O CEBID é um grupo de pesquisa, registrado no CNPq, que reúne, desde 2009, pesquisadores em torno de questões que envolvam as Ciências Biológicas, as Ciências da Saúde e o Direito; promovendo discussões em torno desses temas complexos, garantindo a interdisciplinaridade necessária à construção de respostas legítimas. Realiza reuniões de trabalho, promove eventos, organiza e divulga publicações na intenção de disseminar o interesse e incentivar o debate sobre assuntos de Bioética e Biodireito.
Australian doctors are calling for a campaign to fight mental illness in the medical profession, after it was revealed that four junior clinicians had taken their lives in the past six months.
Writing in The Guardian this week, doctor and author Ranjana Srivastava described the heart wrenching experience of attending the funeral of a colleague who took her own life. Srivastava called on doctors to make a concerted effort to support colleagues who were suffering:
“As a profession, we must do more than lament our dead colleagues. Dealing effectively with mental illness and halting suicide among doctors requires curiosity, compassion and practical support.”
In addition to four deaths across the country in the past half year, New South Wales Coroner Michael Barnes revealed that 20 doctors have committed suicide in his State alone in the past decade.
AMA NSW president Brad Frankum said it was time the industry “faced facts” on suicides. Frankum told the Daily Telegraph that junior doctors were under extreme pressure, and that hospital culture fostered a competitive environment and placed young people under intense scrutiny with extremely long work hours.
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CEBID - Centro de Estudos em Biodireito
The battle over assisted dying is continuing in US legislatures, with various jurisdictions debating bills that would ‘outlaw’ or ‘condemn’ euthanasia and assisted suicide.
Hawaii: A bill to create a physician-assited suicide regime modellled on Oregon's system sailed through the State Senate this week, by a vote of 22 to 3, despite some heartfelt speech from a senator who survived pancreatic cancer. The bill now moves to the House.
Kansas: a House of Representatives Committee this week heard testimony in favour of a resolution that “condemns” physician assisted suicide and promotes improvements to palliative care. Resolution No. 5010, which mirrors model legislation drafted by the lobby group Americans United for Life, calls on the legislature to oppose assisted suicide, “because anything less than a prohibition leads to foreseeable abuses and eventually to euthanasia by devaluing human life, particularly the lives of the terminally ill, elderly, disabled and depressed”.
Washington DC: A Death with Dignity Act became effective on February 20. Although the US Congress has the power to override DC laws, it missed a statutory deadline, so physician-assisted suicide is currently legal in the nation's capital. Opponents in Congress plan to use other measures to nullify the DC law.
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CEBID - Centro de Estudos em Biodireito
The status of assisted suicide in the US state of Montana is curiously ambiguous. In 2009 the Montana Supreme Court ruled that “a terminally ill patient’s consent to physician aid in dying constitutes a statutory defense to a charge of homicide against the aiding physician”. This effectively permitted assisted suicide – without input from the Montana legislature. Ever since then, opponents and supporters of assisted suicide have tried almost every year to introduce bills to regulate or to ban assisted suicide. None of them have succeeded.
The latest bill to ban assisted suicide almost succeeded but failed at the very last minute in a classic case of legislative comedy.
The bill, which declared that a patient’s consent would not be a defense for a doctor who assisted someone in ending their life, passed a second reading on a 52-48 vote on Tuesday. But on the third reading on Wednesday, four legislators changed their votes and the result was tied 50-50. Hence the bill was defeated.
What explained the change?
Two lawmakers changed their vote to support assisted suicide, making Wednesday’s vote 50-50. Then one decided not to support it, making it 51-49, and another, Peggy Webb, a Republican who opposes assisted suicide, made a mistake and voted for it, making it 50-50.
Such is life.
“It was a mistake,” said Ms Webb. “I hit yes and then thought, ‘No, I don’t want assisted suicide,’ and changed the vote. It was too late to change it back.”
