Filenews 15 May 2022 - by Marios Demetriou
"A global conception of bioethics can contribute to the creation of a contemporary Ars Moriendi or a contemporary art of death that will propose a new vision of the way of death, with greater involvement of the family and the community, alongside health systems, more support for the bereaved, education of people about death and addressing the inequalities that accompany not only life but also death." The aboveis one of the strong messages in the official opinion of the Cyprus National Bioethics Committee published last Monday, May 9, 2022, along with the presentation of a recent survey by the Bioethics Committee to record the knowledge, attitudes and perceptions of the general population regarding euthanasia, according to the results of which, more than half (59%) or 6 out of 10 participants stated that they agree, or rather agree with its legitimacy, euthanasia or doctor-assisted suicide or death in Cyprus.
The presentation of the research was made before the Parliamentary Committee on Human Rights by its chairman and scientific coordinator of the research, Professor Konstantinos Fellas, in the context of the continuation of the discussion entitled "Euthanasia – The need to inform and initiate social dialogue in Cyprus", which began at the Human Rights Committee on January 24, 2022. The survey was conducted by IMR/University of Nicosia in December 2021 - March 2022 and the sample size reached 750 people. The selection of the sample was made by the method of randomly stratified sampling and this included an equal number of men and women 18 years and older. "Today," said Professor Fellas, "the official opinion of the National Bioethics Committee is also published, which is unanimous and positively advocates the legalization of voluntary euthanasia, at the heart of which is the valid and informed written consent of the patient. It will be done in very exceptional cases, under strict safeguards to protect dignity and respect for our fellow human beings who suffer from an incurable disease. And I repeat that the legalization of euthanasia is not a substitute for an effective palliative care that the state is obliged to provide to our fellow citizens."
The Cypriot Church expressed its vertical opposition to the possibility of legalization of euthanasia through the mouth of Archimandrite Georgios Christodoulou, chief secretary of the Holy Synod. Serious reservations were expressed in particular by the MP of DIKO Pavlos Mylonas. Some negative concerns were also expressed by DISY MP Rita Souperman.
Ioannis Leontiou, president of the Pancyprian Association of Nurses and Midwives and Phaedon Elias, member of the board of directors of the Pancyprian Nurses' Guild, raised questions about whether the right of the members of the nursing staff not to participate in a euthanasia process is guaranteed if for any reason of their own they do not wish to do so.
Professor Fellas said during the debate that the opinion of the Bioethics Committee "answers many of the logical questions raised today".
The Chairman of the Human Rights Committee of the Parliament, Irene Charalambidou, announced that with the involvement of the Parliamentary Committee on Legal Affairs and in cooperation with the University of Nicosia, the University of Cyprus and the Cyprus Bar Association, a relevant law proposal will be prepared which will be submitted, will be the subject of dialogue and consultation and will be brought to a vote in the Plenum of the Parliament".
No from the Church
In a written memorandum signed by Archbishop Chrysostom, which was served last Monday in the Human Rights Committee of the Parliament, it is stated, among other things, that: "for the Church, euthanasia is either active or passive, is considered a removal of life. If it is intentional, it is considered as assisted suicide, while if it is not voluntary, that is, it is not done with the consent of the patient, it is no different from murder. For the Church, euthanasia, no matter what form it takes, is morally unacceptable because God is the Lord of both life and death. Therefore, to bring about death willingly, regardless of the motive, is tantamount to murder if it is another person, or suicide if it is oneself."
During the discussion, Archimandrite Georgios Christodoulou, chief secretary of the Holy Synod, commented in his own way on the attitude of people to deny death, even of elders who do not believe that they will die. "To say jokingly," she said, "that in my village down in Karpasi, a trapped woman, when asked how old she is, said "107." And when the reporter told her "I wish we would see you in your 150s", she replied "but will you be alive until then my son?".
Yes Ministry under conditions
On behalf of the Director General of the Ministry of Health, Officer Irene Georgiou said that "the ministry's position is that the right to euthanasia should be given provided that the legal framework that adopts it will include strict conditions that will be determined after dialogue, in particular as to the methodology – i.e. whether it will be active or passive – to be followed for euthanasia".
From the Pancyprian Bar Association, the secretary of the Human Rights Committee of the Association Lakis Christodoulou said that "our Committee is at the disposal of the state to make the right legislative regulations".
Some thoughts were also expressed by Dimitris Parperis, representative of the Cyprus Psychological Association. "While someone is in a bed and is in pain and we know that he will soon die, what we will do is difficult for science to answer," he said, among other things, adding: "I think we should find a way that leads us to a more compassionate world and perhaps matches the rest of the values and choices we make in life and health, but the truth is that it is not any of the sciences that are or are not here that will answer this question. It's more about what kind of world we want to build and what kind of system we want to have."
The appropriate legislative framework is a prerequisite
With the positive position of two academics who dealt thoroughly with the issue, the dialogue for the legalization of euthanasia in our country was strengthened. "I believe that under the strict conditions under which it is discussed, the appropriate legislative framework can be found and this is what the maturity of society has shown us", commented Dr. Aristotelis Konstantinidis, associate professor of International Law and Human Rights Law at the Department of Law of the University of Cyprus, during the parliamentary session.
"It is normal, he added, that when there are many strict conditions, the acceptance rate will increase. If they are few, this percentage will decrease. It is up to the parliament, which is the sovereign body of the people, to decide what is the most appropriate arrangement for Cypriot society. There is a misunderstanding and perhaps even a little hypocrisy. The medical world knows this best and we all know it with the experiences we have that passive euthanasia is already taking place in Cyprus - that is, the doctor decides that the patient will not continue to have the ventilator or intubation. And this was done extensively in the period of the coronavirus. However, passive euthanasia can be much more painful for the patient because it can lead to death by suffocation and other painful ways. If the patient had the ability to articulate himself the will and the conditions under which it could be done, I think it would be a more humane process. And of course it is a given that we are not talking about mandatory participation of doctors or nursing staff because it would be a violation of human rights.
