EUTHANASIA AND ISLAMIC RULINGS PERTINENT TO MAINTAINING AND REMOVING ARTIFICIAL LIFE SUPPORT DEVICES

This paper is intended to elaborate on the legal ruling of removing life support from a brain-dead person. Brain death means the permanent absence of brainstem and cerebral functions, not only the death of the brain cortex. Life support devices restore the functions of the heart and respiratory system, which sometimes result in the full recovery of consciousness of the patient and all of his basic functions. It is possible for the patient to restore normal breathing and leave the hospital in a full healthy state. On this basis, it is not permissible for a doctor to remove these devices before the brainstem dies, otherwise this would cause a real and irreversible death of the patient. In this case, the doctor bears full civil and criminal responsibility. The doctor is held accountable if he refrains from providing assistance to this patient who is legally and medically alive. It is permissible to remove artificial life devices once the death of the brain is ascertained in the light of the above-mentioned diagnoses. Then, the patient will be transferred to another room, but his death is announced only after the heart stops functioning. It is from this moment that the rulings of death are applied. The responsibility of removing these devices and declaring death is the work of a specialized medical committee that approves the diagnosis and issues a burial permit.

Comprehensive assessment of a nationwide simulation-based course for artificial life support

Background Successful implementation of medical technologies applied in life-threatening conditions, including extracorporeal membrane oxygenation (ECMO) requires appropriate preparation and training of medical personnel. The pandemic has accelerated the creation of new ECMO centers and has highlighted continuous training in adapting to new pandemic standards. To reach high standards of patients’ care, we created the first of its kind, National Education Centre for Artificial Life Support (NEC-ALS) in 40 million inhabitants’ country in the Central and Eastern Europe (CEE). The role of the Center is to test and promote the novel or commonly used procedures as well as to develop staff skills on management of patients needing ECMO. Method In 2020, nine approved and endorsed by ELSO courses of “Artificial Life Support with ECMO” were organized. Physicians participated in the three-day high-fidelity simulation-based training that was adapted to abide by the social distancing norms of the COVID-19 pandemic. Knowledge as well as crucial cognitive, behavioral and technical aspects (on a 5-point Likert scale) of management on ECMO were assessed before and after course completion. Moreover, the results of training in mechanical chest compression were also evaluated. Results There were 115 participants (60% men) predominantly in the age of 30–40 years. Majority of them (63%) were anesthesiologists or intensivists with more than 5-year clinical experience, but 54% had no previous ECMO experience. There was significant improvement after the course in all cognitive, behavioral, and technical self-assessments. Among aspects of management with ECMO that all increased significantly following the course, the most pronounced was related to the technical one (from approximately 1.0 to more 4.0 points). Knowledge scores significantly increased post-course from 11.4 ± SD to 13 ± SD (out of 15 points). The quality of manual chest compression relatively poor before course improved significantly after training. Conclusions Our course confirmed that simulation as an educational approach is invaluable not only in training and testing of novel or commonly used procedures, skills upgrading, but also in practicing very rare cases. The implementation of the education program during COVID-19 pandemic may be helpful in founding specialized Advanced Life Support centers and teams including mobile ones. The dedicated R&D Innovation Ecosystem established in the “ECMO for Greater Poland” program, with developed National Education Center can play a crucial role in the knowledge and know-how transfer but future research is needed.

Analysis of the legal positions of the European Court of Human Rights on the application of the euthanasia procedure

The article examines the problems of euthanasia and the realization of the human right to suicide with the help of others in the context of the European Convention for the Protection of Human Rights and Fundamental Rights, the case law of the European Court of Human Rights. The authors focused on finding the necessary compromise between protecting the patient's right to life, which is a positive commitment of the state, and protecting the patient's right to respect for private life and individual independence. The main positions of the European Court of Human Rights on the possibility of use in euthanasia and in which cases are analyzed step by step. In each case, it was described under what conditions the applicants had applied to the Court and what the difference was between the cases. It is emphasized what the Court relied on in resolving each individual case. It is stated how the Court interprets the possibility of applying Article 2 of the Convention in a negative light and in what cases and under what conditions the Court considers it necessary to apply the principle of “ratione personae”. It is indicated what is the main difference between active and passive euthanasia, and in which countries any of the forms of termination of life of a sick person is allowed, regulated and clearly regulated. It is noted that the issue of application or discontinuation of treatment was considered taking into account many objective factors that are taken into account in each case. Also, attention is paid to the analysis of the court's position on the importance of the role of the state in matters of termination of life, where countries should be given discretion in deciding on disconnection from artificial life support. Separately, the main risks of legitimizing euthanasia are emphasized, in particular, the authors point to the need to improve and comply with the imperative norms in each country to ensure the fulfillment of the positive responsibilities of each state.

