One of the more controversial subjects in the medical field and elsewhere for many years has been the question of euthanasia, otherwise known as mercy killing or assisted suicide. Those who support the practice feel strongly that the individual freedoms of choice we enjoy during our lifetimes should also extend to apply to our choices regarding the end of life. They point to the prevailing sentiment we express when treating animals that are terminally ill or injured and suffering greatly as a result. In these cases, ‘putting the animal down’ through humane lethal injection is considered the most humane and sympathetic treatment possible. If we take this stance in the treatment of our animals, we should be willing to take this same sort of stance regarding humans who have reached the end of their endurance. Opponents of euthanasia practices being applied to humans suggest that making euthanasia legal opens a dangerous window that would permit increased cases of coerced suicide in which family members may end up pressuring the ailing elderly to hasten their inevitable demise in order to benefit the rest of the family financially. In addition, they argue that being able to legally kill off the terminally ill would reduce any urgency felt by the medical community to develop new medicines or effective treatments designed to prolong life. People who oppose euthanasia on religious grounds argue that allowing assisted suicide is essentially ‘playing God’ and is therefore sinful, but fail to satisfactorily answer questions regarding heroic life-giving interventions such as mechanical lungs and life support. Health care professionals typically point to the Hippocratic Oath as their primary opposition to the practice. This oath, taken by all health professionals, forbids medical providers from purposely taking life. The purpose of this paper is to examine the legal concerns that apply to the issue of euthanasia, to clarify what is meant by the term, present arguments that have been brought forward for and against the practice and finally to reach a conclusion that makes a recommendation on how to best resolve the issue.
Like many of our medical terms today, the word ‘euthanasia is taken from the Greeks, in this case using a term that means ‘good death.’ As early as 1700s Britain, writers were referring to euthanasia as the preferential method by which one might ‘die well’ (“Definition”, 2007). The term euthanasia is typically used to describe a situation in which a terminally ill patient is given a lethal dose of medication as an active process or as a passive process when the patient is removed from a life-support system or is simply allowed to die without active intervention. The doctor’s role in this process could be very active as indirectly inserting the intravenous apparatus containing a lethal dose of medication to end the life when the patient triggers the drug’s administration or more passive in simply prescribing a lethal dose of medication that the patient is then largely responsible for. The issue has been debated by physicians, lawmakers and philosophers since the beginning of recorded history; however, the widespread public debate regarding the legalization of euthanasia has only emerged during the past three decades.
Early discussions of the issue focused on the concept of the living will. ‘Living wills’ became legal in the 1970s which provides the patient with the ability to refuse ‘heroic’ life-saving medical assistance in writing in case they are ever in a situation where they are incapacitated and kept alive only through artificial means (Rich, 2001). This document essentially provides named next of kin the right to instruct doctors to ‘pull the plug’ if the patient’s condition is determined to be hopeless. Although widely debated and contested at first, this practice is now widely accepted. Intended to solve the question of what measures to take on behalf of the patient, these wills did not sufficiently address the potential issue of individuals living in a permanently unconscious state with no medical intervention other than the administration of nutrition and fluids. In situations where no other life support techniques are necessary, these individuals can live for lengthy periods of time with no true hope of recovery. To overcome this problem, many drafting living will turn to power of attorney to express their wishes should they ever be found in this state. “The durable power of attorney allows an individual to designate in writing a proxy or surrogate decision-maker (the attorney-in-fact) who has the same degree of authority to consent to or decline life-sustaining treatment as the patient would if he or she were competent” (Rich, 2001: 68-69). Although this also presents problems as there remains no true way of determining just what the patient would want given the specific details of their unique condition, today’s debate regarding euthanasia has moved beyond the realm of the unconscious patient and into the realm of patient rights. Today, the euthanasia debate is primarily concentrated on questions of individual autonomy. Is it or is it not the right of patients who suffer from extreme pain and have a terminal or degenerative disease to die in a humane way at the time of their choosing?
