HagaMUN – 6,7 and 8 March 2020



General Assembly 6The question of implementing euthanasia in health care systems6th, 7th and 8th of March 2020Gymnasium Haganum, The HagueForum: General Assembly 6Issue:The question of implementing euthanasia in health care systemsStudent Officer:Neri WeeversPosition:Head ChairIntroductionThe words “euthanasia” and “assisted suicide” are often used interchangeably. However they are different and, in the law, they are treated differently. Because they are often used interchangeably, both euthanasia and assisted suicide will be addressed in this report and should be addressed in your resolutions. The question is: “Should we transform euthanasia and assisted suicide into medical treatments?” Withholding and withdrawing medical treatment and care are not legally considered euthanasia or assisted suicide. Withholding food and fluids is considered acceptable removal of a “medical treatment”.Legalizations is about public policy, and it affects ethics, medicine, law, families and children. A Dutch legislator who agrees that doctors who intentionally end their tiny patients’ lives (infanticide) should not be prosecuted said, “I’m certainly pro-life. But I’m also a human being. I think when there is extreme, unbearable suffering, then there can be extreme relief.” This is one of the biggest arguments in favour of euthanasia and assisted suicide becoming medical treatments.There have been various successful attempts to make euthanasia/ assisted suicide into a medical treatment, for example the “Groningen Protocol” and the “Oregon Physician-Assisted Death Initiative”. However a lot of attempts have failed to be accepted.A few arguments against making euthanasia and assisted suicide into medical treatments are that euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.Efforts to change government policies on euthanasia of humans in the 20th and 21st centuries have met limited success in Western Countries. Human euthanasia policies have also been developed by a variety of NGOs, most notably medical associations and advocacy organizations. Definition of Key TermsEuthanasiaIntentionally, knowingly and directly acting to cause the death of another personAssisted suicideIntentionally, knowingly and directly providing the means of death to another person so that the person can use that means to commit suicide.InfanticideEuthanasia for infantsAutonomyIndependence and the right of self-determinationMedical treatmentTreatment of disease by hygienic and pharmacologic remedies rather than invasive surgical procedures.Advocacy groupAn advocacy group is a group or an organization which tries to influence the government but does not hold power in the government.Background InformationDuring the last half of 2005 and the first half of 2006, bills to legalize assisted suicide were under consideration in various states and countries. All had met failure by the end of June 2006. But plans to reintroduce them with some cosmetic changes were made. The proposals were proposed following a step-by-step approach. Proposing an assisted-suicide-only bill which, when passed, would serve as a model for subsequent laws. Only after several laws were passed, would they begin to expand them. This strategy led to the “Oregon Death with Dignity Act.”Arguments in favour of PASWherever an assisted-suicide measure is proposed, proponents’ arguments and strategies are similar. Invariably, promotion rest on two pillars: autonomy and the elimination of suffering. Despite the fact that the laws they propose actually contradict this rationale.AutonomyAutonomy is valued in modern society and patients do, and should, have the right to accept or reject medical treatment. However, those who favour assisted suicide claim that autonomy extends to the right of a patient to decide when, where, how and why to die.The rationale is that when, where, why and how one dies should be a matter of self-determination, a matter of independent choice, and a matter of personal autonomyElimination of sufferingDuring each and every attempt to permit euthanasia and assisted suicide, its advocates stress that ending suffering justifies legalization of the practices. California Assemblywoman Patty Berg said that the assisted-suicide measure was necessary so that people would have the comfort of knowing “they could escape unbearable suffering if that were to occur.”Other arguments in favourNext to the two pillars that are always used in promotion, there are various other arguments in favour that are often used. JusticeJustice requires that we “treat like cases alike.” Competent, terminally ill patients have the legal right to refuse treatment that will prolong their deaths. For patients who are suffering but who are not dependent on life support, such as respirators or dialysis, refusing treatment will not suffice to hasten death. Thus, to treat these patients equally, we should allow assisted death as it is their only option to hasten passion Suffering means more than pain; there are other physical, existential, social and psychological burdens such as the loss of independence, loss of self, and functional capacities that some patients feel jeopardize their dignity. It is not always possible to relieve suffering. Thus physician-assisted suicide (PAS) may be a compassionate response to unremitting suffering. Compassion goes further than elimination of suffering, because it also focuses on for example their psychological burdens.Individual liberty versus state interest Though society has strong interest in preserving life, that interest lessens when a person is terminally ill and has strong desire to end life. A complete prohibition against PAS excessively limits personal liberty. Therefore PAS should be allowed in certain cases.Honesty and transparencySome acknowledge that assisted death already occurs, albeit in secret. The fact that PAS is illegal in most states prevents open discussion between patients and physicians and in public discourse. Legalization of PAS would promote open discussion and may promote better end-of-life care as patients and physicians could more directly address concerns and options.Arguments against PASArbitrary requirementsWhen an euthanasia law or a similar measure is proposed it includes conditions or requirements limiting assisted suicide to certain groups of “qualified patients”. A