Euthanasia Essay, Research Paper

The Right to Choose

The main issues of euthanasia are maintaining the status of illegality, legalizing the procedure, and regulating the procedure. The controversy of euthanasia involves moral, ethical, and legal concerns. “In this country, according to a survey reported in the Journal of American Medical Association, nearly 63 percent of Americans favor legalizing physician-assisted suicide, yet most state statutes criminalize it (Stark, np).” People fear that if legalized, the choice to die will eventually be taken out of their hands and placed in the hands of people who will choose to kill select people based on their own private criteria. Maybe this is true, but it is doubtful. The issues are more realistic and involve our society’s morals and the legal consequences of choice in dying.

Currently, the debate involving the practice of euthanasia revolves around moral and legal issues. The moral debate involves religion and other societal beliefs. Everyone has their own morals and values, which is their God-given, inalienable right. In America, our society’s morals are based in part on religious beliefs. Most religions, especially Christian religions, feel that taking another’s life is wrong and against God’s commandments. The Catholic church feels strongly about euthanasia and encourages both the Catholic congregation and United States politicians to maintain the illegal status of euthanasia.

The legal debate is a hot issue with both proponents and opponents striving to win. In the United States, the Supreme Court decided to allow individual states to decide what to do about physician-assisted suicide. Currently, only Oregon allows physician-assisted suicide. Several other states are debating over the subject but without success. The main legal argument is whether or not a citizen of the United States has the constitutional right to choose between life and death. As it stands now, the Supreme Court ruled we do not have the constitutional right to choose.

One last issue is the financial effect on the person and their family. The surgeries, life support, drugs, doctor’s fees and all the other expenses of a terminally ill patient are staggering. For one week in an intensive care unit, the cost could easily soar to $100,000. The cost of letting a person die is close to nothing when compared to the cost of keeping them alive.

A solution to the debate over euthanasia is highly anticipated. Maybe one day all the issues can be resolved and the bickering over mercy-killing will end. Of course, on the pessimistic side, the right to die debate might never be concluded. The controversy surrounding euthanasia can only be resolved when the procedure is legalized with mandatory, regulatory guidelines put in place to enable both physicians and individuals to decide the best course of action for themselves without fear.

Choice in Dying reminds us that “Although the concept of the right to die has interested philosophers since the time of the Greeks, it was not until recently that the issue became a pertinent and widespread social concern.” A cancer patient named Robert Dent wrote the following in a letter before he died of an injection that he requested (Australian Man First in World, A5). “If I were to keep a pet animal in the same condition I am in, I would be prosecuted. If you disagree with voluntary euthanasia, then don’t use it, but don’t deny me the right to use it.” He requested euthanasia and received it. The word euthanasia is a combination of the Greek prefix Eu, which means “good,” and “thanatos,” meaning “death. Webster’s Dictionary defines it as “the act or practice of killing individuals that are hopelessly sick or injured for reasons of mercy. Euthanasia or “mercy killing” as they more commonly call it, is a highly debated topic that has many aspects. Financial, moral, social, and most important, legal concerns are raised whenever euthanasia is brought up.

There were two major cases in the U.S. that pertain to mercy killing that the Supreme court ruled on and one they refused to hear. According to Choice in Dying’s Legal Developments web page, the following three legal rulings have recently been issued. In 1996, the Ninth Circuit Court in Compassion in Dying v. Washington and the Second Circuit Court in Quill v. Vacco, ruled that the U.S. Constitution protects the issue of physician-assisted suicide when requested by competent, terminally ill patients. The U.S. Supreme Court in January 1997 and June 1997 reversed these decisions based on the Due Process Clause and the Equal Protection Clause of the Fourteenth Amendment; but, they left it up to the states to ban or legalize physician-assisted suicide. In the third predominant case, “Lee v. Oregon (U.S. Court of Appeals, Ninth Circuit; February 1997). The U.S. District Court had held that Oregon’s Death with Dignity Act (Measure 16), the first law in the nation to legally authorize physician-assisted suicide, violated the Equal Protection Clause because the safeguards were insufficient to protect the rights of terminally ill patients who may seek assistance in dying. The Ninth Circuit Court of Appeals, in a 3-0 vote, found that the plaintiffs had no legal standing to challenge Measure 16 because they failed to show any threat of immediate harm and that their claim rested upon a ‘chain of speculative contingencies.’ The Court did not decide the constitutional merits of physician-assisted suicide. The U.S. Supreme Court refused to hear the appeal (Choice in Dying, Legal Developments, np).”

