Death with Dignity: The Legal Dilemmas of Euthanasia

Krzysztof Gorazdowski The Jacob of Paradies University in Gorzów Wielkopolski, Poland Death with Dignity: The Legal Dilemmas of Euthanasia Summary Death with dignity is very often equated with euthanasia and assisted suicide, which are regulated as prohibited acts in articles 150 and 151 of the Polish Penal Code Act of 6 June 1997. However, the media discussion between supporters and opponents of legalization of euthanasia, which is heating up especially when there are cases of terminally ill people who publicly demand the right to a dignified death without pain and suffering, which would entail the decriminalization of euthanasia and assisted sicide in national law. In the European Union, there are no uniform solutions in this respect and each of the mem‑ ber countries can adapt its internal legislation to its own legal regulations. The article points to the definitions and types of death as a legal and medical event, an analysis of existing legal regulations in Polish law related to euthanasia and its variants including assisted sui‑ cide. Additionally, it clarifies important legal doubts related to the existence of the right to a death with dignity as a normative category resulting from the Constitution and a cautious approach of the direction of changes in law in this area in the nearest future – proposing the adoption of a specific legal model due to the approach to the legalization of euthanasia within the European Union and changes in views on euthanasia in the opinion and public awareness in recent times. Keywords: death, dignity, euthanasia, murder, assisted suicide, mercy killing, legal regula‑ tion of euthanasia Introduction Most of us prefer not to think about death and about situation in which we can get affected by an incurable disease, be connected to alife‍‑supporting machines under persistent therapy, or be deprived of the ability to function on a daily basis and to decide for ourselves to leave this world, or leave this decision to doctors, lawyers, or close relatives. Studia Administracji i Bezpieczeństwa nr 5/2018 The wish for death with dignity and the fear of suffering a further unwanted life are existential dilemmas which often invade the public debate due to for example the fate of Alfie Evans who touched public opinion in Great Britain and beyond. The child was admitted to the Alder Hey Hospital in Liverpool in November 2017 with a recognized neurodegenerative disease of unknown eti‑ ology that led to the irreversible destruction of nearly 70 percent of the brain surface by losing the white matter of the brain (tissue that lies under the brain and connects the brain). In fact, the brain of this six‍‑month‍‑old child was only com‑ posed of water and cerebrospinal fluid due to degradation in the disease process. In the spring of 2018, the medical team decided that, in the absence of any hope to improve the child’s vegetative state, continuing the persistent therapy did not make any sense. A decision was made to disconnect life support equipment. The High Court in London and the Court of Appeal of England and Wales approved this decision after the legal battle. It was then that the father of the child, Thomas Evans, approached the public to transport the small patient to Italy and reconnect the devices at the Roman hospital Bambino Gesu. After the disconnecting of the life support devices on 23 April 2018, the child was still alive for 5 days. The case of Alfie Ewans caused quite a stir in the world. Hundreds of people protested in front of the hospital. In defense of the boy’s life, signatures were collected under petitions to Queen Elizabeth II and the British Parliament. Pope Francis I spoke to those who sought to transfer the boy to Italy. There was even a social movement named Alfie’s Army which sought to maintain the child’s life at any price1. In the media, especially on the Internet, the slogan “Save Alfie Evans” appeared. 1. The death of a human being Thanatology or the science of death indicates that the death of the organism is the irreversible cessation of its activities, especially brain activities 2. The cessation of life is of great importance especially in the aspect of organ transplantation and resuscitation issues (orthotanasia). Human life lasts as long as coordinated sys‑ tems work: circulation, respiration and the central nervous system. The cessation of one of them usually leads to death. The nervous tissue dies on average after 3‍‑4 minutes from the lack of oxygen. After stopping your breathing you can keep your heart active for several minutes; up to 30 minutes in healthy adults and up 1 2 J. Bielecki, Dylematy godnej śmierci, „Rzeczpospolita Plus Minus”, 12‍‑13.5.2018, No. 109 (11049), pp. 4‍‑6. T. Marcinkowski, Medycyna sądowa dla prawników, Warszawa 1993, p. 111. 164 Krzysztof Gorazdowski, Death with Dignity... to 2 hours in newborns3. Clinical death as a result of cessation of circulation and respiration is characterized by such symptoms as: reduced muscle tone, passive body position, lack of awareness and reflexes, lack of respiratory movements, heart rate and tones, pale body shells and body cooling. There should be distinction between clinical death and apparent death, where cardiovascular and respiratory functions do not subside so much, which is at a very low level (the so‍‑called vita minima). Clinical death, which can be a revers‑ ible state and usually lasts about 10 minutes, is already close to biological death which is characterized by irreversible changes in organs important to stay alive, especially in the brain tissue. In medicine, attempts have been made to determine the time when it is still possible to restore the full efficiency of a specific organ after clinical death. This time for the brain is 8‍‑10 minutes; for the heart, 15‍‑30 minutes; for liver, 30‍‑35 minutes; for lungs, 60 minutes; for kidneys, 90‍‑120 min‑ utes4. Understanding the phenomenon of death, and in particular its determination, is also associated with the intended organ collection for the purpose of transplant‑ ingand the development of transplant medicine. According to Art. 4, para. 1 of the Act of 1 July 2005 on the procure‑ ment, storage and transplantation of tissue and organ cells (Dz. U. 2017.1000 of 2017.05.22) –cells, tissues, and organs may be taken from human corpses upon death in a manner specified in Act of 5 December 1996 on the professions of a doctor and dentist (Dz. U. 2018.617 of 2018.03.26) for diagnostic, therapeutic, scientific and didactic purposes. It is worth noting that the Act of 24 February 2017 amending the Act on the professions of doctor and dentist and the Act on the col‑ lection, storage and transplantation of cells, tissues and organs (Journal of Laws, item 767) moved matters related to the statement of brain death from Act of 1 July 2005 on the procurement, storage and transplantation of tissue and organ cells (Journal of Laws of 2015, item 793) to the Act on the professions of doct (...truncated)