She said that she remained opposed. “I think life is sacred from birth to death and I think it should be a natural death. I don’t think we should play god. I know people who are suffering but doctors can make them comfortable in most cases.”
The sponsor of the bill, Brad Tschida, was philosophical about his colleague’s error. “No snowflake in an avalanche feels guilty,” he said. “Human beings are emotional creatures more than they are rational.”
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CEBID - Centro de Estudos em Biodireito
Do Rio de Janeiro para a BBC Brasil 16 fevereiro 2017
Direito de imagemTHINKSTOCKImage captionDebate sobre o suicídio assistido em caso de doenças terminais ou sofrimento extremo divide opiniões
Aos 90 anos, o escritor Carlos Heitor Cony não perde o tom jocoso.
Quando indagado sobre o que ainda falta para se sentir realizado, o autor de O Ventre, O Piano e a Orquestra e Quase Memória, romances premiados da literatura brasileira, não pensa duas vezes: "Morrer". E arremata: "Mas, se quiserem me dar o Nobel, aceito!".
Desde que foi diagnosticado com um câncer linfático, em 2001, Cony tem pensado muito na morte. "De certa forma, somos todos terminais desde que nascemos", escreveu em O Homem Terminal.
"Envelhecer é porcaria. Um homem depois dos 50 é anti-higiênico. Por isso, eu me mataria um dia", confidenciou em Memorial do Inverno.
O câncer obrigou Cony a fazer quimioterapia, o que enfraqueceu seus braços e pernas. Em 2013, levou um tombo na Feira dio Livro de Frankfurt, que gerou um coágulo no cérebro "do tamanho de uma maçã".
Hoje, Cony anda de cadeira de rodas, perdeu o movimento do lado direito do corpo e compara o apartamento onde vive, no bairro da Lagoa, zona sul do Rio de Janeiro, a uma UTI. Por essas e outras, se diz solidário a quem cogita a hipótese de suicídio assistido.
"Ninguém quer morrer sofrendo, chorando e gritando. Eu, pelo menos, não. Quero morrer numa boa", avisa.
Mas, para evitar abusos e mal-entendidos, ressalva, algumas premissas devem ser obedecidas. Uma delas é o paciente manifestar sua vontade por escrito, com a concordância de três ou quatro membros da família.
Outra é o médico emitir um atestado comprovando que o paciente é terminal e o estado dele, irreversível.
"Há casos em que os remédios já não produzem mais efeito, a família gasta um dinheiro que não tem e, pior, o paciente não tem mais condições de viver, só de sofrer. Se não há uma solução médica ou científica, o suicídio assistido é a saída mais humana que existe", afirma Cony.
Direito de imagemDIVULGAÇÃOImage caption"Ninguém quer morrer sofrendo, chorando e gritando. Eu, pelo menos, não. Quero morrer numa boa", diz Carlos Heitor Cony
'Não quero que me mantenham vivo a qualquer preço'
O assunto, apesar de macabro, como o próprio Cony admite, é recorrente.
Em outubro do ano passado, o ex-arcebispo sul-africano Desmond Tutu defendeu, na ocasião de seu aniversário de 85 anos, o direito ao suicídio assistido ao pedir que, no fim de sua vida, seja tratado com compaixão.
"Por que tantos são obrigados a suportar terríveis sofrimentos contra sua vontade?", indagou em artigo publicado no jornal americano The Washington Post. "Não quero que me mantenham vivo a qualquer preço", afirmou o Nobel da Paz, que há 20 anos luta contra um câncer de próstata.
Desmond Tutu não é o único adepto da morte digna e indolor. Em junho de 2015, durante entrevista à BBC Brasil, o físico britânico Stephen Hawking, 73, afirmou que, caso se tornasse um fardo para as pessoas ao seu redor ou se não tivesse "mais nada a contribuir", consideraria a hipótese de dar cabo da própria vida.
"Manter alguém vivo contra sua vontade é a derradeira indignidade", declarou Hawking, que desde os 21 anos sofre de Esclerose Lateral Amiotrófica (ELA), doença degenerativa e incurável que ataca os neurônios responsáveis pelos movimentos do corpo e provoca perda de controle muscular.
