The present paper looks into the issue of physician- or doctor-assisted suicide or euthanasia from several perspectives. It neutrally brings forward the arguments put forth by both the proponents and opponents of this act. In the last section of the paper, an evaluation of the entire argument is made. Personal opinion of the authors is also given from time to time. The paper ends with recommendations and suggestions in the light of the research and analysis of the entire situation.
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Definition and Explanation
To get a thorough meaning and explanation of the term euthanasia, it is important to explore the linguistic layer of this term at length. There are a few concepts that are discussed under the single or umbrella term euthanasia. First, the word Euthanasia means that it is an intentional killing done either by act or omission of a human being for their alleged benefits. Here the keyword is “intentional” which means the death is intended by someone; if the death is not intentional and occurs naturally or unintentionally, the act of euthanasia has not taken place.
There is also Voluntary Euthanasia which signifies that the person he or herself has requested to be killed. Non-voluntary Euthanasia is when a person killed did not request for the killing; Involuntary Euthanasia means that a person insisted to be kept alive but was killed. Then there is the term Assisted Suicide. This term refers to the act of assisting someone with the information and guidance so that the person can come to end their life.
If a doctor assists someone to kill themselves, the act is called Physician-assisted suicide. When the intention of taking life is there, either on the part of the person being killed or by someone else, it is considered the act of euthanasia. On the other hand, such terms as “passive euthanasia” are not considered as euthanasia because in this sense the intention of taking life is not there. Passive euthanasia can be defined as the acts that can include the non-commencement of the treatment that was required for the very ailment of the patient and thus the person died.
Also, if the treatment that has shown to have no result on the patient’s cure is withdrawn and the person meet death is also considered passive euthanasia; the treatment may also be too heavy or unwanted resulting in the death of the person under treatment, for instance, high doses of pain-killers can cause death. However, all these forms will not be considered euthanasia because the intention of taking life in all these cases is lacking. To some critics and experts, other terms for these concepts also exist that have not been included here for the sake of space in the paper.
Early History about Euthanasia
Chasing back the early history of euthanasia takes to ancient Greek and Rome where some people find ample evidence to suggest that if the act of euthanasia was not hailed then it was not at least banned either. Although Plato was averse to the idea of committing suicide, he did entertain three exceptions. He allowed suicide to be legitimate practice when
- it was ordered by the judiciary;
- when a misfortune became excruciating; and
- when there is a moral disgrace.
Whether the sense of Plato matched that of the modern-day or not, it is clear that in his book The Republic Plato argued that it was morally alright to disallow intrusive medical aid and treatment to those patients which would simply lengthen their lives and make them unpleasant and make them useless to the state. There are other complex arguments placed both in favor and against what Plato held for assisted suicide or euthanasia to be appropriate practice (Gorsuch, 2000, p. 599).
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Aristotle also held a view on mercy killing and both the proponents and opponents of this act present him to be their intellectual leader. For instance, it is often quoted that Aristotle it did not carry any imposition of injustice on third persons if one chooses his or her death. However, it is also clearly evident that Aristotle viewed the act of intentional suicide or self-killing to be certainly detrimental for the well-being of the state because it is contrary to the correct decision and reason on the part of the state and the law should not permit it. Yet, it must be noted that this passage is unclear and leaves so much for the argument which is heated by both the groups for and against euthanasia.
The debate to trace the marks of euthanasia in the early history of ancient Greek and Rome, as such, still finds ample room in the medical, legal, and political discourse and, I hope, would continue to do so (Gorsuch, 2000, p. 599).
This review of history, however, was intended to let the reader attach to the history of euthanasia. It is from the next section that the paper would argue the concrete accounts for and against mercy-killing.
Background to Euthanasia and Assisted Suicide in American Society
Today, with several issues at stake, American society is faced with one single question which is most contentious and argumentative in legal and public policy circles. The question is: Whether euthanasia should be permitted or not. As such, the burning question seems to catch a high flare around different circles of social science and law. It was on June 4, 1990, that the news revealed that Dr. Jack Kevorkian had assisted Janet Adkins, an Alzheimer’s patient and 54-year-old lady, to bring her life to cease.
