Extracto del boletín núm. 43.
DMD NEWS, SPAIN
Excerpt from bulletin N. 43.
DMD Bulletin 43 June 1997
(Translation: Arthur L. de Munitiz)
EDITORIAL
On the 4th April several members of our association appeared
before the Justice Commission of the Parliament of Catalonia
following on the invitation issued by the President Joan Raventos
after the members of the commission voted unanimously in favour
of the appearance.
For two and a half hours, our president Salvador Paniker, vice
president Juana Betancor and assessor of penal matters of the
Association and professor of Penal Law, Jean-Josep Querait
replied to questions as to the objectives and activities of DMD
put by members of several political parties. The session took
place in an extremely courteous and friendly manner. Those
deputies who spoke asserted that they were personally in accord
with the defence of the right to die with dignity which is
maintained by the DMD Association. Summarising the spirit of the
meeting the P.S.C. deputy Xavier Guitart proposed that topics
related to intimate areas, such as that of voluntary euthanasia
should be voted in parliament according to individual conscience
and not on party lines. Guitart presented to those attending a
super party collaboration to arrive at legal regulation as to
voluntary euthanasia.
The session was also attended by the President of the Bioethics
Commission which is a part of the Health Department of the
Catalan Government, Lluis Monset. Mr Monset explained the work
done by that commission. Among them was the study of the Living
Will as a specific form of informed consent. The Bioethics
Commission has performed its study starting with an interview
last year with our president Salvador Paniker and our vice
president Juana Betancor with the Counsellor of Health Mr Rius to
whom they delivered an extensive dossier on the matter of Living
Will as well as examples of Living Wills prepared by our
association.
The majority of the press and other media in all of Spain have
reported extensively on this appearance. Finally in this Bulletin
we receive from Colombia the very important news that the
Constitutional Court has issued a judgement in favour of
voluntary euthanasia. This information is extremely relevant and
a sign of the change that is taking place in the social
conscience of some countries of South America.
NEWS OF INTEREST
Page 4
The Parliament of Catalonia seeks information as to
euthanasia. The DMD Association explained today, for the
first time in a parliamentary Spanish forum, the reasons why it
requests the legal regulation of euthanasia, the ERC, Mixed
Group, IC-EV and PSC parties expressed a position favourable
towards regulation of this practice which the association
president, philosopher Salvador Paniker described as a
fundamental right whereas the PP party expressed some
reservations and the CIU party put emphasis on the need for
teaching about death before it is actually confronted.
This appearance took place by petition of the Government itself
since last December the Catalan chamber requested the Government
to make a study, before 1998, as to the legal possibility of
establishing in Catalonia the Living Will, a document in which
the person in question expresses the wish that in the case of
terminal and irreversible illness, life should not be prolonged
artificially.
This decision was taken after the ERC party presented a proposal,
not an actual bill, for the regulation of Living Wills. The CIU
party accepted a vote on the proposal but with an amendment that
instead actual establishment of Living Wills there be undertaken
a study on the matter. This has been assigned to the Commission
Assessing Bioethics of the Department of Health whose president
Lluis Monset was also present during the hearing.
Mr Paniker stated "The Right to Die with Dignity is a human
right of the greatest importance. It forms part of personal
liberty and self determination. Since it has become possible for
medicine to prolong life in inhuman conditions the debate on
euthanasia has intensified" declared Paniker ("El
Pais", 5 April 1997).
Proposal, not a Law for depenalizing euthanasia.
Deputy Pilar Rahola, part of the Mixed Party of the Congress of
Deputies presented on 7th March 1997 a proposal not for
legislation requesting the Government to initiate a legal
procedure which de penalises active or passive actions implies in
the exercise of the right to voluntary euthanasia.
Although Pilar Rahola proposes to revise and make adequate the
present Penal Code, in particular Article 143, we must not forget
that there are other alternatives which would allow legal
exercise of this right should agreement on modification of the
Penal Code encounter too many political difficulties. Consider
the compromise solution that transitorily was arrived at in
Holland and that is clearly explained in the article Present
state of legalised assistance to suicide which is published in
this bulletin.
The expression of motives made by Mrs Rahola finds itself fully
in line with the policy adopted by the DMD Association since its
founding. Let us remind ourselves that also on 11 November 1996
last the deputy of the Esquerra Republican party of Catalonia,
Joan Ridao also made a proposal, not for a law, before the
Catalan legislative assembly. The Catalan Parliament agreed to
start a study on the feasibility of the preparation and
distribution of a Living Will in the area of Catalonia within a
year. Concerning the matter we gave full details in our last
Bulletin.
The Colombia Constitutional Court decides in favour of
euthanasia. A judgement of the Constitutional Court does
not impose a prison sentence on those doctors who cooperate with
terminal patients who opt to die, thereby supporting euthanasia.
The Court studied a petition concerning the article of the penal
code that punishes the so-called mercy killing, supported it, but
made an observation: when there is consent of the patient the
assisting person will not be held responsible because such
conduct is justified. The publication of the judgement has
highlighted the debate on euthanasia in Colombia. The country
appears divided in two: on the one side those who think that life
belongs only to God and on the other those who support the
individual right to opt for death in the event of terminal
illness.
It was foreseeable that this split would cause disturbance in a
society as Catholic as that of Colombia which is still bound by a
concordat with the Vatican. But it is a sign that things are
changing. Therefore our president Salvador Paniker has sent
congratulations to Miguel Trias Fargas who is president of the
Foundation for the Right to Die with Dignity of Colombia.
