Orthothanasia (Humanly authentic dying): the reality between two rights:

 

31. Orthothanasia (Humanly authentic dying): the reality between two rights: to live and to die with dignity. Euthanasia: definition, classification and main typologies; argumentation and moral evaluation with reference to the teaching of the Church. Disthanasia (futile treatment): definition, necessary distinctions, moral evaluations.

Introduction:This in compliance with the fundamental principle of human dignity provides about the dignified death. Pleading the inadmissibility of the action it was presented a legal opinion demonstrating with primacy the definitions of orthothanasia, euthanasia and dysthanasia concepts; which allowed a better understanding of the resolution’s text. Euthanasia is understood as intentionally causing the death of a patient suffering from a terminal illness or affected by an incurable disease, practiced by a third party moved by mercy; dysthanasia, as the artificial prolongation of the degeneracy state. Practiced by the doctor using extraordinary treatments; and orthothanasia, as the nonintervention in the development of natural death of patients in the terminal phase of life, when death is imminent and inevitable. Euthanasia means ‘to kill after being asked to’, to accelerate death, assisted suicide ‘to help committing suicide,’ and disthanasia means ‘slow death with lots of suffering,’ and orthothanasia means ‘natural, correct death,’ a normal or natural manner of death and dying.

Part I: Orthothanasia (Humanly authentic dying): the reality between two rights: to live and to die with dignity

Meaning of Orthothanasia: The word orthothanasia was used for the first time in the 1950. It means correct dying, or allowing to die or letting die.             

In the case of letting die, what is directly intended is the relief of the acute pain of the patient. In allowing to or letting die, therefore, death is neither directly caused nor intended or postponed. It merely happens. It is an event, part of the temporal life of every human being. Hence, allowing to die is anti-euthanasia, which unethically anticipates death, and anti-dysthanasia, which unduly postpones it. 

Allowing To Die: Possibilities

Allowing to die includes, in particular, three possibilities.       

First possibility: When the treatment to prolong life is useless or futile for the patient, and therefore ought not to be given. We remember the world of the poet: For man to want to live when God wants him to die is madness.    

Second possibility for letting die: When the prolongation of life or the postponement of death is unduly burdensome in the first place for the patient also for the family. On this point, the Catechism of the Catholic Church summarizes the traditional teaching of the magisterium: “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘overzealous’ treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted” (CCC, 2278).      

Third possibility for allowing to die: When the patient needs painkillers or medical sedation, which does not intend the death of the patient. These painkillers directly mitigate suffering and indirectly may shorten life. Physicians and significant others are committed to relieve pain and suffering, which is their professional commitment, or moral duty limited only by the prohibition against direct killing. Summing up the traditional teaching of the Church, the Catechism states: “The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable” (CCC, 2279). 

Related to the option of allowing to or letting die, we usually face, among others, three objections: one objection refers to doubtful treatment, another to the real meaning of death with dignity, and the third to patients in persistent vegetative state (PVS). 

How about a doubtful treatment- If treatment is beneficial to the patient and not unduly burdensome, it ought to be given: we are to administer our life well. If treatment is truly useless, generally it should not be given. Moreover, if the treatment is doubtful or uncertain, the “best-interest of the patient” principle suggests providing treatment for it might have a potential benefit: in doubt, it is good to be on the side of life.   

Dignified death: Dignifieddeath as a value and as a right currently, it has been highlighted the importance of communication and respect for the patient’s wills to improve their well-being at the end of life. This paradigm shift emphasizes the health care focus transition from cure to care. According to the World Health Organization (WHO), palliative care consist of an approach that seeks to improve the quality of life of patients and their families facing problems due to an incurable disease with a limited prognosis and/or serious illness (life-threatening), through the prevention and relief of suffering by means of the early identification, appropriate assessment and rigorous treatment of not only physical problems such as pain, but also the psychosocial and spiritual. 

The right to die a human and dignified death: Concerning this topic, the members of the working group from the Third world emphasized how important it is, for a human being, to end his days on earth with his personality, as far as possible, whole and entire, both in itself and in its relationships with its milieu, and especially with the family. In countries which are less developed technically and less affected by sophistication, the family gathers round the dying person, and he himself feels a need almost an essential right to be thus surrounded. When we observe the conditions required for certain therapies and the total isolation imposed by them upon the sick person, we do not find it out of place to state that the right to die as a human being and with dignity demands this social dimension.^[1]

 

Part II: Euthanasia: definition, classification and main typologies; argumentation and moral evaluation with reference to the teaching of the Church.

Euthanasia:  (from the Greek  εὐθανασία meaning “good death”: εὖ, eu (well or good) + θάνατος, thanatos (death)) refers to the practice of ending a life in a manner which relieves pain and suffering.