Euthanasia from the Islamic Perspective: Ending Life of a Patient whose Recovery is Absolutely Impossible

Life and death of men is in the discretion of Allah, SWT. No one can decide how long they should live, but Allah, SWT. However, in our society today, life is being terminated by someone such as doctor or family of terminally ill patients when their recovery is absolutely irretrievable according to medical expert opinions. In medical science, ending life for such a situation is called euthanasia i.e. an act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Justification given by pro-euthanasia is that it is the right of the patient who should not suffer unbearable pain physically and who does want to be a burden to their family. They insisted mercy killing is absolutely appropriate if the patient’s body is in gradual decline, their organs are in continuous failure, their agonizing pain is unbearable, and the cost of their artificial support system is beyond their limit. This issue has been controversial to many Islamic as well as social organizations as it is against their doctrine and norms. Since life and death is in Allah’s hand, who is to decide that a life has to be ended at a specific time? Is it against predestination and fixation of life by Allah that when the time come no one can stop its arrival? This undesirable situation is confronted by many Muslims in our world too, hence is there any room in Shari’ah law that allows a physician to end the life of a patient? The objective of this paper is to explore any possibility in Shari’ah law that authenticates ending of a life.

The Citizens of Incubators

Neolife are technologically created and fragmented life forms that have been manipulated by humans and cannot survive without artificial life support. This essay focuses our attention on one of the main vessels of neolife - the incubator. In recent years, especially as a result of the human genome project and through the field of synthetic biology, there is a shift to obscure the incubator as a surrogate vessel and render it neutral, thereby obscuring how, throughout history, what life is chosen or forced to be put in an incubator reflects on human wants and desires. Neolife can be seen as the entanglement of life with its surrogate apparatus, echoing interests of human-centric control, which affect and effect the larger milieu. By focusing on the incubator as such, we question the very idea of biocitizenship, focused as it is on human life, on intact, whole bodies, and on the distinction between environment and biology. Furthermore, the incubator has, throughout its history, served to reproduce and recuperate the very ideologies of race and gender upon which normative biocitizenship depends, despite the fact that developments in biotechnology and the design of neolife may offer the illusion of a “new citizenship” that breaks free from hegemonic human social constructions of species, gender, race, and class.

SURVIVAL AND OUTCOME OF NEUROSURGICAL PATIENTS REQUIRING VENTILATORY SUPPORT AFTER INTENSIVE CARE UNIT STAY

OBJECTIVE The aim of this study was to analyze the clinical outcome of severely ill neurosurgical patients whose need for artificial life support was extended. We sought to determine whether these patients benefit from extended treatment both in life expectancy and quality of life. Furthermore, we evaluated the direct cost of the neurosurgical treatment. METHODS The study group comprised a consecutive series of 346 neurosurgical patients in poor condition who were discharged from the intensive care unit but still in need of artificial respiratory support. The patients had various neurosurgical diagnoses and were treated between 2000 and 2003 at the Department of Neurosurgery, Helsinki University Central Hospital. We followed the outcome of these patients by specially formatted questionnaires 6 months and 1, 2, and 5 years after treatment. Their health-related quality of life was evaluated with EuroQol EQ-5D; quality-adjusted life years (QALY) gained with the treatment and the costs of a QALY were calculated. RESULTS The median follow-up time was 5 years. The mortality rate was 27% at 30 days, 45% at 1 year, and 59% at 5 years after treatment. Of the patients, 20% had a good recovery (Glasgow Outcome Scale [GOS] scores 4 and 5), 18% had severe disability (GOS score 3), none was in a vegetative state (GOS score 2), 59% were dead (GOS score 1), and 3% were lost to follow-up. Of the survivors, 69% lived at home, 22% in a nursing home, 2% were in a hospital, and 7% were lost to follow-up. The median EQ-5D index value was lower than the median index value for the general population: 0.71 (25th percentile [Q1] 0.38 and 75th percentile [Q3] 0.85) versus 0.85 (Q1 0.73 and Q3 1.00). The median cost of the direct neurosurgical treatment per patient was 15 000 € (25th percentile, 10 000 € 75th percentile, 22 000 €). Surviving patients gained a mean of 17 ± 13 QALYs. The cost of 1 QALY was 2521 €. CONCLUSION Prolonged intensive care unit and step-down unit treatment of critically ill neurosurgical patients seems to be clinically justified. Moreover, direct costs of neurosurgical treatment were reasonably low.

Terminal Sedation: Palliative Care for Intractable Pain, Post Glucksberg and Quill

In 1997, the U.S. Supreme Court tacitly endorsed terminal sedation as an alternative to physician-assisted suicide, thus intensifying a debate in the legal and medical communities as to the propriety of terminal sedation and setting the stage for a new battleground in the “right to die” controversy. Terminal sedation is the induction of an unconscious state to relieve otherwise intractable distress, and is frequently accompanied by the withdrawal of any life-sustaining intervention, such as hydration and nutrition. This practice is a clinical option of “last resort” when less aggressive palliative care measures have failed. Terminal sedation has also been described as “the compromise in the furor over physician-assisted suicide.”Medical literature suggests that terminal sedation was a palliative care option long before the Supreme Court considered the constitutional implications of physician-assisted suicide. Terminal sedation has been used for three related but distinct purposes: (1) to relieve physical pain; (2) to produce an unconscious state before the withdrawal of artificial life support; and (3) to relieve non-physical suffering.