The patient's right to end his or her life under certain circumstances: Declaration on euthanasia
| Páginas | 125-138 |
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The Opinion Group of the Observatori de Bioètica i Dret, based at the Barcelona Science Park, was formed to study the ethical, social and legal implications of new biotechnology techniques from a scientific and multidisciplinary point of view, and to make specific proposals for actions to be taken.
The Observatori de Bioètica i Dret itself was created with a view to participating in the university-society dialogue and so as to make its voice heard in the wider society; more specifically its aim is to make submissions to the public, administrative and political bodies which regulate and control research and application of new technologies. Achieving these objectives demands a fluid relationship with the media, so as to improve the quality of information available. The Group has already prepared statements on a number of issues which cause controversy, both in society in general, and among the scientists working in relevant fields.
On this occasion, the Group addresses the issue of euthanasia, which has been a source of controversy for many years, and which returns to the media headlines with every new case reported. The Group’s view is that our progressive recognition of the individual’s autonomy -and therefore, the patient’s autonomy- should culminate in acceptance of the patient’s right to end his or her life under certain circumstances. We recognise that there is a need for specific legislation to regulate this right.
As tends to occur in issues arising in bioethics, there is a great need for multidisciplinary dialogue encompassing ethical, philosophical, anthropological, legal, social and health aspects of the debate. The discussion needs to be solidly based on technical and scientific input from the disciplines whose advances underlie the issue.
The group has been coordinated by a jurist, Dr. María Casado, and a specialist in medical ethics, Dr. Albert Royes, director and secretary, respectively, of the Observatori de Bioètica i Dret, and has received inter-disciplinary submissions from specialists as acknowledged in the annex.
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This Declaration addresses the issue of the individual’s right to end his or her own life under certain circumstances. This issue underlies, at the deepest level, all discussion on individual autonomy. Human dignity is evoked both in defence of the right to end one’s life -the right to a dignified death- and also held up as a reason to reject this right. Clearly, this equivocal use of the term "dignity" reveals underlying differences in conceptions of human life, freedom and human rights in general.
In recent years, media coverage has brought euthanasia to the forefront of our minds. The most recent case was the controversial Humbert case in France in September 2003, in which a mother helped her son to die with the cooperation of a doctor, for whom the state prosecutor has sought a prison sentence. The European Court of Human Rights has had to intervene in this area in the July 2002 cases taken by Diane Pretty against the United Kingdom. And, in Spain, memories of the Sampedro case are still fresh in our minds.
The issue continues to arouse heated debate, and not only in the media. Frequent surveys assess the acceptability of euthanasia among both the general public and health professionals, with a view to determining public opinion on the need for specific legislation. These surveys invariably find that a clear majority of the public favours legislation on euthanasia. This majority has been rising for decades now. In addition, the Council of Europe has also made several recommendations on the issue, since its first declaration in 19761. However, at present only two of our neighbouring countries have introduced specific legislation permitting euthanasia: the Netherlands (2001) and Belgium (2002).
Doctors have always participated in decisions concerning the end of life. At present it is considered good practice to limit, suspend or not undertake treatment in certain circumstances, even though this may lead to the death of the patient: decisions to limit therapeutic effort, limit treatment, or passive euthanasia.2The justification for such
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decisions are found in deontological codes and also in Law 41/2002, of 14 November, regulating patient autonomy and rights and obligations concerning clinical documentation, and even in a number of bioethics statements by the Catholic Church.3Such measures are habitual practice in all hospitals; decisions are taken by doctors in the interest of patients and, in general, with the knowledge and consent of the patient’s family. Failure to take these measures would in fact constitute bad medical practice. The essential point here is, however, that these decisions are taken by doctors, based on their professional judgement and their concept of good practice.
Respect for individual freedom and for the rights of the patient has become especially important in health professional-patient relations. Indeed, it is a sphere in which the autonomy of the individual is central. The clearest manifestations of this autonomy are the requirements to provide patients with accurate and truthful information and to obtain their consent; however, the requirements of respect for patient autonomy do not end here.
The General Health Law of 1986 initiated a concretion process for the fundamental rights of those in healthcare and, especially, for the right to make decisions concerning one’s own health. Since then, the process has gradually advanced: through introduction of the concept of informed consent, through recognition that competent persons can exercise their right to refuse medical treatment or intervention, including life support, and through introduction of laws on living wills -an issue addressed in another of the Opinion Group’s publications. This process must continue to advance, providing concrete content to the provisions already in place and accepting that free exercise of personal autonomy can also entail the right to decide to end one’s life, under certain circumstances; that is, accepting voluntary active euthanasia.
The debate on the legitimacy of euthanasia must be approached from a twofold perspective: firstly, as a question of respect for individual autonomy and secondly, as a matter of solidarity with those suffering from serious illness. The...
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