New Directors for the World Federation of Right to Die
Societies.At the eleventh Congress of the World
Federation of Right to Die Societies held in Melbourne
(Australia) in October 1996 the following directors were elected:
President: Hugh Wynne
Vice-president: Mary Gallnor(Australia)
Secretary: Malcolm Hurwit(UK)
Treasurer: Frank(New Zealand)
Assistant Directors:
Aycke Smook(Holland)
Ken Minami(Japan)
Meinrad Schaar(Switzerland)
Margarita Appel(Sweden)
Jacques Pohier(France)
Editor of the Bulletin of the World Federation: Derek Humphry
The next congress will be held in Zurich in 1998. The
date is yet to be determined.
Given that our association was unable to send to the Melbourne
Congress any representative, on account of the cost involved, we
publish in the Articles section of this Bulletin a summary and
commentary of what took place at that congress. It was prepared
by Derek Humphry, editor of the Bulletin of the World Federation
and author of the best sellers The Right to Die and The Last
Solution both published in Spain by the Tsquets publishing house.
New proposal concerning Living Will before the Basque
Parliament. The Basque deputy Juantxu Domingues, acting
for his party IE/EB, has presented a new proposal before the
Basque Parliament, concerning Living Wills. We remember that his
previous proposal of March 1996 received a very favourable
welcome and promoted a wide-ranging debate in Basque society on
this topic. We reproduce below part of the prepared text: Last
May of 1996, this Chamber debated at the proposal of the Left
Unity / Basque a proposal, not a bill, that has as its objective
to place at the disposal of the citizens of the Basque country a
document identified as Living Will, so that all those who
considered it opportune might leave manifest declarations as to
their will not to be "maintained alive by extraordinary and
artificial means when suffering from an incurable and painful
illness that leads inevitably to a certain death".
The initiative presented by the Left Basque Unity Party gave rise
to a interesting debate and opposing opinions with regard to
every person's right to die with dignity. Our commitment in this
area is clear. We work to put in place the Living Will document
of which there should be a record maintained by the Department of
Health.
This is a matter of the greatest social interest, a rational and
intimate right of every person. Similar propositions have been
approved in Australia and Holland and in other places closer to
our vicinity they are the subject of discussion and the making of
resolutions. Concretely, the Catalan Parliament has given
approval to the preparation of a study that envisages the setting
up of the Living Will in that community. The text which we now
submit for debate, takes as reference this agreement which does
live up to all expectations of the Left United Basque Party but
does constitute a good starting point that defines the road to
follow in the future.
PROPOSALS NOT A LAW. The Basque Parliament
requests the Basque Government to, within a year, return to this
Chamber, a report prepared by experts in these matters, that
determines the legal viability and real and judicial efficacy of
establishing in our Community a document to be known as Living
Will by means of suitable legislative initiatives and/or
regulations.
Vitoria-Gaasteiz 19 March 1997
Current State of Legislation respecting
Euthanasia and Assisted Suicide
ADMD Bulletin No 59 March 1996
US: The Oregon "Death with Dignity Act"
In November 1994 there was adopted by referendum legislation
authorising doctors to prescribe lethal substances which would
assure a dignified end to life in the State of Oregon. Before it
came into force, a judge declared in unconstitutional with the
pretext that it introduced inequality between "protection
against suicide" between citizens have a terminal illness
and others. This decision is presently being appealed. The law
sets the following conditions for a patient obtaining a
prescription that will allow him or her to end their days in a
humane and dignified manner:
Commentary
This law is very restrictive. It is special because it limits
authorisation of lethal substances to patients whose expected
life is very short (less than six months). It excludes euthanasia
and the patient must take the substances unassisted with no
provision for what to do if he or she is physically incapable. By
excluding euthanasia it could put the doctor in a compromising
situation should the prescribed substance induce coma instead of
death. In this case, the doctor will have only two options:
abandon the patient or attempt reanimation which would be in
total contradiction with the patient's request. Also, this law on
the other hand has multiple precautions to ensure precise
application. On the contrary it does not foresee any judicial
notification, only a medical procedure, namely (notes in the
patient record). Evidently this law has been specially designed
to avoid giving any opening to what is known to be violent
opposition. The law is presented not as assistance to suicide but
as a means of helping towards the termination of life for those
patients whose death is quite imminent. In the currently very
conservative context of the US it would nevertheless represent
real progress, were it finally to come into effect. Netherlands
Legislation concerning euthanasia
Introduction
It must first be specified, before anything else that in the
Netherlands agreement was reached among parliamentarians, jurist,
doctors (both in favour and opposed to de-penalization) to define
euthanasia as the act of deliberately provoking the death of
someone according to their request. This restrictive definition
makes obsolete the distinctions between voluntary and involuntary
euthanasia, active and passive, direct and indirect. It excludes
situations such as the newly born as well as that of patients who
can no longer express their will. It is a matter of an act and
not an omission, such as not starting or interrupting some
treatment. The administration of medications to reduce pain in
doses that are known to have as a secondary effect the reduction
of life is also not within the scope of this definition.
Euthanasia if accepted in this way would be included in article
293 of the Penal Code (introduced in 1891) and still in effect
today which provides for someone committing such an act a prison
sentence of 12 years maximum and a fine of the fifth category
(100,000 florins). Article 204 reduces these penalties to three
years of prison and a fourth category find for assisting a
suicide.
Jurisprudence
Notwithstanding these articles a code of jurisprudence has been
established since 1973 according to which a doctor that practices
euthanasia at the request of a patient with incurable illness
that must endure intolerable suffering.
