Brian Cox, MD

Medical Doctor, Research Scientist,


This conversation is closed.

Euthanasia: In favor or opposed?

Some questions to get you thinking:

Should patients be allowed the right to die?
Are doctors obligated to assist patients with their dying wish?
Should assisted suicide be illegal?

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    Jun 25 2012: I am a huge advocate for palliative care and for paitent directed care. That includes a knowing informed patient choice not only to refuse all curative treatments but to seek and receive assistance with suicide or euthanasia.

    It is very hard for some people to understand.

    As a patient for very advanced cancer I experienced pain beyond measure for which no relief was possible except a few hours peace in a morphine induced stupor. I was lucky to recover from that but if that had been something I had to endure for the rest of my life, I would have begged for euthanasia or assisted suicide. It should come as no surprise that it is very very common for people suffering at such extremes to request euthanasia or assistance with suicide.

    When there i s no cure and no possibility of comfort or awareness and the patient has requested it, by advance directive or by active communication at the time, it is cruel to withold it and criminal to make it a crime..
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      Jun 26 2012: Your perspective and experience with this issue trumps anything I can say on the contrary. I cannot fathom your plight.

      However, from my research and interviews, I have found doctors report it is very uncommon for patients (even those in excruciating pain) to request euthanasia.

      I can understand why you can empathize with someone willing to take their own life, but are you glad you never sought out such a permanent solution?
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        Jun 26 2012: Brian,

        If you interviewed the spouses, close friends or relatives of patients with terminal illness involving extreme pain, inability to eat or other very extreme symptoms or even hospice volunteers or nurses you'd get a very different research result., Brian. It is very common for patients to ask for reassurance that loved one's will insure a dignified death

        At hospital or medical established palliative care or even hospice .conferences, I am always astonished at how out of touch doctors are with patient needs. Astonishing that would be true of palliative care which is a patient directed acceptance of death. Palliative care is still having trouble finding a foothold in hospitals and the establishment finds it very difficult to embrace the idea that people choose a dignified death. Hos[ice has helped pave the way for a more patient centered approach that focuses on the acceptance and preparation for dying. In time palliative care will gain acceptance and hopefully evolved a more patient centered awareness within the medical profession.

        In answer to your personal question my extreme pain and other symptoms (mostly from the treatment not the disease..extreme chemo and radiation) I was not terminal and I was on such a m,edical roller coaster in and out of emergency rooms ( not easy when you live on a remote island island ) I never got to that choice.

        Brian, we are never "dying persons" we are living persons right to our last breath. The quality of that diminished and ever diminishing life is critically important and particular to each patient. that must be honored.

        If you want to understand euthanasia spend some time as a volunteer in hospice or palliative care or with people in the advanced stages of terminal illness. Witness and attend that suffering. Talking to doctors will not yield much valuable patient centered information.
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          Jun 27 2012: With our ever-aging population, I, too, hope palliative care finds sustained support. I am almost sure it will. Medicine gallops ahead every year.

          As far as honoring patient life, I think I have demonstrated my aversion for ending it artificially during our conversation. I truly believe in patient respect and dignity and feel I should never be part of/witness a 'solution' as permanent as assisted suicide.

          In the future, I plan on spending copious time with patients. As a medical student who has never been a patient, I am far from an expert on this subject. People like you are the true experts, which is why I am determined to find out what you think and feel.
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        Jun 27 2012: Brian,

        Sounds like you may have a belief system based struggle with the idea of pain relief that may hasten death or other extreme situations in which patients may seek a dignified death, I think when you have your first experience with a vibrant person in full livingness trapped in an out of control body, trapped in suffering beyond comprehension your belief system might update itself on the spot when that person says "Doc can you help me?"
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          Jun 27 2012: That absolutely could be true as I have never faced such a situation. However, I appreciate your insights as they will help shape my future actions.
        • Jul 17 2012: There are plenty of people who manage to the live with their illness to the very end without ending their life ahead of time. I know their are some who would rather get help in killing themselves.They either do it themselves or get someone to help them get what they need to take their life. However it should never be the business of the medical field to be involved with one of these killings. It is too dangerous and doctors need to do deal with healing and saving lives only. It has worked this way for millions of years and should not change.The only changes I think that should be made is enforcing the laws when it comes to euthanasia. I also think that dnrs and no drastic measures need to stay out of the medical field as well. Not only can patients lives be healed and saved but we can also spare the families of these euthanized patients a lifetime of heartbreak and endless suffering, It will help many people this way.
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        Jun 27 2012: Brian,

        You have a very nice bed side manner...I encourage you to see the movie WIT available on netfix or from amazon
        As a patient I can tell you it is a very accurate patient centered account of extreme illness. This one doesn't involve euthanasia or hastened death ..the patient is in a clinical trial.

