Euthanasia is a decision to purposefully terminate a person’s life for the sake of that person (Rowe, 2019). It can be subdivided into four types, depending on the act of termination: (i) involuntary euthanasia (when the patient is not consulted), (ii) non-voluntary euthanasia (when the patient has no capacity to decide), (iii) voluntary passive euthanasia (when care is withdrawn), and (iv) voluntary active euthanasia (when termination of an individual’s life occurs by administering an agent) (Rowe,2019).
Paediatric euthanasia involves a range of issues that are materially different from those of adult euthanasia, with the main difference being that infants and young children are not able to decide on their own futures, while adults are (Engelhardt, 2010). Although one can argue that euthanasia is or should be a personal right, this statement can be ambiguous at times with respect to children. This is because young children have personal rights but they are unable to exercise them on their own behalf with regard to the matter of their life and death (Engelhardt, 2010). As a result, paediatric euthanasia raises many questions relating to the rights of children, the obligations of adults to prevent the suffering of children, and the possible effects on society of facilitating the death of seriously ill children (Engelhardt, 2010).
According to the South African Law Commission, it is legal for a Medical Practitioner, under specified circumstances, to cease or authorize cessation of all further medical treatment of a patient whose life functions are being maintained artificially while the patient has no spontaneous respiratory or circulatory functions, or where his brainstem does not register any impulse (Mahomed, Louw & Olivier, 2000). In addition, every person above the age of 14-years old in South Africa, who is of sound mind and assisted by his or her parents or guardian, is competent to refuse any life-sustaining medical treatment or the continuation of such treatment (Mahomed, Louw & Olivier, 2000).
Over the past few weeks, I’ve been working with children who were moderately to severely ill at Red Cross War Memorial Children’s Hospital. My interactions with each patient varied on their condition and it ranged from playful and interactive to serious and disengaging. The experiences that I have had on this block has been eye opening as I left Red Cross Hospital each day feeling that one should never take life for granted and should always be grateful for being healthy as many people often neglect this.
One of the most overwhelming experiences that I’ve had during my five weeks at Red Cross Hospital includes a 13-year-old boy who was involved in a pedestrian vehicle accident and sustained a severe traumatic brain injury which included a base of skull and left temporal lobe fracture. The patient was transferred from ICU to the ward I was working in during my first week. I, therefore, worked closely within the multi-disciplinary team in order to promote and maintain range as well as function. Although the patient had almost no voluntary movement of his limbs and was not verbally responsive, I learnt to communicate by teaching him to respond with blinking his eyes.
It was after one week that the patient’s vitals became unstable and he had to be transferred back into the ICU ward. Although I could no longer treat this patient (as I was on my paediatric and not ICU block), I still kept myself updated with regards to conversing with the doctors and the ICU physiotherapist. The patient ended up staying in ICU for the entire duration of the rest of my block at Red Cross Hospital, with each day resulting in further regression in function. Eventually, in my second last week, the medical team discussed their way forward and informed the parents about his prognosis, with withdrawing his treatment being a possible option.
After hearing this news, I felt shattered and to a point furious because he was only 13-years old and therefore has his entire life ahead of him. Further more, it seemed unfair to me that his parents were the ones deciding if he should live or not as he was only one year away from being legal to make those decisions.
Adults belong to themselves in a sense that they are rational and responsible for their own actions while young children are neither rational nor responsible (Engelhardt, 2010). Young children rely on the care of those who are responsible for them and those responsible for them exercise the children’s right on their behalf (Engelhardt, 2010). In this sense, it is clear that children belong to families in ways that adults do not. Furthermore, all the rights and duties of a child are exercised and ‘held in trust’ by others for a future time in which the child is yet to develop (Engelhardt, 2010). As a result, medical decisions to treat or withdraw treatment often rely on the probability and cost of achieving this future independent status (Engelhardt, 2010).
The physician’s role in euthanasia is to present sufficient information to parents in order to facilitate them in making a decision (Engelhardt, 2010). When parents have to decide whether or not to commence with euthanasia, the decisions often involve a choice between expensive treatment with little chance of achieving a full, normal life for the child or ‘letting nature take its course’ by withdrawing treatment and letting the child die as a results of the defects (Engelhardt, 2010).
During my experience of euthanasia at Red Cross Hospital, I initially felt that it should in fact be the individual’s decision on whether or not euthanasia should be commenced, especially considering that my patient was almost of legal age to make those decisions. However, when looking back and thinking about the situation, the patient was realistically not in a state to make decisions for himself and it was only right for be the parents to make that decision for him. Furthermore, this became clearer with literature which suggested that since children are not independent individuals but exist in and through their families, parents are the appropriate ones to decide whether or not to continue treatment when (a) there is not only decreased likelihood of full human life but also great likelihood of suffering if the life is prolonged, or (b) when the cost of extending life is great (Engelhardt, 2010). In addition, parental decision must be accompanied by a physician who can provide accurate information on the costs, prognosis, and consequences of both withdrawing or continuing with treatment (Engelhardt, 2010).