A sentence of the Court of Rotterdam in 1981 adds the obligation
of the doctor to consult with one other health professional the
situation as to duration of suffering, the desire to die, and the
absence of an alternative solution acceptable to the patient. The
patient request must be the result of an autonomous decision
without exterior pressure.
In 1984 a case of euthanasia was heard for the first time before
the Supreme Court of the Netherlands. The Amsterdam appeal
tribunal sentence which had declared the doctor guilty, without
applying any penalty, was nullified since the tribunal had not
taken into account force majeure (the conflict of obligations,
and state of necessity). The case was returned to the Hague
Appeals Court resulting in acquittal, therefor confirming the
opinion of the first trial. Several other cases were also heard
in different courts, resulting nearly always in acquittal, if the
aforementioned conditions were met.
Preparation of a new law
A state commission on euthanasia, created in 1982, published its
report in 1985. The Commission proposes that no penalty be
attached The Commission proposes that anyone should not be
considered punishable who intentionally puts an end to the life
of another person at the express request of the latter if the act
is performed by a doctor in a scrupulous medical manner for a
patient in a desperate situation. The guarantees that must be
observed are very close to those established in jurisprudence.
The Commission also examined the matter of a previous patient
declaration. It decided that it will only prevail if the patient
is no longer in a positions to express an oral request. While he
or she is able, a simple oral declaration is enough and can at
any time revoke a previous written request. The Commission
considers that the doctor performing euthanasia should indicate
in the death certificate that it is not a natural death; he or
she will have to write a report detailing the manner in which the
criteria of the Penal Code have been met and send this document
to a state official. The Commission report also took an interest
in the problem of those who care for a patient that will be
involved in the matter of euthanasia and also of the preparation
and administration of medications or other products used.
The Netherlands Medical Association (KNMG) expressed its point of
view in a detailed report of 1984, completed in 1986. The KNMG
considers that the exercise of the terminal phase is not that
which should matter, what counts is the duration of the will to
die, the unacceptable level of suffering, and the absence of any
reasonable hope of recovery. The distinction between mental and
physical suffering is abandoned but complaints due to social
factors (concerning which medicine can play no part) or
psychiatric (which reduce the free nature of the patient's
request) should not be within the bounds of the area for
euthanasia. Negotiations between the majority parties led finally
in 1989 to an agreement according to which a national commission
of enquiry should be established, first to study the way in which
jurisprudence was applied in reality. It was stipulated that,
during the period in which the commission was acting, the rules
of jurisprudence in the matter of euthanasia should continue in
effect.(In 1990 a meeting between Prosecutors and an agreement
between the medical association and the ministry o justice had
finished in exactly specifying the procedure for certification of
death in cases of euthanasia, there would be no prosecution if
the criteria of "scrupulous medical conduct" were
followed). The National Commission of investigation was placed
under the jurisdiction of the presidency of the Prosecutor
General of the Supreme Court of the Netherlands, Professor
Remmelink. It entrusted to the institute of Public Health of the
University of Erasmus, Rotterdam, under the direction of
Professor van de Maas, the study of the specifically medical
aspects of the problem.
The report of this commission was published in 1992. It
determined that a third of deaths occur unexpectedly and that in
another third, although foreseeable, there was no need for
medical intervention in the terminal phase. However in nearly a
third of deaths, the doctor must make a decision which could
change the time of death: either cessation of treatment (17.5 %
of deaths) or palliative care, essentially analgesics whose
dosage is usually high enough to shorten life (17.5% of deaths)
and finally (1.8% of deaths or 2,300 cases per year) euthanasia
at the request of the patient and in 0.3% of deaths (400 cases
per year) medically assisted suicide. The commission issued among
others, a series of recommendations concerning above all the
training of doctors and paramedical personnel.
In a note of 8 November 1991, directed to the Presidents of both
Houses of Parliament, the government is of the opinion that in
order to guarantee the maximum level of security, both for the
authorities involved as for the doctors as concerns the procedure
to follow and the information to be obtained it would be
convenient to give the procedure a legal foundation. With this
objective the government proposes changes to the law as to the
declarations of deaths, including within it the procedure for
declaring cases of euthanasia that has been adopted since 1990.
The declaration should be made in the first instance to a
municipal medical and legal official who in turn will inform the
Queens Procurator. This last will decide in each case whether
there should be a judicial prosecution, as would be the case if
there was not an instance of 'force majeure' nor a state of
necessity or explicit request of the deceased. Articles 293 and
294 of the Penal Code would not be changed. An administrative
ruling adopted in April 1994 sets out the questionnaire that the
doctor should fill in and attach to the death certificate. The
proposed law was adopted in February 1993 by the Second Chamber
of Parliament and in November by the First Chamber.
Commentary
The Netherlands legislation is therefore the result of a
compromise. It responds both to the will of an immense majority
of the population and medical establishment who wish to see
consolidated into law the rights obtained during nearly a quarter
of a century (euthanasia and assisted medical suicide being
possible without legal prosecution under certain conditions)
while respecting the values of a minority with moral principles
that are traditional and restrictive (euthanasia and assistance
to suicide continue to be punishable). The fact that a condition
of "force majeure" has been clearly defined permits the
doctor to act freely according to his or her conscience when a
patient according to "strict medical conduct" has the
security of not being prosecuted notwithstanding articles of the
Penal Code that condemn euthanasia and assistance to suicide.
The seriousness of the legislators must be admired: they took all
possible precautions: the opinions of experts and moral
authorities by means of existing commissions or those created for
the circumstance, to examine attentively jurisprudence, opinions
of medical associations, medical investigations both past and
future.