        As you are so interested in this important humanitarian issue, I am sure you will find a way to be a one on one companion to people with terminal illness who are suffering at the extremes. Bringing that experience back to medical school and into formal medicine will be a great service to the may who suffer at extremes.

        There is a very long way to go. The very few palliative care units trying to take root in hospitals are often referred to as "the death squad"..a long way to go to close this care gap in modern medicine.
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    Jun 26 2012: Whoever gives an opinion on this has to have been helpless next to someone suffering without any possibility of relief and a death verdict from doctors, day after day, night after night. There is no other legitimate position to give any opinion but being the one suffering and dying.
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      Jun 26 2012: I think your perspective highlights the importance of competence.

      In a perfect world, we would all be in complete control of our own destiny. The pursuit of dignity through autonomy is an essential facet of human freedom.

      However, how can those lacking competence (coma, brain trauma, severe depression, etc.) provide a reliable source of personal opinion? Shouldn't we protect these people?

      Most historical cases of euthanasia eventually fall into the debate of competence.
    • Jul 5 2012: I fail to understand how I cannot have an opinion as to if I should be allowed, by a bunch of random people, to end my own life in a painless manner because I am not suffering. If someone wishes to die, that is their right, it is their life to end.

      The debate of assisted suicide (which need not even be assisted, but available) tramples on the rights of those who are competent. Competence is simply a red herring used to prevent any euthanasia at all. After all, even non-assisted suicide remains illegal in some countries. In more countries, advising a person as to how to commit suicide means prison. In yet more countries helping someone properly commit suicide means prison.

      The ACLU of America defines the prohibition of assisted suicide to be cruel and unusual punishment. I tend to agree. Forcing makeshift non-assisted suicides ensures the person dies in agony, or worse, doesn't die at all, when there are proven clinical methods of pain-free death.
      • Jul 17 2012: Medical staff should not be responsible for taking or to help take a life. That would be up to the patient. It has gone on like this since the beginning of time. It is not a job requirement of medical staff nor should it be a job requirement of a medical staff to participate in taking a life. The job of the medical staff is healing and saving lives not taking them.
        • Jul 17 2012: First, what part of my posting is this even a response to? These generic talking points are getting tiresome and do nothing to progress the conversation.

          "It has gone on like this since the beginning of time."

          Are you really using the "it's tradition" argument? Dogma is not a path to progress. If we all lived by dogma, we'd still be worshiping the sun on a flat earth below a firmament with bloodletting as a cure-all.

          "Medical staff should not be responsible for taking or to help take a life. That would be up to the patient."

          You are partially correct. Being a doctor is a profession, which is defined by a job description. You change the job description and the responsibility changes. It's quite easy. If you don't want to do the job, you don't apply for the job. It is basic employment. If you wish to avoid aiding in suicide, don't work for a place which requires it.

          "That would be up to the patient."

          You are entirely correct, and the doctor's job is to aid the patient in their treatment. Put simply, if life is the ailment, suicide is the treatment. If a doctor does not wish to perform euthanizing, there are thousands of other careers out there.

          I find "not my job" to be the most baseless of all of the regurgitated talking points regarding euthanasia. If you don't want to do a job, don't apply for it. There is always someone who has _all_ of the patients' interests at heart, not just the ones they agree with.

          Your entire argument of "should" is meaningless. Employers post job descriptions, employees fill them. If you don't wish to do the job, don't apply. There will be no shortage of doctors willing to take the job, after the doctors who feel they have the right to dictate what employers "should" do head to the unemployment office.
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    Jun 26 2012: It is our life. We should have the right to decide when we exit, especially if suffering from a terminal illness.

    It already happens passively. Letting people die rather than medicate or additional surgeries.
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      Jun 26 2012: In patients with severe debilitating illness, passive forms of euthanasia are cruel. For instance, in a patient with respiratory failure on a respirator. Turning off the respirator is the equivalent of suffocating the patient.