In his own statement, Dr. Stergios Mitas, assistant professor at the Law School of the University of Nicosia, said that "with the Fellas research we have two data, the mapping of social trends and perceptions and a testimony and positioning of principles. I note – he added – that on some of their key points these two presentations are intertwined, and this can only positively animate the Commission's orientation. Personally, I do not think that any statistical trends are an indicator of correctness, but they can be a very fertile subsoil for legislation for the right reasons. And I find that there are the right reasons in the spirit of the opinion of the Committee on Bioethics. Above all, with the repeated note that the principle that governs from the beginning to the end the whole proposed regulation and procedures, is the self-determination and autonomy of the patient. The emphasis that all this concerns highly circumscribed cases also responds to another objection and reservation that this may be vulnerable to abuse. The other emphasis that this does not absolve or replace the obligations of the welfare state to everyone for medical care from the beginning to the end of life, also responds to another reservation or objection that all this can lead to a utilitarian cost-benefit balance for public finances."
When life becomes unlivable...
"The position of the Cyprus National Bioethics Committee (CBRN) is that in principle all margins and modern medical and pharmaceutical technology should be exhausted in order to offer effective palliative care to patients who suffer and experience pain and hardship during a situation that cannot be treated," the written opinion published by the CBRN made public last Monday states, among other things. The following are added: "In such extreme cases where life becomes unlivable and in the absence of treatment the patient, while in full consciousness, chooses to end his life with good death, human compassion and compassion is appropriate to be ready to offer this ultimate medical option under certain conditions, only as a voluntary or non-voluntary euthanasia. Depending on the case, active or passive euthanasia may be chosen.
The CVB in no way agrees with the application of unintentional euthanasia. In the case of voluntary active euthanasia, it generally appears that this is acceptable based on the current value background of society for cases of incurable painful diseases with a short life expectancy and/or for patients with a strong and progressive degeneration of quality of life. In particular, similar issues should be clarified, such as any insurance cover or other financial consequences for patients expressing the wish to be euthanised, as well as ensuring the right decision by those involved to avoid speculation against the sufferer.
Respect for human dignity must be respected throughout the process and this must be ensured by medical practice, while emphasis must be placed on the previously expressed directive or 'living will' of the patient and there must be constant monitoring of its legality in the light of factors such as time, a change of decision; capacity to act, which allow it to be taken into account at the material time. Because it is not possible to cover each individual case by general rules and because we pay full respect to the autonomy and dignity of each patient, the CBRN considers that each case should be subject to a distinct thorough study and evaluation by a team of experts that will include a doctor, a psychologist, a social worker or other experts, in order to ensure that the right decision is taken, provided that in case of implementation of euthanasia there will be no return. While it is impossible to know all the details, when studying each case, it is appropriate to take into account data concerning not only the individual individually, but also the wider family and financial situation, the possible conflict of interest, etc.
PROTECTION OF HEALTH PROFESSIONALS
It is understood that during the ratification and implementation of euthanasia, all legal measures must be taken and relevant legal documents must be prepared in order to protect the doctors or other health professionals involved. Finally, the CBRN recommends that actions be taken to transfer experiences, expertise and knowledge from other countries that apply euthanasia protocols in order to train accordingly the various representatives of stakeholders in the best possible handling of such incidents. It is stated that the present opinion was approved by all the following mentioned members of the Cyprus National Bioethics Committee (in alphabetical order), who were present at its meeting, dated 30 March 2022: Konstantinos Fellas president, Ioannis Kolos vice-president (rotating for six months October 2021 – March 2022) and members Anastasia Nikolopoulou, Andri Panagiotou, Antonis Farmakas, Georgios Papantoniou, Kleopas Kleopas, Kyriakos Felekkis, Konstantina Kapnisi Christodoulou, Konstantinos Deltas, Marios Kariolou and Christina Loizou".
INTERVENTION
A matter of life and death
I particularly like this photo of the 90-year-old now famous American psychiatrist and author Irvin Yalom with Marilyn's one-year-old younger wife, a successful feminist gender writer, professor of French Literature at Stanford University in California. It was shot in 2017 — the year Yalom had expressed confidence that "Becoming Myself" would be his last book. But three years later he was destined to undo that assurance.
In an online post on March 31, 2020, he first publicly referred to the death of his beloved Marilyn that occurred in November 2019 at their home in Palo Alto, California. He also referred to his new book that they had started writing together before she finally succumbed to cancer. "Soon after we learned of her diagnosis," Yalom explained, "she told me during a walk that she would like us to write a book together about her illness and how it affects our lives. And that's what we did. Ten months ago we began to alternately write chapters in our new book about what we think about her illness and the approaching death.
"Marilyn died last November, five months ago, and since then I have been writing the second half of the book alone. Yesterday I finished the last chapter. It is a book about dealing with her deadly illness, about her death and about my own path of grief that she followed. I gave it the title "A Matter of Death and Life." In this autobiographical book, Yalom describes, among other things, in shocking detail the end of Marilyn's life, which at her own request – due to the constant unbearable pain she felt – was caused by the administration of lethal pharmaceutical doses by their family doctor, in the presence of Yalom himself and their four children.
I note that California is the fifth U.S. state to legalize – in 2015 – euthanasia. "Marilyn," Yalom wrote in the last lines of the book, "I remember so clearly the phrase you repeated: that it is not a tragedy to kill an 87-year-old woman who has no regrets about anything in her life. This idea, that the fuller one lives, the less tragic one's death is, is for me the more real"...
