Euthanasia: The Era’s Most Wreched Dilema (Final) Essay, Research Paper

Euthanasia: The Era’s Most Wretched Dilemma

The term euthanasia is not new to the twentieth century. Even in ancient societies, terminally ill people requested to have their lives ended; though the meaning of euthanasia for them differed from its meaning today. The English word euthanasia is taken from the Greek eu thanatos good or easy death. However today it is given a different meaning, because of the social and moral issues it touches. In the present day the term euthanasia is associated with the act of mercifully (although some might argue this point) ending the life of a hopelessly suffering patient with his or her consent. If the patient is incompetent, then the closest living relatives have the power to make substitute judgment – the guardian or surrogate attempts to reach the decision that the incapacitated person would make if he or she were able to choose (Quinn 289-290). The term incompetent patient refers to a condition in which a patient lacks the capacity to make substantially autonomous decisions about his or her own care (Hoefler 36). The movement to legalize euthanasia began in 1906 when the Ohio legislature referred a bill to its Committee on Medical Jurisprudence, which proposed the legislation of active voluntary euthanasia. The bill was rejected by a vote of 78 to 22. Similar attempts to legalize the practice occurred in Nebraska, New York and recently in the state of Washington. Today most states prohibit assisted suicide; Illinois, Ohio and Michigan call it murder. However the prosecution of those who assisted the suicide is unusual. It is not surprising that there is so much variation from state to state, because doctors themselves do not agree on the morality of active euthanasia. The debate, revolving around euthanasia, is based on several questions: Is euthanasia ethical? Is suffering a preparation for death, and if it is, should people be spared it? Do people have a right to die? Does euthanasia go against the Judeo-Christian beliefs? And the final and most topical question is should euthanasia be legalized?

One of the issues that should be given special attention, when discussing euthanasia is the ethical question. Is euthanasia ethical? Even though it is very disputable issue one thing is clear euthanasia can be ethical only under very specific circumstances. Derek Humphry, the founder of the Hemlock Society and the author of several books on euthanasia, including Jean’s Way, Final Exit, and Dying with Dignity, thinks that suicide and therefore certain form of euthanasia can be justified. Humphry describes two forms of suicide: suicide for mental health reasons, which both he and the Hemlock Society oppose; and justifiable suicide, or autoeuthanasia. He argues that autoeuthanasia is an acceptable choice for those suffering from terminal illness or severe physical handicap, and he outlines the conditions under which it can be considered an ethical act: Being a mature adult (age depending on the individual). That it is clearly a considered decision. That the self-deliverance is not made at the first knowledge of the life threatening illness and that reasonable medical help is sought. That the treating physician has been informed and his response taken into account. Have made a will disposing of your worldly effects. Make plans to exit this life, which do not involve others in criminal liability. Leave a note saying exactly why you are self-destructing (80-81).

In those parameters Humphry describes euthanasia as a clear and simple procedure, which in actuality is just the opposite. His point of view applies only to an emotionally healthy person. If an individual is terminally ill, his emotional health and rationality are questionable. Since those parameters cannot apply to the bigger percentage of cases, they cannot judge autoeuthanasia. When patients remain conscious, their sense of integrity and of coherence of their lives crucially affects their judgment about whether it is in their best interests to continue to live. Athletes, for example, or others, whose physical activity was at the center of their self-conception, are more likely to find handicap’s life intolerable. Other type of people to find handicap’s life intolerable is the dominant type. If throughout their entire lives people lived independently, by their own ideas and beliefs, once put in the situation, where they are no longer dominant, they loose their passion for living. For such people, a life without the power of motion and self-control is unacceptable; it is not worth living. A good example is Friedrich Nietzsche, a great German philosopher of 19th century, who said, In a certain state it is indecent to live longer. To go on vegetating in cowardly dependence on physicians and machinations, after the meaning of life, the right to life, has been lost, that ought to prompt a profound contempt in society (421). To him the meaning of life was lost, if he could not live independently, physical dependency would sicken his spirit. He wanted to die proudly when it is no longer possible to live proudly (422).