      Euthanizing patients passively seems dignified and painless, but the reality is somewhat different.

      Active euthanization is similarly not ideal. Dignitas specializes in this process and they have developed what they believe is the best form of euthanasia. Imagine you want to end your life - the process is as follows:

      During a Dignitas visit, you and your family are interviewed in the equivalent of a hotel room. A single Dignitas employee video records the interview and asks you to expressively state you would like to end your life. You are given some last time with your family before they are asked to leave the room. At this point, an anesthetic and lethal drug cocktail is administered. Your family is then called back into the room to hold you as you slowly pass away. The whole process takes less than an hour.
      • Jul 17 2012: Active euthanasia is also done when the patient does not want to die but is forced to die instead of being given the medicine that is needed to cure them. It may start out as passive. When medicine is given that will assure the death of the patient the euthanasia then goes from passive to active. Sometimes the patient does not die fast enough for the staff so the staff has to actively kill the patient by some other way. It can also be done by other pain meds with narcotics and sedatives. The reason I call this active is because it is done with the staff knowing what kind of meds to use but deciding to use something that will assure the patients death instead.The reason that the doctors came to this conclusion was because they labeled the patient as having no quality of life. The reason the patient had no quality of life was from an sedative overdose that caused the patient to go in a vegetative state (coma) for a period of time. So they labeled the problem as patient as having no quality of life and the killer treatment was put in place. This happens to people who are of a certain age or anyone who can possibly be considered a burden of anykind.That is why I would love to see any medical staff who euthanizes be put in prison for life. If they want so much to force a person to die, who does not even want to die and cause the family a lifetime of suffering as they watch their relative being tortured and being forced to die then it is only fair that this medical staff spend a lifetime in prison thinking about what they did,instead of getting away with it and free to do this to some other innocent victim.
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        Jul 19 2012: Agree its not without its problems, even if you dump the religious objections and it is the persons choice. And there are many different situations and approaches.

        Actively ending life versus withholding treatment. Treatment might range from switching a respirator off to forgoing radical surgery or even antibiotics.

        Another dimension is the physical and mental capability of the person.

        If a person has their faculties and is suffering and wants to end their life that is very different to a coma or dementia.

        But if someone wants to end their life I tend to think that is their choice.

        That is not to say this might be a selfish choice if you have dependents especially etc

        My personal rule is not to kill myself in the heat of the moment, but to wait until tomorrow to think about it.

        But ultimately if the pain was extreme and endless if hope had gone and existence was torture I would reserve the right to end it

        We had a tough call recently with a relative with severe dementia. Its not easy when they are beyond reason.

        Every situation case by case I guess.

        Agree it might cause more suffering to switch of a respirator if the person is aware than something more active. It maybe nearly impossible to avoid all suffering whether physical or emotional in these situations.

        The dignatis approach doesn't sound to bad to me when you compare it to some alternatives.

        In the end people are choosing what they think is the least bad option of a whole bunch of crappy options.

        If it is their choice to die, its tragic, but I'm okay with that. Is it black and white, is it risk free, might people off themselves because of the financial burden, its very complex, but I suggest keeping people breathing as long as possible is not always the most humane thing to do.

        The life is sacred motto oversimplifies the issue. Quality of life is also sacred.
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    Jun 26 2012: I think assisted suicide is a viable medical treatment option that should be available for those with no alternative to suffering.

    It should be a treatment plan worked out between the physician and the patient with input from other stakeholders. But the decision rests entirely with the patient

    I hope it is there if I ever need it.
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      Jun 26 2012: I agree with your sentiment, but many physicians would argue that death is not a "treatment" option.

      As I have stated above, certain factors such as motivation, competency, and patient-doctor trust are all at odds during a euthanasia consultation. These issues confound even adamantly expressed consent for assisted suicide.

      I think it is important to remember that doctors see death every day, but they never forget a patient they could have saved.
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        Jun 26 2012: Well then, I would go to a different doctor. When I am interviewing a doctor I do ask those questions so I can make an informed decision.

        If you have a problem with discussing this with your patients then don't. Refer them to someone who can. But I would be very angry if we were having a discussion about the end of my life and all of a sudden you break my trust and tell me you won't work with me here. There is nothing to be confounded about. Be frank, upfront and no trust will be at risk.

