Active voluntary euthanasia. physician assisted suicide

11
1
1


BY NDOMBOL NLOGA PIE- LEON II
INTRODUCTION
Since that man asks about his life and his death, he also questions on this "good death" that is euthanasia. Lifestyle changes and mentalities since the Second World War led to an explosion of debate about it, leading to the emergence of pro- euthanasia movements as well as changes in legislation in some countries. Following the decriminalization of euthanasia in the Netherlands, most Western countries, France has launched a reflection aimed at defining the opportunity, at the dawn of xxv century to follow suit. In this context it seemed necessary to try to move away from debates, often restrictive, between anti and pro- euthanasia if possible to find other alternatives

I. DEFINITIONS
A. Evolution of euthanasia
Over time, the term euthanasia has taken different even opposite meanings, inspired by religious beliefs, socio- economic, political or possibilities of medicine and science at the time.
1. Euthanasia in Antiquity
The etymology of the word is Greek, after Euthanatos made the prefix eu meaning "good" and thanatos "death." In literal translation, euthanasia corresponds to a "good death", a gentle death -without suffering or painful symptoms, an "ideal" death somehow.
This word appears for the first time in the third century BC, in a word the Greek historian Polybius, extract Stories, where recounting the death of Cleomenes, he describes the suicide of it, this act is motivated by the desire avoid a dishonorable death after a military defeat. The "good death", avoiding dishonor, agony, suffering and horrors of old age, keeps this sense until the early first century AD, as in The Lives of the Twelve Caesars Suetonius, work in which the author describes the death of Augustus, fast, without suffering, in the arms of the beloved.
At the end of the first century AD, appears the alternative concept. It is not so much to experience a gentle death, but above all to escape a death we know horrible as described in an excerpt of Jewish Antiquities of Flavius JOSEPH (livre9 Chapter 4): four individuals forced to live outside the city as suffering from leprosy, decide to go to the enemies to not starve, "or we slay them, or they are put to death and would have a more gentle death."

1. Euthanasia in the middle Ages
For nearly twelve centuries, the term euthanasia disappears completely due to the development of Latin at the expense of the Greek and especially by the growing role played by the Catholic Church. The importance of this is found in everyday life, in popular beliefs and customs, some of which can evoke euthanasia practices. So the Sunday sermons recommended avoiding making infants sleeping in bed with their parents in order to avoid the risk of accidental suffocation not always in these times of scarcity. Death if it is not caused is sometimes desired. Popular traditions make that one recalls with particular Saint by region to accelerate the death of a relative.
2. Euthanasia for Francis BACON
The 1605 years is a milestone in the semantics of the word euthanasia ; Indeed , it is under the impetus of the English philosopher Francis Bacon that term takes on new meaning that it will keep for almost three centuries and which will evolve into the sense that we now ready to palliative care . This new direction appears for the first time in Du progress and the advancement of knowledge and in its final form in a book from 1623:
«Je dirai de plus, insistant sur ce sujet, que l'office du médecin n'est pas seulement de rétablir la santé, mais aussi d'adoucir les douleurs et souffrances attachées aux maladies ; et cela non pas seulement en tant que cet adoucissement de la douleur, considérée comme un symptôme périlleux, contribue et conduit à la convalescence, mais encore afin de procurer au malade, lorsqu'il n'y a plus d'espérance, une mort douce et paisible ; car ce n'est pas la moindre partie du bonheur que cette euthanasie, et qu'on observa aussi au décès d'Antonin-le-Pieux, qui semblait moins mourir que tomber peu à peu dans un sommeil doux et profond On rapporte aussi d'Epicure qu'au moment où sa maladie ne laissait plus d'espérance, il se procura une pareille mort, en se gorgeant de vin et noyant, pour ainsi dire l'estomac et le sentiment ; ce qui donna lieu à ce trait d'une épigramme: Hinc Stygias ebrius hausit aquas, c'est à dire qu'à l'aide du vin il masqua l'amertume des eaux du Styx. Mais de notre temps, les médecins semblent se faire une loi d'abandonner les malades dès qu'ils sont à l'extrémité ; au lieu qu'à mon sentiment, s'ils étaient jaloux de ne point manquer à leur devoir, ni par conséquent à l'humanité, et même d'apprendre leur art plus à fond, ils n'épargneraient aucun soin pour aider les agonisants à sortir de ce monde avec plus de douceur et de facilité. Or, cette recherche, nous la qualifions de recherche sur l'euthanasie extérieure, que nous distinguons de cette autre euthanasie qui a pour objet la préparation de l'âme, et nous la classons parmi les desiderata».
This text is interesting in more ways than one. It not only sets the main principles of the philosophy of the current palliative care, but it also introduced the role of the physician in this easy death and in its preparation. The doctor as a practitioner must develop its knowledge in order to intervene with his incurable patient. We are far from suicide and death as an alternative to a horrible fate. It's a third person involved in this good death. It is longer thinks in terms of quality of the final moments but in terms of action favoring such a death without cause it. Death is seen as a natural part of life that no one can escape.
3. Euthanasia in the nineteenth century
We see that from ancient times until the end of the seventeenth century, euthanasia means the experience of dying, the quality of the final moments of life without outside intervention. It is death that is desired and gentle happens to his "hour ". It was not until the early nineteenth century that we will see a new meaning; is now involved in this euthanasia. It accompanies the dying to make it easier transition. In a finding and a desire for good death, we pass to the act of taking care of the dying patient.

