TOPIC:

DEATH & DYING

CASE:
PHYSICIAN ASSISTED
DYING
(Jack Kevorkian)
CONTENTS:
1. HISTORICAL BACKGROUND
2. ETHICAL ISSUES
– Principles Involved
– Arguments for and against
3. DEVELOPMENTS
– Updates, regulations or laws
4. CASE IN THE PHILIPPINES
1. HISTORICAL BACKGROUND
• words eu and thanatos which
combined means good death
1. HISTORICAL BACKGROUND
400BC
• "I will give no deadly medicine to any
one if asked, nor suggest any such
counsel." Hippocrates mentioned and
opposed euthanasia in the Hippocratic
Oath
• Hence the Greeks and Romans still
allowed voluntary euthanasia
1. HISTORICAL BACKGROUND
1828
• first known anti-euthanasia law in the
United States was passed in the state of
New York, with many other localities
and states following suit over a period
of several years.
• After the civil war, voluntary
euthanasia was promoted by advocates,
including some doctors.
1. HISTORICAL BACKGROUND
Prior to World War II
• In 1939, non-voluntary euthanasia was
practiced for the first time by German
physicians, to eliminate the diseased and
disabled among the German people in closed
gas chambers.
• The Nazis used the same gas chambers to
exterminate captured Russians, gypsies and
Jews. 
• 300,000 Germans
1. HISTORICAL BACKGROUND
Oregon Assisted Suicide
(1998)
The U.S. state of Oregon legalizes
assisted suicide in 1998.
1. HISTORICAL BACKGROUND
Kevorkian Sentenced to Prison
(1999)
In 1999, pathologist Dr. Jack
Kevorkian was sentenced to a 10-25
year prison term for giving a lethal
injection to Thomas Youk who was in
the final stage of ALS (amyotrophic
lateral sclerosis)
1. HISTORICAL BACKGROUND
Netherlands Legalizes Euthanasia
(2000)
In 2000, the Netherlands became the
first country in the world to legalize
euthanasia.
1. HISTORICAL BACKGROUND
Belgium Legalizes Euthanasia
(2002)

In 2002, Belgium became the second country in

the world to legalize euthanasia.
1. HISTORICAL BACKGROUND
Netherlands Legalizes Euthanasia
(2000)
In 2000, the Netherlands became the
first country in the world to legalize
euthanasia.
CONTENTS:
1. HISTORICAL BACKGROUND
2. ETHICAL ISSUES
– Principles Involved
– Arguments for and against
3. DEVELOPMENTS
– Updates, regulations or laws
4. CASE IN THE PHILIPPINES
The practice of ending the life of a terminally ill
person in a EUTHANASIA?
painless or minimally painful way,
for the purpose of limiting suffering.
ETHICAL ISSUES
 Classification of euthanasia:
– Physician assisted suicide
– Voluntary
– Nonvoluntary
• Procedural decision
– Passive euthanasia
– Active euthanasia

What is physician-assisted suicide (PAS)?

Is physician-assisted suicide ethical?

What are the arguments in favor of PAS?

What are the arguments against PAS?
What is phyasician-assisted
suicide (PAS)?
• Physician-assisted suicide (PAS)
generally refers to a practice in which
the physician provides a patient with a
lethal dose of medication, upon the
patient's request, which the patient
intends to use to end his or her own
life.
Some other practices that should be distinguished from
PAS are:
• Terminal sedation: This refers to the practice of
sedating a terminally ill competent patient to the point
of unconsciousness, then allowing the patient to die of
her disease, starvation, or dehydration.
• Withholding / withdrawing life-sustaining
treatment: When a competent patient makes an
informed decision to refuse life-sustaining treatment,
there is virtual unanimity in state law and in the
medical profession that this wish should be respected.
• Pain medication that may hasten death: Often a
terminally ill, suffering patient may require dosages of
pain medication that impair respiration or have other
effects that may hasten death. It is generally held by
most professional societies, and supported in court
decisions, that this is justifiable so long as the primary
intent is to relieve suffering.
Is physician-assisted suicide
ethical?
• The ethics of PAS continue to be debated.
• Often this is argued on the grounds that PAS
may be a rational choice for a person who is
choosing to die to escape unbearable
suffering.
• Furthermore, the physician's duty to alleviate
suffering may, at times, justify the act of
providing assistance with suicide.
• Arguments rely a great deal on the
notion of individual autonomy.
– recognizing the right of competent people
to chose for themselves the course of their
life, including how it will end.
• Opponents argue that PAS runs
directly counter to the traditional
duty of the physician to preserve life.
 What are the arguments in
favor of PAS?
1. Respect for autonomy: 
• In some situations the choice of the patient
takes priority over other considerations.

• Suppose that person says after all alternatives

have been thoroughly considered , "My life is
no longer worth living; I cannot stand it any
longer; I want to end it now to avoid further
pain, indignity, torment, and despair." 
 What are the arguments in
favor of PAS?