        And boo hoo that physicians never forget the patient they could have saved. I got my own list. This is NOT ABOUT YOU. Never forget that.
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        Jun 27 2012: You'll be ok kid.
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    Jun 25 2012: Hi Brian.
    I remember David Steel's abortion bill. I was all for it; it was designed to help those who really needed it & was fenced in with all sorts of safeguards to ensure it was not abused. Today, well........
    Euthanasia is the same sort of deal. I would happily face jail to put a loved one out of misery, if really necessary, & hopefully one of my loved ones would do the same for me. I would not trust the system with that sort of power however. They should keep the peace, & dispose of the trash period. That way we could all sleep well at night.

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      Jun 26 2012: Well said: "I would not trust the system with that sort of power..."

      I think it is important to examine euthanasia from every perspective. When I first faced this issue of euthanasia, I felt compelled by personal choice, freedom, etc. It was only until I began to look at the consequences of such legislation, both personally and professionally, that I began to adapt my views.

      I would like to talk about the similarities and differences between abortion and euthanasia, but I will quickly run out of room :)
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      Jul 19 2012: I tend to agree Peter.
  • Jul 2 2012: Last I checked slavery was frowned upon, so with that knowledge I have no right to ownership of anyone's body but my own. If someone wants to kill their own body, that is their choice to make, not mine. I am not their owner any more than I wish for them to own me.

    As for doctors being obligated, not at all. If they don't wish to perform assisted suicide, they can work at a hospital which does not perform them, or has dedicated staff which will. That said, hospitals should have the right to refuse employment to a doctor who refuses to perform such procedures, as it hurts the business of the hospital. If there is an employee willing to perform ALL duties, they should take preference to those who refuse some of them. In short, free market business.

    I fail to see the complexity of this topic. People either forcibly claim ownership of another person (pro-slavery) or they respect the human rights of everyone.
  • Jun 27 2012: First, my credentials. I watched my father in law decline from a robust miner to a virtual vegetable, incapable of making any decision. The process took twenty years and it is hard to imagine anything more cruel than what he experienced.

    When he finally passed, my wife and I promised each other we would not go through anything like that. We have had many conversations about dying and death, and we have power of attorney for each other.

    Brian, I can well understand your dilemma. Part of western society has long had an attitude toward death that makes it seem unnatural. Dylan Thomas' poem, "Do not go gentle in that good night" exemplifies this attitude. But to someone in excruciating pain, this notion would seem laughable if anything could.

    "I want you to consider a world in which doctors could write a prescription for euthanasia. How would that change our perception of doctors?"

    In this regard, our perception of doctors must change in the context of changing our perception about life, dying and death. Death is a natural part of life. If doctors could and would write a prescription for euthanasia, it would certainly change my perception of doctors for the better. Fighting death to the bitter end may seem glorious, but the reality is altogether different. If a doctor could legally participate in assisted suicide, but refuses, I would consider that doctor unrealistic, or possibly inexperienced, and would have a hard time trusting him at all.

    In the west, and especially in the USA, we honor people who fight and die for freedom. Well the opposite of freedom is slavery, and the situation of most people who seek assisted suicide is far worse than slavery.
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    Jun 26 2012: I have read all your comments, including the comments in "The Right to Assisted Suicide" conversation posted by Stewart. From what I have read, it seems that most are in favor of euthanasia under a certain pretense. Many of you have highlighted that in certain cases of unbearable, progressive suffering, you would consider assisted suicide.

    However, I want you to consider a world in which doctors could write a prescription for euthanasia. How would that change our perception of doctors? Current practice dictates that a doctor must always keep you alive and well, regardless of your circumstances. If euthanasia was legalized, a doctor would suddenly be involved in the prescription of death.

    Do you think only certain factions of doctors should be considered Euthansizers?

    Would this be similar to those who conduct abortions?