B. Euthanasia at: XXth century
If the twentieth century is the source of changes sense euthanasia, it is also marked by considerable confusion at the origin of the addition of various adjectives to the word in order to clarify its meaning. We can see in the following examples that this addition only increases the ambiguous term.
1. Eugenics Euthanasia
The twentieth century was marked, in its first half, the association of the word euthanasia to eugenics adjective. Indeed, the notion of easy death, caused by compassion that appears at the end of the nineteenth century, adrift in the 1920s in Germany under the influence of Nazi ideology, to serve a death caused to economic, ritual purposes and in order to improve the genetic heritage of a society or a nation. Thus, writes Michel Maret, «eugenics can include or induce euthanasia." Currently, eugenics given way to the term ethnic cleansing whose motivations are close. Can be cited for example the treatment of Albanian civilians in Kosovo or the elimination of a million Rwandans, the majority was represented by Tutsis in 1994 at the fall of the regime of President Habyarimana Hutu Jwenal.
2. Active or direct euthanasia
This term refers to the intentional act of hastening or causing death by administering lethal drugs, by their nature or their dose to shorten the suffering of an incurable patient that is to say the disease is progressive and limited prognosis. The deadly process is different from the process already underway. One can add to this expression, the voluntary or involuntary adjectives whether the patient or not expressed the desire to die.
3. Passive Euthanasia
It consists of the omission or deliberate interruption of lifesaving care, with the aim to shorten the life of a patient. The death is related to the deadly process underway. This definition takes the concept of intentionality that is not accepted by all, as some see this term that the refusal of aggressive treatment.
4. Indirect Euthanasia
It means a death row to the effects of drug therapy, surgical or otherwise, without death is deliberately sought. In this terminology, we are no longer in the field of certainty and the desire to kill but in the area of risk of death. There is more here intentionality.
5. Economic Euthanasia
It refers euthanasia done for monetary reasons and performance.
6. Mercy- killing
When speaking of euthanasia, we often see up the Anglo-Saxon term of mercy -killing that can be translated as «kill pity," it is a given to relieve death, a death given by compassion and can take various forms ranging from euthanasia performed without or at the request of the patient assisted suicide.
7. Attempt to set
If the French terminology is confusing to the multiplicity of definitions of euthanasia, it does not hold true in Anglo -Saxon countries which are limited to a single definition of the term regardless of passive or indirect nature of the act. It seems therefore necessary to try to give a generally accepted definition for this term, far nuances of specialists. We can offer the definition of Patrick VERSPIEREN «euthanasia consists in giving knowingly and intentionally killing; euthanasia is the act or omission that deliberately causes the death of the patient in order to end his suffering. »
C. Assisted suicide
Assisted suicide refers to situations in which the patient gives itself death, the third intervening only to bring him in attaining his gesture. It differs from euthanasia in which suicide, no third party is involved. Assisted suicide implies the agreement and the intentionality of the wizard in this gesture. As the Professor Claude CHARDOT "it implies complicity of others, agreement, actually participating in the intent and the act of suicide. Man climbs on the parapet of the bridge, nobody using it, and man made himself the ultimate movement. ".
D. aggressive therapy
Paula MARNE defines aggressive therapy as does "use all medical means at disposal to keep a person alive. ". These means have no therapeutic purpose; it is only to improve the life span regardless of the quality thereof. We can thus talk about unreasonable practices, even if this «madness " is based on a prognosis often difficult to make. According to Article 37 of the Code of Ethics: "In all circumstances, the physician must strive to alleviate the suffering of his patient, morally assist and avoid any unreasonable obstinacy in investigations or therapeutics. « The term aggressive treatment is replaced by the expression unreasonable obstinacy that exceeds the concept of medical treatment since the patient supports and human health as a whole.