Etymology: Like other terms borrowed from history, the “euthanasia” has had different meanings depending on usage. The first apparent usage of the term “euthanasia” belongs to the historian Suetonius who described how the Emperor Augustus, “dying quickly and without suffering in the arms of his wife, Livia, experienced the “euthanasia” he had wished for.” The word “euthanasia” was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a “physician’s responsibility to alleviate the “physical sufferings” of the body.” Bacon referred to an “outward euthanasia” —the term “outward” he used to distinguish from a spiritual concept —the euthanasia “which regards the preparation of the soul.”

In current parlance it has come to mean different but related things depending on philosophy and political persuasion: Opponents to euthanasia and assisted suicide , refer to an “active causation of a patient’s death by a physician”.Proponents instead refer to palliative care and easing of suffering.

What is Euthanasia: Euthanasia is the termination of a very sick person's life in order to relieve them of their suffering.

Classification of Euthanasia: Euthanasia may be classified according to whether a person gives informed consent into three types: 1. voluntary, 2. non-voluntary 3. involuntary.

1. Voluntary: When euthanasia is conducted with consent. Voluntary euthanasia is currently legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon and Washington in the U.S.

2. Non-voluntary: When euthanasia is conducted on a person who is unable to consent due to their current health condition. In this scenario the decision is made by another appropriate person, on behalf of the patient, based on their quality of life and suffering.

3. Involuntary: When euthanasia is performed on a person who would be able to provide informed consent, but does not, either because they do not want to die, or because they were not asked. This is called murder, as it’s often against the patients will.

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Controversy: Various arguments are commonly cited for and against euthanasia and physician-assisted suicide.

 

Argumentation:Arguments for

Freedom of choice: Advocates argue that the patient should be able to make their own choice.

Quality of life: Only the patient really knows how they feel, and how the physical and emotional pain of illness and prolonged death impacts their quality of life.

Dignity: Every individual should be able to die with dignity.

Witnesses: Many who witness the slow death of others believe that assisted death should be allowed.

Resources: It makes more sense to channel the resources of highly-skilled staff, equipment, hospital beds, and medications towards life-saving treatments for those who wish to live, rather than those who do not.

Humane: It is more humane to allow a person with intractable suffering to be allowed to choose to end that suffering.

Loved ones: It can help to shorten the grief and suffering of loved ones.

We already do it: If a beloved pet has intractable suffering, it is seen as an act of kindness to put it to sleep. Why should this kindness be denied to humans?

Arguments against

The doctor’s role: Health care professionals may be unwilling to compromise their professional roles, especially in the light of the Hippocratic Oath.

Moral and religious arguments: Several faiths see euthanasia as a form of murder and morally unacceptable. Suicide, too, is “illegal” in some religions. Morally, there is an argument that euthanasia will weaken society’s respect for the sanctity of life.

Patient competence: Euthanasia is only voluntary if the patient is mentally competent, with a lucid understanding of available options and consequences and the ability to express that understanding and their wish to terminate their own life. Determining or defining competence is not straightforward.

Guilt: Patients may feel they are a burden on resources and are psychologically pressured into consenting. They may feel that the financial, emotional, and mental burden on their family is too great. Even if the costs of treatment are provided by the state, there is a risk that hospital personnel may have an economic incentive to encourage euthanasia consent.

Mental illness: A person with depression is more likely to ask for assisted suicide, and this can complicate the decision.

Slippery slope: There is a risk that physician-assisted suicide will start with those who are terminally ill and wish to die because of intractable suffering, but then begin to include other individuals.

Possible recovery: Very occasionally, a patient recovers, against all the odds. The diagnosis might be wrong.

Palliative care: Good palliative care makes euthanasia unnecessary.

Regulation: Euthanasia cannot be properly regulated.

Now, is it immoral to end one’s suffering? Or, is it morally upright to let that person live long with agony together with the family suffering emotionally and financially?

Moral Evaluation: 

Possible reasons for the proposition that euthanasia is moral:

1.      It is an act or method of causing death painlessly so as to end suffering: advocated 
by some as a way to deal with victims of incurable disease.

2.      Many times we do not have enough money to pay for the needed medical care not knowing if the patient is going to get any better. In a way, we are just wasting time and money on a situation that won’t get better. If the patient wants euthanasia, why not do it if we cannot end the huge amount of money wasted on a treatment that won’t help.

3.      It stops the person from having a bad quality of life. Having a patient suffering is not giving him a better quality of life.

4.      It allows the patient to retain their dignity.

5.      It may be necessary for the fair distribution of health resources.

 

Possible reasons against the proposition that euthanasia is moral:

1.      The life and will of a person are the basic things that the law promotes to protect. Let us not contradict it with legalized killing.