2. The role of the physician is to do what

is best for the patient, and in some
extreme situations this may include
hastening death upon the voluntary
request of the dying.
 What are the arguments in
favor of PAS?
3. Compassion: 
• Suffering means more than pain; there
are other physical and psychological
burdens.
• It is not always possible to relieve
suffering.
• Thus PAS may be a compassionate
response to unbearable suffering.
 What are the arguments in
favor of PAS?
4. Individual liberty vs. state interest:
• Though society has strong interest in
preserving life, that interest lessens
when person is terminally ill and has
strong desire to end life.
• A complete prohibition on assisted death
excessively limits personal liberty.
• Therefore PAS should be allowed in
certain cases.
 What are the arguments in
favor of PAS?
5. Openness of discussion: 
• Some would argue that assisted death
already occurs, albeit in secret.
• For example, morphine drips ostensibly
used for pain relief may be a covert
form of assisted death or euthanasia.
• That PAS is illegal prevents open
discussion, in which patients and
physicians could engage. Legalization of
PAS would promote open discussion.
 What are the arguments
against PAS?
1. Sanctity of life: This argument points
out strong religious and secular
traditions against taking human life. It is
argued that assisted suicide is morally
wrong because it contradicts these
beliefs.
 What are the arguments
against PAS?
2. Passive vs. Active distinction: 
• The argument here holds that there is an
important difference between passively
"letting die" and actively "killing."
• It is argued that treatment refusal or
withholding treatment equates to letting
die (passive) and is justifiable, whereas
PAS equates to killing (active) and is
not justifiable.
 What are the arguments
against PAS?
3. Potential for abuse: 
• Here the argument is that certain groups of
people, lacking access to care and support,
may be pushed into assisted death.
• Furthermore, assisted death may become a
cost-containment strategy.
• Burdened family members and health care
providers may encourage option of assisted
death. To protect against these abuses, it is
argued, PAS should remain illegal.
 What are the arguments
against PAS?
4. Professional integrity: 
• Here opponents point to the historical ethical
traditions of medicine, strongly opposed to
taking life.
• For instance, the Hippocratic oath states, "I
will not administer poison to anyone where
asked," and "Be of benefit, or at least do no
harm."
• Furthermore, major professional groups
(AMA, AGS) oppose assisted death. The
overall concern is that linking PAS to the
practice of medicine could harm the public's
image of the profession.
 What are the arguments
against PAS?
5. Fallibility of the profession: 
• The concern raised here is that
physicians will make mistakes.
• For instance there may be uncertainty in
diagnosis and prognosis.
• There may be errors in diagnosis and
treatment of depression, or inadequate
treatment of pain. Thus the State has an
obligation to protect lives from these
inevitable mistakes.
 SUMMARY

REASONS AGAINST
• People might commit euthanasia against a person’s wishes.
• People might recover from an illness against all odds.
• Doctor’s diagnosis might be wrong.
• Christians believe in the Sanctity of Life. Against
Commandment ‘Do not kill’.
• Jesus suffered on the cross – he didn’t cut short his suffering
therefore not down to us to end our life.
• Doctors are against euthanasia it is their job to try and save
& protect life.
• Some people think accepting suffering may have a spiritual
value for your soul.
• Jesus cared for the sick, he never talks about any type of
euthanasia
• Christians have Hospices – hospitals where the terminally ill
are cared for, without losing their dignity.  
 SUMMARY

REASONS FOR
• People have a right to decide when they
want to die.
• Wrong to keep people alive beyond their
natural life span (e.g. life support
machine).
• Gives people the ability to die with
dignity.
• Relatives spared the agony of watching
their loved ones suffer a slow and painful
death.
CONTENTS:
1. HISTORICAL BACKGROUND
2. ETHICAL ISSUES
– Principles Involved
– Arguments for and against
3. DEVELOPMENTS
– Updates, regulations or laws
4. CASE IN THE PHILIPPINES
The Case of Dr.
Kevorkian
• Beginning of 1999

• Kevorkian served eight years of a 10-to-25-

year prison sentence for second-degree
murder.

• June 1, 2007

• He was released on condition that he would

not offer suicide advice to any other person.
• January 15, 2008

• Kevorkian gave his largest public lecture

since his release from prison, speaking to
a crowd of 4,867 people at the University
of Florida.
• The Gainesville Sun reported that
Kevorkian expressed a desire for assisted
suicide to be"a medical service" for
willing patients.
• "My aim in helping the patient was not
to cause death“

• "My aim was to end suffering. It's got

to be decriminalized."
• February 5, 2009

• Kevorkian lectured to students and

faculty at Nova Southeastern University
in Davie, Florida. Over 2,500 people
heard him discuss tyranny, the criminal
justice system and politics.