II. EUTHANASIA IN PRACTICE
A. History practices
1. Antiquity
Within the meaning currently defined, the term euthanasia has been used until the nineteenth century. These are mainly in the most primitive societies that could find related practices and particularly social euthanasia in the form of neglect or killing elderly or seriously ill or by the infanticide of children with deformities. In the Greco-Latin antiquity, the trend was to eugenics. Thus, in the Republic of Plato, it is advocated elitism and admitted See advocated the elimination of newborns with birth defects as well as adults "perverse and poorly made." Similarly, Aristotle advocated neonatal exposure misshapen and accepted the children's redundant: "As for the children to exhibit or to raise from birth, be it a law not to raise any deformed child; and in the case of too many children, if the rule of manners prohibited, which exposes any newborn. "
Later, Plutarch in his Life of Lycurgus describes the murder of weak or crippled children, thrown off a cliff Spartans just after birth. Strabo relates meanwhile, in a word, the authenticity of the facts is not assured, customs of "assisted suicides" of old and low to Ioulis on the island of Ceos. This custom is described as an institutionalized custom, introduced for the community's survival. In the Roman Empire, suicide assistance is also accepted. Thus, in Marseilles, as described by the Roman historian VALERE MAXIME, this assistance role devolved public services of the city.
2. The middle Ages
In France , it seems that in the countryside, euthanasia practices existed as the " blessed mallet " in Brittany, instrument kept in the sacristy of the parish and used to shorten the life of the dying. Most commonly in Europe, we witnessed choking between two mattresses rabid.
3. Renaissance
In Utopia of Thomas MORE, the author seems to describe acts of euthanasia that would have occurred on the island of Utopia, perpetrated by its inhabitants. These descriptions, whose authenticity could not be demonstrated because of the text translation difficulties, described assisted suicide for the terminally ill and under great suffering.
4. Institutionalized euthanasia
This is extremely rare and "justified" by the need for survival of a group. She met with Eskimos Nunaga in Canada until the 1950s, where it disappeared during the introduction of pensions for the elderly and family allowance. Similarly, this practice still exists among Yuits islands of St. Lawrence and the Chukchee North - eastern Siberia.