The Netherlands Voluntary Euthanasia Association (NVVE) is
however critical of the fact that penalties are still specified
in the Penal Code. It does not accept that the notions of
"euthanasia" and "criminality" should be
linked and asks for a change of the law. Many doctors feel
uncomfortable with a procedure that obliges them to admit having
committed an act punishable by law. There is complaint also
concerning the long period of time that passes between the act of
euthanasia (and its declaration) and the time when they can be
sure of not being prosecuted. These two facts provoke uncertainty
and disquiet, which causes some doctors to not make a declaration
as to euthanasia. The Netherlands Medical Association in a report
of August 1995 requests that this situation be ended by proper
legislation.
References: Kenis Court Diary March 1995 Number
5 750 pages 176-177.
ADMD Bulletin 59 March 1996
A summary of this report was published in the ADMD bulletin of
March 1993 pages 2 to 7.
Australia: The Northern Territory Law
Rights of the Terminally Ill Act
The Norhern Territory is a small state of 1.35 million square km
with 170000 inhabitants. As in the rest of Australia, its
inhabitants benefit from a federal system of health insurance:
hospitals are free and consultations, treatments and palliative
care are funded by the state either partially or completely.
General medicine is highly developed, most inhabitants have a
family doctor to whom they are faithful and who serves as link to
specialists when needed.
On 25th May 1995 the NT Parliament voted in a law that defines
the rights of a patient suffering from a terminal illness and
authorises doctors to prescribe and administer lethal substances
that will result in the death of patients with terminal illnesses
who have made a formal request. It was foreseen that this law
would come into force in one year (exact date is not specified)
when educational programs have been started and palliative care
services developed.
The law sets the following conditions for the practice of
euthanasia and medical assistance in suicide:
Commentary. This legislation creates a
situation practically the same as that in the Netherlands (see
above). As in the Netherlands, it does not only consider the case
of patients that are conscious and able to express their wishes.
Similar precautions have been taken to avoid any "slippery
slope".
Although the notion of terminal illness which appears here is not
among the conditions in the Netherlands, the fact that no
specific duration of remaining life is given allows a fairly
flexible interpretation that matches the Netherlands requirement
extreme irreversible suffering.
Ref: Euthanasia in Australia - The NT Rights of
the Terminally Ill Act, N Engl J Med 1996 334:326-328.
Editors note: Although the Australian Parliament
struck down the NT law on 24 March 1997, we consider that
interest of its content makes it advisable to reproduce here the
text published in the French Right to Die Association ADMD. As to
the repeal of the NT law, refer to the News of the World section.
ARTICLES
Page 15
Report on the 11th International Congress of the World
Federation of Right to Die Societies, Melbourne Australia,
October 1996.
Derek Humphry, Newsletter. Review of the World Federation of
Right to Die Societies, 29 November 1996.
I have attended all the International Congresses held by the
World Federation since 1978 and there was a special feeling in
Melbourne, Australia from the 16th to 18th October 1996. A
feeling of victory and optimism as to the future.
Many things had taken place in the two years since the last
meeting in the UK: in Oregon there had been approved the Decree
on Death with Dignity and the Supreme Court of the US agreed to
have recourse to it in important cases. A few thousand miles to
the north of the congress, in a small tropical area known as the
Northern Territory there had existed for three months a law which
allowed voluntary euthanasia and medically assisted suicide for
the dying.
One person, Robert Dent, a terminal cancer patient had already
taken advantage of this law. Dent and the doctor who assisted
him, Dr Philip Nitschke were heroes to millions of people for
having legally broken the barrier against assistance in dying.
Also welcomed in Melbourne was the politician Marshall Peron,
whose courage and intelligence led to the passing of ground
breaking law through Parliament in 1995.
At the time of the Congress in Melbourne, all Australia was
embroiled in an intense debate as to the morality of euthanasia
(the brash Australians do not use euphemisms such as assistance
in dying). The mass media were full of references as to whether
some politicians could or could not derail the new law, or if the
Supreme Court wished to test the constitutionality of the law, as
took place in the US in 1997.
The dosages of medication required for painless euthanasia and
effective self liberation were the subject of discussion in open
sessions in the presence of journalists and writers while in 1991
when my how-to-do-it book Final Exit appeared in Australia, it
was instantly forbidden by government censorship. (On appeal, the
prohibition was rescinded). Perhaps the theme that was most
discussed during the congress was when and how to advise a
terminal patient seeking help, since this was one of the
determining circumstances of the NT Terminal Patient's Rights, of
the Dignified Death Act of Oregon and whatever other potential
new legislation. It was fascinating to listen to an English
lawyer Malcolm Hurwitt point out that the basis of English law
(following which the first British colonies, including the US
have based their present legal systems) consider that a person is
sane and rational until the contrary is proved. Which leads to
the question as to why the new laws require that the poor
terminal patient must prove competence in order to shorten life
and reduce suffering. Some might say that the request by itself
is a supreme act of rationality. One does not need to prove
competence in order to have children.
The title of the congress Voluntary Euthanasia: Protecting the
Choice was very suited to the matters discussed. Both the
delegates and public were conscious of the necessity of
protecting that which has already been obtain in law and from
public opinion to ensure that the new law works well and learning
from its implementation how to extend it to other countries and
states. Australia, like the US must make legal reforms to allow
acceleration of death, state by state.