Since then the personality of Dr. Kevorkian became highly controversial and it was later known that he was claimed to have assisted over 130 suicides. American history cannot forget what in 1990 Dr. Kevorkian did, that is, he has performed the act of mercy killing or euthanasia for the countrywide television audience on the program ‘60 Minutes’. He strongly expressed his desire that debate over legalizing euthanasia should be carried on.
Dr. Kevorkian was later convicted of murder (second-degree) after an assessment of his doings in which Dr. Kevorkian chose to be his council. However, what is equally noteworthy is that it was not only Dr. Kevorkian that wrote the argumentative history of medical discourse in the United States, but it was others who saw that euthanasia or mercy killing should be promoted. In this group, the allied of Dr. Kevorkian, is the Hemlock Society, a devoted group to the promotion of euthanasia and its legalization. This society has markedly praised the act of Dr. Kevorkian for “breaking the medical taboo on euthanasia”. Additionally, The American Civil Union has come forward to take up the defensive for Dr. Kevorkian Kevorkian (Gorsuch, 2000, p. 599).
There was another uphill in this argument in American history in the year 1992 when a gynecology resident turned in an unnamed article to the Journal of the American Medical Association. This article ignited the fire on the issue of euthanasia and a very long-standing debated started in highly prominent medical journals of the country because of what was described in it. The article was entitled “It’s Over Debbie”. It related the account of how the anonymous author administered a deadly injection to a bed-ridden cancer-struck patient (it is considered euthanasia and not assisted suicide). The author had never met the patient but had to meet her demand that she wanted to “get this over with”.
After the article was published, the Hemlock Society’s book, Final exits: the practicalities of self-deliverance and assisted suicide for the dying just jumped to the best-seller list of the New York Times. In easy to read large print, this book provides the reader with the step-by-step instructional procedure to carry out some different methods of “self-deliverance” or euthanasia. Even in the year 2000, on January 18, the sales of this book, among all titles, ranked 4,347 on Amazon.com. Findings by a New England Journal of Medicine study suggest that instances of death by asphyxiation by plastic bag (a method of death highly recommended in the book Final exit) increased considerably after the publication of the book which is another point of heated argument in the scholarly as well the laypersons’ circles (Gorsuch, 2000, p. 599).
Political and Legal Implications
What has been noted above is simply the indication that a giant wave of political and legal argument was well on its way. Today, the American nation sees that the issue of euthanasia and assisted suicide has taken up sky-high importance both in the discourse of legal argument about the act and political thinking. The debate over this issue has up to present produced a considerably increasing activism on legal as well as political fronts. In the year 1988, a referendum campaign in California that was aimed at lifting the ban on euthanasia met a failure but was later able to secure enough signatures.
In the same way, other states followed like Washington DC, in 1991, went through a similar effort and obtained 46.4 percent of the entire votes against this ban. What is important to note here, however, is that attempts on the legal and political front both in favor and against the legalization of euthanasia have been well-rooted in the pages of history as early as the 1980s. To be precisely pinpointing of the entire situation reveals that ever since 1992, in the various state legislature, several bills have been duly introduced: all these bills aim to lift the status of euthanasia or assisted suicide to a legal level where the law finds room for the practice of this act.
The states to go for such a legalization attempt are Alaska, Arizona, Colorado, Connecticut, Hawaii, Iowa, Maine, Maryland, Massachusetts, Michigan, Nebraska, New Hampshire, New Mexico, Rhode Island, Vermont, and Washington. However, what is interesting to note is that, up to the very present day, all these states have failed to form any legal policy that supports the act of euthanasia or assisted suicide to be the legitimate practice of the medical field. It must be noted that there are a few states that have duly put in efforts that curb any such attempt of legalizing euthanasia and instead reaffirmed their laws that prohibit euthanasia or assisted suicide.