REFERENCE LIST:
Engelhardt, H. (2010). Ethical Issues in Aiding the Death of Young Children. Retrieved from https://users.manchester.edu/Facstaff/SSNaragon/Online/texts/235/Engelhardt,%20Aiding%20the%20Death%20of%20Young%20Children.pdf
Mahomed, I., Louw, A., & Olivier, P. (2000). Euthanasia and the Artificial Preservation of Life. Retrieved from http://www.justice.gov.za/salrc/reports/r_prj86_euthen_2000_nov.pdf
Rowe, M. (2019). Euthanasia and Abortion. Retrieved from https://docs.google.com/presentation/d/1avAhF0tKyfCkg82cYVd_Jkg8fihbp3J9_gjifHhjmyE/edit#slide=id.p
4 thoughts on “Euthanasia – whose decision?”
Hey Raadiyah! I hope you dont mind me commenting on your work, Just doing so as Gowa has not posted anything yet.
I will use the rubric to comment on your work.
Content: I think the topic of Euthenasia is relevant to our ethics lectures in class, I really liked how you were able to link your emotions and clinical experiences to the topic. Furthermore, have you thought about looking into the laws in South-Africa with regards to the topic. Attaching literature to the topic will increase its strength as well. The usage of images and videos at the start of the presentation will assist in getting your point across. I think your description of the experience is strong and thought provoking. You however need to attach more literature to it, ie laws of euthenasia in other countries.
Argument: I found that it was difficult to initially see what your argument was. However you did mention passive Euthenasia, I suggest that you look into more literature with regards to the topic of passive Euthenasia within the scope of South-Africa.
References: I felt that you needed to include more references, You did add one by Rowe, however it is not in your bibliography. I know that its hard to add references when its only a draft, therefore I am confident that you will add many more in your final submission.
Writing: There was very little grammatical errors throughout your piece, I think that your paragraphs flowed really smoothly from one to the next. However your piece was relatively short, therefore there is a need for you to add more content to it. This can be done by adding more literature, I would advise that you do not try to end with a yes or no answer as this is a complex topic, with many ethical considerations.
I am confident that this piece is a good basis for you to do really well in the final submission, I thought that it was well written and was really thought provoking!
Apologies if my comments were in any way offensive, feel free to contact me if you require any further assistance. Keep well & well done.
Hi Raadiyah. Thank you for submitting such an interesting piece.
Content: The topic of euthanasia is relevant to the ethics module, I enjoyed how you were able to link one of your own clinical experiences to the topic of euthanasia. Have you perhaps thought about finding articles relating to euthanasia in a South African context?
Argument: I initially struggled to find what your argument was, but it became more apparent in the closing paragraph. Maybe find articles on the limits of responsibility of a person’s next of kin in life or death situations, if that makes any sense.
References: I trust that more references will be added to strengthen your argument.
Writing: Although your writing piece was a bit short, there were very few grammatical errors throughout and it had good flow to it. Maybe you could make the objective of your piece more apparent in the opening paragraphs.
Hi Raadiyah
Your piece of writing is very interesting. Enjoyed reading about your experience at Red Cross Hospital and your encounter with euthanasia. It is quite sad that it is still a child, and I can only imagen how hard such a decision must be for a parent.
In my opinion it would have been nice to get a definition of euthanasia earlier in your piece, and not only at the end. This would have made it easier to connect to your piece, and to see where you are going with your story about the patient.
It would be nice if you can add more literature to your piece, maybe about what our country say about euthanasia, when the law say it is applicable for a second party to decide about ending the life, etc. It would also be nice if you can add different opinions or views on euthanasia.
It was easy to read your piece, as you used paragraphs effectively. Thank you for sharing. Hope this comments will help.
Hi Raadiyah,
My apologies for the late comment.
I much enjoyed reading your piece on ethics. I can agree with Umar that it was thought provoking, and I could put myself into your shoes with regard to feelings of the situation.
This piece has reminded me that not all patients enjoy physiotherapy treatment, but it is still important that they receive treatment.
Below are my comments on your work:
Content:
Euthanasia is definitely one of the relevant topics which we’ve covered in class. I liked that you were able to make use of a personal experience for your writing, and to support it with relevant litterature. Your writing has made me think differently to clinical practice as I have not yet treated a paediatric patient, therefore it was thought provoking to read about your experience in that setting. That must’ve been a very emotional experience for the boy and his family. I’m saddened that it led to euthanasia and would only have hoped for a suitable recovery for the boy.
Argument:
Slight difficulty identifying your argument. Therefore, I’d suggest that you write more about your feelings on the situation to provide more clarity on your argument. Also if you could add more supporting litterature to the topic. As mentioned above, I’ve not yet had a paeds block, therefore your writing captured my attention quite strongly in what you had experienced in that setting. Your writing is logically consistent as it starts off in your first paragraph by describing your work setting and your feelings towards the patients which you were exposed to, your second and third paragraph is about the individual whom your writing is about and your experience with him, and your fourth paragraph is your litterature supporting and defining euthanasia and the different types. I’d suggest that you try bringing a stronger point across with the additional litterature which I hope you’ll add.
References:
There are references present, they are according to the APA style as requested for our studies. It does however lack a list of references in the end. I do feel that your references are strong, but the way it has been included in your writing makes them appear rather weak. However, I can see a fair attempt at you trying to support your position.
Writing:
Your writing is gramatically correct. I did not identify any spelling errors in your writing. Your text was pleasantly easy to read.