will continue to live with this observation of programmed death, may have serious consequences in terms of guilt and responsibility.

Finally, I regularly hear from the mouths of our politicians that health is expensive and I wonder ... What does that mean? Is that so regularly heard this chorus would have an influence on how to handle the most suffering patients of our society?

The Senate, which normally represents the "wisdom" of the country will it have enough ethical discernment to prevent abuses and prevent the irreversible?

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