Let us however view the countervailing arguments: Does suffering ennoble? Is suffering a part of life and a preparation for death? Another consideration is whether, by taking your life before the illness runs its course, you are depriving yourself and your family and friends of a valuable period of good life, love and companionship. Practitioners of voluntary euthanasia do enjoy their lives, however they want to leave this world under their own control, not driven into coma by some illness. People want to be in control of their deaths, it’s a God given right and depriving them of euthanasia means depriving them of their right to live and to die, as they want. In his book Dying With Dignity, Derek Humphry says: Helping another to die in carefully considered circumstances is part of good medicine and also demonstrates a caring society that offers euthanasia to hopelessly sick persons as an act of love (91). But we cannot think about whether death is in someone’s best interests unless we understand this dimension of the interests people have. Sometimes people want to live on, even though the pain is unbearable, in order to do or finish up something important. They want to finish a job, for example, or to learn something they have always wanted to know. Other people want to live on for a more general reason: as long as they have any sense at all, they think that just being alive is something. On the other hand, people often think they have strong reasons of a comparable kind for not staying alive. They are scared to continue: terrible pain or constant nausea or the horror of intubation or the confusions of sedation. Many people just do not want to be remembered living in those circumstances; others think that it is degrading to be wholly dependent, or to be the subject of continuing anguish. People that have been independent their entire lives do not want to be a burden to anybody, especially to those that love them and care about them. At least part of what they fear about dependence is its impact not on those responsible for their care, but on themselves, on their own dignity. This brings us to another important matter: the role of doctors in euthanasia.

Suicide is a non-criminal act, yet the law makes it illegal to assist or even to supply the means, for a competent adult to engage in this non-criminal act. Although the possibility of physician-assisted suicide is good news to those who are expected to suffer and then die a long and agonizing death, the majority still shrugs and calls it murder. They claim that if physicians would be allowed to terminate people s lives, they would become killers, and the profession would never be worthy of trust and respect as a healer, comforter, and protector of life in all its frailty (Baird and Rosenbaum 27). However, nearly all states recognize the patient’s rights to refuse all treatments, Fourteenth Amendment prohibits others from invading one s body against one s will, including food and fluids, if they are terminally ill and become permanently incompetent (Hoefler 170). Physicians are legally obligated to follow the patient’s decisions. Thus patients have the legal authority to determine the time of their death, even if they don’t have the legal authority to determine the method by which they will die. Competent patients also can refuse any treatment, knowing that the death will result, even if they are not terminally ill. This creates a paradox: if an individual can refuse treatment, to purposely end his or her life, why are the doctors not allowed to help do it faster and less painful? If the individual has already made the choice to die, he or she should be shown some compassion and helped.

The most famous practitioner of euthanasia is Dr. Jack Kevorkian. Dr. Kevorkian has been charged by the state of Michigan in two cases with illegally assisting a suicide, he and the American Civil Liberties Union have challenged the Michigan law that makes assisted suicide illegal. A Michigan judge released Kevorkian from jail after he promised not to assist in any suicides until all legal issues surrounding the cases between Kevorkian and the State of Michigan have been resolved. Dr Kevorkian has begun a petition drive to legalize assisted suicide in Michigan. He has assisted in the suicide of 20 people. He developed a crude but effective suicide machine that allowed individuals to take their own lives in a painless and efficient fashion. In his book Prescription: Medicide, Dr. Kevorkian states: A legitimate, comprehensive, and universally valid code of medical ethics no longer exists. In fact, it never did. What has traditionally passed for ethics among doctors is a vague body of unwritten rules of obscure origin that loosely prescribes professional etiquette among themselves and for their relationship with patients (159). The most common answer to the question why the doctors do or do not do things in certain ways is the “Hippocratic Oath,” that was formulated by a famous doctor Hippocratic in ancient Greece during the fifth century B.C. For the majority of doctors, especially those over the age of fifty, the oath was something occasionally mentioned in medical school, but rarely studied in detail. However, officially all medical ethics have to obey this oath. It is considered to be a coercive, nondiscriminatory, doctrinaire or ideological method of deciding what is right (160). But not to Dr. Kevorkian, he calls today’s medical ethics Stone-Age Ethics (159), saying that our technology moves forward faster than our beliefs. To him euthanasia is a relief from endless pain and suffering, not a destruction of something valuable and priceless.

