Euthanasia – Ethical dilemma Bc. Lucie Valová Seminar work 2022 OBSAH 1....... EuthanaSIA.. 3 USED LITERATURE.. 8 1 Euthanasia To begin with, let's explain the difference between an ethical problem and an ethical dilemma. Ethical problem is understood as a situation, in which it is evident how the worker should act, but acting like this is against his morals. For example, it can be a situation when the worker thinks that the client should receive help, but the worker can not provide it to him, because the client does not meet the requirements set by the institution where the worker works. Ethical dilemma is understood as a situation when a worker cannot decide between two or more options that are equally inappropriate and represent a conflict of moral principles, and these options do not correspond to the hierarchy of values ​​of those who are affected by the decision. It is not clear to the worker which decision will be more acceptable(Ondriová, 2021, s.28). Ethical dilemma appears in health care in various areas. Healthcare is denoted as an art and a science. Art is considered to be the combination of experience, innovativeness and personal values, and with this, healthcare workers also enter into a relationship with the patient. Every person encounters many ethical questions and dilemmas in their daily life. Areas in which ethical dilemmas most often occur in healthcare practice are: ● clash of personal values ​​with the values ​​of the organization or profession ● conflict of legal or moral rights in individual situations ● conflict of interest simultaneously for multiple patients ● dividing loyalty between the interests of the client and the organization (Ondriová, 2021, s.31). According to the World Medical Association (WHA), the concept of euthanasia is defined as the conscious and intentional performance of an act with the clear intention to end the life of another person under the following conditions: - the subject is a competent informed person with an incurable disease who has voluntarily requested that his life will be ended - the dealing person knows about the condition of this person and his wish to die and commits this act with the primary intention to end the life of this person - the deed is done with sympathy and without personal gain (Munzarová, 2008, s. 19). Previously, euthanasia was divided into passive - active, voluntary - involuntary. This is no longer used because it was misleading. There is a difference between assisted suicide and euthanasia. Assisted suicide is a situation where one person provides another person information, advice or resources that can be used for committing the suicide. It is about offering help to a person who wants to end their life, not directly ending their life. In the Czech Republic, euthanasia is a crime and it is classified as murder. By law is assisted suicide considered to be a crime of participation in suicide, and it is a crimie whether the suicide was completed and death occurred or it was a suicide attempt in which death did not occur (Ptáček, 2012, s.35). Euthanasia is legalized in the Netherlands and Belgium (since 2002) and Luxembourg (since 2008). Assisted suicide is possible in Switzerland - it is also allowed for foreigners who travel to this country, to have it there. In selected US states – (Oregon, Washington, Montana) and in Canada. In my opinion, legalization of euthanasia any other form of it is a very debatable topic not only in the Czech Republic, but all over the world. Different opinions and views collide. In the following table, I have selected the most frequent arguments for and against euthanasia. PRO CONS Individual autonomy of the patient, i.e. the patient has the right to decide on the scope of health care throughout the course of the disease. He also has the right to decide about the circumstances of his death. The patient does not have the right to request from the doctor any treatment or procedure because he thinks he needs it. A doctor should have the right not to comply with a patient if he is asked to kill him or help him commit suicide. Everything that increases the space of human freedom cannot be allowed. Religious beliefs about the sanctity of life must be respected. Today's society with a very radical diversity of values ​​entails a very different understanding and approach to the basic questions of life and death. The legal order must respect the diversity of society. Human life is sacred. It is not something we can get rid of when it stops serving us. This is universally true, absolutely. It is not a specifically religious belief. An advanced incurable disease can cause physical and psychospiritual suffering to the patient. In these situations, patients may assess their quality of life as unacceptably low and undignified. He assumes that his situation is "worse than death". The suffering of patients at the end of life is real. However, it can be effectively eased. Patients who request euthanasia do not have access to good health care and support from their families. If they had this family, they would not have request the