h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I have had to make my own experiences on that issue. I worked as a paramedic for some years, and we were frequently called to the beds of elderly people who were just about to die right in front of us. We were obliged (by law) to take any measures to keep those people alive, including and not limited to cardio-pulmonar reanimation (CPR).

I remember one case when we were called to a nursing home where an old man in his nineties was in his bed, surrounded by his children and some of his grandchildren. He had obviously made his peace with the world, had his beloved ones near and was ready and prepared to die in peace and dignity. Due to the aforementioned legal reasons the staff of the nursing home had to call us when the man was no longer able to stay alive without immediate medical assistance.

I felt so bad when we had to rush in, get all the others out of the room and perform a final medical battle with all that CPR, oxygene, drugs, ECG, ... Unfortunately it is quite common that you break ribs during CPR, especially those of older people. Needless to say that we had no chance to save that persons life, and he died with our hands all over him. Everything we achieved was to rip him out of the society of those he wanted to have around him as he died, break three of his ribs, give him some electroshocks and a severe dose of drugs.

That was one of the reasons why I finally wanted to quit that job.

Of course, that case was quite clear (legal implications put aside): That man was old and seriously diseased, and all he had to expect were some more days (weeks, months, ...) of agony. I wouldn't have had a bad sleep that night if we had turned around and waited at the door for a very short time just to find out that we "were too late".

In Germany (where I live) there's an official crime that is called "Unterlassene Hilfeleistung" (=failure to render assistance). That means that you can go to jail if you don't take any reasonable measures to help someone who is in imminent danger. So if you do what's right (at least from a personal point of view) and try not to take away the very last dignity, you are about to skate in very thin ice.

The problem is that the decision to let someone die, to turn off the medical machinery, to push the button or to pull the plug will usually be a final and irreversible one. You can't make up your mind a little later on and say "Oh, I'd rather try it again."

The very first sentence of the German "Grundgesetz" (=constitution) says: "Die Würde des Menschen ist unantastbar." (=Human dignity is inviolable) ... I can see no dignity at all if you rush into a room where someone is willing, ready and prepared to die on their own free will.

Unfortunately the term "euthanasia" is extremely prejudiced by recent German history. Tha Nazi regime killed handicapped or mentally ill people as 'unworthy life' and called that euthanasia. That'S why the issue is referred to rather as 'Sterbehilfe' (=assisted death) in Germany. In my online dictionary I found the term 'medicide' for 'Sterbehilfe'. If that is a politically incorrect term to use, I apologize here and now, but it sounds at least sensible to me.

In my opinion there are two different qualities of medicide that should be discussed seperately:

First there is 'passive' medicide, i.e. turning of the machine, pulling the plug, giving up CPR, ... . This has been done many times, and I have had to do that myself, well, not really often, but more than a couple of times. There are some criteria that have to be matched (doctors or, God forbid, lawyers will be able to point that out more precisely, as those criteria may vary from jurisdiction to jurisdiction), such as lack of brain waves, ECG zero line, ..., then a doctor may be tempted to decide to quit further treatment. This is a very hard decision if friends and relatives of the patient are present, and it is not unusual to talk to them first.

IMHO passive medicide is an absolutely sensible and decent thing, as long as the motive force is not only to stop 'wasting medical ressources' but the clear and obvious fact that there is no way back for the patient.

Second, there is 'active medicide'. This is a totally different thing. If you have to kill someone in order to put them out of their misery it's hard to find the difference between shooting them with a cal .50 gun and giving them a lethal overdose of anaesthetic drugs, except that the first one causes a severe mess.

Another thing is what I would call 'medically assisted suicide'. If someone decides to commit suicide, they should at least be given the chance to do that with dignity. The problem is just to find out wether this decision has been made of sound mind. If someone is in agony and can't stand that any longer, there may be at least some doubt wether a decision to commit suicide is really serious or if it would be taken back as soon as the illness is gone ...

The whole issue is a matter of dignity, respect and common sense. As I mentioned before:

"Human dignity is inviolable."

Jeremy

... and one very important thing that I forgot to mention: There are many people who are desperately waiting for a donated kidney, heart, liver, lung, whatever organ can be transplanted today. The cruel demand for these organs has affected, does affect and will affect the medical staff's decision on when to turn off the machine. YOu have only a limited timespan to explant a heart if you want to save another person's life. Basically, the organ donor has to be physiologically alive, although in a finally and irreverably moribund state. The question is: Who decides that?

I know a young man whom I came to rescue after a severe motorcycle accident (I worked as a paramedic). He had been overlooked by a lorry and had crashed into the gap between the rear two axes. His skull was broken, as were both arms, one leg, several ribs and vertebrae. We had to resuscitate him several times until the heli took him to hospital. Two doctors were present, both of which said "If we're lucky we can at least save his heart and kidneys for someone else". Some months later I accidentally met him in a regimen center where he worked hard to recover from that horror crash. He was still alive and obviously doing fine.

That was a borderline case. If someone had decided that his state was hopeless and that it was time to take out his organs, I guess obody would have doubted that decision. He would be dead, and up to three other people would be alive.

The implications of organ donation to the issue of euthanasia are so overwhelming ... but you have to look at them from both sides. Imagine a young family whose dad is going to die of kidney failure. He could be saved if he got a new kidney. At the same time a young motorbiker lies in hospital with no chance ever to recover, but his relatives insist to keep him alive under all circumstances. It's a really tough question that arises here: Should we respect the wish of the young family's dad to stay alive, even at the cost of another person dying? Or should we respect the wish of the other family not to see ther son die? There are two lives at the stake, and only one will make it ...

Jeremy

... and one very important thing that I forgot to mention: There are many people who are desperately waiting for a donated kidney, heart, liver, lung, whatever organ can be transplanted today. The cruel demand for these organs has affected, does affect and will affect the medical staff's decision on when to turn off the machine. YOu have only a limited timespan to explant a heart if you want to save another person's life. Basically, the organ donor has to be physiologically alive, although in a finally and irreverably moribund state. The question is: Who decides that?

I know a young man whom I came to rescue after a severe motorcycle accident (I worked as a paramedic). He had been overlooked by a lorry and had crashed into the gap between the rear two axes. His skull was broken, as were both arms, one leg, several ribs and vertebrae. We had to resuscitate him several times until the heli took him to hospital. Two doctors were present, both of which said "If we're lucky we can at least save his heart and kidneys for someone else". Some months later I accidentally met him in a regimen center where he worked hard to recover from that horror crash. He was still alive and obviously doing fine.

That was a borderline case. If someone had decided that his state was hopeless and that it was time to take out his organs, I guess obody would have doubted that decision. He would be dead, and up to three other people would be alive.

The implications of organ donation to the issue of euthanasia are so overwhelming ... but you have to look at them from both sides. Imagine a young family whose dad is going to die of kidney failure. He could be saved if he got a new kidney. At the same time a young motorbiker lies in hospital with no chance ever to recover, but his relatives insist to keep him alive under all circumstances. It's a really tough question that arises here: Should we respect the wish of the young family's dad to stay alive, even at the cost of another person dying? Or should we respect the wish of the other family not to see ther son die? There are two lives at the stake, and only one will make it ...

Jeremy

Sorry, ... rotten mouse button ...

ho, i see i could have saved opening up a whole new thread, you said it all. I think that it must be made possible to die decently, and at the same time pain management will have to play an integral part in the decision making process.