The Ethical and Societal Implications of Euthanasia

First published 2022

Euthanasia, often referred to as mercy killing, entails ending the life of a hopelessly ill or injured individual to alleviate their suffering. This act has been at the centre of an intense ethical debate. Some people endure extreme physical pain in their last days, prompting arguments in favour of euthanasia as a compassionate solution. There are also those who, facing debilitating diseases, desire euthanasia to evade potential loss of mental faculties. Many argue these wishes should be honoured. However, this perspective is met with resistance, particularly from those who believe it contradicts the foundational moral tenet that killing is wrong.

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From a traditional Judeo-Christian standpoint, euthanasia is equivalent to murder, violating the biblical commandment “Thou shalt not kill.” Similarly, from a secular viewpoint, law’s main objective is to protect the sanctity of human life. The complexity arises when balancing the agonies of dying individuals with religious beliefs, legal traditions, and medical ethics, especially in instances of physician-assisted death.

The debate over euthanasia is not new. Its name originates from the ancient Greek term for “good death.” While its roots are ancient, some argue that it has become increasingly challenging to achieve a good death in modern times. Medical advancements have prolonged life and enhanced health, but have also complicated the dying process. In the past, many would die at home due to diseases like pneumonia or influenza, whereas now, many succumb to lingering, painful conditions like cancer in hospitals.

The contemporary debate on euthanasia can be traced back to the case of Karen Ann Quinlan in the 1970s. After an unfortunate mix of alcohol and tranquilizers, Quinlan lapsed into a coma, reliant on machines for breathing and feeding. A court battle ensued when her parents wished to remove her from life support, with her doctors opposing. This case, ending with the removal of her respirator, set the precedent for patients’ rights to decline unwanted medical interventions.

A similar case in 1990 involving Nancy Cruzan further expanded these rights. After a car crash, Cruzan fell into a coma and was kept alive by feeding tubes. While her parents saw the removal of these tubes as ending unnecessary treatment, the state argued it was a means of killing her through starvation. Ultimately, the U.S. Supreme Court ruled that patients could legally refuse such treatments, even if death resulted. This raised questions about the extent to which guardians could make these decisions on behalf of incapacitated patients.

Subsequent to the Cruzan case, focus shifted towards more active forms of euthanasia. Notable is the case of “Diane,” a patient of Dr. Timothy E. Quill. Suffering from leukemia, Diane asked for means to end her life, leading Quill to prescribe her lethal sleeping pills. This case stirred discussions about the legality of physician-assisted suicides. Although Quill aimed to enhance end-of-life care, he became a pivotal figure in debates surrounding the legality of assisted suicide. By 1997, the Supreme Court ruled that states could decide their stances on the issue. To date, while most states prohibit it, Oregon has legalised the practice.

However, no discussion on euthanasia is complete without mentioning Dr. Jack Kevorkian, who claimed to have aided over 130 individuals in dying. His methods, often involving individuals he had not previously known, were controversial, as was his advocacy for medical experimentation on patients before their deaths. Kevorkian’s actions, including administering a lethal injection on national television, ultimately led to his conviction for murder in 1999.

Kevorkian’s trials, alongside other notable cases, have significantly impacted the public’s perception of euthanasia. What was once seen as radical, like removing a respirator, is now considered less contentious than physician-assisted suicides or direct mercy killings, as in Kevorkian’s case. The evolving debate encapsulates critical questions about the ethics of euthanasia, its legalisation, potential for abuse, and the role of medical professionals in assisted deaths. As society grapples with these issues, many hope to find a balance that ensures individuals can experience a dignified and “good death.”

Links

https://journalofethics.ama-assn.org/article/evolution-surrogates-right-terminate-life-sustaining-treatment/2006-09

Did Galen Help or Hinder Progress in Medicine?

First published 2021

Galen, a prolific Greek author of antiquity, played a foundational role in medical education throughout the Byzantine empire and Europe for numerous centuries. However, Galen primarily considered himself a medical practitioner rather than an anatomist, theorist, or researcher. He dedicated many decades of his life, spanning from approximately 162 CE until his death after 203, to treating patients primarily in the city of Rome within the Roman empire. His writings now offer us the most direct glimpse into the medical practices of highly skilled ancient doctors.

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Galen’s patients ranged from some of the empire’s most influential figures, including Emperor Marcus Aurelius and his household, to ordinary individuals. He provided medical care not only to the wealthy, treating their spouses, children, and slaves, but also to peasants he encountered in rural areas, acquaintances of acquaintances he met on the streets, and various patients who visited the clinic in his home. In a lost treatise called “That the Best Men Profit from their Enemies,” preserved in Arabic, Galen even claimed never to have accepted payment for his services. The numerous anecdotes Galen shared about his patients, over 300 of which survive in his works, do not portray him as a detached courtier distanced from everyday society. Instead, they illustrate Galen as a public figure, widely known and recognized, approached on the streets, invited to engage in debates, and constantly accompanied by a retinue of friends, supporters, students, household staff, and professional assistants.