'O prolongamento de uma vida sem qualidade pode ser considerado um crime!'
No Brasil, o tema já inspirou, além de algumas crônicas de Cony, o romance A Mãe Eterna - Morrer É um Direito, da psicanalista e escritora Betty Milan.
Nele, a narradora fala da dificuldade de passar da condição de filha para mão da mãe. A certa altura, ela se pergunta até quando a vida deve ser prolongada e questiona a obsessão terapêutica do médico, que procura vencer a morte a todo custo.
"O suicídio assistido é um benefício sempre que a pessoa expressa claramente seu desejo de ir embora ou porque está sofrendo, como no caso de Desmond Tutu, ou por considerar que cumpriu sua missão na Terra, como Stephen Hawking", diz Betty, que buscou inspiração na própria história e na de sua mãe para escrever o livro.
Dona Rosa, hoje com 99 anos, anda com dificuldade, escuta pouco e enxerga mal.
"Para certas pessoas, o envelhecimento é insuportável e o fim da vida deve ser humanizado. Se nós tivermos certeza de que vamos ser ajudados a morrer, viveremos muito melhor. O prolongamento de uma vida sem qualidade pode ser considerado um crime", afirma a escritora.
Direito de imagemLAILSON SANTOSImage caption''O suicídio assistido é um benefício sempre que a pessoa expressa claramente seu desejo de ir embora ou porque está sofrendo', diz Betty Milan
'Viver com dignidade. Morrer com dignidade'
Apenas alguns poucos países, como Holanda, Suíça e Bélgica, autorizam a prática. A Holanda se tornou o primeiro a descriminalizar o suicídio assistido, em 2002. Lá, é preciso que a doença seja incurável e que o paciente esteja "lúcido e consciente" ao pedir ajuda para morrer.
A Suíça é o único país do mundo onde um estrangeiro pode se matar com a ajuda de terceiros. Para tanto, precisa desembolsar cerca de 4.400 francos suíços - o equivalente a R$ 13.200, fora as despesas com hotel, traslado e passagem aérea.
Desde 1998, quando foi fundada, até 2014, a associação Dignitas, o mais famoso centro de suicídio assistido da Suíça, já ajudou mais de 1.700 doentes terminais ou pacientes com doenças incuráveis e progressivas a terem uma morte rápida e indolor com uma dose de 15 mg de uma substância letal misturada com 60 ml de água.
O lema da instituição é "Viver com dignidade. Morrer com dignidade".
A legislação suíça permite o suicídio assistido desde que não seja por "motivos egoístas". Por exemplo: ajudar uma tia a morrer só para colocar as mãos em sua fortuna. Já nos EUA, a decisão cabe a cada Estado. Atualmente, é permitido em apenas seis: Washington, Oregon, Vermont, Novo México, Montana e Califórnia.
O Brasil não tem legislação sobre o tema. Por meio de seu artigo 122, o Código Penal proíbe o ato de "induzir ou instigar alguém a suicidar-se ou prestar-lhe auxílio para que o faça". O crime é passível de pena de dois a seis anos de prisão quando o suicídio é consumado, ou de um a três, caso a tentativa resulte em lesão corporal grave.
"Os que se opõem à prática sustentam ser dever do poder público preservar, a todo custo, a vida humana", analisa a advogada Maria de Fátima Freire de Sá, pesquisadora do Centro de Estudos em Biodireito (CEBID) e autora do livro Direito de Morrer - Eutanásia e Suicídio Assistido. "Muitas vezes, eventuais direitos do indivíduo estariam subordinados aos direitos do Estado. Para os que a defendem, o conceito de vida precisa ser repensado. Será que vida digna é aquela segundo a qual o indivíduo ainda se mantenha ligado a aparelhos, totalmente infeliz e dependente da boa vontade dos outros?"