As medical technology, financial concerns, and the age of people all increase, so will the demands for a legal decision on the euthanasia issue. Medical technology has advanced to a point that people can now be kept alive against their will. The people who support the right to die believe that medical technology has advanced so much that doctors can keep a person’s body alive, even if the brain is not functioning. Medical advances and technologies have made it possible to survive pneumonia, heart attacks, and kidney failure. New drugs and surgeries have made living longer possible. And when people are in critical condition and about to die, artificial respirators and tube feeding will keep the body alive, even when the person might want and need to die. Medical technology will continue to advance and will necessitate alternatives to current medical practices and changes to medical and societal beliefs.

Various religions and society impose their beliefs and morals on the individual causing more confusion. In Euthanasia: The Battle for Life, Dr. Raymond Bohlin discusses what the Bible says about life, suffering, and death. He quotes scripture that reflects the Christian beliefs that God has created us, numbered our days, and that no one can take another’s life because it breaks God’s commandment. He goes on to imply that the issue can be resolved by praying, speaking out, and reaching out to the sick and the elderly. Just days before he died, Chicago Cardinal Bernardin had this to say to the court, ” I am at the end of my earthly life. As one who is dying, I have especially come to appreciate the gift of life. For the court to accept assisted suicide would send a false signal that a less-than-perfect life is not worth living (Peres, News Section).” This stance is surprisingly different from surveys of Jewish willingness to participate in physician-assisted suicide. With a ratio of almost 3:1, Jewish respondents would participate in the procedure although it appears that the response is against Jewish teaching. However, it may not be against the teachings because the prime teachings are that each person is an individual and that ‘loving kindness’ should be extended to each person (Newfield, np. The two illustrated religious thoughts reflect our society’s confusion over the issue of euthanasia. On one side are the people who want to legalize physician-assisted suicide because they believe that it is an individual’s choice to decide to die with dignity. On the other side are the people who believe euthanasia should remain illegal because it is wrong to kill. Both religion and society have changed their established standards of beliefs in the past to encompass the beliefs of the people. They can do it again.

Another cause of the euthanasia debate is the financial concerns for both the family and society. As reported by The Villanova Center for Information Law and Policy, most people who are against euthanasia believe “it will only be a matter of time before courts will sanction putting people to death, not because they are desperately ill and want to die, but because they are deemed to pose an unjustifiable burden on society.” P.J. King feels that the insurance industry in the future will offer patients the option to die instead of spending a lot of money on expensive treatments. This decision will be based on solely on cost containment. Not only do we have the insurance industry interested in the money saved through euthanasia, but we also have the heirs of the terminally ill who might be interested in the money they can receive it the patient chooses to die instead of suffer. Money and age, these are powerful change agents.

There are three primary solutions which could feasiblely be argued both for and against by the people and politicians most interested in the euthanasia debate. To properly evaluate the solutions, certain criteria must be chosen. Personal – Is the patient terminal and suffering and does he choose to die? Medical – Is it ethical, accepted practice and is the patient terminal/suffering? Religious – Is it moral and have the individuals involved considered their actions concerning their beliefs? Legal – Is it a crime to assist a terminally ill patient in dying?