    How would you be referred to these types of doctors?
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      Jun 26 2012: I think it all plays on the doctor's right to not treat someone, so a doctor who didn't want to euthanize a patient could just refuse to do so. So in this case you build a data log of doctors who are willing to do it and you get refereed to them.
      I think it would be incredibly cruel and arrogant to call such doctors dealers of death as the media surely would, they would be doing a very brave act and a real act of treatment for those who wish to die.

      p.s are you studying at Queens Belfast? if so what are your thoughts on it?
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        Jun 27 2012: Yep! Going into my 4th year, passed all of my exams as of yesterday. Queen's is a great Uni. It's hard for me to compare as NI is very different from from America, but I find the curriculum to be very clinical, hands on, and inclusive of lots of patient contact. I think I miss the sun most though!
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          Jun 27 2012: Ha try living here for 16 years with rain almost every day. I my self am thinking about going to Queens or Trinity in Dublin, not to do medicine though. O well enjoy your final year, and if by chance there's a sunny day you should go to the Mournes sometime.

          p.s At first I totally thought you were the physicist Brian Cox
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          Jun 27 2012: Brian, As a new (almost) doctor and consistant with the theme ... I assume you will return to the US to practice .... what are your thoughts on Obamacare and the included Death Panels and associated "control" of doctors and the medical profession. Your conversation will become imposed law and this conservation and opinions to the contrary mute. The role of doctors and the medical profession will be forever changed. Will this influence where you chose to practice .... Your views on the government intervention into the medical profession and regulating medical decisions please.
      • Jun 29 2012: Unfortunately, I disagree with your view. How can it be a doctor's right ? Is it the doctor who is having to undergo all the pain and suffering or is it the patient himself ? Does the doctor hold the ability to understand the patients emotion? No. The patient coupled with his closest family members are the sole beings who hold this ability and thus, in my opinion , it is the patients right to take this decision, rather than the doctor himself
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          Jun 29 2012: Yes but doctors by law have the right to not treat someone, if you walked into a hospital with a broken arm or anything, the doctor has a legal right not to treat you.
        • Jul 17 2012: Doctors are not doctors so they can kill people they are doctors to heal and save people. They do not have the right to kill their patient just because the patient or the family of the patient demands it. That is not a doctor's job. Their job is to heal and save lives. Killing patients is not in the job description.
    • Jun 26 2012: It all depends whether the patient can make their own decision about it, whether there should be a thing like a DNR but for euthanizing, where the patient has signed a thing beforehand.

      As about the doctors, I think there should be "courses" for that, so only trained, professional and experienced doctors can do this, rather than any old doctor, because no doubt there would be loads of scandals and inquiries about this sort of thing.

      If the patient is too incapacitated to make a decision (i.e too much pain or a coma), there should be something like a general consensus among the closest family.

      In the end, I quote the famous Game of Thrones "you will see exactly what life is worth, when all the rest has gone"
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        Jun 27 2012: The problem is that most euthanized individuals may lack the competence to simply 'sign on the dotted line.' Additionally, it may be impossible to provide evidence otherwise.

        At the minute, no programs for euthanization exist as the process is still an illegal process. Your proposal has been considered previously, but many doctors (palliative care and anesthetists included) feel euthanizing is contrary to their vocation. They argue they would lose patient trust if they were able to provide a euthanizing service.

        It is a difficult balance between patient competence, motivation, family pressure, and medical opinion. However, even if all parties are in agreement, no single person typically wants to be responsible for the permanence of ending someone's life.
        • Jun 27 2012: I don't think I explained myself properly, I mean like, at any point in ones life, someone can sign a paper saying that if they are in a state where it's just going to be endless pain and suffering, then the option of euthanasia is possible.

          I can understand why doctors feel that way, because they live to save people. But I guess that the way I see it is that a person can be saved through death. I know I'd much rather be put out of my misery than be suffering in one way or another.

          However, I know if it was my mum or something which was in this condition, there would be a big part of me not wanting to let go.

          Also just slightly off topic, I find it a bit strange how many countries 33 states in America (I think it's 33...) can give out the death sentence, but not euthanasia. I know thats a bit of a weird thing to say, but if people are so morally just to say when someone can be put in the chair or not, they can rather do that to someone rather than help someone relieve their pain.

          But again, it's different to passing the sentence than actually carrying it out I suppose. I think however, whoever passes out the sentence (talking about both capital punishment and euthanasia) should do the deed. I suppose its harder in terms of euthanasia, because if the patient decides they want it, then they are supposed to kill themselves...