Associação médica debaterá tema no Brasil
Direito de imagemTHINKSTOCKImage caption"A vida não nos pertence. Não podemos concebê-la. Da mesma forma, uma vez perdida, não podemos recuperá-la. Somos administradores de um dom recebido por Deus", defende Dom Antônio Augusto, bispo auxiliar do Rio de Jameiro
Procurada pela reportagem, a Associação Médica Brasileira (AMB) informou que não tem uma posição sobre o assunto. Mas adiantou que, em março, representantes da entidade vão se reunir com membros do Conselho Federal de Medicina (CFM) para debater o tema.
Desde 2006, o CFM procura disciplinar o uso de tratamentos fúteis (considerados inúteis) em pacientes na fase terminal da vida. Por meio de uma resolução, os médicos podem suspender o tratamento ou os procedimentos que estão prolongando a vida desse doente, se for o desejo dele, com o objetivo de lhe abreviar a morte, sem sofrimento.
Na maioria dos casos, mantêm-se as medidas ordinárias, como as que visam reduzir a dor do paciente, e suspendem-se as extraordinárias ou as que estão dando suporte à vida.
"A ortotanásia (ou "morte correta") dá ao cidadão enfermo grave, em circunstâncias de doença terminal e irreversível, o direito de morrer com dignidade, sem a obrigatoriedade de uso de meios desproporcionais em respeito a sua vontade", explica o médico Carlos Vital, presidente do CFM.
"Seu advento garante a humanização do processo de morte ao evitar prolongamentos irracionais e cruéis da vida do paciente", acrescenta ele.
'Uma coisa é matar. Outra é não conseguir impedir uma morte'
A posição do CFM é endossada pela Igreja Católica. O bispo auxiliar da Arquidiocese do Rio de Janeiro, Dom Antônio Augusto Dias Duarte, explica que a vida é um dom de Deus e, como tal, temos um poder relativo sobre ela.
"A vida não nos pertence. Não podemos concebê-la. Da mesma forma, uma vez perdida, não podemos recuperá-la. Somos administradores de um dom recebido por Deus. Por essa razão, a Igreja recomenda às pessoas que não optem pelo suicídio assistido", explica Dom Antônio Augusto.
Ex-professor do Curso de Pós-Graduação de Bioética da Pontifícia Universidade Católica (PUC-RJ), Dom Augusto, que também é médico, lembra que, em seus últimos dias, o papa João Paulo 2º tomou a decisão de não mais ir ao hospital para se submeter a meios desproporcionais de tratamento.
Na ocasião, a doença já tinha evoluído de tal maneira que permanecer ligado aos aparelhos apenas prolongaria seu sofrimento físico e moral.
"No suicídio assistido, você mata a pessoa. Na ortotanásia, a exemplo do que aconteceu com o santo padre, você não consegue impedir a morte dela. São duas coisas completamente diferentes", enfatiza Dom Antônio.
Quanto a Carlos Heitor Cony, embora diga que, da vida, só espera a morte, ele já trabalha em dois novos livros: Missa para o Papa Marcelo e Cinco Prudentes Virgens, ambos sem previsão de lançamento.
"No meu primeiro romance, já dizia que não queria morrer como negociante falido ou amante renegado. Quero morrer lúcido. Por isso, sigo trabalhando", justifica o escritor.
The US state of Colorado has legalized assisted suicide, but its large Catholic hospital system is refusing to cooperate, according to STAT.
The state’s largest healthcare company, Centura Health, which operates 15 hospitals and more than 100 physician practices and clinics, will “opt out” of offering aid in dying. Centura is jointly operated by Catholic Health Initiatives and Adventist Health System, associated with the Seventh Day Adventist Church, which also opposed assisted suicide.
The second-largest, SCL Health, says that patients who request assisted suicide will be given the option of transferring to another healthcare facility. SCL Health runs seven hospitals and dozens of clinics.
