It’s ‘No’ to euthanasia for the terminally ill

Facing the probability of imminent death can be disturbing to the patient and the relatives and friends but the reality needs to be faced. They have to accept that death is inevitable once the available treatments have been exhausted. They go through several phases in the acceptance of death: Shock at the news, then denial, acceptance and finally the reality of passing on.

In all this, the patient should be respected as a person and not seen an object on whom to experiment. Terminal illnesses such as cancer with extensive metastases, multiple organ failure, Aids, certain lung and heart problems, chronic kidney failure and liver failure and old age need to be handled carefully by medics in conjunction with the patient and the family.

Every effort must be made to put such patients in the hands of specialised personnel in palliative care, whereby they can have cheer in their last days and get psychological support and adequate medication.

Experimental drugs and other medical treatment may be used after careful assessment of the patient and their condition. If the drugs prove ineffective or are expensive, the patient may discontinue their use. This applies to admission to the intensive care unit (ICU) or high dependency unit (HDU).

A patient with multiple organ failure ought not be admitted to such units but to a general ward bed if special nursing care is needed. In most cases, such patients would prefer to be at home under the care of the family and homecare nursing.

Resuscitation is not to be carried out and the patient is allowed to pass away serenely and with dignity. It is not heartless to withhold certain treatments which prove to be unnecessary and a burden to the patient and the family.

In medicine, there are limits as to what can be done and nobody normally expects miracles when death is inevitable. Often, the plea of the patient to terminate their life in the case of excruciating pain, breathing problems or other medical conditions that they may suffer from is one that should raise the spectre of reviewing the treatment and the necessary means employed. However, euthanasia (‘mercy killing’) or assisted suicide are not solutions as they put the patient and the medical team in a position to be lord over matters of life and death.

The means applied ought to be proportionate to the gravity of the condition and availability of specialised treatment in major hospitals. Disproportionate means lead to loss of dignity of the patient and should not be used. Hence, the patient and family should be given all the scenarios associated with the illness.

Faced with inevitable death, and despite the proportionate and ordinary means used, it is reasonable in conscience to renounce certain treatments which only serve towards a precarious and painful prolongation of life. This is to be done without abandoning proportionate and normal measures such as nutrition, oxygen and drug treatment.

It is not permissible to administer drugs which take away consciousness without serious reasons. The patient should normally be alert enough to sort out family, material, economic and spiritual matters.

Dr De Souza is a retired medical doctor with a special interest in Medical Ethics.