Euthanasia Essay, Research Paper

EUTHANASIA

A critical analysis.

Euthanasia is a controversial subject, not only because there are many different moral dilemmas associated with it, but also in what constitutes its definition. At the extreme ends of disagreement, advocates say euthanasia (which in Greek means “easy death”) is a good, or merciful, death. Opponents of euthanasia say it is a fancy word for murder.

Between the two extremes, there are various positions for and against euthanasia. One position opposes cases of “active” euthanasia, where an active, or overt, effort is made to bring about death, such as in administering a lethal injection, but accept “passive” euthanasia, which is generally described as declining to initiate extraordinary or even ordinary medical treatment, as moral.

Another position advocates that passive euthanasia is acceptable when the person to die has consented. Other positions include situations where a terminally ill patient is unable to consent as justifiable, because it resolves a hopeless situation. Conversely, even with this gradation, some opponents to euthanasia believe that voluntary, passive euthanasia is the same as suicide; involuntary euthanasia is considered to be murder.

Because euthanasia poses classic dilemmas as to its morality, it is not surprising that many issues arise in the legal and medical arenas. In law, the resolution of a particular case cannot always be applied to resolve another. In the medical realm, interpretation of medical doctrine concerning treatment of terminally-ill patients can result in entirely different applications.

In two relatively recent cases, the Supreme Court had to decide the future of patients that were considered to be in chronically persistent vegetative states. The courts had to decide whether to continue with the prevailing treatment, as advocated by the medical community, or discontinue treatment at the request of the patients’ guardians. The courts considered several factors in making a determination: What are the state’s interests in terms of human life? When does the patient’s right to refuse treatment override the state’s interest? What does the right to refuse treatment entail, and is it included in the patient’s right to privacy? Do a patient’s guardians have the right to refuse treatment on behalf of a patient? What constitutes ordinary and extraordinary medical treatment?

The court indicated that a patient’s right to refuse treatment was an extension of the constitutionally-derived “right to privacy” and, more importantly, permitted the assignment of those rights to Quinlan’s guardians.

With the Matter of Quinlan decision, the Supreme Court attempted to set forth a process to balance the state’s interests, which were seen as preserving human life and the physician’s right to administer medical treatment according to her best judgment, with that of the individual. The court reasoned that the state’s interest weakens and the patient’s right to refuse treatment increases as the “degree of bodily invasion increases and the prognosis dims.” In this case, because it was agreed that the patient was incurable, the treatment, a respirator, was seen as being extraordinary treatment, so the Supreme Court indicated that no civil or criminal liability would be levied if the treatment was withheld.

With the Matter of Quinlan decision, the Supreme Court extended a person’s constitutionally-derived “right to privacy” to include the right to refuse treatment. Perhaps more importantly, the Supreme Court permitted the assignment of determining the right to refuse treatment to Quinlan’s guardians.

These two landmark findings in Matter of Quinlan clearly raised the legal and moral hackles of the Supreme Court in Cruzan v. Harmon (1984). In this case, the Supreme Court found that the right to refuse treatment plainly did not exist, either in the context of constitutional law, or in common law. The court determined that the common-law right to refuse treatment means that the patient must be informed, and so the conditions of that right did not exist in Cruzan. Further, the Cruzan court did not find the situation of a woman’s decision to terminate a pregnancy as being analogous of a decision to terminate a comatose patient, as the Quinlan court had. The Cruzan court also found that the “penumbra” of privacy rights that the Quinlan court relied on to develop the right to refuse treatment was not absolute (Roe v. Wade and Bowers v. Hardwick), nor was it transferable.

Finally, even if the right to privacy included the right to refuse treatment, the Cruzan court reasoned, that right had its limitations. The Cruzan patient, unlike Quinlan, breathed on her own, but relied on a gastrostomy tube for nourishment. Essentially then, the refusal of treatment was really a refusal of food and water. The Cruzan court did not see that the right of privacy or the right to refuse treatment included the right to refuse food and water.

The court’s determination of what individual interests did and did not consist of substantially weakened the balance between individual rights and state’s rights in favor of the state. The Cruzan court further shifted the balance towards the state when it stated that the State’s interest is in the unqualified preservation of life, an interest that does not weaken in light of the patient’s rights.

These findings led the Cruzan court to deny the patient’s guardians the ability to refuse food and water. Supplying food and water, the court reasoned, met the state’s interest in life, and there was no undue hardship placed on the patient.