The Colorado law specifies that healthcare systems may not prohibit their doctors from discussing end-of-life options with their patients or from writing prescriptions for lethal medications which can be consumed elsewhere. The policies of Centura and SCL may be testing this provision, a representative of Compassion & Choices, the assisted suicide lobby group, told STAT. C&C is thinking of a legal challenge to their policies.
Other healthcare systems in Colorado will offer the option of assisted suicide, so patients in urban areas will still be able to access it. But in rural areas, sometimes the Catholic system is the only one available.
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The American Psychiatric Association (APA) has taken a strong stand against euthanasia. In a formal position statement approved by its board of trustees this month, it says:
The American Psychiatric Association, in concert with the American Medical Association’s position on Medical Euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.
This implies that it is not ethical for a psychiatrist to help a non-terminally ill person to commit suicide, either by providing the means or by direct lethal injection, as is being currently practiced in The Netherlands and Belgium.
Although this binds only APA members, the APA is one of the world’s most influential professional bodies. The World Psychiatric Association (WPA) is considering a similar statement.
Dr Mark S. Komrad, of the APA ethics committee, says that the APA is now in a position to formally protest the involvement of Dutch and Belgian psychiatrists in euthanising patients with non-terminal psychiatric disorders.
He fears that Canada and several states in the US are headed in the same direction. Already psychiatric patients are being helped to commit suicide by activist organisations like Final Exit.
“So far, no other country that has implemented physician-assisted suicide has been able to constrain its application solely to the terminally ill, eventually including non-terminal patients as legally eligible as well,” says Dr Komrad. “This is when psychiatric patients start to be included.”
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CEBID - Centro de Estudos em Biodireito
The Labor Government of the Australian state of Victoria will introduce legislation into the Parliament next year to legalise assisted suicide. The Labor Party will allow its MPs a conscience vote.
Assisted suicide recently failed in the South Australian Parliament, but only after the Speaker cast the deciding vote. Supporters of change have been buoyed up by their near miss in Adelaide and by a widely publicized campaign orchestrated by media personality Andrew Denton.
Victorian Premier Daniel Andrews is a late convert to the cause of assisted suicide after his father died of cancer earlier this year. “Community sentiment on this issue is changing” he says, “and I know many in Victoria think it’s time we have this debate – a debate that respects people’s views and respects people’s lives.”
A discussion paper will be released for public comment early next year, followed by consultations with stakeholders. The Government expects to introduce the legislation in the second half of 2017.
Victorian Sex Party MP Fiona Patten welcomed the Government's "bold" move. "Allowing terminally ill people the right to die when they choose with dignity, is not only compassionate but common sense," she said.
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CEBID - Centro de Estudos em Biodireito
A debate in the American state of Iowa over the legalisation of assisted suicide prompted the Des Moines Register to survey how well in works.
In California, where it became legal on June 9, stories are already emerging that the letter of the law is not being observed. California multi-media and performance artist Betsy Davis died on July 23, one of the first to take advantage of the new law. She had ALS and since she was too weak to drink the lethal drugs herself, she was propped up by friends and someone, following instructions from a doctor, held the cup for her – which was probably illegal. The standard lethal drug, Seconal, was not available, so her friends mixed up a cocktail of drugs, hoping that they would work properly. She took four hours to die, which is not the instant death that most people expect.
In Oregon where assisted suicide has been legal since 1998, and in Washington state, where it has been legal since 2009, the statistics from 1,642 deaths convey a mixed message.
Complications: about 2.5% experience complications, such as regurgitation, seizures, or waking up.
Incomplete records: in nearly 30% of cases, records are incomplete, even for important issues like complications.
Prolonged death: in Oregon the mean time before death was 25 minutes, but one person took four days.
No data: in Vermont and Montana, deaths are not tracked at all. There are no records. “Assisted suicide is nearly untraceable. There is minimal reporting and tracking,” Marilyn Golden, a senior policy analyst for the Disability Rights Education & Defense Fund in California, told The Register. “It almost appears as if the practice of assisted suicide has deliberately been made secretive, all with the claim of patient confidentiality.”