One solution, legalization of euthanasia, would decriminalize the procedure and allow patients a true choice. At this time our citizens time, money, and resources are being ill-used in law suits and criminal cases to determine the legality of physician-assisted suicide. Barbara Dority, in The Humanist states “In order to grant the wishes of dying patients for help to end their suffering, we have to change the fact that doing so is against the law. How can we ask doctors- -in consultation with “families, clerics, and communities”- – to commit a serious crime for which they risk losing their licenses and possibly being arrested and going to jail? The legal issues must be confronted and a legal right to request physician aid in dying for the terminally ill secured.” “Justice John Paul Stevens noted in his U.S. Supreme Court opinion that under certain circumstances, if state bans on assisted suicide were found to ‘impose an intolerable intrusion on the patient’s freedom,’ they could be invalidated (Peres, News Section).”

The evaluation of legalization of euthanasia as a possible solution reflects that all criteria are minimally met. Euthanasia is a private matter between the terminal and suffering patient and the physician. The decision is made with physician and patient but there are no guidelines to protect against abuse. The moral issue is private and no longer relative because the action is not a crime; therefore, no one would be prosecuted.

The opponents of euthanasia feel that legalization would not be supported and if passed, there would be no guarantees of protection from abuse. “Opponents of euthanasia in both the Netherlands and the United States argue that there are insufficient control and oversight procedures to legalize physician-assisted suicide (Stark, np).” According to Susan Okie of the Washington Post, recent surveys reflect that less than 16 percent of the nation’s physicians admit to receiving requests for euthanasia and only 4 percent have taken action.

Outright legalization of euthanasia would be a very chaotic idea. Very few people or physicians support this idea. Some people may be left dying slowly and painfully, while others may receive euthanasia when they don’t want it or need it. Outright legalization provides relief to some, while creating problems for others.

Regulated legalization will provide the choice to patients and physicians along with guidelines for implementation. Guidelines are needed to ensure the proper choice is made based on the individual’s condition and that the timing is appropriate. In the United States, Oregon has a new law known as the Death with Dignity Act. It provides terminally ill adults with the right to obtain a prescription from a physician for medications to end their lives. The law has three main conditions that need to be met: two doctors decide life expectancy is less than six months; patient must request assistance three times, once in writing; and the physician must wait 15 days after the initial request. Physicians who follow the guidelines cannot be prosecuted or disciplined (Health ResponseAbility, np). In 1990, the Dutch Ministry of Justice voted to accept the royal Dutch Medical Association guidelines which determined when euthanasia is not acceptable and becomes a crime (Smith, p 36). Regulated euthanasia would not only give people a dignified death, but also save families money. It costs thousands of dollars a year to keep someone alive through medication and technology, but it only cost a few dollars to give someone a lethal injection. The evaluation of regulated legalization as a possible solution reflects that all criteria are fully met. Terminal and suffering patients can make a choice that is right for themselves. The medical ethics and guidelines are established and should be followed.The religious criterion is met because the moral issue is private and since it is no longer illegal, no commandments are broken. Again, but much stronger, the legal criterion is fully met as there is no prosecution unless guidelines are not followed, which protects patients from abuse.

The opponents of legalization feel that not enough care is provided and that legalization will cause people to be killed when they don’t want to die. In his book, Keown warns about the slippery slope of killing others than those who clearly state they want to die. “Safeguards, he claims, have proved ineffectual. Non-voluntary euthanasia is now widely practiced and increasingly condoned. His alternative is a strong advocacy of palliative care: a mix of proper pain management, symptom control, psychological and spiritual support” (Killing With Kindness, p 16). Palliative Care, opponents feel, should be more in the forefront. According to Choice in Dying, more than two million people in America die each year with 80 percent of those in care facilities. Vivienne Nathanson, head of ethics at the BMA, says that “Doctors have become more aware that palliative care is effective. Temptation may come when adequate care is not available. But that’s exactly what doctors and families should be demanding, not euthanasia. Once we have a perfect palliative care system, that is the time to look at the issue” (Killing With Kindness, p 16).

