This is a sensitive topic. You may have heard about it in movies or on the news abroad. We are going to talk about the possibility of a person suffering from a terminal illness and unbearable pain receiving medical help to end their life with dignity. But before we begin this story, there is one very important thing to remember. That is, this method is completely illegal in Sri Lanka. We are only talking about this article to educate you about the world’s views on this concept and how it is practiced in legal countries.
What is this 'physician-assisted death'?
Simply put, Physician-Assisted Death is when a physician prescribes a lethal dose of medication to end the life of a conscious adult patient suffering from a terminal illness.
The important thing here is that the doctor gives the medicine to the patient himself, at a time of his choice, to end his life. The doctor never gives the medicine to the patient. The patient has complete control over the decision-making and implementation.
Don't confuse it with 'euthanasia'!
Many people confuse the terms 'physician-assisted dying' and 'euthanasia' as the same thing. However, there is a clear difference between the two. Although both aim to relieve the suffering of someone who is suffering from severe pain, the way they are implemented is different.
Euthanasia is illegal in many countries around the world.
Let us further clarify this difference with the table below.
| Characteristic | Physician-Assisted Death | Euthanasia |
|---|---|---|
| Who will administer the medicine? | The doctor prescribes the medicine and gives it to the patient. | The doctor prescribes the medicine. |
| Who injects the medicine? | The patient takes the medicine at their own convenience. | The medicine is given to the patient (often as an injection) by a doctor or other person . |
| Final control | Completely in the hands of the patient. | In the hands of another person. |
Is this system legal? What is the situation in Sri Lanka?
This is the most important part. Under the Sri Lankan Penal Code, aiding or abetting suicide is a serious crime. Therefore, the concept of 'physician-assisted death' is completely against the law of our country.
However, in some states in the United States and in other countries such as Switzerland, Canada, and the Netherlands, this is permitted under very strict rules and conditions. Even in those countries, to obtain this permission, a patient must meet the following qualifications:
- Must be over 18 years of age.
- There must be a medical condition that is incurable and confirmed by doctors to be fatal within the next 6 months.
- You need to be in a good mental state (with a clear mind) to make your own medical decisions.
- You must be able to ingest the medicine yourself.
What laws are there to protect patients?
Even in countries where this method is legal, very strict safeguards are in place to ensure that the patient's decision is not influenced in any way.
- Educating about other options: The doctor who prescribes the medication should clearly inform the patient about other options available to them, such as pain control, palliative care, and hospice care.
- Right to change your mind: The doctor should explain to the patient that they have the full right to change their mind and not use the medication at any time, even after the medication is delivered home.
- Multiple medical opinions: A patient cannot make this request from just one doctor. At least two doctors must meet to confirm the patient's condition and mental state.
- Freedom for doctors: No doctor can be forced to participate in this process. If it goes against their ethics, the doctor has the right to withdraw from it.
What are the different opinions on this?
This is a topic that has sparked a great deal of debate around the world. Even among doctors, there are differing opinions on this. Let's take a look at both sides.
| Arguments in favor of physician-assisted death | Arguments against physician-assisted death |
|---|---|
| Personal Choice and Dignity: Someone suffering from unbearable pain should have the right to decide how and when to end their life. | Contradicts the role of a doctor: The primary responsibility of doctors is to save and heal lives. Assisting in death is contrary to that role. |
| Ending suffering: In some medical conditions, the pain and suffering are so severe that death may be the only humane option to escape it. | Risk of misuse: There is a risk of inducing patients who are mentally weak, considered a burden to their family, or subject to external pressure to do so. |
| Psychological relief: Even just holding the medicine in your hand, the thought, "I can get rid of this suffering if I want to," brings great psychological relief to the patient. It is reported that about a third of those who take the medicine die without using it. | Lack of attention to alternative treatments: Instead of developing highly effective treatments such as pain management and palliative care, there is a risk that death will become socially accepted as an easy option. |
What can we do in our country?
We must remind you again that this practice is illegal in our country. But there are many important things we can do for a loved one who is suffering from an incurable disease and severe pain.
Pain management and palliative care are two of the most important areas of advanced medicine today. Rather than trying to cure the disease, the goal is to control the physical symptoms of the disease, such as pain, shortness of breath, nausea, and psychological stress and fear, and create an environment where the patient can live as comfortably and with dignity as possible throughout their stay.
If a family member or friend is suffering from this condition, and they are in so much pain or distress that they are thinking about death, the best thing to do is to talk openly with your doctor about it. Ask them what treatments and care are available to help them ease their pain and make life easier.
Take-Home Message
- Physician-Assisted Death is when a patient ends their life by taking medication prescribed by a doctor. It is different from Euthanasia.
- This practice is completely illegal and a punishable offense in Sri Lanka.
- There are strong arguments for and against this in the world. It is a very complex ethical issue.
- The best and most legitimate way to reduce the suffering and pain of someone suffering from a terminal illness is to provide pain management and palliative care .
- If your loved one is suffering from this condition, talk to your doctor about their pain and mental state and get advice on the best possible care.
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