III. ARGUMENTS FOR AND AGAINST EUTHANASIA
1. Invocation of individual rights against breaking of a taboo
The contours of the concept of the right to life are discussed, philosophical, legal and moral. Many philosophical and religious traditions and reject suicide in its various forms. More specifically reject euthanasia: the intervention of an actor who ends the patient's life is treated as a form of murder. Thus, a group of Belgian medical personnel-has he been able to point in a manifesto against euthanasia that "The legal authority of euthanasia violates a prohibition founder and this affects even the foundations of our democracy by defining a class citizens who can be given the death with the approval of the company "The issue of euthanasia necessarily beyond the level of individual rights. The geneticist Axel Kahn, a member of the National Consultative Ethics Committee, and states that "The individual desire to want to die only calls from secular society no moral reprobation. It does not follow, of course, it returns to the company "to provide this service" to whom the application. "
Robert Badiner, former Justice Minister and main architect of the abolition of the death penalty, the introduction of euthanasia exception in the law could not be done without affecting the right to life, "the first of human rights ". He believes that the penal code "has an expressive function and that as such it should reflect the values of a society"; "It is at its highest level when it comes to life and death. No one can deprive others of life in a democracy. "
2. The exercise of the freedom and autonomy
Axel Kahn evokes the forced nature of the request for euthanasia. This constraint dimension it seems incompatible with gasoline exercise of authentic freedom. Therefore, the corporation's first response to these requests should never be the organization of an assisted suicide or an act direct euthanasia, but should be trying to restore the conditions of authentic freedom through restoring a desirable life to better reflect the patient's wishes, including when he becomes unable to express them, many states have implemented the ability to issue advance directives. The World Medical Association has announced a number of recommendations regarding the form of the guidelines during its general meeting 2003
3. The vision of the dignity of human life
A point which marks the very commonly dividing line between supporters and opponents of euthanasia is the vision of human dignity, since it is an argument both to justify maintaining the ban on euthanasia that its decriminalization. Thus, a recommendation of the Parliamentary Assembly of the Council of Europe, adopted May 21, 1999, states that the dignity is an absolute concept: "The dignity is inherent in the existence of every human being. If possession was due to peculiarities, skills or any conditions,
Dignity would neither be equally nor universally characteristic of all human beings. The human being is invested with dignity throughout his life. Pain, suffering or weakness can do without. "The recommendation therefore calls for" dedicate and protect the right of the terminally ill and the dying to comprehensive palliative care "and to" maintain the absolute prohibition on intentionally taking the life of terminally ill or dying. "
Rather, the philosopher Simon Blackburn believes that it is impossible to "found prohibition of euthanasia on the respect for life (let alone respect for dignity), since it actually requires the prohibition it is not respect for life, but respect for the act of dying - that is to say, being treated as sacrosanct often intolerable procedure without any dignity, cruel and painful of our natural dissolution. "The impact of euthanasia on the question of human dignity beyond the scope of the questioning of an individual situation of end of life. Thus, the critical report Sicard euthanasia because "she internalizes the negative societal representations of a number of old cases, disease and disability", risking away medicine "care of humanity and universal duty accompaniment. »
4. Social Resource Management
Part of euthanasia advocates seek to go beyond both the vision of dignity and freedom of absolute individual in favor of a utilitarian concept of morality. Utilitarianism allows, and possibly promotes the sacrifice of individual happiness in favor of that of the majority. In this context, it is considered legitimate to optimize the use of medical resources by focusing on patients whose lives can be saved, and to consider as a burden the resources to keep alive people who can no longer make anything to society. This design, theorized by the philosopher Peter Singer has advocated including in Switzerland by the President of the Christian Democratic Party ( PDC), Christophe Darbellay .
5. Consideration of suffering
According to opponents of euthanasia, pain is now well considered and often calmed effectively, especially in palliative care services. There remains significant not suffering pain. So:
Progressive loss of control over her own body, as in the case of neurodegenerative diseases;
The feeling of suffocation;
Deformation of her body, especially her face;
Permanent loss of autonomy.
The fall in euthanasia cases in the Netherlands between 2001 and 2005 seems attributed, according to the authors of a report based on statistics on euthanasia, improvement of palliative care. Some doctors and commentators objected to the need for an introduction of euthanasia in the law, because of the progress (present and future) of palliative medicine in the fight against the suffering in its entirety. Thus, the geneticist Axel Kahn says "I would resolve to a euthanasia law if that was the only way to soothe the pain. »
6. physician's role Vision
The medical opinion on the legalization of euthanasia is shared. Thus, a survey conducted by INSERM in 2003 shows that 45% of French GPs are in favor of decriminalization of euthanasia comparable to that of the Netherlands. The study authors report that "The most doctors involved and more comfortable in palliative care and monitoring of life purposes are often hostile to legalization of euthanasia," unlike "those who feel uncomfortable to patients facing the end of life. » The same study indicates a trend, especially among physicians who have not received specific training, assimilating techniques such as Stop resuscitation sedation or euthanasia. It indicates a correlation between the tendency to make this assimilation and the fact to declare in favor of euthanasia.
In any case, that euthanasia is decriminalized or not, the challenges for physicians and health care teams are ethical: the law does not override the ethical and personal reflection in the choice of acts end life (whether lethal injections to stop making care or terminal sedation). In the case of euthanasia in particular, the question of its ethical legitimacy should not be confused with the question of legalization or decriminalization. In this regard, the philosopher Marta Spranzi notes that "the fact of explicitly authorize medical staff to give death, were that the laudable intention to alleviate the suffering of patients, is perceived, especially by doctors themselves as more problematic than the reality of the gesture itself, accomplished in the silence of the medical relationship "because of possible abuses.
7. Arguments on the need and feasibility of a controlled introduction
When changing the laws of Belgium, one of the arguments in the explanatory memorandum is that doing euthanasia in a medical context avoids practices that would still have taken place clandestinely, and allows placing the actors in conditions good coaching practices and legal certainty