euthanasia. If there is a situation where death does not represent any harm for the patient, but on the contrary a benefit, the request for death at the hands of the doctor is valid. And the execution itself is ethically acceptable. Life always has more weight and value than death. It is not possible to eliminate suffering by eliminating the person who suffers. Euthanasia and assisted suicide can be an expression of solidarity, mercy and compassion between the doctor and the patient. Euthanasia is not a merciful/dignified death. The dignity of a doctor is fulfilled by a doctor who accompanies the patient and helps him alleviate the symptoms of an incurable disease and accompanies him until natural death. A doctor who kills his patient is, in a way, trampling on his dignity. Palliative care can alleviate many aspects of suffering at the end of life, but not all suffering. There remains a large part of suffering that cannot be influenced or eliminated with the help of palliative medicine. Palliative care is good at alleviating all suffering at the end of life. When quality palliative care is available to the patient, he does not even think about requesting euthanasia. Euthanasia has always been here: it is better to allow it and regulate it by law and have control over it than to ignore it. Just because it happens or exists does not mean it is good and we should legalize it. Experience from countries where some form of assisted death is legalized shows that it is not abused. Experience from the Netherlands shows that the number of requests and euthanasias is increasing. The indication criteria are impermissibly expanded. Some euthanasias are performed without the explicit consent of the patient. Legalizing euthanasia puts pressure on dying patients. The patient is always in a weaker position. A request for euthanasia is "expected" from the patient. Euthanasia is beginning to be perceived as a "normal" way of ending life. The awareness of the fact that this is a completely extraordinary and exceptional resource has been lost. At the same time, the legalization of euthanasia led to a significant development of palliative care in the corresponding countries. Euthanasia is morally wrong and unacceptable. The fact that the development of palliative care could have been supported at the same time as legalization will not change this. Tabulka 1 For and opposite (Vácha, 2019, s.52-58) According to the arguments for and against euthanasia, we can state that for every pro there is a strong con. When enacting euthanasia or assisted suicide, we must ask ourselves whether anyone has the right to force a medical professional to perform it. A healthcare worker also has his rights, and above all his moral and ethical principles. Nothing and no one should put a medical professional in front of a situation that is against his principles, not even the law. Therefore, it is quite clear why the topic of euthanasia is so discussed. This topic has many supporters, but also opponents. In defense of supporters, I must state that I understand the reasons for euthanasia. Patients with an incurable disease, who have no hope of curing or moderating the disease and suffer from unbearable pain and their quality of life is not dignified, should be able to decide about their further stay in this world. However, I think that the concept of allowing euthanasia or assisted suicide should be that, it will be carried out by medical professionals for whom this action will not conflict with their moral and ethical principles. It goes without saying that legal protection and clear demarcations are necessary, so there cannot be an abuse. The question is palliative medicine, which has been developing in recent years. I think that it is a good way, however, there may still be situations when even a well-set palliative treatment does not relieve the patient from his suffering (e.g. social). Of course, there is a rich network of paliatrists who are available. Nowadays, we lack this network, and therefore not all patients can benefit from this care. In the next few years, the network of palliative medicine should be expanded, including better information for patients, so that it is more accessible and patients are aware of this option. My opinion regarding the legalization of euthanasia is positive, but under strictly defined legal conditions for its use. 2 USED LITERATURE MUNZAROVÁ, Marta, 2008. Proč ne eutanazii, aneb, Být, či nebýt?. Vyd. v KNA 2. V Kostelním Vydří: Pro občanské sdružení Ecce homo vydalo Karmelitánské nakladatelství. ISBN 978-80-7195-304-3. MUNZAROVÁ, Marta, 2005. Eutanazie, nebo paliativní péče?. Praha: Grada. ISBN 80-247-1025-0. ONDRIOVÁ, Iveta, 2021. Etické problémy a dilemata v ošetřovatelské praxi. Přeložil Ludmila MÍČOVÁ. Praha: GRADA Publishing. Sestra. ISBN 978-80-271-1696-6. PTÁČEK, Radek a Petr BARTŮNĚK, 2012. Eutanazie – pro a proti. Praha: Grada. Edice celoživotního vzdělávání ČLK. ISBN 978-80-247-4659-3. VÁCHA, Marek Orko. Eutanázie: definice, histore, legislativa, etika. Praha: Grada Publishing, 2019, 112 s. ISBN 978-80-271-2575-3.