Issues in Interdisciplinarity 2020-21/Truth in Euthanasia

Introduction
This chapter aims to explore the issue of Truth in Euthanasia in the Netherlands. This country was the first to legalize the practice of euthanasia. Since then, there has been an ongoing debate over this issue for the last 30 years. Euthanasia is a Greek term, that translates to “good death”. It emerged as a response to the criticism of medical advance, that controlled the lives of humans. What was supposed to give freedom to vulnerable patients, might lead to violation of human rights and doctors’ abuse of power.

The research has been limited to the Netherlands, one of the two countries in Europe where active voluntary euthanasia is legal. During the debates in other countries, where euthanasia is considered unethical, the Netherlands is used as an example of legalization. Establishing truth in euthanasia requires an understanding of the medical, legal, and ethical perspective.

Law
By establishing rules that correspond to reality, truth is the foundation of law. The consideration of whether euthanasia should be legalized emerged in 1973 with the "Postma case". The lawsuit against a physician, who performed euthanasia, shed light on the debate over the establishment of new criteria and their truths. It allowed euthanasia to be conducted on a patient. In 2002, the Netherlands legalized euthanasia with the “Termination of Life on Request and Assisted Suicide Act”.

The Dutch law considers euthanasia as a criminal offence but does not recognize it as murder. It is legal under the circumstances of “hopeless and unbearable” pain. Article 293, from the Dutch Penal Code, highlights the consequent punishment of an individual who “deliberately terminates the life of another person”. However, when it is conducted by a doctor, who respects the "diligence criteria", it is not punishable. Euthanasia is considered an ambiguous concept from a legal perspective. Therefore, the truth in euthanasia, according to Dutch law, is subjective to a specific case, simultaneously being limited by an objective legal act.

Moreover, euthanasia is framed by the legal interpretivism, but the truth about the act itself relies on the doctors' honesty. When euthanasia is performed, documents underlining the act need to be completed and reported to authorities. Some physicians do not enter the legal process by stating untruthful reasons for a patient’s death. Therefore, the limitation of the Dutch legal framework of euthanasia relies on the truthfulness of healthcare professionals. Unfortunately, in some cases, it can lead to abuse of power and obtaining manipulated truth.

Medicine
Truth in medicine is empirical as doctors tend to use statistics to define medical methods. However, this is not the case for euthanasia where many ongoing cases require much deliberation due to a multilateral truth.

The modern criterion of death is based on the “total brain standard” which establishes someone dead after the cessation of all brain activity. However, this standard was debated in 2013 when Jahi McMath was declared brain-dead but was still kept on life support until June 2018. She retained hypothalamic functions of her brain and did not meet the “total brain standard” criteria. Even though this case occurred in the United States, it highlights that not having a global protocol to determine death, complicates the situation of euthanasia all around the world. Truth in euthanasia is, therefore, multilateral, as it depends on the definition of death, which is still changing.

Voluntary Passive Euthanasia (VPE) and Voluntary Active Euthanasia (VAE) are not authorized in the same proportions by doctors. VAE is seen as “murder” since the medical practitioner administers patients with a lethal overdose of medication instead of letting them die (VPE). Nonetheless, by associating the death of a person with brain death, our identity is defined by our mind and brain, not by our body. Thus, from this perspective, the body is seen as a form of life support that keeps the brain alive, erasing the difference between VAE and VPE. However, this medical truth is limited by the law as the Netherlands and Belgium are the two only countries legalising VAE in Europe. Therefore, there is no absolute truth in euthanasia since different disciplines clash against each other.

Ethics
Studying truth in euthanasia from an ethical perspective is essential for the understanding of the debates surrounding it. It raises moral dilemmas. Ethics, as a discipline, investigates if euthanasia is a crime on itself and if doctors are the appropriate professionals to end the life of a person. In 1978, J.H van den Berg, a Dutch psychiatrist, published Medical Power and Medical Ethics. The author questioned the tradition of protecting life at all costs. He suggested a new medical ethics code, focused on the right of the patient to complete knowledge and power over their life. Pluralist truth in euthanasia can be found in two moral justification suggested by van den Berg.

The first one provides a non-medical justification of “respect for autonomy”. Patients, if they want to, can exercise their free-will and voluntarily ask for euthanasia. However, this raises the first ethical question on the abuse of this method by the patients and the doctors. If the patient is unconscious when euthanasia is considered, who should make the decision?

The second justification states that respect for pain should be considered the main moral principle supporting euthanasia. However, the ‘unbearable suffering’ stated in the Dutch law is subjective. How can the doctor define the truth if he is unable to feel the pain of the patient?

Ethics, as a discipline, try to establish the truth in euthanasia by respecting patient's free will and pain. Ethics use a pluralist truth, taking into consideration different perspectives, all being true to some extent.

Tensions between Disciplines
Euthanasia emerged in the Netherlands as a response to medical technology. It arose as an ethical idea and aimed to give freedom to vulnerable patients by applying pluralist truth. Later, the nature of this practice changed and lost its initial premise. It is limited by law and legal interpretivism, which can lead to abuse of power and manipulation of the truth. The law impacts medical practitioners and restricts their actions. These disciplines aim to cooperate to define holistic truth. However, they create a paradox where one limits another, leading to unwanted solutions.

This idea is linked to the debate between emotions and reason. Truth in law is often defined with reason. It allows law specialists to apply universal practices that do not take into consideration their own emotions. In contrast, ethics use emotion and are based on defining what is right or wrong, taking into consideration the autonomy, pain, and free-will. Dutch medical professionals apply both, reason and emotion, while establishing the truth in euthanasia.

Conclusion
Overall, truth in euthanasia can be debated within three disciplines: law, medicine, and ethics. The interdisciplinary truth obtained in the Netherlands does not apply to other countries. They each have their socio-political and cultural factors that influence the regulations. That implies that truth in euthanasia worldwide is more relative than absolute since it depends on different perspectives. Finally, it is essential to acknowledge that truth in euthanasia can be manipulated. Thus, it is linked to power, another interdisciplinary issue, and its abuse by patients and doctors.