patient qualified to receive the treatment of assisted suicide must be an adult who is capable of making decisions and must be diagnosed with a terminal condition. Establishing arbitrary requirements that must be met prior to qualifying for the medical treatment of euthanasia or assisted suicide contradicts the two pillars on which justification for the practices is always based (autonomy and elimination of suffering). These arbitrary requirements were included after a series of defeats, euthanasia and assisted-suicide proponents learned that they had to propose laws that appeared palatable and therefore included arbitrary requirements.Sanctity of lifeReligious and secular traditions upholding the sanctity of human life have historically prohibited suicide or assistance in dying. PAS is morally wrong because it is viewed as diminishing the sanctity of life.Passive versus active distinctionThere is an important difference between passively “letting die” and actively “killing.” Treatment refusal or withholding treatment equates to letting die (passive) and is justifiable, whereas PAS equates to killing (active) and is not justifiable.Potential for abuseVulnerable populations, lacking access to quality 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 loved ones to opt for assisted death and the protections in legislation can never catch all instances of such coercion or exploitation. To protect against these abuses, PAS should remain illegal.Professional integrityHistorical ethical traditions in medicine are strongly opposed to taking life. The overall concern is that linking PAS to the practice of medicine could harm both the integrity and the public’s image of the profession.Fallibility of the professionThe concern is that physicians will make mistakes. For instance there may be uncertainty in diagnosis and prognosis. Thus the State has an obligation to protect lives from these inevitable mistakes and to improve the quality of pain and symptom management at the end of life.Slippery slope effectThis argument encompasses the apprehension that once PAS is initiated for the terminally ill it will progress to other vulnerable communities, namely the disabled, and may begin to be used by those who feel less worthy based on their demographic or socioeconomic status. In addition, vulnerable populations are more at risk of untimely deaths because, “patients might be subjected to PAS without their genuine consent.”Medical ethicsCode of EthicsThe Code of Ethics states that PAS is prohibited. It prohibits PAS because it is “fundamentally incompatible with the physician’s role as healer” and because it would be “difficult or impossible to control, and would pose serious societal risks.”Hippocratic OathPAS is contrary to the Hippocratic Oath, which is the oath historically taken by physician. It states “I will give no deadly medicine to anyone if asked, nor suggest any such counsel.” The original oath however has been modified many times and, contrary to popular belief, is not required by most modern medical schools, nor confers any legal obligations on individuals who choose to take it. There are also procedures forbidden by the Hippocratic Oath which are in common practice today, such as abortion.Declaration of GenevaThe Declaration of Geneva is a revision of the Hippocratic oath, first drafted in response to forced euthanasia, eugenics and other medical crimes performed in Nazi Germany. It contains, “I will maintain the utmost respect for human life.”International Code of Medical EthicsThe International Code of Medical Ethics, last revised in 2006, includes “A physician shall always bear in mind the obligation to respect human life.”Statement of MarbellaThe Statement of Marbella was adopted by the World Medical Assembly in 1992. It provides that “PAS, like euthanasia, is unethical and must be condemned by the medical profession.”Religious stancesUnitarian UniversalismUnitarian Universalists advocate the right to self-determination in dying, and the release from civil or criminal penalties of those who, under proper safeguards, act to honour the right of terminally ill patients to select the time of their own deaths.CatholicismCatholicism acknowledges the fact that moral decisions regarding a person’s life must be made according to one’s own conscience and faith. The Catechism of the Catholic Church believes that God created human life, therefore God is the judge when to end life. From the Roman Catholic Church’s perspective, deliberately ending one’s life or the life of another is morally wrong and defies the Catholic doctrine. The Roman Catholic Church also teaches its followers that the act of euthanasia is unacceptable, because it is perceived as a sin, as it goes against the Ten Commandments.JudaismWhile preservation of life is one of the greatest values in Judaism, there are rare instances of suicide and assisted suicide appearing in the Bible and Rabbinic literature. However the conclusion of the majority of later rabbinic authorities, and accepted normative practice within Judaism, is that suicide and assisted suicide can not be sanctioned even for a terminal patient in intractable pain.The Church of Jesus Christ of Latter-day SaintsThe Church of Jesus Christ of Latter-day Saints (LDS Church) is against euthanasia. Anyone who takes part in euthanasia, including "assisted suicide", is regarded as having violated the commandments of God. Members should however not feel obligated to extend moral life by means that are unreasonable when dying becomes anizations ProposingVarious organizations and NGOs over the whole world support medical aid in dying.The World Federation of Right to Die Societies consists of 49 right to die organizations from 26 countries. The Federation provides an international link for organizations working to secure or protect the rights of individuals to self-determinations at the end of their lives. The World Federation of Right to Die Societies believes that regardless of their nationalities, professions, religious beliefs, and ethical and political views all those who fully appreciate the consequences of carrying out their wish to die and who take into account the reasonable interests of others should have access to a peaceful death at the time of their choice.OpposingVarious organizations and NGOs over the whole world are against medical aid in dying. Most