Regulated legalization is the best solution because the concerns of both opponents and proponents are addressed. To reach the point of legalization, people must first be properly educated of all the facts. The appropriate organizations should establish implementation guidelines and set up regulatory and censorship procedures. Politicians will need to use these guidelines to decriminalize the act of euthanasia.

Outright euthanasia is illegal. “Dr. John Keown, editor of Euthanasia Examined (Cambridge university press), who is opposed to voluntary euthanasia says: ‘The fundamental basis of the case for voluntary euthanasia is an acceptance of the notion that certain lives are no longer worthwhile” (Smith, p 36). The Christian Medical Fellowship discuss their beliefs and further state “A law enabling euthanasia will undermine individual and corporate incentive for creative caring. A patient with a terminal illness is vulnerable and may not be objective about their own situation. Patients who on admission to the hospital say they want to die, usually change their mind after effective symptom relief. Terminally ill patients also adapt to a level of disability that they would not have previously anticipated they could live with. They come to value what little quality of life they have left.” Wesley Smith of the National Review reminds us that “Outright euthanasia remains illegal in every state. And assisted-suicide is banned, either by statute or through court interpretation in 47 states. President Clinton has signed a law prohibiting federal funds from being used for assisted-suicide.”

The evaluation of outright euthanasia as a possible solution reflects that only some criteria are met. There is no legal choice; therefore, the procedure is still cloaked in secrecy and shame. Since there is no legal or ethical protection, it will still be done but at the risk of prosecution. Theological and societal beliefs are not eroded because euthanasia is not an openly accepted practice. And, the legal status remains the same; there will be prosecution for physicians who aid the dying.

A better basis for public policy is to ensure that treatment is according to the patient’s wishes. In the United States, a solution has not been agreed upon. However, the best solution will have to address not only society’s concerns, but also the individual’s desires to be the best the solution.

Legality offers opportunity for choice. Those who are pro-choice, as reported on Villanova’s internet page, believe “the decision how and when to die is one of the most intimate and personal choices a person can make in a lifetime, a choice, central to personal dignity and autonomy. How a person dies not only determines the nature of the final period of existence, but in many cases, the enduring memories held by those who love him.” Guidelines provide security from abuse. Not only will our terminal ill and suffering be protected, but our depressed, disabled, and otherwise incompetent citizens will be protected from physicians and family members who may want their loved ones’ lives ended. Maintaining the illegality of euthanasia does not solve any of the issues and contributes to secretive and shameful procedures.

The best solution is controlled regulation and through legalization, the decriminalization of euthanasia. The Voluntary Euthanasia Society has already established proposals for a voluntary euthanasia law. Some requirements are: the patient must be a mentally competent, incurably ill adult that is suffering unbearably; request must be in writing; must seek a second medical opinion and psychiatric assessment; the final decision must be the patient’s alone; and only a doctor may perform the act (Voluntary Euthanasia – The Basics, np). By decriminalizing the act of euthanasia, doctors no longer need to worry about prosecution and can freely choose to help or not to help a patient end their suffering. State laws or regulations governing physician-assisted suicide will be necessary to protect against abuse and ensure that assisted-suicide is conducted professionally and fairly.

The evaluation of regulated legalization as the best solution reflects that all criteria are fully met and compared to the other possible solutions, the best choice for all parties.

People will have a choice and there will be guidelines to help them and their physicians decide the best course of action. Religious and social morals would be upheld because euthanasia will be a legal but private decision. Physicians, no longer prosecuted, will be able to assist the dying.

With legalization, greedy actions by family members and the insurance industry will be paramount. Though it appears that legalization with regulation is the best solution, the effort to maintain the regulatory aspects will be difficult. There will be misuse of the guidelines. The health insurance industry will lobby and try to infringe their revenue generating beliefs into the process. And last, but not least of all, greedy family members hungry for their inheritance will try to coerce the dying and suffering into choosing euthanasia. We cannot regulate society’s or an individual’s values and morals. But by offering a legal alternative that provides for death with dignity, we are showing our faith in people to do the right thing for themselves and their family members.

