Synet på begrensning av livsforlengende medisinsk behandling i ulike religioner

Abstract

Background: End-of- life care poses fundamental ethical problems to clinicians. Development of new technology within medical and science have made it possible to keep patients alive with life-sustaining medical treatments such as elective intubation, mechanical ventilation, dialysis, artificial nutrition and hydration. The questions related to ethical decisions of withholding or withdrawing curative treatments have received substantial attention in medical journal as well as in public debate.

Euthanasia is usually divided into active euthanasia and withholding/withdrawing curative treatments (previous known as passive euthanasia). Active euthanasia and assisted suicide are by the law illegal in Norway, this should be separated from withholding/withdrawing curative treatments. Withholding/withdrawing treatments are common and legal in Norway. The decision however serves difficult ethical problems, especially when the patients are in coma.

Aims and objectives: The aim of this article is to discuss withholding/withdrawing curative treatments related to Christianity, Islam, Hinduism and Buddhism.

Methods: Extent literature review of articles written by religious leaders, doctors and medical ethics committees. Other data sources include books and different webpages to provide different perspectives regarding withholding/withdrawing curative treatments.

Result: Defining euthanasia is a difficult and complex task, which causes confusion among health care-workers. Withholding/withdrawing curative treatments covers different actions such as “do not resuscitate” known as DNR, do not start lifesaving treatments- and withholding or withdrawing treatments in terminal ill patients. Thus the patient will die from the disease itself and not by the actions performed by clinicians (3). Dying from such actions is known as active euthanasia. Christianity, Islam, Hinduism and Buddhism are all against active euthanasia and assisted suicide. The religions permit withholding/withdrawing treatments to various degrees. The Roman Catholic Church allows passive euthanasia which includes the use of pain relief and withdrawing treatments, but the previous pope, John Paul II, argued strongly against the actions of withdrawing artificial hydration and nutrition of incurable patients. Islam has a divided view of withholding/withdrawing treatments. According to Islamic European Council for Fatwa and Research (ECFR) (13) withholding/withdrawing treatments is permitted. Hinduism prohibits active euthanasia and assisted suicide, though the religion acknowledges death by starving “prayopavesa” (15), in order to achieve spiritual contact and salvation. Buddhism is careful when it comes to decisions of withholding treatments, because of the families` and doctors` individual intentions, like heredity and their own gains.

Conclusion: The goal of this article is to give the readers a broad perspective of withholding/withdrawing treatments related to different religions. This is important in order to understand other cultures and to prevent miscommunications among clinicians and patients/families. Systematic approaches and clear communications about withholding/withdrawing treatments should be given more attention when it comes to similar cases.