CONCLUSION
In conclusion, we can say that behind a request for euthanasia, it is often an application for recognition that is expressed by the patient entering a dynamic relationship must be recognized and to be answered. This is always the expression of a comprehensive pain called "total pain" and that covers all fields of the physical, mental, spiritual, and social. Underpinned by fear of death. We can quote a phrase Philippe GELUCK lends his comic hero chatting: "I'm so scared to death that I would be afraid to die quickly to less time." This expression is not associated only to patients at end of life is a reflection of the frequency of requests for death in the general population, occurring in various situations made mourning, professional or marital failures . The demands made by the family are also the reflection of intense suffering which can be superimposed projection phenomena guilt, lassitude and sometimes an early bereavement. Access to such a request could only accentuate this feeling of responsibility of the survivors. It is therefore appropriate in view of these findings to adopt an appropriate attitude by always placing the patient at the center of reflection. We must therefore sit the patient in order to signify the gravity of his request was heard and listen to the reasons that led the patient to perform. As the Doctor Salamagne "the first drug administered to the patient is the doctor himself! Hearing this request, sitting down, to signify the gravity, receive without interpreting it, not wanting to discuss, without preparing an argument, is the first skincare. ". This listening phase is essential because it will help to better understand the demand by limiting the interpretations of expressions of the patient, often ambiguous and ambivalent.

BIBLIOGRAPHY

ABIVEN M., CHARDOT C., FRESCO R., Euthanasie, alternatives et controverses, Presses de la renaissance, Paris, 2000
ARISTOTE, Politique, Tome III, Première partie, Livre VIII, texte établi et traduit par AUBONNET J., Paris, 1986
AURENCHE S., l'euthanasie, la fin d'un tabou? .ESF éditeur, 1999, Paris
Axel Kahn, « L'euthanasie : un droit ? Une liberté ? » La revue du projet, 6 avril 2011
Broeckaert, Bert. "Palliative Sedation, Physician-Assisted Suicide, and Euthanasia: 'Same, Same but Different'?". American Journal of Bioethics 11.6 (2011): 62-64. Academic
CHARDOT C., La mort donnée pour soulager, Annales médicales de Lorraine et de l'Est, 35, 1996
CHARDOT C., Quelques réflexions à partir d'une expérience cancérologique, Rencontre des Comités Régionaux d'Ethique Médicale au Sénat, Il Mai 2001.
Golden M., T. Zoanni. Killing Us Softly: The Dangers of Legalizing Assisted Suicide. Disability Health Journal, 2010. (3):16–30. Web. 22 October 2013.
Kerridge I., M. Lowe, C. Stewart. Ethics and Law for the Health Professions. 3rd ed. New
LA MARNE P., Ethique de la fin de vie, Editions Ellipses, Paris, 1999, 128 p.
MARET M., L'euthanasie, alternative sociale et enjeux pour l'éthique chrétienne, Edition saint Augustin, 2000,
BACON, première partie, De la dignité et de l'accroissement des sciences, livre quatrième, chapitre II, traduction revue, corrigée et précédée d'une introduction par M.F. Riaux, Paris, 1843
PREVOST A., L'Utopie de Thomas More, Paris, 1978
Stéphane Kovacs, « La Belgique veut étendre l'euthanasie aux mineurs » Le Figaro, 20 février 2013
VALERE MAXIME, Faits et dits mémorables, Livre 2, VI, 7d, texte établi et traduit par Robert COMBES, Tome 1, Paris, 1995, pages 181-182.
VERSPIEREN P., Face à celui qui meurt, Des clés de Brouwer, Paris, 1984,207 p.
Worsnop, Richard L. "Assisted Suicide." CQ Researcher 21 Feb. 1992: 145-68. Web. 02 Nov. 2015