The benefits of regulated legalization are numerous and apply not only to the physician and the terminally ill patient, but also to society. Decriminalization and establishment of guidelines will mean that society no longer will have to foot the bill for prosecutions and can feel safer that there are no more “Dr. Death’s” lurking in the background. The individual will no longer fear having to ask for the procedures and they can trust their physicians to utilize established guidelines. Physicians will no longer be prosecuted but will have a choice to participate with established guidelines to lead them.

To have a choice in death will mean that society can be educated and grow with the needs of its people as it has always been forced to do. The individual can understand the guidelines before utilizing them in their own private choice. Choice will also mean that physicians can choose to assist or not assist, as their own beliefs allow.

With medical technology advancing, along with an aging population, it is important that the controversy over euthanasia is resolved legally and morally or we may find ourselves at the mercy of opinionated people who will decide who dies and when they die. We cannot regulate values and morals for individuals and society. We can offer a legal remedy to a problem that continues to exist in hotel rooms and in the back of vans. We have all heard of people who suffer with a terminal illness or even commit suicide. This is not the best way to for a patient’s life to end. The agony of suffering is extremely demoralizing to the patient and to the family.

A better way to ease the misery and the suffering is to respect the individual’s right to choose the best course of action for their life and their death. Those who are pro-choice, as reported on Villanova’s internet page, believe “the decision how and when to die is one of the most intimate and personal choices a person can make in a lifetime, a choice central to personal dignity and autonomy. How a person dies not only determines the nature of the final period of existence, but in many cases, the enduring memories held by those who love him.” If nothing is done about the euthanasia issue, our society will continue to turn a blind eye to the issue and people will continue to seek alternatives behind closed doors. Society must become educated on the issue of euthanasia and lobby the politicians for effective and realistic changes to the law so that they can protect physicians from prosecution and individuals will finally have the right to choose death instead of misery.

“Australian Man First in World To Die With Legal Euthanasia.” The New

York Times Sept 26 1996: A5. Proquest Direct.

Bohlin, Raymond. Probe Ministries. “Euthanasia: The Battle for Life”. www.probe.org.

Choice in Dying. “Legal Developments”. 1998. Web@ choices.org.

Choice in Dying. “Issues: Background on the right to die”. 1998. [email protected].

Daniel, Caroline. “Killing With Kindness”. New Statesman. Aug. 15 1997: v126 n4347 p16.

Dority, Barbara. “The Ultimate Civil Liberty”. The Humanist. Jul-Aug. 1997: v57 n4 p16.

King, P.J. Ohio Right to Life. “Forced Euthanasia?”. April 1996. www.ohiolife.org.

Newfield, Philippa. The Institute for Jewish Medical Ethics of the Hebrew Academy of San Francisco. “Euthanasia, Physician Assisted Suicide and the Dying Patient: Medical Status”. Webmaster.

Okie, Susan. “Country’s Doctors Remain Divided Over Physician-Assisted Suicide”. Washington Post, January 8, 1997. Sec A15

Peres, Judy. “Assisted-Suicide Bans Upheld”. Chicago Tribune. June 27, 1997. Section News.

Smith, Wesley J. “Death Wars: As Euthanasia advocates press their case, the moral

health of the country is at stake”. National Review. Jul 14, 1997: v49 n13 p36.

Stark, Albert. “Building a National Consensus on Assisted Suicide”. The Trenton Times.

March 31, 1996. America Online.

The Villanova Center for Information Law and Policy, 96 C.D.O.S. 1507. “US 9

Compassion in Dying vs. State of Washington”. America Online.

Voluntary Euthanasia Society. “Voluntary Euthanasia – The Basics”. America Online.