          I dunno, I'm kind of arguing with myself now haha
        • Jul 17 2012: To Rob the death penalty is also horrible. Innocent lives have been taken by use of the death penalty as well as innocent lives that were taken by use of mercy killings.Abortion is another euthanasia that takes innoncent lives. It is just too much killing and all needs to stop.
        • Jul 17 2012: The problem with dnrs is they are used to kill people by psychopath medical staff who do not want to treat. An example of this would be when the medical staff gives an endless supply of sedatives and other pain narcotics while the patient is already in a medical emergency coma from another drug overdose. the staff yells out dnr and sedatives all at the same time. It is truly unbelievable that even psychopath medical staff can be such incredible low lives as that.This patient is not even the slightest bit terminal.
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      Jun 26 2012: Whose idea is that doctors keep me alive and well? Sorry but that's my job. If I have a health issue I seek out the doctor or if I have pain or a broken bone or something.

      I don't think it will ever get to the point where doctors can write a prescription for it. First of all, the pharmacists will not be willing to fill that script and imagine trying to transport or store it safely. I think it should be an in-office/hospital or bedside procedure with the physician in attendance to pronounce.

      I also agree with Stewart, there will be physicians that can ethically help and others that cannot based on their own morality. That needs to be respected. Maybe there should be a sub-specialty or board certification in thanatology. Evidence based practice and such. I think the best physician for this is the general practitioner who has developed a therapeutic relationship with the patient and has a broader understanding of the situation and ramifications of the decision. They would also know the patient, hopefully for years, and can best coordinate the procedure into a treatment plan.

      I think there is a huge difference between euthanasia and assisted suicide. I would really have to think about Rob's suggestion that the family and physician can end someones life, even in a coma. Imagine the possible abuses there. I would have to think about it.
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        Jun 27 2012: It is definitely a controversial issue and I understand how passionately you feel about this issue. I am merely attempting to provide the opposing view for your consideration. I think this issue is too quickly dismissed as 'patient choice' when all parties involved need consideration. Exactly as you have pointed out, if euthanasia or assisted suicide were legal, would there be abuses? legal ramifications? sustained family guilt?
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          Jun 28 2012: No, I think you are wrong. I have been in these situations many many times. Not assisted suicide but code or no code. The ONLY person that should have any say is the patient. Believe me they are not happy if you resuscitate them and prolong thier suffering because the next of kin panics and makes us jump on their chest. Unfortunately most of the world thinks like you do, or should I say, most of the world is afraid of lawsuits from the family members who do not die.

          It is patient choice and everybody else should stay out of it. There would be no abuse at all if we could get that in place.
        • Jul 17 2012: To Brian
          I do think that if it were legal it would be even more dangerous. There are psychopath and lazy medical staff who do not mind killing people. I could just see them telling the family of the poor patient/victim that the patient is suffering so lets abide by the patients wishes and kill them, or if the patient said ahead of time they would want to be euthanized if they went into a coma the psychopath doctor could simply put the patient in a drug induced coma and the patient is euthanized. Euthanizing can also cover up drug overdose mistakes made by doctors. If we do not make it so easy for drs to cover up mistakes by use of euthanasia then maybe there would not be as many mistakes made. There should also be heavy consequences for doctors who do use euthanasia.

          I have seen dnr being used to kill as well as no drastic measures. These two things are legal and are being used in the wrong way by what I call psychopath doctors. Also euthanasia is being used even though it is not legal. So with that said, I can only imagine what would happen if it were legal in the medical field.

          Instead any medical staff who participates in it should spend their life in prison maybe this will set an example to the psychopath uncaring lazy doctors. It seems the only thing that will make a psychopath do the right thing is the fear of prison. That would at least help the situation although not stop it completely.
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    Jun 26 2012: I think it depends on the reason why you'd want to end your life. If you're suffering and you know it will only be worse, why not? But it shouldn't be performed if there is not a strong reason to do it. Once I watched a very interesting film named "You Don't Know Jack" (2010) about this practice during an Ethics class.
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      Jun 26 2012: "Reasons" are difficult to ascertain and certain shades of grey exist in every case of assisted suicide. Let me give you an example:

      A grandmother "Sara" has progressive, debilitating rheumatoid arthritis and diabetes leading to kidney failure. She is requiring dialysis at the cost of $40,000 (£28,000) per year. She will survive for the next 10 years with adequate treatment, but needs caregivers to help her wash, clothe, and manage her cooking. Although she loves seeing her grandchildren, she knows she is a financial burden on the family. She is suffering, her lifestyle is worsening, and she cannot help be depressed by her situation.