Even the home state of Dr. Kevorkian Jack, Michigan, is an instance of this stance against this social aspect of medical practice. In New York, an effort was made through a blue-ribbon panel that was administered to lift the ban on euthanasia; however, there was a unanimous vote that simply was against any such effort and thus the effort did meet an inconclusive end and the motion was solemnly rejected.
Similarly, Maryland carried on a statute in which for the very first time codification of the state’s common law ban on euthanasia or assisted suicide was undertaken. From 1996 to 2000 states like Oklahoman, Iowa, and Virginia came forward to strengthen their laws against the practice of assisted suicide or euthanasia. Interestingly, Congress has also been dragged into the messy pond of the debates and attempts over euthanasia. It is presently absorbed in looking for how the matter of overruling Oregon’s referendum that permitted suicide assistance can be effectively put into practical implications (Gorsuch, 2000, p. 599).
American history also saw the proponents of euthanasia and assisted suicide coming on the legal front to furiously clench teeth against any such attempts that went against their hopes and intentions: a legal stance that curbed the voice in favor of this act. As such, the frustration that was created among the proponents of this act because of the failure of early referendums to voice their concern for the legislative effort, these people turned to courts in the mid-1990s.
They consulted to courts in New York and Washington and sought laws that could declare any laws against suicide assistance as being unconstitutional. It all resulted in a wild legal battle in lower courts. Even a federal court could find a constitutional right that allowed the practice of assisted suicide; another court, contrarily, found that no such right ever existed in the history of the American constitution! What more? The appellate courts that were reviewing these federal decisions came up with opinions that were even more cracked.
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What ultimately came through was that the cases knocked the doors of the United States Supreme Court for assistance: “The Court’s 9-0 decisions upheld the Washington and New York laws banning assisted suicide and were hailed as a major victory for assisted suicide opponents” (p. 599).
However, few people had the idea that the crucial concurring Justices saw the cases as arousing only surface level challenges to legislature and laws against the act of assisting suicide and reversed the right to take into consideration in forthcoming cases if those laws are unconstitutional as applied to fatally ill people who want to die by their own consent. Henceforward, far from resolving the issue with concrete groundwork, the Court’s ruling assured that it would even be a more heated debate in the times to come. In the legal discourse, a considerable portion can be found that intensively talks about minute details regarding the decisions and views of the Court’s judges and other critics (Gorsuch, 2000, p. 599).
Contribution of Final Exit to the Arguments about Euthanasia or Assisted Suicide Today
It would be a mistake to overlook what role the publication of Derek Humphry’s book Final Exit has played in the now long-standing argument that many find in favor and against mercy killing or euthanasia. The current waves of activity around legislature, media, and scholarly circles have so much to bear for Final Exit. It is noted that this book has recently roused a reawakening of the public concern about the act of assisted suicide. What is highly debatable concerning the book is that the book does not come to a level where a refined, scholarly approach can be held in favor of the act of assisted suicide or euthanasia.
What, instead, the book argues is that the doctors and the nurses should start assisting their patients for a peaceful suicide without “engaging in discussion, seeking consensus, or awaiting changes in law”; the book, all the same time, encourages patients that they commit suicide, with misstatements which make the alternatives look highly difficult. The book is largely considered a deeply disturbing source whenever there is any such situation in which euthanasia or assisted suicide can be a possibility because the book can lead to irresponsible acts toward unwarranted deaths.
Surprisingly, Final Exit just barely touches upon the grand issue of whether euthanasia or physician-assisted suicide legal aspect should be explored and that whether this act should be legalized in America. This defect of the book simply portrays its surface-level probing into the matter of mercy killing and no intellectual debate can find amble ground to base on the book. However, on the other hand, it “assumes the current state of affairs, with physician-assisted suicide and active euthanasia condemned by law and by the ethical pronouncements of the organized medical profession” (Wolf, 1998, p. 30).
