중앙데일리

Why is there a debate about ‘dying with dignity’?

There’s a conflict between societal values and end-of-life issues.

Feb 17,2009
Candles illuminate posters about Eluana Englaro outside “La Quiete” hospital where the comatose accident victim at the center of a right-to-die drama gripping Italy died on the evening of Feb. 9 in Udine, Italy. AFP
Volatile right-to-die debates have recently been rekindled by media headlines in Korea and Italy.

The term “right to die” is often used in relation to questions about whether or not a patient whose life is maintained only by a life support system should be allowed to die.

The concept is also referred to as “dying with dignity.” At the center of the debate is who if anyone should make the decision about ending such a life.


The Italian case

Eluana Englaro, an Italian woman who has been in a coma since a 1992 car accident, died on Feb. 9 after her family requested doctors to remove a feeding tube to allow her to die naturally and with dignity. Her life had been dependent upon the artificial life support system for 17 years, and her father said she “had clearly expressed the wish to die in case a an accident left her in a coma or a vegetative state.”

The father battled his way through Italy’s courts for a decade. The Milan Court of Appeals denied the father’s request in 1999 and the Court of Cassation again denied the appeal in 2005. The Court of Cassation is roughly equivalent to the Supreme Court of the United States.

The highest court allowed a new trial in Oct. 2007. The Milan Court of Appeals ruled on July 9, 2008 that her feeding can be suspended. During the same month, the Italian legislature filed a jurisdictional conflict before the Final Court of Appeal, challenging the legitimacy of the decision to remove the feeding tube. The petition was rejected.

On Nov. 13, 2008, Italy’s highest court awarded the patient’s father the right to stop artificial feeding of his daughter.

On Feb. 6, clinic workers began the gradual suspension of food and water for Englaro. On the same day, Italian Prime Minister Silvio Berlusconi issued an emergency measure that would have forced the continuation of treatment for her, but President Giorgio Napolitano refused to sign it.

She died on Feb. 9.

The Korean case

About the same time in Korea, a similar court battle over the “right to die with dignity” was being reported.

Upholding a lower court decision, the Seoul High Court ruled on Feb. 10 that doctors should unplug an artificial respirator that has been keeping a 76-year-old woman breathing since she fell into a coma last year.

After their mother slipped into a vegetative state, her children asked the court for permission to stop the treatment keeping her alive. They said their mother would not have wanted to go on living this way.

Both the district court and the appeals court ruled to have her life support system to be removed. They, however, made clear that the decision is not to grant the family’s request, but based on the patient’s presumed will to die.


First-ever Korean court guidelines

In addition to the ruling, the Seoul High Court also issued guidelines for unplugging an artificial respirator.

A patient must have no possibility of recovery, and should have formed a serious intention of stopping treatment, the court said. The treatment to be stopped must be linked to maintaining the patient’s current state, and doctors are not allowed to stop any pain alleviation or other medical treatment, the court said. The court also made clear that only a doctor may unplug the artificial respirator.

The court said it chose not to use the term “voluntary euthanasia” in its ruling because it is questionable that it fits this case. The court also said it did not use the term “death with dignity” because it might beautify death.


Debates over voluntary euthanasia and the right-to-die

The dictionary definition of euthanasia is “the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy.”

The word has its roots from the Greek words for a “good death.” Human euthanasia may be voluntary or involuntary.

Voluntary euthanasia and physician-assisted suicide have been the focus of great controversy in recent years.

Debates over voluntary euthanasia have been raging since the 1970s amid growing concern over individual rights. The “right-to-die” debates in Korea and Italy are the latest.

Advocates of euthanasia uphold individuals’ “right to die” while others including religious communities and social conservatives, condemn the idea.

As debates grew, physicians increasingly faced ethical dilemmas; as doctors, they have taken the Hippocratic Oath to do no harm to their patients.

In Korea’s latest case, Severance Hospital, where the patient was being treated, has refused to unplug the life support system for the woman, and the family took the case to court.

After the district court ruled that the patient’s artificial respirator should be unplugged, the hospital appealed.

The Seoul High Court upheld the lower court ruling, and the hospital said it will have a discussion to decide whether it will take the case to the Supreme Court.

The Seoul High Court issued the guidelines with its ruling because the medical community including Severance Hospital has requested specific standards for stopping treatments that only prolong the life of a terminal patient.

Law needed

While court rulings can be used as precedents, more specific legal standards are needed. Grand National Party Representative Shin Sang-jin has submitted a bill to the National Assembly regarding a patient’s right to die with dignity. The bill is currently pending at the legislature.

The Seoul High Court has also asked the legislature to play a more active role to legalize the matter. “More and more patients will see their lives aided by machines, taking into consideration the development of the medical environment,” the court said. “We are concerned that some premature judgment may stop treatment for patients with the potential to recover, causing death.”

“The state has the duty to guarantee people’s basic rights and to establish a law to specify and conceptualize these basic rights. Therefore, it is inappropriate for the current situation, in which doctors, patients and families are handling the issue, to continue,” the court said.

“It is necessary for the legislature to enact a law to specify the standards, procedures, methods of stopping life support treatment for a terminal patient by taking into account the opinions of society.”


Seoul High Court’s guidelines for removing an artificial respirator

*A patient must have no possibility of recovery.

*A patient should have formed a serious intention of stopping treatment.

*The treatment to be stopped must be only linked to maintaining the patient’s current state, and doctors are not allowed to stop any pain-reducing or other medical treatment.

*Only a doctor may unplug the artificial respirator.

By Ser Myo-ja Staff Reporter [myoja@joongang.co.kr]


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