The problem of euthanasia has been a matter of concern for humanity since antiquity. The importance of the end of life was firstly introduced by Hippocrates, who added “moral practice” of medicine in the oath, condemning the administration of a lethal drug from the physician to his patient, either in order to put an end to his life or to the life of any unborn fetus.
Development of medical science, rapid evolution of medical technology and progress in Intensive Care Unit (ICU) medicine offered the potential to effectively treat diseases, further expand life expectancy, and reduce transmitted diseases. Under these conditions, significant ethical and legal problems have emerged, both in the treatment of many diseases and the dilemma of continuation or withdrawal of treatment intervention.
Euthanasia is defined as "end to life out of mercy", in end-stage disease, or situations due to which life becomes particularly unpleasant or unbearable. The term “euthanasia” comes from ancient Greece when a different meaning was initially proposed. In ancient times, what intrigued the Greeks the most was great and glorious death in order to give to the diseased immortality and fame after death. In the original concept of euthanasia, the word “eu” means good, beautiful, brave, noble, while the second part of the word expresses the natural “death”. Euthanasia sets an end to life on request and is defined as the process where a doctor intentionally gives an end to the life of a person by the administration of drugs, under the voluntary and competent request of that person, who lacks intent to cure.
Francis Bacon (1561–1626) translated the Greek word euthanasia in English clarifying the meaning as "enhancing death, to put an end to a life full of pain and intolerance." Euthanasia is defined as "the deliberate killing incurable, with his consent or without it, in relief or redemption of the painful agony of unbearable pain existing therapies fail to soothe". In other words, this “death inducing method is done for specific reasons”.
Depending on how euthanasia is performed, the term can be further classified based on the subject who takes initiative and the way euthanasia is executed.
Euthanasia has been further investigated in several forms and has been divided according to social issues and values, due to scientific progress or the complexity of the methods used to overcome the legal and ethical responsibilities.
Recently, “early euthanasia of defective neonates”, like infants who develop serious health problems, has been widely discussed via highlighting the growing interest of legal science and public opinion. This action is not a form of euthanasia. In fact, proponents of this practice argue that this kind of euthanasia belongs to the concept of abortion, but does not lose the independent character as a form of euthanasia.
A separate type of euthanasia is the field of disconnection of patient from artificial life-sustaining machines. This action is often characterized as a form of passive euthanasia, which is not accurate, as the disconnection of the patient reflects an action. In fact, this form is similar to active euthanasia which is a possibly unfair human action. In order to be accepted as a type of euthanasia, disruption of technical means of life support must fulfill two conditions, pre-existing patient declaration of his/her intent and the progressive aggravation of patient’s condition with likely fatal consequences in contrast to previous permanent and steady state.
“Assisted suicide” is considered as another aspect of euthanasia and is actually defined as the action of providing a form of medication with toxic effect on human body aiming to terminate life in its critical end-stage condition. Moreover, the respect to the right in autonomy and self-determination has been a field of controversy. In the literature it has been referred as “Wills Euthanasia”, “Living Will”, “Advance directives for end of life” and “Biological Wills”. Their content is medical advice based on which the patient refuses or accepts in advance specific treatments that will be proposed in the future by the physician. This advice contains further information on the expected course of the disease and gives the potential of selection of a specific person as a representative of the patient in his/her personal health matters in the case patient’s ability to judge and take decisions for his/her life becomes impossible in the future.
Conflict on euthanasia definition and aspects is initially derived from the arguments on the right to life, which is internationally protected and widely guaranteed constitutionally. Interestingly, relevant provisions such as the European Convention for the Protection of Human Rights, the European Court of Human Rights and the European Oviedo Convention (1997) on Human Rights and Biomedicine have been extensively occupied with the issues aforementioned.
Dilemmas on euthanasia have gained medical, legal, political, social and economical aspects. In the Netherlands, regulation of euthanasia has been officially established, while in Luxembourg euthanasia was legalized by the parliament in 2008 and the official adoption was announced in 2009 [1]. Australia enacted the "Act on patient rights in the last stage," or more simply the legitimacy of “active, voluntary euthanasia” [2, 3]. The first US state allowing medically assisted suicide, was Oregon by adopting the Law “death with dignity” (Death with Dignity, Act of 1994) but under strict conditions [4]. In 2008, Washington State allowed in similar conditions to those of Oregon, euthanasia. In addition, the state of Montana, allowed euthanasia, after a court decision in December 2008 [5].
Controversial opinion on the establishment of the right to euthanasia in Greece is of particular interest since there is no relevant legislation. The Greek legislation does not contain the term “euthanasia” beyond the term “homicide in consent” which consists of an offense of Criminal Law. Greece has signed the Treaty on Human Rights and Biomedicine in Oviedo, Spain.
The Greek Orthodox Church has a precise position against all forms of euthanasia, claiming the protection of life to the fullest and considering life as a sacred gift from God.
The purpose of this study is to investigate the attitude and adequacy of knowledge of relatives or friends of patients hospitalized in an ICU towards euthanasia and to identify and evaluate possible factors affecting their decisions about possible euthanasia.