2.      No person shall be advised, worst, be assisted in killing himself. Life has always been sacred. It should be treated as such.

3.      It is indeed important to remember that we don’t necessarily see best when our eyes are filled with tears and, hence, that our emotions might cloud our ability to make rational judgments

4.      By becoming common place and used in medical practice along with more traditional methods of healing, society becomes desensitized toward death to the point where life is no longer valuable.

5.      There can be no mercy in killing. The prohibition of killing is an attempt to promote a solid basis for trust in the role of caring for patients and protecting them from harm.

The teaching of the Church on Euthanasia

In “The Charter for Health Care Workers”, published in 1995 by the Pontifical Council for Pastoral Assistance to Health Care Workers, one can read, in paragraphs 147 and 148:

Euthanasia is a homicidal act, which no end can justify. By euthanasia is meant an action or omission which of its nature or by intention causes death, in order that all suffering may be eliminated. Euthanasia’s terms of reference, therefore, are to be found in the intention of the will and in the methods used.

The pity aroused by the pain and suffering of terminally ill persons, abnormal babies, the mentally ill, the elderly, those suffering from incurable diseases, does not authorize any form of direct euthanasia, active or passive. This is not a question of helping a sick person, but rather the intentional killing of a person.

Medical and paramedical personnel -- faithful to the task of “always being at the service of life and assisting it to the end” cannot cooperate in any euthanistic practice even at the request of the one concerned, and much less at the request of the relatives. In fact, the individual does not have the right to euthanasia, because he does not have a right to dispose arbitrarily of his own life. Hence no health care worker can be the executive guardian of a non-existent right.

It is a different matter when there is question of the right, already mentioned, of dying with human and Christian dignity. This is a real and legitimate right which medical personnel are called on to safeguard by caring for the patient and accepting the natural termination of life. There is a radical difference between “death dealing” and “consent to dying”: the former is an act suppressing life, the latter means accepting life until death.

In his encyclical “The Gospel of Life” ((Evangelium Vitae) dated March 25, 1995, John Paul II wrote this about “the tragedy of euthanasia”, in paragraphs 64 and 65:

At the other end of life’s spectrum, men and women find themselves facing the mystery of death. Today, as a result of advances in medicine and in a cultural context frequently closed to the transcendent, the experience of dying is marked by new features. When the prevailing tendency is to value life only to the extent that it brings pleasure and well-being, suffering seems like an unbearable setback, something from which one must be freed at all costs. Death is considered “senseless” if it suddenly interrupts a life still open to a future of new and interesting experiences. But it becomes a “rightful liberation” once life is held to be no longer meaningful because it is filled with pain and inexorably doomed to even greater suffering.

Furthermore, when he denies or neglects his fundamental relationship to God, man thinks he is his own rule and measure, with the right to demand that society should guarantee him the ways and means of deciding what to do with his life in full and complete autonomy. It is especially people in the developed countries who act in this way: they feel encouraged to do so also by the constant progress of medicine and its ever more advanced techniques...

In this context,the temptation grows to have recourse to euthanasia, that is, to take control of death and bring it about before its time, “gently” ending one’s own life or the life of others. In reality, what might seem logical and humane, when looked at more closely is seen to be senseless and inhumane. Here we are faced with one of the more alarming symptoms of the “culture of death”, which is advancing above all in prosperous societies, marked by an attitude of excessive preoccupation with efficiency and which sees the growing number of elderly and disabled people as intolerable and too burdensome. These people are very often isolated by their families and by society, which are organized almost exclusively on the basis of criteria of productive efficiency, according to which a hopelessly impaired life no longer has any value.

For a correct moral judgment on euthanasia, in the first place a clear definition is required. Euthanasia in the strict sense is understood to be an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering. “Euthanasia’s terms of reference, therefore, are to be found in the intention of the will and in the methods used”.

Euthanasia must be distinguished from the decision to forego so-called “aggressive medical treatment”, in other words, medical procedures which no longer correspond to the real situation of the patient, either because they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family. In such situations, when death is clearly imminent and inevitable, one can in conscience “refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted”. Certainly there is a moral obligation to care for oneself and to allow oneself to be cared for, but this duty must take account of concrete circumstances. It needs to be determined whether the means of treatment available are objectively proportionate to the prospects for improvement. To forego extraordinary or disproportionate means is not the equivalent of suicide or euthanasia; it rather expresses acceptance of the human condition in the face of death.

 

In modern medicine, increased attention is being given to what are called “methods of palliative care”, which seek to make suffering more bearable in the final stages of illness and to ensure that the patient is supported and accompanied in his or her ordeal. Among the questions which arise in this context is that of the licitness of using various types of painkillers and sedatives for relieving the patient’s pain when this involves the risk of shortening life.