The book with so many such fallacies and defects is considered to be merely a “suicide manual” rather than an intellectual attempt to probe into the matter of assisted suicide which can lead the nation to some solid ground. The abstract arguments presented in the book do not impress the legal and intellectual circles of the nation. The book, however, aroused a huge common interest which is a tragedy in itself because the common opinion did not go into as much detail about the legitimacy of the arguments presented in the book as is needed. The result was observed to be an increase in suicide attempts.
Moreover, the book wrongly discards the value of ethics and call ethicists as people who are cowardly apologists and are “self-styled” experts who not no feeling for someone who is suffering from an illness that is completely terminal. With this outline, it must be brought forward that assisted suicide as portrayed in Final Exit is not something that is seen in legal and medical discourse. The book as such has so much on it credit that eventually misled several people. Whatever, the book is one of the important millstones the nation has covered in recent times (Wolf, 1998, p. 30).
Arguments for Assisted Suicide or Euthanasia
It is important to also look at the other side of the intellectual argument that is presented in the favor of assisted suicide or euthanasia. There are a considerable number of scholars and experts who seemingly come up with a legitimate argument to favor the act of mercy killing or euthanasia. For instance, Salem (1992) finds it fine to challenge assumptions against mercy killing from the viewpoint of medical legalization and the perspective of paradigmatic expression.
The author states that physician-assisted suicide does not give way to death which can be considered medicalized. Instead, according to the author, doctor-assisted suicide is the medicalizing of death. By this argument, the author contends that it is possible a patient due to painful and long-standing terminal illness is likely to attempt suicide which can be duly turned into a medical event. As such, medicalizing doctor-assisted death would not only free the patient of the suffering being gone through by the patient, but it would also be an extension of medical power over life and death.
As far as the argument that mercy killing is asserting a patient’s autonomy, the author contends that doctor-assisted suicide is an impediment to it. According to Salem, it must be well accepted what liberal/libertarian argument presumes about an individual’s autonomy with regard to physician-assisted suicide. It attributes that “the individual is precisely [at] the liberty to govern oneself free from external constraints”.
Moreover, the author argues that if the patient herself considers it appropriate to ask the physician to assist her in meeting death, it is not suicide but an act of assistance which is also not suicide. Moral, autonomy, free choice, individual rights all center on the same idea that an individual is free to choose from the given options in life. All those people who favor medical death as a legitimate practice, according to the author, do consult to this basic idea of individual autonomy and which must not be overlooked when it comes to the argument about doctor-assisted suicide.
In addition to the above, Salem (1999) explores that when it is alright to suggest that an individual is liberal enough to choose ways of living life, then how it is not appropriate when the same individual is willing to direct their physician to assist them for suicide in a condition that is more likely to get worse with the passage of time and the patient would suffer rather than get cured. It is a dilemma on the societal level and must be addressed so that the true individual autonomy concept can be developed which is: the patient is also free to choose either life or death at their own will.
The author, however, clearly mentions that it is only in the cases where there is a clear indication that the patient would get into worse condition and would eventually meet death. The author also contends that the patient who is suffering the agony of pain at the end of their life must not be overlooked for the sake of arguments only. What is important is to consider this a virtually substantial ground to pave the way for mercy killing. Moreover, medical development is not the ultimate solution to the agony suffered by the patient because there are limitations here too (Salem, 1999, p. 30).
American Medical Association on Physician-Assisted Suicide
It is important to note, with whatever has passed above, that what stance American Medical Association has taken up to now with regard to doctor-assisted suicide. As for this issue, American Medical Association has rightfully come to the front to address this issue, especially the issue of physician-assisted suicide. At present, the stance that the American Medical Association takes on doctor-assisted suicide is for life.