The Swiss surprise. It was a surprise for the
majority of the delegates, and illustrates how closely we are
focused on legal reforms in our own countries, to learn that in
Switzerland assisted suicide has been allowed since 1937, and it
does not have to be through a doctor provided that the motive for
doing so be pure and noble. As yet there has been no case of
alleged abuse of this law. Of the approximately 100-120 cases of
assisted suicide reported in Switzerland every year only in about
20 do doctors participate. The same lack of criminal sanctions
exists in Germany but the guilty conscience of the public with
respect to the Holocaust and Nazi euthanasia in which forcible
action was taken against persons incapacitated physically or
mentally makes the subject taboo in this country. Norway also has
no legal prohibition but religious and social taboos cause any
assistance in dying to be kept hidden.
We learn that there is a movement to obtain new laws in England
and Scotland. In England there have been six attempts to change
the law on assisted suicide since 1935, but each time completely
frustrated, particularly by pressure from the churches even if
80% of the population approve of voluntary euthanasia.
Many in Holland are not satisfied with the present procedure of
authorising what is termed "Medical Decisions at the End of
Life" (MDEL). The Netherlands Voluntary Euthanasia Society
(NVVE) is putting pressure on the Parliament in favour of a new
law in 1997 which will consecrate the usual directives as legal.
This will remove the public stigma of performing what is
technically a criminal act and will improve the situation of
doctors who feel harmed by it.
The meeting was among the most outstanding with the VES of
Victoria as brilliant hosts and able to take advantage of the
world attention being paid to Australia in this matter. I think
the international current in favour of the theme "death with
dignity" is moving in unstoppable fashion and that if we
manage our advances in a responsible manner the next century will
see the matter complete resolved.
Note: Final Exit is published in Spain as El
ultimo recurso (The last recourse) by Tusquets Editions,
Barcelona, 1992.
Editorial note: In the law approved in the
Northern Territory it was established as one of the requirements
for receiving assistance in euthanasia that the mental capacity
of the patient should be verified by a psychiatrist. It is to
this that Derek Humpry refers.
Assisted Suicide in Switzerland.
Translation of the booklet Assisted Suicide in Switzerland: when
is it permitted, by Meinrad Schar, president of Exit, the Swiss
Association for Death with Dignity. Zurich December 1996.
Switzerland, one of the smallest countries in Europe has seven
million inhabitants. Given that a seventh part of the population
if over 65 years old it might be expected that there is a high
incidence of medical problems. Chronic degenerative illnesses are
the principal cause of illness and death. Medical technology can
prolong life of the elderly and chronically ill but cannot
maintain them as independent, free of health problems, or able to
manage their own affairs. Medical technology can also improve
palliative care, that is those treatments whose purpose is the
control of symptoms. However we must remember that in between 5%
and 10% of cancer cases, symptoms cannot not be relieved
completely or only at the cost of losing personal individuality.
Page 18
Table 1: Some Swiss Statistics
| 1900 | 1990 | |
| Population, millions | 3.3 | 6.9 |
| Persons over 65 (thousands) | 300 | 1,100 |
| Mortality/1000 | 18 | 9 |
| Infantile Mortality | 140 | 7 |
| Life Expectancy Males | 49 | 75 |
| ..Females | 51 | 82 |
The right to Death with Dignity. In surveys of
the Swiss population as to death with dignity, there is always a
majority in favour of active euthanasia and assisted suicide and
around 100% agreement as to passive suicide. The results offer a
strong contrast between medical and religious groups. Around 60%
of doctors that are members of the Swiss society for death with
dignity (EXIT) are in agreement with active euthanasia in
specified conditions, those who are not members are in a majority
opposed to both active euthanasia and assisted suicide. In all
countries, suicide is not forbidden but in nearly all countries
assistance to suicide is liable to legal prosecution. (In the UK,
the penalty for assistance to suicide is 14 years prison). Why
can a person suffering commit suicide and yet is forbidden to
receive medical assistance in so doing?
As late as 1937 there was passed a law in Switzerland allowing
assisted suicide in certain conditions. Article 15 of the Swiss
penal code reads as follows person that for egoistic motives
persuades or assists another to commit suicide shall be punished
with at least five years imprisonment. According to this,
assisted suicide would seem to be no longer a problem. But in
reality, this is not the case. There is too much opposition to
this liberal law. The Swiss Academy of Medical Sciences states
clearly that assisting a person to commit suicide is not the duty
of a doctor. The problem is that a doctor is the only person
qualified to assist a seriously ill patient that wishes to die.
While the aforementioned academy is opposed to assisted suicide,
it is in favour of passive euthanasia.
Page 19
Table 2:Swiss Laws relative to "Death by
Request" (including "mercy killing") and
"Assisted Suicide".
Article 114
A person that ends the life of another for humanitarian reasons, also termed mercy, at the urgent and serious request of the other will be sentenced to prison.
Article 115
A person who for egoistic motives, persuades or assists another to commit suicide will be sentenced, both in the case of attempted as in successful suicide to hard labour in prison for more than five years.
Table 3:Directives of the Swiss Academy of Medical
Science (EXCERPT) The rights and responsibilities of the doctor:
The doctor is allowed to give a patient large doses of
medications to alleviate pain or other symptoms, but not in order
to shorten the life of the patient. (A doctor may kill a patient
by an overdose of morphine and will not be prosecuted if the
intention was to treat symptoms, but if the intention was to end
the life of a patient the doctor may be condemned to at least
five years prison. It would be preferable to allow voluntary
euthanasia controlled and documented rather than officially
prohibit it while there is a clandestine way of doing it without
any controls.