Euthanasia is only allowed as an accepted medical practice in one state, Oregon, and three countries, Switzerland, Belgium and The Netherlands. Oregon’s law was challenged in the U.S. Supreme Court early in 2007, but was upheld by a vote of six to three. This wasn’t the first time it was challenged, though, as President Bush attempted to derail the Oregon law in 2001 by stating that assisted suicide wasn’t a ‘legitimate medical purpose.’ The justices of the court, however, remained unconvinced by Bush’s argument. “Justice Sandra Day O’Connor pointed out that doctors participate in the administration of lethal injections to death row inmates” (Roh, 2006), a practice most often employed in the state of Texas, where Bush had been governor before being elected president and he had never challenged that practice throughout his governorship. The Oregon laws are based upon those used in the Netherlands because they require the involvement of second opinions and evidence that there is an imminent resumption of death within a reasonable time frame of when the procedure is requested. In addition, the patient requesting euthanasia treatment must make several requests for the procedure, all spaced out over weeks, as a means of ensuring that they are of sound mind in making this decision and the patient must be willing to administer the overdose of drugs themselves. There are several individuals who have written against Oregon’s laws, including Lauren O’Brien (2005) and Kay Olson (2007), but these individuals are typically addressing abuses they have found in the system and usually as they apply to personal cases in which counseling would or should have been able to prevent mistakes. Olson, for instance, describes the case of a particular woman of her acquaintance who was considered to be incompetent in arguing for her own case and, through numerous abuses in a system focused upon capitalistic concerns rather than humanitarian ones that may have been prevented with more ordered law, became a victim of the Oregon euthanasia laws. O’Brien illustrates how a successful writer she knows might have inadvertently cut short a brilliant career had euthanasia been an option at the time he first suffered a paralyzing accident but fails to consider how counseling might have prevented this step as it did help him avoid considering unassisted suicide.
As this discussion illustrates, the debate regarding euthanasia embraces compelling and impassioned arguments on both sides of the issue. Those who support legalizing euthanasia are primarily concerned with the amount of human suffering experienced by the patients themselves. There are several diseases such as cancer that commonly cause a lingering and excruciatingly painful death. Family pain is also considered as watching a loved one in the slow, agonizing process of dying from a disease eating away at their organs is very difficult, but to see them suffer even when coping drugs are administered is unbearable. This emotionally and physically torturous situation for the patient and family is played out in every hospital of the nation every day of the year but prolonging the suffering often serves no humanitarian purpose. To many people, it is unimaginable to allow anyone to spend the last six months of their life enduring constant pain, unable to control bodily functions, convulsing, coughing, vomiting, etc. The psychological pain for both the family and patient is also unimaginably horrific as the patient loses their personality in the fog of pain and medication. If the patient were a dog writhing in untreatable pain and snapping at caregivers uncontrollably, most would agree that the only humane option would be to ‘put her to sleep.’ Patients suffering from Alzheimer’s are in a different situation in that they endure a different type of pain usually for a long period as everything they know and love slowly slips from their memory. Many people who led vibrant, active and purposeful lives before being struck by Alzheimer’s disease are remembered by their family members in a state of complete mental breakdown (Messerli, 2007). The right to die with dignity for humans is not prohibited by the Constitution but is instead prevented mostly by religious zealots who seem to ignore the humane dictates of their own beliefs.
The unfortunate reality behind the euthanasia debate is that the majority of people in the United States die a ‘bad death.’ Approximately 53 percent of Americans believe euthanasia is not only a compassionate option but also ethically acceptable. Another 69 percent would support the legalization of euthanasia according to a Gallup Poll conducted in 2004 (“Public Grapples”, 2004). Many people who oppose doctor-assisted suicide laws fear the potential for medication abuse. However, as the laws enacted in Oregon have shown, it is possible to craft reasonable laws that guard against abuse while still protecting the value of human life. For example, laws could be drafted that requires the approval of two doctors plus a psychologist, a reasonable waiting period, numerous applications spaced out over a reasonable period to ensure a sound mind, family members’ written consent and limits of the procedure being applied only to specific medical conditions known to lead inevitably to death.
References
“Definition of Euthanasia.” (2007). Medicine.net. 2009. Web.
“(The) Fight for the Right to Die.” (2004). CBC News. 2009. Web.
Messerli, Joe. (2007). “Should an incurably ill patient be able to commit physician-assisted suicide?” Balanced Politics. 2009. Web.
O’Brien, Lauren. (2005). “Opposing Legalization of the Right to Die.” Emmitsburg Area Historical Society. 2009. Web.
Olson, Kay. (2007). “Euthanasia in Oregon.” The Gimp Parade. 2009. Web.
“Public Grapples With Legality, Morality of Euthanasia.” (2004). The Gallup Poll.
Rich, Ben A. (2001). Strange Bedfellows: How Medical Jurisprudence has Influenced Medical Ethics and Medical Practice. New York: Springer.
Roh, Jane. (2006). “Supreme Court Backs Oregon Assisted Suicide Law.” Fox News. 2009. Web.