The Cruzan reasoning avoids some of the difficulties presented in the Quinlan case. First of all, it avoids a slippery slope of problems which could be encountered in enabling the assignment of individual rights to a guardian. Even though a guardian may act in the best interest another, it does not replace the actual intentions of the individual. The Cruzan decision also avoids at least two moral dilemmas that Quinlan decision tends to create. First, while the Quinlan case indicates that no civil or criminal liability is assigned to the act of removing treatment, there is no direction as to how to resolve any moral liability for the person who will physically remove treatment. Second, the Quinlan case places the judicial branch in the delicate position of having to qualify what medical conditions warrant treatment, a position they do not have the expertise for.

The Quinlan and Cruzan cases, insofar as they offer important guidelines for the treatment of terminally-ill patients, pose some problems for the reasoning of J. Gay-Williams. In Gay-Williams’ view, these cases would likely constitute “passive” euthanasia, where treatment is withheld from terminally-ill patients. According to Gay-Williams, failure to continue treatment after it is realized that the patient has little chance of benefiting from it is perfectly acceptable, and the medical community must make these kind of decisions all the time. In fact, says Gay-Williams, “passive” euthanasia does not really constitute euthanasia at all.

However, in his arguments against the benevolence of “active” euthanasia, Gay-Williams cites as a “slippery slope” giving others the authorization to decide on behalf of a patient, especially members of the medical community. Euthanasia may have a corrupting effect, Gay-Williams indicates; doctors may not try as hard to save a critically ill person, and this may transfer over to their treatment of less-ill patients. But it is not clear how it is acceptable, on one hand, for the medical community to discontinue treatment of terminally-ill patients when “there is no hope,” yet it is not acceptable to give them the authorization to decide on behalf of a patient.

Gay-Williams argues against the purported “benevolence” of euthanasia in two others ways; he provides an argument from nature and another from self-interest. First, he argues, every human has a natural inclination to continue living. Euthanasia is therefore wrong, even without an appeal to religion and morality, because it destroys this natural tendency, and sets us up against our own nature.

Second, Gay-Williams indicates, there is always a possibility that we will work against our own interest if we practice euthanasia. Not only are we prone to error in diagnosis, there might be an experimental procedure that we are not aware of that will hasten our improvement. In addition, because we make often make decisions impulsively, especially when we are in pain, we may give up too easily.

Unlike Gay-Williams, James Rachels sees the differentiation between passive and active euthanasia, where it is generally seen as permissible to withhold treatment and allow a patient to die, as making no moral sense. In particular, he criticizes the American Medical Association (AMA) doctrine regarding terminally-ill patients as making this distinction, and says that this causes extreme confusion for the medical community.

Rachels, points out a case which would cause this sort of confusion is where “allowing to die” by withholding treatment might be more painful than a quick intentional lethal injection. Additionally, allowing a “passive” doctrine of euthanasia allows for decisions to be made regarding life and death that are made on irrelevant grounds. Rachels cites the example of not operating on a infant with an intestinal blockage because the infant has Down’s Syndrome as a prime example.

Finally, the distinction made regarding intent is questionable, according to Rachels, because having the intent to kill and letting someone die can result in the same end – death – so it ultimately makes no difference what the original intent was. According to Rachel, then, the differentiation between passive and active euthanasia is incorrectly based on the rationale that there is a significant moral difference between intentionally killing and intentionally doing nothing.

Bonnie Steinbock criticizes Rachel’s position against the AMA doctrine. She says that contrary to what Rachel indicates, the AMA doctrine does not draw a distinction between active and passive euthanasia. Rather, it draws a distinction between 1. intentional termination of life, and the cessation of extraordinary efforts to prolong life, and 2. the difference between ordinary and extraordinary care. She sees Rachel’s example of starving infants to death as a misinterpretation of the doctrine.

According to Steinbock, discontinuing care of a patient can result from the caregiver’s intention to termination life, but there are other reasons for care discontinuance. Such reasons include discontinuance at the patient’s directive (which is seen as a right to be protected from the unwanted inference of others), stopping treatment if it is no longer doing any good, or when the treatment is doing more harm than good. It can be seen that the right to refuse treatment can quickly lead to a patient’s death given the circumstances, especially if that care is the last known element of preserving the patient’s life. But none of these reasons, say Steinbock, equate withdrawing care to the right to kill, as she believes Rachels implies. Steinbock’s argument against identifying cessation of treatment with intentional termination seems to be once of imprudence given a historical viewpoint that surgical treatment is seen as intrusive battery on a person requiring their assent.

Not having read the AMA doctrine personally, it is difficult to support either claim as to what the doctrine spells out, and what applications can arise from its interpretation. But what is clear is that the doctrine is subject to misinterpretation in terms of what can be considered extraordinary and ordinary care. And just like in the Cruzan and Quinlan decisions, it seems to be a matter of interpretation as to precisely where patient’s rights come into play. There is a gray area as to where a treatment, applied during a time where there is hope for a patient’s recovery, fades into a condition where the treatment is insufficient to bring the patient back.