The practice of Assisted Suicide. EXIT publishes
a manual for patients that are incurable but not incapacitated
who request assistance in dying. Adult members of EXIT for at
least three months can obtain this pamphlet from the organisation
headquarters. It contains all the information needed for seeking
the help that EXIT can provide and a detailed description of the
procedure. Formerly there was given a prospectus to members who
sought instructions as to the ways and means of committing
suicide. (This prospectus was withdrawn from sale about five
years ago). Recently a "medication leaflet" has been
published by two right to die European societies containing
detailed instructions as to different ways of committing suicide.
This leaflet may be useful for hypochondriacs but is no practical
help to seriously ill patients who do not wish to suffer any
longer from unbearable pain or other symptoms. Gravely ill
persons need help! They cannot wait weeks before suiciding. All
the medications in the above mentioned leaflet can only be
obtained on medical prescription. The patient, always with a
guilty feeling, must lie to his or her doctor or deceive the
pharmacist. In additions he or she cannot be sure that the
recommended substance will act equally for everyone, and further
there is the risk of vomiting and loss of the medication that was
taken. This is why we withdrew such works and we do not recommend
lists of doctors who can be used for self-liberation.
The EXIT procedure for assistance to suicide
Table 4:Necessary conditions for assisted suicide (Exit, Swiss society for Death with Dignity, Zurich) The person making the request must be:
- Over 18 years of age
- Mentally capable
- Member of Exit
- Resident in Switzerland
- Suffering from a serious illness or unbearable conditions of health with negative prognosis
- Wish to die with the help of Exit The diagnosis of the illness and the prognosis must be confirmed by a doctor
Page 22
COLLABORATIONS
Hospital Pyjamas
Jordi Vives Sancha
Between fiction and non-fiction, Jordi Vives Sancha, third year student of B.U.P describes the death of his father when Jordi was ten years of age This account won the 1997 prize of the Sant Just Desvern school of Barcelona and an additional prize from the local municipality. Original in Catalan. Following is translated from the Spanish version which follows the Catalan one.
The gentleman dressed in hospital pyjamas felt tired, tired that the doctors, without knowing what was happening to him, were giving him false hopes; he remembered the empty pills that they give to the elderly to keep them quiet. In spite of being paralysed in a wheelchair, he was not an idiot, he was aware of how his life was slipping away, little by little, as if to force him to endure every moment of suffering. Now his spittle fell from his mouth. That produced in him a feeling of disgust, not because of what others might see or think of him, which was all the same, he was disgusted with the feeling of impotence that had made him fall so many times, when he tried to stand up. From his closed world, he saw his smiling family, trying to raise his spirits, but he knew completely that the only thing they succeeded in doing was to ease their own consciences. While he still could speak, he had asked a thousand times for the old war rifle ... Oh! he had dreamed so many times of using that rifle for the last time!
A solution would have been to stop eating, refuse any alimentation. And he had tried it, but his family did not understand or did not want to understand his situation and selfishly had taken him to hospital. That for him was like a punishment "if you do not behave you will go to hospital where they will prick you with needles, the food will not be good, you will be alone, and you will have to put up with the sound of your neighbours artificial respirator. And there you will not get sleeping pills to pass the night and at the least sign we will probe you and if you disturb us we will plug you into the machine."
Until now, he had gone along putting up with it all but what most bugged him was that some friend might visit and start one of those hateful monologues, remembering all they had done together.
He spent his last days in bed. It was strange to see him because in spite of his face being totally disfigured, one could have sworn he was laughing. He knew it would not be long before he was better and at last could rest. Fortunately the doctor in charge was useless, and one Friday after losing consciousness he died of constipation.
It is fortunate that he could not attend his own funeral celebration, it was the most doleful affair ever seen. Listening to all those hypocritical manifestations ... that did not suit him. But on the other hand, the final farewell went well. The priest was never more correct than when he said "and now he rests in peace". I myself observed everything from behind the dark glasses that hid my tears, and I could still hear him say "when I die, to hell with those who remain". Now, if I close my eyes tightly and concentrate, I still see him very self confident looking for mushrooms in the woods, with his old curved stick. And I, in the background with one of the local dogs, running from here to there and asking him if that mushroom was a good one, and when we should eat... He turns and looks at me, with a satisfied smile.
Page 24
Death with dignity in Argentina
In November 1996 the Chamber of Deputies of Argentina was about to approve a proposed law relating to Death with Dignity. In this country, where the Catholic church is the most conservative of Latin America and blocks any kind of lay initiative, all the political parties, from official peronists to opposition radicals, right through an alliance of the centre left and the provincial conservative party, were in agreement on this measure. The only condition was to reject expressly and categorically any attempt to identify Death with Dignity with euthanasia, either active or passive. Finally, even a representative of the church hierarchy admitted that it was proper to put an end to medical "therapy without limits".
The proposed law considers the situation of "any person who suffers an incurable illness and is in a terminal state or has suffered an accident causing the same state" and stipulates that terminal patients "may refuse clinical and surgical treatments that are extraordinary and disproportionate to the prospects of recovery and which cause suffering". Although riddled with clauses that made its application difficult, the proposal was an enormous advance for a country subject, we repeat, to a harsh clerical policy of no change.
Unfortunately, the proposal was adjourned indefinitely when the parliamentary groups became embroiled in a Byzantine debate as to the right of the patient to be informed concerning his or her illness, Could it be that a hidden hand intervened to hinder things? Page 25 NEWS OF THE WORLD Germany The magazine Stern has published the results of a survey of doctors relative to euthanasia. The results show that indirect euthanasia has wide support: some 80% of doctors in public hospitals and 74.3% of those in the private sector approve it. As to active euthanasia, the proportion of doctors that state that they have performed it for humanitarian reasons is 32.2% in hospitals and 30.2% privately.
