Strategies are available to treat severe refractory symptoms, treat depression, and cope with some people`s anxiety, which could lead to the future with an incurable disease. About 10% to 15% of pain and other physical symptoms (such as dyspnea and excited delirium) cannot be controlled with first- and second-line approaches and become refractory. For these symptoms, there is the possibility of palliative sedation. Palliative sedation is defined as “the supervised use of drugs designed to induce a state of diminished or unconscious consciousness (loss of consciousness) to alleviate the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family, and health care providers in patients who die imminently.”55 Their intention is not to hasten death, which distinguishes them from euthanasia. The goal is to achieve comfort at the lowest possible dose of sedatives (usually with an infusion of midazolam, not with opioids) and with the mildest sedation. Some patients are therefore comfortable with mild sedation, so that they can continue to interact with the family; In other cases, comfort is achieved only at deep levels of sedation. Lawmakers in several countries and jurisdictions have voted against legalizing euthanasia and have passed it in the past year alone, in part because of the concerns and evidence outlined in this document. These jurisdictions include France, Scotland, England, South Australia and New Hampshire. They chose to improve palliative care services and train health professionals and the public. If there were “age discrimination” in the health sector and certain types of care were denied to people over a certain age, euthanasia could be seen as a logical extension of this practice. The fear is that if euthanasia is allowed, vulnerable people will be pressured to end their lives. It would be difficult, if not impossible, to prevent people from using persuasion or coercion to get people to ask for euthanasia if they don`t really want to.
The prohibition of alcohol consumption, prostitution, gambling, etc. does not lead to the elimination of these practices, whether in abusive or non-abusive form. Similarly, the choice is not between euthanasia and the absence of euthanasia, as abuse occurs only in the former. Instead, he chooses between euthanasia with or without regulation. Either way, there will be abuses, and assuming there is nothing wrong with euthanasia per se, we might as well legalize and regulate it. Competent palliative care may well be enough to prevent a person from feeling the need to consider euthanasia. Battin et al. 51 reviewed data from Oregon and the Netherlands and, like 30 others, concluded that there was no evidence that vulnerable people, with the exception of people with AIDS, were disproportionately more likely to be euthanized. In this study, the term “at risk” was defined as older, female, uninsured, low-educated, poor, physically disabled or chronically ill, younger than the age of majority, affected by psychiatric disorders, including depression, or who belong to a racial or ethnic minority. Finlay and George challenged the study on the grounds that susceptibility to passage or euthanasia cannot simply be classified by race, gender or any other socioeconomic status.
Other characteristics, such as emotional state, response to loss, personality type, and sense of being a burden, are also important.52 Patients are also sensitive to their doctors` level of education and experience in palliative care and their doctors` personal opinions on the subject. For example, one study showed that the more doctors know about palliative care, the less they prefer euthanasia and Pas 53. A recent dramatic example of the lure of the logical slope is the euthanasia of 45-year-old twins in Belgium in December 2012. Marc and Eddy Verbessem, deaf since childhood, were confronted with the additional handicap of blindness. Their doctor acknowledged that they were suffering incurably and put them to sleep.41 Euthanasia of patients with incurable diseases, although it may be legal in Belgium, will certainly meet with the disapproval of most doctors. Even within the pro-euthanasia movement, this development can be seen as an aberration. Nevertheless, there are more and more commentators who subscribe to the following philosophy: “If a patient is mentally capable and wants to die, his body itself represents an unjustified life support that unfairly prolongs his mental life”.42 “The bottom line is that we have seen no evidence of the slippery slope and there is no good reason to believe that the experience on this front in Australia would be any different. [The Australian panel reports] all conclude that the slippery slope arguments are not supported by valid and reliable evidence. The United Nations has concluded that the euthanasia law in the Netherlands violates its Universal Declaration of Human Rights because it poses a risk to the rights to safety and integrity of the life of every human being. The UN also expressed concern that the system might fail to detect and prevent situations where people might be unduly pressured to grant access or euthanasia, and that existing safeguards could be circumvented. It seems to me that, as with the opposition, which is based on the question of whether the doctor is “active”, the argument that doctors should only be “healers” focuses too much on the doctor and not enough on the patient.
If healing is no longer possible, if death is imminent and patients find their suffering unbearable, then the role of the doctor should shift from healing to relieving suffering in accordance with the patient`s wishes. Nevertheless, no physician should have to comply with a request for assistance in the death of a terminally ill patient, just as no patient should be compelled to make such a request. It must be a choice for both the patient and the doctor. While the tone of the previous discussion can and should be rather “frightening,” the substance it appeals to has clearly gained a foothold in the current medical literature. A description of the procedures for successful euthanasia was published; one is entitled “Euthanasia: Drugs and Medical Procedures”.21 It contains protocols for treating terminal dyspnea or terminal agitation, euthanasia, and induction of “controlled sedation.” Controlled sedation is placed in quotation marks by the author, presumably because he believes it must be nuanced; According to him, it represents a hypocritical reaction to suffering and is undertaken with the aim of muzzling the patient during his death. We take note of the ethical issues raised here by “palliative sedation,” sometimes referred to as “terminal sedation,” in which the dying patient is sedated to relieve otherwise immeasurable suffering. We suggest that the first term be used when sedation is the only reasonable and medically appropriate means of relieving the patient`s suffering (if it is not euthanasia); The latter term is appropriate if these conditions are not met and the doctor intends to accelerate the death of the patient (if it is euthanasia). Another extremely important issue is that if PAS and euthanasia are “medical treatments,” the surrogate`s decision-makers have the power to accept them for the patient. Their decisions must be based either on their knowledge of what the patient would have wanted or, if those desires are unknown, on their belief that these interventions are in the “best interest” of the patient. Would mentally incapacitated persons and persons with dementia or disabled newborns, as is currently the case in the Netherlands under the Groningen Protocol, be eligible for “therapeutic homicide”51 Justice Smith`s findings that SAP is not inherently unethical may also be questioned; whereas the individual`s right to autonomy takes precedence over the value of respect for life; whereas the sanctity of life is only a religious value; whereas there is no relevant ethical or moral difference between the refusal of life-sustaining treatment resulting in the death of the patient and euthanasia; and that the availability of legalized PAS is a necessary “medical treatment” for some. With this scenario in mind, we can see the hidden hypothesis in the slippery slope argument against the legalization of euthanasia: it is the assumption that the euthanasia cases that the Netherlands now allows are morally wrong. But the problem is that many advocates of a legal right to die would deny that these cases of euthanasia are false.
Some of us think that the suffering a person suffers does not have to be the product of an incurable disease for it to be unbearable. We also recognize that some psychological conditions are persistent and as unbearable as physical suffering. And we realize that it is not only competent patients, but also incompetent patients who can suffer from conditions that do not make their lives worth living. Therefore, we want euthanasia and assisted suicide to be permitted in such a wide range of cases. However, if we cannot make this change to the law in one step, we recommend a more limited liberalization of the law first. Once this change is made, people may realize that the next step and then the next one are also acceptable, even if they can`t see it now.
