Dead End

a philosophical problem

Lawyer: ...... and in agreeing to defend you, Doctor, let me make it clear that the code of ethics binding an advocate to his client is as sacrosanct as that between a doctor and his patient. You must tell me everything. If I ask you a shock question, answer me. It might be the very question prosecution counsel asks during your cross-examination. I need to know your answer beforehand.
Doctor: I understand.
Lawyer: Your patient charges that you practiced Involuntary Passive Euthanasia upon her by deliberately causing the removal of hospital services so as to bring about her death. Did you?
Doctor: I most certainly did not.
Lawyer: All I know about euthanasia is what I see in the media or hear on talk-back radio. I am your typical uninformed "John Citizen" but that is about to change. So here we go. When you graduated as a doctor did you swear to honour the Hippocratic Oath?
Doctor: Yes.
Lawyer: The Oath has a clause bearing on euthanasia; "To please no one will I prescribe a deadly drug to my patient, nor give advice which may cause his death." Is that right?
Doctor: Yes. The words vary but that is the substance.
Lawyer: Do you believe euthanasia is justifiable?
Doctor: Yes.
Lawyer: Would you actively practice it?
Doctor: Yes, when by ending a life it releases an individual from an incurable disease or intolerable suffering.
Lawyer: You see no conflict between the ethics of the Oath and the performance of euthanasia?
Doctor: No, not when the patient's suffering is ended.
Lawyer: What about young people coming into geriatric medicine as a career? Will they take the Oath today and euthanase their patients tomorrow?
Doctor: The Oath is no longer insisted upon. Nevertheless, the patient's best interest would still be the doctor's concern.
Lawyer: It's hard enough to understand taking the Oath and practicing euthanasia, but to practice medicine without commitment to a code of ethics? Phew! I will move on to another aspect. Do the public understand euthanasia?
Doctor: Well, yes and no. They mostly understand voluntary euthanasia where to end their life they would ask to be given a lethal injection. Less understood is where the patient asks to be removed from a life-support facility.
Lawyer: I understand the difference. The first is Active Voluntary, which ends the life almost instantly and the second is Passive Voluntary in which the patient fades away. But aren't there other names confusing the issue?
Doctor: Yes. Euthanasia has several forms, being either active or passive. Just euthanasia alone or with the adjectives, Voluntary, Active Voluntary, Passive Voluntary, Involuntary, Active Involuntary, Passive Involuntary, Non-Voluntary, Compulsory. I doubt the public understands.
Lawyer: If they did, would they oppose some of them?
Doctor: I am sure they would.
Lawyer: I have noticed that discussions and newspaper articles tend to be about "Voluntary Euthanasia" and rarely any other? Have you noticed that?
Doctor: Yes. I think it is because the man in the street can relate to it. Many have "put to sleep" a favourite pet to alleviate its suffering. They would want a similar quick, non-suffering death in their own case.
Lawyer: So, because of the mercy they show animals, they, if suffering similarly, would chose voluntary active euthanasia and ask for a lethal injection. But I think that is where the public's thinking stops. Just consider passive voluntary euthanasia. If the public realised that this not only covers stopping a patient's medication, or removing his life-support system, but also the slow starving to death of a comatose patient, would the number supporting euthanasia diminish?
Doctor: Possibly, but in unofficial TV and radio polls there is typically 75% in favour 25% against.
Lawyer: I accept your figures, but point out that those polls are usually quite specific and induce a biased response, even if unintended, from an ill-informed public. The question is posed as '"Are you "For" or "Against" voluntary euthanasia?"' Note the word "voluntary". We know the public don't understand the different forms of euthanasia but in these unofficial polls they have only a black and white decision. Is it any wonder that public opinion becomes polarised when promoted this way?
Doctor: I have noted in talk-backs that the reason that triggers a "For" response is rarely asked or offered, but if someone is "Against" the reason why this stance is held is often asked. If it is on religious grounds the point is often disparaged as an unreasonable attitude.
Lawyer: I think a "For" response tends to be an automatic first choice, even before a person has given it serious thought, it stemming from "I wouldn't let an animal suffer" thinking. Whether "For" or "Against", only opinions of those who have seriously considered the case ought be taken into account. A nation-wide referendum, therefore, ought never take place on euthanasia.
Doctor: I agree.
Lawyer: The public seems to think that there are only a comparative few who want to avail themselves of euthanasia if it becomes legal. In the Northern Territory, Australia, two people were unable to be euthanased because the Senate voted against it. The public responded as though these two cases were the only ones, at that time, involved with euthanasia. I believe the public have little idea of the actual numbers on whom euthanasia is being practiced on a continuous basis.

Pro-euthanasia senator Dr Bob Brown stated that statistics show about 4400 Australians each year are being given a lethal injection. That averages to one every two hours. The number taken off medication, life support systems and food and water is thought to be higher. That means there is one person being written off every hour, of every day, of every year!