The article also has the information that throws light on the grey area in which euthanasia is practised. There is a rejection of the assertion by palliative care institutions that requests for euthanasia disappear due to their caring methods. To the question as to whether requests for euthanasia had been received from those in palliative care centres, hospital doctors replied yes in a proportion of 54.4% and 30.2% in the private sector.
(Bulletin of the DGHS No 1 17 Jan-Mar 1997)
Australia. Figures published by the
Australian and New Zealand Journal of Public Health for September
1996 seem to corroborate the fact that in countries with a high
level of medical care, euthanasia has a greater probability of
being legalised. According to this publication Australians have
longer life expectancy than North Americans or the British and
the quality of medical care is better. The same is true in
Holland, a pioneer country in the field of euthanasia.
Dr. Nitschke, the doctor who designed the program to be used by
those taking advantage of the Northern Territory law has placed
the program on the Inter net. The address is:
http//www.taunet.net.au/deliverance. Dr Nitschke has stated that
by making his program available in this way, other better ones
might be introduced. Also 80% of his patients ask how to make use
of the Northern Territory law.
(VESS Bulletin Vol. 17 No 1 Jan. 1997)
Setting Aside of the Northern Territory Law On 24 March 1997 the
Australian Parliament set aside the assisted suicide law of the
Northern Territory. The following was published in the
"Periodico" newspaper of Catalonia.
The Australian parliament set aside yesterday the first and only
law in the world that allows euthanasia, nine months after the
Northern Territory approved assisted suicide. The Senate rejected
the law by 38 votes to 33 and with five abstentions passed last
July which authorised that terminal patients could put an end to
their lives by means of a computer system in the presence of a
doctor. Euthanasia continued to be illegal in the other states.
The results of the voting were known at dawn on Tuesday in
Australia after a heated debate. One of the main promoters of the
campaign in favour of euthanasia, Dr Philip Nitschke - who, under
protection of the law helped four persons to die - immediately at
the entrance to the Senate set alight a copy of the law in
protest to the result of the voting. Nitschke accused the Upper
Chamber of having dashed the hopes of four terminal patients that
had completed all the legal formalities to end their lives.
"The Australian senate" affirmed Nitschke "has
betrayed all the terminal patients of this country. Especially
two persons who spend the night in agony in the Northern
Territory".
At the end of the debate, a senator in favour of euthanasia
challenged his opponents if they had the courage to explain their
votes to those who looked to suicide as a means of ending their
suffering. "How can they say we will not let you do
it". We intervene because we know better than you what you
are feeling, in spite of your pain, your suffering, your
indignity, asked Senator Bob Brown of the Greens.
Four persons had suicided legally with a machine that injected a
lethal substance using a computer program, since the NT
legislation came into force in July. The first was Bob Dent, aged
66, a terminal cancer patient who took advantage of the system in
September to leave what described in writing as "a red
mountain of pain".
Before yesterday's vote, the conservative party which is in power
left its followers free to vote according to their conscience,
but Prime Minister Howard made his position clear "I
believe" he said in December "that there are some
things that cannot be questioned and respect for life is one of
them. I believe that according to surveys this is not a popular
opinion but it is my opinion". Surveys indicate that 75% of
Australians support voluntary euthanasia.
("El Periodico" of Catalonia, 25 March 1997)
Denmark. Doctor Michael Norup of the University
of Copenhagen has investigated the attitude of doctors of that
country towards terminal patients. The majority of doctors
surveyed said that they had made decisions to shorten the life of
dying patients provided they are in agreement. To do so, they
have administered large doses of sedatives and discontinued
futile treatments. About 2% had participated in assisted suicide
and 5% had administered a lethal injection. 30% of those surveyed
considered as correct practices such as assisted suicide and
lethal injections.
(VESS Bulletin Vol. 17, No 1 Jan. 1997)
Italy. We have received an information leaflet
for a new pro voluntary euthanasia organisation: EXIT-Tramonto
Felice with headquarters in Turin. UK
The British Medical Journal carries in the issue of 30 November
1996 a survey conducted by Drs Sheila McLean and Allison Britten
of the Institute of Ethical Medicine and Law of the University of
Glasgow, Scotland. The results indicate a definite support for
the right of any adult to decide on his or her own life.
80% of a sample of 986 persons agreed with the following
statement: "Human beings should have the right to decide
when to die". An interesting fact is that the majority of
those surveyed preferred voluntary euthanasia (42%) to assisted
suicide (28%) while doctors preferred assisted suicide (43%) to
voluntary euthanasia (19%). From these data it may be deduced
that neither patients nor doctors wish to have final
responsibility for the act. In voluntary euthanasia it is the
patient that decides but the doctor (or relative or friend) that
carries it out. In assisted suicide, the doctor only provides the
patient necessary help for the ending of his or her life.
Almost 50% of doctors express a wish for legal change in this
matter, with slight variations between home doctors, surgeons,
hospital doctors and psychiatrists. Pharmacists (72%) and
anaesthetists (56%) gave even larger percentages in support of
this change.
The English VES society has put forward a proposal to parliament
which would "allow a patient with severe suffering because
of an incurable physical condition to seek medical assistance to
end life". The sick person would have to be in a terminal or
incurable condition diagnosed by two doctors and have sufficient
mental capacity to request assistance in dying should he or she
suffer physical or psychological effects that cannot be
supported. Another condition is that the patient have signed two
forms requesting death in dying and have not cancelled any of
them.