However, the question of whether he helped or hindered progress in medicine is a matter of debate. It is necessary to explore both sides of the argument, shedding light on additional aspects of his influence.

On one hand, Galen’s contributions to medicine were substantial and influential. He was a prolific writer, and his works became the standard reference in medical education for centuries. Galen’s emphasis on systematic observation and dissection of animals, particularly pigs and monkeys, contributed to a deeper understanding of anatomy. His descriptions of the circulatory system, nerves, and muscles, although not entirely accurate by modern standards, were groundbreaking for his time and laid the foundation for future anatomical studies.

Furthermore, Galen’s writings on pathology and therapeutics were influential. He developed a system of humoral medicine, which proposed that health depended on the balance of four bodily humors (blood, phlegm, black bile, and yellow bile). While this theory may seem outdated today, it guided medical practice for centuries, shaping the way physicians diagnosed and treated diseases.

However, there are also significant arguments to suggest that Galen hindered progress in medicine. First, his teachings were dogmatic and dominated medical thought for over a millennium. This rigid adherence to Galenic principles stifled innovation and discouraged the questioning of established ideas, potentially impeding the development of more accurate medical theories and treatments.

Second, Galen’s reliance on animal dissection limited his understanding of human anatomy. He made several errors in his anatomical descriptions due to the anatomical differences between humans and the animals he studied. This hindered the advancement of human anatomy and delayed the correction of these errors until the Renaissance when human dissection became more accepted.

Furthermore, the dominance of Galenic medicine discouraged the pursuit of alternative medical approaches and hindered the development of a more diverse and comprehensive medical knowledge base. Only with the gradual decline of Galenism in the Renaissance did medical science begin to explore new avenues of understanding and treatment.

In conclusion, Galen’s contributions to medicine were undeniably significant, especially in terms of his anatomical observations and descriptions. However, his dogmatic influence and the limitations of his theories had the effect of hindering progress in medicine to some extent. While Galen’s work laid important foundations, it also held back the development of more accurate and innovative medical practices. Ultimately, the impact of Galen on the progress of medicine is a complex and multifaceted issue, and the answer to whether he helped or hindered remains a matter of historical interpretation.

Links

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61240-3/fulltext

The Evolution of Medical Training: A Journey from Antiquity to Modernity

First published 2021; revised 2022

Doctors’ training has undergone profound changes throughout history, reflecting shifts in knowledge, societal values, and technological advancements. One of the most striking contrasts can be found between the educational paradigms of the Middle Ages and today’s modern era.

During the Middle Ages, the foundation of medical knowledge was predominantly based on the teachings of the ancient physician Galen. Regarded as the authority on all matters medical, Galen’s texts were religiously followed. Practitioners of the time rarely received hands-on experience or engaged in practical teaching; instead, their training heavily depended on poring over these texts. This method, however, limited their perspective and ability to make accurate diagnoses, often leading to treatments that were far from effective.

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The Renaissance period brought about a shift in this outlook. Pioneering individuals such as Vesalius and Harvey began to question the long-standing beliefs rooted in Galen’s teachings. Their bold ventures into dissecting human bodies paved the way for a more profound understanding of human anatomy. This crucial turn marked a departure from the theoretical to the practical. Dissection and hands-on experience started taking precedence in a doctor’s training regimen, thereby fostering a better understanding of the body and its myriad complexities.

Furthermore, as the centuries rolled on, medical knowledge expanded exponentially. The once-monolithic teachings of Galen gave way to a plethora of new discoveries about anatomy, infection, and disease mechanisms. Groundbreaking findings, like Pasteur’s germ theory in 1864, transformed the medical landscape, making it essential for doctors to continuously update their knowledge and adapt to these new insights.

While theoretical knowledge and practical skills were evolving, so too were the methods of validating a doctor’s competence. A significant shift in doctors’ training was the increasing emphasis on formal education and validation. No longer was it sufficient for aspiring doctors to simply study and practice. The establishment of formal examinations by institutions such as The Society of Apothecaries and the Royal College of Surgeons in 1815 ensured a minimum standard of expertise. Furthermore, the inauguration of medical schools in prestigious institutions, like the one at Edinburgh University in 1884, underscored the growing importance of structured education and research in medical training. Such moves fortified the professionalism and respect associated with the medical profession.

To sum up, the transformation in doctors’ training over the centuries has been profound. From a singular reliance on Galen’s writings, medical education branched out, incorporating revolutionary ideas from thinkers like Vesalius and Pasteur. Equally important was the transition to a more structured and rigorous training process, evident in the emphasis on university-based education and formal examinations. This evolution, underpinned by continuous learning and validation, has ensured that doctors today are better equipped than ever before to cater to the health needs of society.

Links

https://www.bma.org.uk/media/2067/bma-the-changing-face-of-medicine-june-2017.pdf