Let me now raise the issue of giving a patient a lethal injection. Though this breaks the present law, would you still administer it?
Doctor: Yes, in voluntary cases.
Lawyer: Ok, but what is written up as the cause of death? Do doctors put it as death by lethal injection or as death from terminal cancer, or whatever the dread disease was?
Doctor: The disease would be shown as the cause. The treatment the patient received would be appended.
Lawyer: I suggest that because a lethal injection is illegal it will be described euphemistically to conceal the fact, assuming it is mentioned at all.
Doctor: I grant that "medicalese" can hide a multitude of sins. In many cases the true cause of death will not be entered on the death certificate.
Lawyer: That could, indirectly, prove disastrous on a vast scale. Imagine that you are researching cancer, endeavouring to find a cure, even testing drugs on willing patients. You do a statistical analysis of death certificates but dump your research data because you can't be sure which are true and which are the euthanasia deaths falsifying your figures. This may cause you to throw away a cure because it looks like a failure. Euthanasia may, indirectly, be delaying cures of the very diseases it seeks to ameliorate.
Doctor: That may be so, and I now see another danger. If a euthanased patient's death is not honestly recorded it might seem that the life-saving drug of his treatment was a failure and result in it being withdrawn from other patients.
Lawyer: Do you see the implications? A doctor who practices euthanasia, has to

Doctor: Superficially it sounds bad, but it is the law that needs changing. It could require that more than one doctor be involved in decisions as it was in the Northern Territory.
Lawyer: In the Northern Territory three doctors had to give their approval. One doctor did not need to know the case in question, only approve in principle. This law was under pressure. Pro-euthanasia doctors wanted only two doctors for a legal decision, only one of whom needed to be familiar with the case.
Doctor: I have seen statements to that effect.
Lawyer: Assume a doctor, who had practiced euthanasia before it became legalised, did not like a new law's restrictions. He broke the law in the past when he didn't like it, why wouldn't he break the law again?
Doctor: I suppose that could happen.
Lawyer: I imagine a doctor gets to know his patient extremely well in cases where euthanasia is likely.
Doctor: Of course, but a patient is still a "case". One must not become emotionally involved. Bedside manner is important but first and foremost is the treatment of the patient.
Lawyer: I understand that and agree completely with your concept of a "case". I see a somewhat different scenario when it comes to nursing staff. Their involvement is at a more emotional level. They continually administer to the patients' needs and requests and turn a sympathetic ear to a suffering patient and to the patient's family. Do they ever euthanase patients?
Doctor: God forbid! No!
Lawyer: Tasmanian nurses met to put forward their case for Voluntary Active euthanasia. They were on TV, and some were in tears. Nurses are close to patients; meet their families, children and friends. Sympathy thus extends beyond the patient. Do nurses ever secretly administer a lethal injection without the doctor's knowledge, but at the request of a traumatised family member?
Doctor: It may be so.
Lawyer: Why did Tasmanian nurses have that meeting? Why the tears? Was it because some had administered lethal injections at the request of patients and were looking for a retrospective way out to ease their consciences? If a nurse performs euthanasia it will not be passive, because someone will see that the life support system is withdrawn and know who is responsible. Nurses would use lethal, that is, active, injections. Is this why they wanted Voluntary ACTIVE euthanasia legalised? The situation for doctors who favour euthanasia is quite different. Both active and passive methods are amenable to them. If they put a case it will be for the non-specific Voluntary euthanasia.

A few days after the Tasmanian nurses met, the newspaper told of a nurse from Canberra who was compiling a catalogue of doctors and NURSES prepared to practice euthanasia. How did nurses get involved in euthanasia decisions and practices? It is outside the bounds of their duties. In the same article another nurse confessed that she had twice caused death by illegally administering a lethal injection.
Doctor: There is no way that nurses ought involve themselves in euthanasia decisions. They know next to nothing of a patient's medical status.

Lawyer: I will now return to the legal case brought against you. Let me run over the facts. Mary, your patient, lives in Tasmania but was holidaying in Adelaide when she lapsed into a coma. Although she remained in the coma for quite some time she needed no medication but needed food supplied through tubes. You and Mary's husband, John, stood at Mary's bedside. What did you say to him?
Doctor: I said, "I am sorry to say this, John, but Mary's situation is hopeless. She is in a vegetative state and will never recover. She is brain-dead and knows nothing and can feel nothing. I suggest that you ask for her feeding tubes to be removed so that she can live or die as nature chooses. But it is your decision and yours alone, I can only offer you my best advice."
Lawyer: If John were to follow your advice and Mary were to die, am I right in thinking the pro-euthanasia lobby would have regarded John as a true caring person who had done the right thing?
Doctor: Yes, and would have held him up as an example to the public of what they ought do in similar circumstances.
Lawyer: I understand that John is fairly religious, but what was his reply to your suggestion?
Doctor: He said, "Even though I am satisfied that you have done everything possible for Mary I am not going to take your advice. I want you to continue to provide all that is necessary to keep my wife alive. I intend taking her home to Tasmania and to care for her."
Lawyer: I will give the sequel from my preliminary notes. 'Normal support continued. Some weeks later, Mary suddenly awoke. She was as mentally alert as before lapsing into the coma. She is now out of hospital and leading a normal life. Amazingly, Mary was able to repeat the bedside conversation between the doctor and her husband. Although she was in a coma and the doctor's diagnosis was that she was brain-dead, she heard every word. The only apparent consequence of her stay in hospital is that she now stumbles.' Is all this a fact?
Doctor: Yes.
Lawyer: The case against you will probably hinge on Mary's stumbling; the claim being that its manifestation resulted from, and is evidence of, your deliberate malpractice, in:-

Doctor: I am not guilty!
Lawyer: Do you agree that if your involuntary passive euthanasia advice had been followed Mary would have suffered a prolonged, agonising death?
Doctor: I believe that to be so.
Lawyer: Have you formed any estimate of the number of patients who have lost their lives as a result of your wrong diagnoses?
Doctor: No, no, no, no!

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