(VESS Bulletin Vol. 17 No 1,l Jan. 1997)
Page 28
FOR OUR FRIENDS ABROAD .. In English
Two initiatives mooted in Catalonia may influence the future of
legislation on euthanasia in Spain. On the one hand, last
November 1996, a nationalist political party, Esquerra
Republicana de Catalunya, presented a bill to make it possible
the official distribution of a Living Will in Catalonia backed by
the Catalan Parliament. The bill does not contemplate active
euthanasia. The Catalan Parliament agreed on nominating a
commission that would study the subject for a year and see the
chances of carrying out that initiative in the Catalan area. The
Catalan Parliament cannot legislate on that subject but would be
able to elaborate a Living Will as a form of Informed Consent.
Informed Consent is clearly sanctioned ad promoted in the General
Sanitary Law of 1986. Secondly, the same party has also proposed
a bill to the Spanish Parliament in order to legalise voluntary
euthanasia (passive and active). Last but not least, the
parliamentary Catalan Commission of Justice invited members of
our association to a session in order to have direct information
of DMD's goals and activities. All the representatives from all
political parties agreed on that appearance. The session was
celebrated on April 4th. and lasted for two and a hall hours. Mr.
Paniker (DMD President), Ms. Betancor (DMD Vice-president) and
Dr. Queralt (DMD Criminal Law Counsellor) answered to all the
questions made by the party's representatives. That session was
not a debate but an interesting and friendly meeting which may
open the path to a future collaboration between DMD and the
Catalan Parliament on the voluntary euthanasia issue. The
President of the recently created Bioethics Catalan Commission
attended the session, too. That Commission is studying the
ethical implications of Living Will in the broader context of
Informed Consent. DMD impulsed this study alter an interview with
the Catalan Minister of Health, who passed the subject on to the
Bioethics Commission. DMD has provided the Commission with
written and oral information on the subject.
Page 29
MEETINGS
European Division Meeting. London 26 April, the
European Division of the World Federation of Right to Die
Societies will meet to discuss questions related to progress in
voluntary euthanasia in different European countries. Attendance
open to any member of the associations forming part of the
European Division such as DMD in Spain. Contact VES: Phone +44 18
6524 8776 Fax:+44 1865 2004256.
Health, ethics and health services. Granada 15
to 17th May on the University Campus of Cartuja. Twelve day
seminars on Public Health and Health Administration organised by
the Andalusian School of Public Health. Contact 958 161 044
Fax:958 161 142 Course on Civil and Penal Responsibility in the
Health Field Second semester of the Law College of Barcelona. Of
interest to doctors and lawyers: themes will be treated such as
medical protocols, informed consent, the rights of privacy of the
sick person.. Contact Maria Gomez Jara Tel: 93 487 2814
Ethical compromises in Health Services. Cuenca
14 to 16 July. Summer course of the University of Catile, La
Mancha. Contact Maria Paz Mompart, director of EU, Nursing and
Physiotherapy of Toledo: Tel 925 268 800.
Issues for a Catholic Bioethic. Cambridge (UK)
28 to 31 July. Congress organised by the Linacre Centre for
Health Care Ethics. Contact: Clarissa Fleischer Tel +44 0 171 289
3625 Fax: +44 0 171 266 5424 Health Care Issues in Pluralistic
Societies. Nijmegan (Holland) 4-8 August. Contact Bert Gordjin,
Dept of Ethics, Philosophy and History of Medicine, Catholic
University. Congress organised by the Linacre Centre for Health
Care Ethics.
Page 30
CORRESPONDENCE
Farewell to Nicholas.
Jan. de Kler Member Number 839. During a short visit to Holland,
we went to the house of some close friends in Amsterdam with whom
we had much contact when we were there in the winter. His wife
opened the door and we entered the dining room. The meeting was
moving and emotional. He, who had always been as strong as an oak
tree, was now an idiot, sitting in a chair, sideways dressed in a
dressing gown. He had changed into an old rag. His energy was
gone. He was awaiting death, the last stages of cancer. It was
too much for us, we could say nothing. The situation was so
painful that we began to cry together. He made a helpless gesture
lifting his hands and looked at us dole fully as if he wanted to
say: It is not my fault!
There was a knock at the door, the doctor entered and went to the
bedroom. Now he had a cystitis. Perhaps another metastasis. They
made a very good and solid couple. They did not have an easy
life, always working hard, four children, a miserable time during
the world war, their finances were not good but a marvellous
harmony united them. And now they must face an inevitable death
and his wife must remain alone. I looked sideways at Nicholas. A
phenomenon and big man had degenerated into the shadow of a
graceless man, I felt a knot in my throat.
We parted almost without words, what was there to say? I held his
hands in mine, previously massive, now flaccid. We knew we would
never see each other again. We had to return to Spain. Three
months later, his wife telephoned us. Nicholas had requested
Death with Dignity from his doctor, because the pain was
unbearable. The doctor accepted and, surrounded by his family,
Nicholas said farewell for ever. After this telephone call, my
wife and I were afraid of looking at each other.
It was the 9th of February. A black day.
This page has been visited 172 times since Feb. 25, 1997.
Go to NEWS (English) Volver a Noticias de pàgina
principal (Castellano)
Send comments to Miguel A. Lerma at: mlerma@math.utexas.edu
or to: admd@redestb.es
Last modified: Nov. 12, 1997