While praise may be due to the person who voluntarily accepts suffering by forgoing treatment with painkillers in order to remain fully lucid and, if a believer, to share consciously in the Lord’s Passion, such “heroic” behaviour cannot be considered the duty of everyone. Pius XII affirmed that it is licit to relieve pain by narcotics, even when the result is decreased consciousness and a shortening of life, “if no other means exist, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties”. In such a case, death is not willed or sought, even though for reasonable motives one runs the risk of it: there is simply a desire to ease pain effectively by using the analgesics which medicine provides. All the same, “it is not right to deprive the dying person of consciousness without a serious reason”: as they approach death people ought to be able to satisfy their moral and family duties, and above all they ought to be able to prepare in a fully conscious way for their definitive meeting with God.

Taking into account these distinctions, in harmony with the Magisterium of my Predecessors and in communion with the Bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium.

Part III: Disthanasia (futile treatment): definition, necessary distinctions, moral evaluations

Difinition:The etymology of the term is from the Greek language: δυσ, dus; "bad, difficult" + θάνατος, thanatos; "death". In medicine, dysthanasia means "bad death"[1] and is considered a common fault of modern medicine.[2]

Dysthanasia means slow and painful death without quality of life. This study aimed to know whether nurses identify dysthanasia as part of the final process of the lives of terminal patients hospitalized at an adult ICU. This is an exploratory-qualitative study. Data were collected through semi-structured interviews with ten nurses with at least one year of experience in an ICU, and interpreted through content analysis. Results indicate that nurses understand and identify dysthanasia, do not agree with it and recognize elements of orthonasia as the adequate procedure for terminal patients. We conclude that nurses interpret dysthanasia as extending life with pain and suffering, while terminal patients are submitted to futile treatments that do not benefit them. They also identify dysthanasia using elements of orthonasia to explain it.

 Necessary Distinctions

The dysthanasia is the complete opposite of euthanasia, it is the opposition that has the patient, amily and even doctors to die. Despite all the complications that may arise around a disease, can be considered disthanasia an opportunity for those who do not want to die, but it is important hat the society that supports human rights in all its features, is dysthanasia considered a "Overkill" against the patient, usually because the patient and subjected to a series of actions that cause suffering beyond measure. dysthanasia cruelty is not medical, but if it is clear that this process slows the rest the patient alone, there are cases in which the patient wanted to stop going through all that's happening with death and prevented. From this matrix is generated opinion establishing two camps, the first is in favor of rest and a high of suffering, and the other is the exhaust all possibilities to live and to overcome the disease. 

Moral Evaluations: The dysthanasia when applied in diseases that have no cure loses some sense presented, the effect that medication can have on the patient's health is zero or negative, however, he continues to manage any method for improvement. In these cases euthanasia would apply, but not done, then it dysthanasia. This method of " Survival "is applied to people who are important to any institution, they may be, from families to governments, which should not a personality of these dies, the dysthanasia may seem selfish, perhaps because a person exercising functions in society can be met by a healthy one, but in this case also associated religious beliefs on certain occasions "Extreme", and that when we speak of an impossibility to live and not allowed eternal rest we are talking about a decision away from reason and consistency with the nature of each. God's timing is perfect and nothing will change.

Disthanasia seems to have free flow through the hospitals and goes unnoticed. In fact, it is a useless treatment, cultivated by a Western society which values saving the life at any cost and submits patients to therapies which do not prolong life, but rather the death process. Cure is impossible, expected benefit is meanest, the effect is harmful. It is the therapeutic obstinacy or the medical futility.

Conclusion: Among this number of concepts emerges orthothanasia which, different from euthanasia is sensitive to the death humanization process and to pain relief. It does not tolerate disproportionate treatments, does not incur in abusive delays, it faces death at the right time, without falling in the disthanasia trap. It generates the possibility of discussing with people the difference between curing and treating, between maintaining life when this is the right procedure or signaling death when its time arrives. Death then may be understood as part of life, offering experiences which may be enriching and unforgettable. Orthothanasia is an atypical approach because it is not the cause of death, since the dying process has been already installed. On the other hand, it is advocated after the irreversibility of a pathological condition. The first two concepts are interpreted as crimes in most of the countries, regulated by the penal code as homicides. The search for these means is closely related to fear of pain, loneliness or family abandonment, and by rejection of the coldness and impersonality permeating the assistance to many of our end-of-life counterparts. So, we once more understand the mandatory indication of palliative, correct and safe care in a society which shall not fail to the point of having its participants asking for the right of dying because they are not cared for. Palliative care is a powerful alternative to the proposals of legalizing euthanasia or assisted suicide.

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[1]Ibid., Pp. 6-7.