In the 9th Circuit case with regard to physician-assisted suicide, an amicus brief noted that “There is, in short, compelling evidence of the need to ensure that all patients have access to quality palliative care, but not of any need for physician-assisted suicide”. What is the core argument of the American Medical Association is that doctors are trained both practically and morally to serve the purpose of saving a life by treating patients and treating them in any situation whatsoever.
This is what medical science completely centers on. Henceforth, if the doctors perform the dual role of taking life, even on the consent of the patient, it would simply mar the credibility and the worthy trust attached to the profession of medical science and the trust that is the basis of the relationship between a doctor and a patient. Thus, the announcement of the Institute of Ethics by the American Medical Association is in the same series of achieving the goal that assisted suicide is not favored by the association (Life Issues Institute, 2000).
There are a number of projects, programs, and attempts that are either in process or will be in execution in the near future. These segments are aimed at achieving the same goal: educating the member doctors (an initial number estimated to be 20,000) on the issue of doctor-assisted suicide. The central point of these projects is also to initiate efforts in which alternative ways of treating patients would be taken into consideration which would simply show non-conformity to the notion of euthanasia.
The other part of these projects is also to create awareness for palliative care which will aim to give patients ways by which they can overcome their fear of suffering at the hands of a painful illness. Moreover, the doctors would be educated in the use of pain control and will be provided intensive training for that (Life Issues Institute, 2000).
What is notable from the above review of the stance taken by the American Medical Association is that doctor-assisted suicide is actually a stain on the life-friendly-only profession of medical science and all efforts should be initiated to keep the profession life-friendly-only. This is important to note that such a stance is a great wave in the sea of medical, legal, political, and ethical ground of the United States of America where so much has already been taken on both in favor and against doctor-assisted suicide or euthanasia.
Policy Making and Human Dignity
When it comes to policy formation with regard to the issue of euthanasia and human dignity, it must be noted that this area is also not without argumentative grounds. According to Hyman (2003), the policy formation keeping the notion of human dignity is very complex because the concept of human dignity and its importance is very abstract. The abstract nature, however, is so subtle that the core view about it varies massively from nation to nation, from one religion to another; the author points out that even within the boundaries of one country such notions find considerably varied understanding different from one community to another, from one group to another, and so forth.
Therefore, it is not very easy to suggest that the United States legislature will find a streamlined poll of opinion either in favor or opposition of legalizing the matter of physician-assisted suicide or euthanasia. Thus, the matter is extremely controversial and needs to be scrutinized at length before any legitimate argument can be put in place.
In the paper, it has been argued that traces of euthanasia are found in early history and that a number of solid arguments are put in the favor of this motion. Additionally, the opponents of doctor-assisted suicide or euthanasia are also not without solid ground to have their voices heard. However, the present debate as to whether it should be allowed or not has much credit to such hasty attempts as Final Exit that, according to my personal opinion, did form a view about euthanasia as something that is right on the surface level without delving into legitimate details. Today, the American nation must look for the ways in which the feasibility of practical ways of life can be weighed.
Once done with it, the nation should be decided whether this act should be allowed or not. However, it is not wrong to suggest that life teaches us that we should be ready to fight any suffering, problem, and challenge so that the continuation of life which is the basic reason for all activity on the planet, can continue. There is no doubt that the stance taken against euthanasia by American Medical Association is the one in the same connection and must be respected by all.
Euthanasia.com. Euthanasia definitions. 2008. Web.
Gorsuch, N. M. (2000). The right to assisted suicide and euthanasia. Harvard Journal of Law & Public Policy. (23) 3, p. 599.
Hyman, D. A. (2003). Does technology spell trouble with a capital “T”? Human dignity and public policy. Contributors: Harvard Journal of Law & Public Policy (27) 1, pp. 3+.
Life Issues Institute (2000). AMA: Anti-euthanasia, pro-pain control. Web.
Salem, T. (1999). Physician-Assisted suicide. The Hastings Center Report (29) 3, p. 30.
Wolf, S. M. (1992). Final exit: the end of the argument. The Hastings Center Report (22) 1. pp. 30+.