      Sara decides the best outlet is euthanasia, and she consults Dignitas in Switzerland.

      For the sake of argument, assume Sara is competent. This case highlights the importance of motivation.

      Has Sara been motivated by her own free will? Or has she been motivated by her family's will?

      Does she feel she is a burden?
      • Jun 27 2012: Brian, this is a good case because it is a difficult case and highlights the key issue of values.

        Just how important is it to Sara that she has become a burden rather than a productive caregiver within her family? To Sara, this change could be a complete reversal of her very identity, and be intolerable. How can someone outside the family judge this?

        In this case, if I was Sara's physician, I would have some long talks with her to get to know her better before making a decision. And the physician always has the option to suggest that the patient see someone else.

        As for the shades of grey, at some point a decision must be made that the patient is competent and not acting under duress. If those two facts can be established, the decision belongs to the patient.
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    Jun 25 2012: Hi Brian theres a TED idea on the right to assisted suicide, I put two comments on it and think they'd be worth reading for you,
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      Jun 26 2012: I read them both, very insightful and thorough. I agree with a lot of what you said, and responded more-or-less in the above comment. Thanks for your insight!
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    Jul 24 2012: There is always an application of wisdom that is peculiar to every case.
  • Jul 21 2012: Fundamentally this is a question of education. Instead of the term "euthanasia", for which many people have an aversion to, the term should be "physician-assisted suicide". Thus we should begin the conversation of how we can compassionately assist those who are terminally ill, to decide how and when they wish to leave this life.
    To die with dignity is a human right.
  • Jul 17 2012: This situation has been going on for many years. If a person wants to kill themselves because of a terminal disease then they need to do it on their own time and without the help of any kind from the medical staff. It has been happening like this for years. At least with the doctors who do not practice euthanasia.

    Euthanasia has happened in the medical field and in the U.S. It has been going on before it was even legal in Oregen and Washington and all over the U.S. It needs to stay out of the medical field because it has no business being in it. It should be illegal everywhere along with dnrs and no drastic measures. The no drastic measures are things like medicine that a patient needs to recover from their illness. If the patient has no drastic measures on his charts the patient dies from a curable infection because most medicine are considered drastic measures as far as the medical staff is concerned and therefore will not be given. It is whatever the medical staff thinks is no drastic measures not what the patient thinks.

    Therefore anything from no drastic measures and do not resuscitate and euthanasia needs to stay out of the medical field cause these things kill patients who are otherwise curable. People better really think about that. I have experienced this myself and I could not believe what I actually saw happen in the medical field when these things are in place. Euthanasia is not even legal in our state but still practiced. I would love to see laws enforced to have any medical profession who is involved with this be put in prison where they belong to live out their life for stealing the life of their patient.
  • Jul 17 2012: I am very much opposed to euthanasia. Already it is too easy for doctors to kill someone even if it is not legal in the state where it is happening. Medical professions have no business or right to kill a patient.The medical professions need to only concentrate on healing and saving lives not taking them. The doctor could tell the family that the person has no quality of life and then if the patient had asked to be euthanized for this reason then the patient is killed.Or if a patient had asked to be euthanized if they were ever in a coma and they fall into a coma from sedatives they are euthanized.The problem with this is that it is common for medical professional to put patients into drug induced comas sometimes just for the staff's convenience. If something happens where the patient is overdosed the doctor may not want them to come out of the coma for fear of brain damage and the doctor will be held responsible. The patient may not even have brain damage but the person will get euthanized anyway. As it stands today all a doctor has to say is that the patient has no quality of life and they can either let a person die or give the person the wrong meds to kill. It is called mercy killings and they can be done on people without terminal illness, doctors do get away with this. This can happen without the family even knowing about it. I think that all medical staff should be put in prison when they euthanize and laws need to be enforced for anyone who is involved with euthanasia. I also think that all dnrs and dni should be illegal since psychopath staff can use it as a tool to kill a patient and get away with it.
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      Jun 26 2012: It does sound harsh. Morally it is burdensome because your flippancy makes it look like murder rather than mercy.
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    Jun 25 2012: I published a paper last year detailing my opinion. Its pretty dry but comprehensive.