find it a great sin, going against equality or going against the function as a healer.Neutral There have been calls for organizations representing medical professionals to take a neutral stance on assisted dying, rather than a position of opposition. The reasoning is that this would better reflect the views of medical professionals and that of wider society, and prevent those bodies from exerting undue influence over the debate. Various organizations have changed their stance from opposing to neutral.CountriesAs of March 2018, active human euthanasia is legal in the Netherlands, Belgium, Colombia, Luxembourg and Canada. Assisted Suicide is legal in Switzerland, Germany, the Netherlands, the Australian state of Victoria and the states Washington, Oregon, Colorado, Hawaii, Vermont, Montana, Maine, New Jersey, California and of the United States of America and in the District of Columbia.4011930635040005001112520Current status of euthanasia around the world4000500111252021463007621??Active voluntary euthanasia is legal??Physician-assisted suicide is legal??Passive euthanasia is legal??Euthanasia is illegal??Euthanasia status unknown21463007621Major Countries and Organizations InvolvedThe NetherlandsThe Netherlands was one of the first countries to have a law concerning euthanasia. The Netherlands also accepted the “Groningen Protocol” on infanticide.The United States of AmericaThe United States of America is majorly involved because of the Oregon Death with Dignity Act that was accepted. This Act is an example for all people trying to make an euthanasia law that will be accepted by their government.The World Federation of Right to Die SocietiesThe World Federation of Right to Die Societies consists of 49 right to die organizations from 26 countries. The Federation provides an international link for organizations working to secure or protect the rights of individuals to self-determinations at the end of their lives.Timeline of EventsDateDescription of eventNovember 8, 1994The Oregon Physician-Assisted Death Initiative, also known as Measure 16, was approved.August 1976The Tokyo declaration was accepted. The World Federation of Right to Die Societies was formed.October 1996The Melbourne declaration on physician assisted dying was accepted. It supports the autonomy of the terminally ill and their right to receive medical help to die if they so desire.October 1998The Zürich declaration on assisted dying was accepted.September 2000The Boston declaration on assisted dying was accepted.September 2002The Brussels declaration on assisted dying was accepted.2004The “Groningen Protocol” was accepted and elicited worldwide outrage.The Royal Dutch Medical Association (RDMA) urged the Health Ministry of the Netherlands to set up a board to review euthanasia for people who had “no free will,” including children and individuals with mental retardation or severe brain damage following accidents.May 2006An assisted-suicide bill, patterned after Oregon’s law permitting assisted suicide, fail to gain approval in the British ParliamentJuly 2009The UK Royal College of Nursing voted to move to a neutral position on assisted dying2015The California Medical Association dropped its long-standing opposition during the debate over whether an assisted dying bill should be introduced thereThe California End of Life Option Act was signed into law later that yearDecember 2017The Massachusetts Medical Society (MMS) voted to repeal their opposition to PAS and adopt a position of neutralityOctober 2018The American Academy of Family Physicians (AAFP) voted to adopt a position of neutrality from one of the opposition. This is contrary to the position taken by the AMA, who oppose it.January 2019The British Royal College of Physicians announced it would adopt a position of neutrality until two-thirds of its members think it should either support or oppose the legalisation of assisted dying.Relevant UN Treaties and EventsOregon Death with Dignity Act, 15 February 2019The Brussels Declaration on Assisted Dying, 20 August 1970Tokyo declaration, 1976Previous Attempts to solve the IssueMost attempts to legalize assisted-suicide have failed. This is due to the fact of the many counter arguments, that can be read under Arguments against PAS under Background Information. However due to the step-by-step approach some attempts have been successful, like the Oregon Death with Dignity Act. Since the establishment of The World Federation of Right to Die Societies more steps have been achieved on an international basis. The World Federation of Right to Die Societies keeps growing and keeps getting new members from a wide variety of countries.Possible SolutionsA possible solution is to make strict regulations on what all the different terms mean and to regulate these. You could set up or ask an already existing organization to regulate this and see to it that all cases are reported and handled equally. You should question yourselves if you want to keep the arbitrary requirements or if you want to set up a body to consider the cases of for example people with dementia or children. 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Marker, site/euthanasia-assisted-suicide-health-care-decisions/.“Medical Treatment.”?The Free Dictionary, Farlex, medical- .“Melbourne Declaration on Physician-Assisted Dying.”?The Free Dictionary, Farlex, .“Oregon Death with Dignity Act.”?Healthoregon, Public Health Division, Center for Health Statistics, 15 Feb. 2019, oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf.“Oregon Measure 16, Physician-Assisted Death Initiative (1994).”?Ballotpedia, Ballotpedia, (1994).Starks, Helene, and Clarence H. Braddock. “Physician Aid-in-Dying.”?UW Medicine, UW Medicine, .“The Brussels Declaration on Assisted Dying.”?The Brussels Declaration on Assisted Dying | The World Federation of Right to Die Societies, The World Federation of Right to Die Societies, es/news/brussels-declaration-assisted-dying.“Tokyo Declaration 1976.”?Worldrtd, The World Federation of Right to Die Societies, sites/default/files/pagefile/Tokyo declaration 1976 & manifesto.pdf.“World Federation of Right to Die Societies.”?Wikipedia, Wikimedia Foundation, 7 May 2019, or AppendicesOregon Death with Dignity Act declaration 1976 Brussels Declaration on Assisted Dying ................
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