• Poor sound and a long lecture caused

many people to leave within 45 minutes.
For those who remained, he discussed
euthanasia during a question and answer
period.
• September 2, 2009

• He appeared on Fox News Channel's Your

World with Neil Cavuto in his first live
national television interview to discuss health
care reform.

• September 20, 2009

• He appeared at Kutztown University of

Pennsylvania to speak to a sold-out audience.
Sellers of tickets claimed that all tickets were
sold out within 5 minutes of the office opening.
REGULATIONS/
LAWS OR
ANYTHING THAT
DEVELOPED OUT
OF THE CASE
Michigan Governor Signs Bill Making Assisted
Suicide a Felony

• Causing a person by force to commit suicide is murder.

Causing, by force or coercion, a person to attempt
suicide is attempted murder. Doing any of the
following with the intent to assist someone in a suicide
is a felony punishable by up to 4 years in prison and/or
a fine of $2000:
• 1. Provide the means by which an individual
attempts or commits suicide
2. Participate in an act by which an individual
attempts or commits suicide
3. Help an individual plan to attempt or commit
suicide

• This does not apply to providing pain medications with

the intent to relieve pain and not to cause death.
STAND OF OTHER
RELIGION AND
LEGAL STATUS
IN DIFFERENT
COUNTRIES
RELIGIOUS STANDPOINT
Roman Catholic Church
• Euthanasia is a grave violation of the law
of God, since it is the deliberate and
morally unacceptable killing of a human
person.

• The Roman Catholic Church regards

euthanasia as morally wrong. It has
always taught the absolute and
unchanging value of the commandment
"You shall not kill".
Buddhism
• Buddhists are not unanimous in their
view of euthanasia, and the teachings of
the Buddha don't explicitly deal with it.

• The most common position is that

voluntary euthanasia is wrong, because it
demonstrates that one's mind is in a bad
state and that one has allowed physical
suffering to cause mental suffering.
Hinduism
• According to the Doctrine of Karma, a
person cannot escape from his/her Karma
by committing suicide.

• Whatever has to be faced has to be faced.

If one tries to escape from a problem in
this birth, it will have to be faced in a
higher proportion in a subsequent birth.
Also, committing suicide adds a big
Karmic burden on the individual.
Islam

• Muslims are against euthanasia.

• They believe that all human life is sacred

because it is given by Allah, and that
Allah chooses how long each person will
live. Human beings should not interfere
in this.
Judaism

• The Jewish tradition regards the preservation

of human life as one of its supreme moral
values and forbids doing anything that might
shorten life. However, it does not require
doctors to make dying last longer than it
naturally would.

• If someone's life is ending and they are in

serious pain, doctors have no duty to make that
person suffer more by artificially extending
their dying moments
LEGAL STANDPOINT
Philippines
• Committing and attempting suicide is not
punishable by law but assisting someone in
their suicide is.

• It can't be concluded as legal in the Philippines

but at the same time, it is not illegal. For the
moment, there are no specific laws dealing
with the issue of Euthanasia yet.

• Active euthanasia (basically means that it’s the

physician’s prerogative) is not legal anywhere.
Albania  

• Euthanasia was legalized in Albania in

1999.

• Passive euthanasia is considered legal

should three or more family members
consent to the decision.
Belgium

• The Belgian parliament legalized euthanasia in

late September 2002. Proponents of euthanasia
state that prior to the law, several thousand
illegal acts of euthanasia were carried out in
Belgium each year.

• According to proponents, the legislation

incorporated a complicated process, which has
been criticized as an attempt to establish a
"bureaucracy of death".
•  
Netherlands

• In 2002, The Netherlands legalized

euthanasia including physician assisted
suicide.

• The Ministry of Public Health,

Wellbeing and Sports claims that this
practice "allows a person to end their life
in dignity after having received every
available type of palliative care."
Luxembourg

• On March 18, 2009 Luxembourg has enacted

legislation to legalize euthanasia, thereby becoming the
third European country, after the Netherlands and
Belgium, to permit the intentional killing of dying or
otherwise vulnerable people.

• According to the bill, euthanasia will be regulated by a

living will or advance directive. Doctors will also be
required to consult with a colleague to ensure that the
patient has a terminal illness and is in a "grave and
incurable condition" before killing him.

•  
• The United States

• Euthanasia is illegal in most of the

United States. It is legal in the states of
Washington, Oregon, Montana and to a
limited extent in Texas.
CONTENTS:
1. HISTORICAL BACKGROUND
2. ETHICAL ISSUES
– Principles Involved
– Arguments for and against
3. DEVELOPMENTS
– Updates, regulations or laws
4. CASE IN THE PHILIPPINES
Euthanasia in the Philippines
• Euthanasia is illegal in the Philippines
and is punishable by law
• The controversial Reproductive Health
Bill (family planning, contraceptives,
and abortion)
END… Thank You!