AURENCHE S., l'euthanasie, la fin d'un tabou? .ESF éditeur, 1999, Paris, 188 p.

ABIVEN M., CHARDOT C., FRESCO R., Euthanasie, alternatives et controverses, Presses de la renaissance, Paris, 2000, 314 p.

Œuvres de BACON, première partie, De la dignité et de l'accroissement des sciences, livre quatrième, chapitre II, traduction revue, corrigée et précédée d'une introduction par M.F. Riaux, Paris, 1843, pages 201-202.
MARET M., L'euthanasie, alternative sociale et enjeux pour l'éthique chrétienne, Edition saint Augustin, 2000, 394 p.
MARET M., L'euthanasie, alternative sociale et enjeux pour l'éthique chrétienne, Edition saint Augustin, 2000, 394 p.
ABIVEN M., CHARDOT C., FRESCO R., Euthanasie, alternatives et controverses, Presses de la renaissance, Paris, 2000, 314 p.
CHARDOT C., La mort donnée pour soulager, Annales médicales de Lorraine et de l'Est, 35, 1996, pages 139-148
VERSPIEREN P., Face à celui qui meurt, Des clés de Brouwer, Paris, 1984,207 p.

CHARDOT C., Quelques réflexions à partir d'une expérience cancérologique, Rencontre des Comités Régionaux d'Ethique Médicale au Sénat, Il Mai 2001.
LA MARNE P., Ethique de la fin de vie, Editions Ellipses, Paris, 1999, 128 p.
Communiqué du Professeur GLORION B., Obstination thérapeutique déraisonnable: le cadre déontologique et le cadre éthique, Salon du MEDEC, Paris, Il mars 2000
ARISTOTE, Politique, Tome III, Première partie, Livre VIII, texte établi et traduit par AUBONNET J., Paris, 1986, page 107
VALERE MAXIME, Faits et dits mémorables, Livre 2, VI, 7d, texte établi et traduit par Robert COMBES, Tome 1, Paris, 1995, pages 181-182.
ABIVEN M., CHARDOT C., FRESCO R., Euthanasie, alternatives et controverses, Presses de la renaissance, Paris, 2000, 314 p
PREVOST A., L'Utopie de Thomas More, Paris, 1978, page 549
Stéphane Kovacs, « La Belgique veut étendre l'euthanasie aux mineurs » Le Figaro, 20 février 2013
Axel Kahn, « L'euthanasie : un droit ? Une liberté ? » La revue du projet, 6 avril 2011
Robert Badinter, Rapport de la mission d'évaluation de la loi N° 2005-370 du 22 avril 2005 page 570-571, sur le site assemblee-nationale.fr
Axel Kahn, « L'euthanasie : un droit ? une liberté ? » La revue du projet, 6 avril 2011
Simon Blackburn, Review from Times Literary Supplement, 30 septembre 2005.

Conclusions d'un rapport officiel cité par la Libre Belgique
Conclusions de l'étude sur le site de l'agence de presse spécialisée APM international

Peut-on distinguer euthanasie active et euthanasie passive ? Marta Spranzi, La Vie des idées, 24 avril 2009