To some Kevorkian became a hero; others however call his actions a moral outrage. Kevorkian helped kill someone whom he met for the first time two days earlier-Janet Adkins. After explaining his machine to Adkins over dinner, he apparently decided that she was competent to make the choice to kill herself. Arthur Caplan, the director of the Center for Biomedical Ethics at the University of Pennsylvania said: Kevorkian is a pathologist, not a psychologist or a psychiatrist. He has limited experience in dealing with living patients. His stock in trade was examining dead ones. Could he really be confident that Janet Adkins wanted to die based upon two days of personal contact and one dinner conversation? Although Caplan’s accusation may seem too extreme, we will never know what really happened. The suspicious part of this case is that Adkins died through hanging herself and Kevorkian assisted her. That is a step away from traditional euthanasia, which is normally done through lethal injection, or orally. Many raised the question why she did not kill herself by taking sleeping pills. On the other hand Adkins’s choice is understandable: What could be more devastating than to try to end one’s life, and awake to find one had failed? Is Jack Kevorkian a killer or a rescuer? Maybe he is just one of us-ordinary people, who do not philosophize about euthanasia on paper, but have to make this choice in life. According to Kevorkian euthanasia is a matter of personal choice.

Another point that needs to be raised when arguing euthanasia is are laws prohibiting assisted suicide unconstitutional? Do we have a “right to die”? Most of those who oppose legislation of doctor-assisted suicide and active voluntary euthanasia ground their argument in a simple foundation: it is wrong to directly intend the death of an innocent human being, including oneself. Opponents of euthanasia say that if it is wrong to kill directly, it is wrong to assist in direct killing, even in the voluntary suicide of a terminally ill patient. The proponents, on the other hand, argue that if “life” of the terminally ill person is coming to an end, and the only question is whether the terminally ill person must undergo unbearable pain and suffering until death comes naturally , that person can make the choice to end the unbearable pain and suffering by the use of physician-prescribed medications. Why should an adult child struggle to prolong the life of a terminally ill parent when even parent does not want this life? And why should the aging parent continue to struggle, when such an alternative exists?

This brings us to another question: should euthanasia be legalized? The proponents believe that if euthanasia will be legalized, the first generation after legalization might still feel some powerful moral sentiments against killing in this context, because they were raised to think so. This might tend to hold down the numbers of supporters at first. But tree or four generations later, Americans might come to see this as the way to die. As an example they use a reform, passed by the government in Netherlands. This country has the most advanced outlook on euthanasia. Though active medical intervention to cut short life, at the express request of the patient, remains a crime, doctors who commit that crime are guaranteed immunity-as long as they follow certain rules. In her article A Dozen Caveats Concerning the Discussion of Euthanasia in the Netherlands, Margaret P. Battin writes: “Many American observers of the Dutch practice of euthanasia are tempted to claim that euthanasia is legal in Holland; others insist that it is not. Both are right-but only partly so. Killing at the request of the person killed as well as assistance in suicide remain crimes under the Dutch penal code, punishable by imprisonment; however when euthanasia is performed in accord with a set of guidelines it may be defended under a plea of force majeure and so is reasonably sure of not being prosecuted”(89). As seen from this article, Dutch legislature took an alternate root: it did not fully legalize euthanasia, but did not banish it either. Another benefit of legal aid in dying is to relieve fear. There is no evidence to suggest that most patients, given the opportunity to end their lives, wouldn’t. But knowing they have the option would be merciful in itself. – Writes Betty Rollin, a correspondent to NBC News (245). She is on the people who went through the euthanasia experience. Her mother had an ovarian cancer and wanted her suffering to be over. With the help of Betty and her husband her wish came true. The fact that Betty assisted in her mother’s death does not make her a murderer; she actually proved her love to her mother by ending her pain. Betty Rollin is one of those people who support the idea of individual choice.