1994 Health ResponseAbility Systems. America Online.

1997 Christian Medical Fellowship. “12 reasons why voluntary euthanasia should not be legalized”. [email protected].

Annotated Bibliography

“Australian Man First in World To Die With Legal Euthanasia.” The New

York Times Sept 26 1996: A5. Proquest Direct. This article describes the actual

procedure used when Australia’s new law was first used to aid the dying.

Bohlin, Raymond. Probe Ministries. “Euthanasia: The Battle for Life”. www.probe.org. This

online article, written from the viewpoint of a Christian organization talks about what

the Bible says in relationship to living and dying. It also points out the supposed fallacy

of the laws in Holland

Choice in Dying. “Legal Developments”. 1998. Web@ choices.org. This is a very good

eight page online article about the legal battles currently being fought in different

states.

Choice in Dying. “Issues: Background on the right to die”. 1998. [email protected]. This

six page online article from a major organization involved in the euthanasia issue

provides background on the right to die. It discusses the different types of euthanasia,

the medical futility, and the facts about end-of-life care.

Daniel, Caroline. “Killing With Kindness”. New Statesman. Aug. 15 1997: v126 n4347

p16. This cover story shows that people’s sentiments are changing in the United

Kingdom about euthanasia. Many organizations are requesting the government to

legalize the procedure.

Dority, Barbara. “The Ultimate Civil Liberty”. The Humanist. Jul-Aug. 1997: v57 n4 p16.

Ms. Dority, active in the right-to-die movement discusses the moral issues involved

with physician-assisted suicide. She knows there will be many complications with

legalization.

King, P.J. Ohio Right to Life. “Forced Euthanasia?”. April 1996. www.ohiolife.org. This

is a good three page online article about the insurance insurance industry’s impact on

euthanasia.

Newfield, Philippa. The Institute for Jewish Medical Ethics of the Hebrew Academy of San Francisco. “Euthanasia, Physician Assisted Suicide and the Dying Patient: Medical Status”. Webmaster. This eight page article provides an overview of euthanasia and discusses the religious, medical, and legal aspects of legalization.

Okie, Susan. “Country’s Doctors Remain Divided Over Physician-Assisted Suicide”. Washington Post, January 8, 1997. Sec A15. Ms. Okie discusses the Supreme Court

rulings and the effects as seen primarily from the opponents to euthanasia viewpoint.

Peres, Judy. “Assisted-Suicide Bans Upheld”. Chicago Tribune. June 27, 1997. Section News. Ms. Peres provides comments on the Supreme Court rulings with discussion based on each of the justices opinions.

Smith, Wesley J. “Death Wars: As Euthanasia advocates press their case, the moral

health of the country is at stake”. National Review. Jul 14, 1997: v49 n13 p36. The

prominent nature of the debate is due to court cases. Public opinion favors legalization.

Stark, Albert. “Building a National Consensus on Assisted Suicide”. The Trenton Times.

March 31, 1996. America Online. This Special to The Times article provides

background on the euthanasia legal issues in the past and the current legal status.

The Villanova Center for Information Law and Policy, 96 C.D.O.S. 1507. “US 9

Compassion in Dying vs. State of Washington”. America Online. This 84 page online

article fully discusses the Supreme Court case, the background, the plaintiffs’

viewpoints, and the opinions of each of the justices. This was very interesting reading.

Voluntary Euthanasia Society. “Voluntary Euthanasia – The Basics”. America Online. This

two page online article from a major international organization involved in the right to

die issues provides information on the organization and it’s plans to change the United

Kingdom’s suicide laws.

1994 Health ResponseAbility Systems. America Online. This two page online article

discusses Oregon’s new law also known as the Death With Dignity Act.

1997 Christian Medical Fellowship. “12 reasons why voluntary euthanasia should not be legalized”. [email protected]. This religious organization believes that legalization should be avoided because the risk to society and patient autonomy is too great.