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CEBID - Centro de Estudos em Biodireito
California’s new End of Life Option Act, which permits assisted suicide, has some disturbing consequences, writes Wesley J. Smith in First Things. According to recently passed regulations terminally ill patients in mental hospitals have a right to request assisted suicide.
Under the Act, a lethal drug can be prescribed only “if the patient is not suffering from impaired judgment due to a mental disorder.”
Unless the patient is forcibly confined in a mental hospital and probably pumped up with powerful drugs. In that case, the regulations specify that:
A terminally ill patient, as defined by the End of Life Option Act, may petition the superior court for access to participate in activities under the End of Life Option Act by requesting release from the custody of the Department of State Hospitals from the court. If the court orders release from the custody of the Department of State Hospitals, the Department of State Hospitals shall release the patient to the ordered entity or person.
Furthermore, if a patient is too dangerous to be discharged, the state hospital must make assisted suicide available in the hospital.
Smith contends that the this is utterly inconsistent:
These are people denied their very freedom due to diagnosed severe mental disease! They are undoubtedly being treated with powerful psychotropic medications. In what universe could they possibly be deemed “not to be suffering from impaired judgment due to a mental disorder”?
The ironies are disturbing. For example, if a patient is hospitalized because he is acutely suicidal from deep depression, no court would free him for the purpose of committing suicide. Indeed, in such a circumstance, preventing that lethal act is the very point of the institutionalization! But if that same suicidal patient can show that he has been diagnosed with terminal cancer, he can be freed for that same purpose—even if the reason he wants to die is the depression and not the terminal diagnosis.
Assisted suicide was defeated by the narrowest of margins in the state of South Australia this week – for the 15th time. After a marathon debating the issue, the MPs were split, 23 against the Death with Dignity Bill, and 23 in favour. The speaker of the House cast a deciding vote against it at 4am.
Although South Australia is geographically remote from high-profile battles over end-of-life issues, the debate there was followed closely by the world media and was reported in the New York Times, The Economist, the Washington Post and the Guardian. If it had cleared the hurdles there, assisted suicide would probably have been legalized in Australia’s other states. The result may have had some influence in the debate in Washington DC, where the City Council has voted 11-2 to legalise it. But after being signed by the mayor, it still needs to be approved by Congress. With Republicans now controlling the White House, the House of Representatives and the Senate, this is hardly certain.
MPs in Adelaide, the state capital, were expected to pass the bill after intense lobbying by Andrew Denton, a well-known comedian, TV presenter and radio who has made assisted suicide a personal crusade. But it seems that the dangers of authorizing a doctor to kill another person worried wavering legislators.
Within hours of the failure of the bill in South Australia, former Premier Lara Giddings introduced the Voluntary Assisted Dying Bill 2016 into Tasmania’s lower house, although it is unlikely to be debated until next March.
"The problem is not going away and the members of the house are kidding themselves if they think they've killed it off," Andrew Denton told AAP. "There is no cure for cancer, there is no cure for motor neuron disease, there is no cure for multiple sclerosis. All those people who are facing painful deaths are still going to be facing those painful deaths."
Stephanie Packer is a 33-year-old Californian woman with a terminal disease, scleroderma, a chronic autoimmune condition that causes scar tissue to form in the lungs. She has four children. Four years ago she was told that she had three years to live -- and now she knows that she is on borrowed time.
In this video, she speaks about how the possibility of accessing assisted suicide in California has changed the attitudes of other patients with the same ailment. Now some feel that perhaps they ought to give up struggling and accept assisted suicide.
Ms Packer also claims that her medical insurance company refused to pay for an expensive chemotherapy drug which could extend her life and give her more time with her children. But it did agree to cover the cost of drugs for assisted suicide – and she would only be out of pocket by $1.20. She says vehemently that the State’s broken health care system must be fixed “so that people start to live instead of feeling that they have to choose to die”.
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CEBID - Centro de Estudos em Biodireito