However, the opponents of legalization of euthanasia also have good points. They are afraid that legalizing euthanasia will turn it from a merciful killing into business, that people will see it as a way to die. Euthanasia is intended to relieve people from suffering. It should not become a business. Making euthanasia into a business would be a big mistake, it will cheapen the value of life, and turning death into something you can simply buy. Financial pressures may also lead to expansion of euthanasia by limiting funding for terminal care. Legislators considering the cost of terminal care in the Medicare and Medicaid programs, or private insurers representing premium payers, may see the profit in it and take it as an obligation to encourage euthanasia as a more cost-efficient way of dying. Moreover, The high costs of medical care sometimes become a primary factor in surrogates decisions for the incompetent members of the family, especially if it is a low-income family. With the advancements in medical technology and growth of population, the health care rates are rising substantially. For instance, in order for a mother of the incompetent patient in a coma to prolong her daughter s life, she has to spent $550 a day, which is 30% to 60% less than a hospital would charge for same level of care (Novack 41). As a result, many surrogates make their decisions considering the psychological or financial burden to the families, as well as other influencing factors, disregarding the best interests of the incompetent patient.

Another question that is raised, concerning the legalization of euthanasia is: Does euthanasia go against the Judeo-Christian beliefs? Stephen Sapp, one of the opponents of euthanasia, states: “Our society, basing its view primarily on the fundamental values of Judaism and Christianity, has always forbidden the taking of innocent life and has considered that act one of the most serious, if not the most serious, breaches of morality possible” (Active Euthanasia, Religion, and the Public Debate, 1991). This is one the main reasons why the majority of people do not accept euthanasia. Many religious institutions view it as an act against God’s will, and therefore as a sin. The religious heritage teaches us that God is the Creator of man, thus Man’s interest in his life and in his body is subservient to those of the creator. Therefore the Man has no moral right to shorten his own life. By suffering the Man is forcibly reminded that it is the Creator who is the ultimate proprietor of human life – a lesson that Man might otherwise forget. The church teaches us that Man is commanded to procreate and to preserve life that is entrusted into him by the Creator. Whether or not Man finds value in his life he has to sustain it until the Creator reclaims it.

On the other hand euthanasia is not contrary to Judeo-Christian beliefs. Jewish tradition teaches us that life and death are not passive, but active categories. One of the most quoted passages from Hebrew Scriptures is Deuteronomy: I have set before you life and death, the blessing and the curse, therefore choose life that you may live-you and your seed (30; 19). Within the biblical setting the definition of life was simple breathing. Also in the scripture there is an indication that it allows us the final act of free will. We are to choose life that you may live, therefore since death is the ending of life, it is up to us to choose it. Even if some choose to interpret the final act of dying to belong only to the giver of life, the human has control until it is wrested from him or her. If life is a gift than a person has the right to refuse this gift. Euthanasia was born not out of anger and hatred, but of concern and compassion – to put an end to unbearable suffering. Therefore it is not a way to create misery, but to end it.

In my opinion that is the attitude that people should have towards euthanasia. It is up to each and every one of us to decide if we want to live or die. We cannot leave this issue up to the government or philosophers. Euthanasia is not a crime, because it is done with the individual’s consent. We might never know the true motives of Dr. Kevorkian or other physicians, assisting in suicides, but is it really that important? What is important here is that what they do is noble: those physicians help people to end their pain, knowing that they may be prosecuted and put in prison. Aside all the legal consequences it is a great moral responsibility and not everybody would agree to take it upon themselves. The measure of dying with dignity is very important; people want their final days to be happy. There is nothing dignified with being sedated all the time, knowing that sooner or later it will end anyway. To me it does not matter whether death is an end or a beginning. We should always come down on the side of personal choice.

Baird, Robert M., and Stuart E. Rosenbaum, eds. Euthanasia the Moral Issues. Buffalo, New York: Prometheus Books, 1989.

Battin Margaret Pabst. The Least Worst Death: Essays in Bioethics and the End of Life. New York: Oxford UP, 1994: inc88110.

N.p.: Hebrew Scriptures is Deuteronomy, n.d. 30; 19.

Hoefler, James M., and Brian E. Kamoie. Deathright: Culture, Medicine, Politics, and the Right to Die. San Francisco: Wesview Press, 1994.

Humphry, Derek. Dying with Dignity. Carol Publishing Group: New York, NY, 1992.

Kevorkian, Jack. Prescription: Medicide. Prometheus Books: Buffalo NY, 1991.

Novack, Janet, The $550-a-Day Nursing Home. Forbes Jan. 1992: 41-42.

Quinn, Kevin P., Bishops Misstep. Commonweal May 1990: 288-292

Rollin, Betty. If you love her help her die, by Betty Rollin. Betty Rollin & William Morris Agency, 1992.