The Right to Die
The word Euthanasia originated from the Greek language: eu means “good” and thanatos means “death”. Euthanasia (Greek, “good death”) is the practice of killing a person or animal, in a painless or minimally painful way, for merciful reasons, usually to end their suffering. However, some people define euthanasia to include both voluntary and involuntary termination of life (Humphy 12). Like so many moral/ethical/religious terms, “euthanasia” has many meanings. Euthanasia, in the strict sense, involves actively causing death. This is, in some cases, legal like in the Netherlands, but in few other countries. Euthanasia, in a wider sense, includes assisting someone to commit suicide, in particular physician-assisted suicide (PAS). Allowing death — e.g. by not providing life support or vital medication– is not considered euthanasia if it is the patient’s wish (Robinson). It is sometimes called passive euthanasia in cases where the patient is unable to make decisions about treatment. “Living Wills” and “Do Not Resuscitate” orders are legal instruments that make a patient’s treatment decisions known ahead of time; allowing a patient to die based on such decisions is never considered euthanasia. Terminal sedation is a combination of medically inducing a deep sleep and stopping other treatment, with the exception of medication for symptom control (such as analgesia). It is considered to be euthanasia by some, but under current law and medical practice it is considered a form of palliative care (Humphry 14). Advocates of euthanasia generally insist that euthanasia should be voluntary, requiring informed consent, and that it should only be used in cases of terminal illness that cause unbearable suffering, or an eventual, complete loss of awareness. Its opponents challenge it on several ethical grounds, including a slippery slope argument that it is the first step towards compulsory euthanasia (Leon 22).
Voluntary euthanasia is the truest and fullest form of euthanasia wherein the individual requests euthanasia – either during illness or before, if complete incapacitation is expected (a coma would be an example). Euthanasia in these cases differs from suicide by existing only within the context of the amelioration of suffering in the process of death. Volition must be informed and free (i.e. not under duress from any third party) (Capek, Fox, and Kamakahi 33). Involuntary Euthanasia is what some describe as the killing of a person who has not explicitly requested aid in dying. It is often done when resuscitation is not expected, or after severe brain damage that renders a person incapable of making life decisions. Therefore any euthanasia is not voluntary, but also not involuntary. Famously notable as “turning off life-support”, this is most often done to patients who are in a Persistent Vegetative State and will probably never recover consciousness (Wickett, Humphy 41). Involuntary euthanasia is where an individual may distinguish between life and death – and may fully realize the difference between them. Any medical killing is involuntary. If, for example, a man knows he is going to experience severe agony, and does not consent to death, euthanasia imposed upon him is ethically and morally, if not legally, classed as murder. In Nazi Germany the term “euthanasia” (Euthanasie) referred to the systematic killing of disabled children and adults. This has tainted the word in German-speaking countries; the alternate term is “Sterbehilfe”, which means “help to die.” Any time that medical personnel determine on behalf of a sentient and responsible individual that his or her life is not worth living, the medical killing of such a person as it is considered to be done for the prevention of suffering is involuntary euthanasia. This is not to be confused with medical killing in cases of capital punishment or as part of genocide (Robinson).
Proponents of euthanasia argue that only patients can determine when suffering makes life worse than death and that such persons can and should be allowed to make the decision. Some also argue that terminally ill patients are respected more by having their suffering end than by being kept alive against their will. Additionally, a utilitarian argument can be made about the harms to the whole of maintaining the individual beyond viability (Yount 42). They also believe that people should have control over their own bodies and that complete prohibition on assisted death excessively limits personal liberty. If a person is competent, they should have right to choose death (“End of Life Choices”).
The second type of argument against euthanasia is that it is not prudent to advocate it; that is, eventually we all may be suffering, and if we think ahead, we may think it better if the doctors on whom we depend are not tempted to perform euthanasia. Euthanasia is inherently less complex than palliative care, and training for euthanasia does not qualify a physician to estimate a patient’s response to palliation (Robinson). Like all medical procedures, euthanasia can fail, or bring additional suffering (Capek, Fox, and Kamakahi 52). Some claim that if euthanasia were allowed, doctors might press people into euthanasia to reduce medical costs. Many people believe that saving medical costs is a coercive argument that should disqualify a person from giving free consent (Robinson). Many doctors argue against euthanasia, as providing death is antithetical to their primary function and training. The Hippocratic oath that all doctors take states, “I will not administer poison to anyone where asked,” and “Be of benefit, or at least do no harm.”. If, some have argued, a doctor is trained both to cure and kill, then he or she is being told always to judge when to kill, and his or her best efforts at saving life will not be expended (Leon 28). Many religious people are said to object to euthanasia. Christians believe that one’s life is derived from God and it is God’s to take, and destroying it is an offense to God (Wickett and Humphry 56) Further, in most Western nations the prohibition on killing is considered a moral absolute that cannot be conditioned by ethical concerns (Yount 47).
After an extensive discussion the Belgian parliament legalized euthanasia in late September 2002 (Humphy 76). The new legislation, however, institutes a complicated process, which has been criticized as an attempt to establish a bureaucracy of death (Robinson). Nevertheless, euthanasia is now legal and its proponents in the country hope that it will stop many illegal practices (it is said that several thousand illegal acts of euthanasia have been carried out in Belgium each year) (Humphy 78).
On January 28, 2005, Marcel Tremblay of Kanata, Ontario held a press conference to announce plans to kill himself, saying his life with pulmonary fibrosis was unbearable. After attending his own living wake, the 78-year-old man committed suicide at 11:51 pm Eastern time. He had previously said his wife and adult children would surround him while he placed a bag over his head and filled it with helium (Robinson). Tremblay said that he publicized his suicide plans to help change laws over assisted suicide. His lawyer said police were satisfied that Tremblay had a sound mind and that authorities would not intervene (Leon 1020. Canada decriminalized committing suicide and attempting to commit suicide in 1972. However, under Canada’s Criminal Code, assisted suicide is illegal and punishable by up to 14 years in prison (Robinson).
In The Netherlands the Termination of Life on Request and Assisted Suicide (Review Procedures) Act, legalizing euthanasia and PAS in certain circumstances, took effect on April 1, 2002. The law permits euthanasia and PAS when, and only when, the patient has asked repeatedly, the patient’s suffering is unbearable with no prospect of improvement, and the doctor has prior to the act consulted a colleague (Humphry 112). Euthanasia remains a criminal offense in cases not meeting the law’s specific conditions (Yount 96). From the time that euthanasia first came to be widely practiced in the Netherlands, it was formally subject to review by boards of doctors in each hospital. The law essentially codified what had already been an unofficial law. The legislation has wide support among the socially libertarian Dutch, who have one of the world’s highest life expectancies (Robinson). In 2003, in the Netherlands 1,626 cases were officially reported of euthanasia in the sense of a physician causing death (1.2 % of all deaths). By far, most reported cases concerned cancer patients (“End of Life Choices”).
In the United States, the most common form of euthanasia is withholding tube feeding to elderly and incapacitated patients. This is generally considered an abuse when the patient might recover. These patients die protracted deaths by dehydration (Robinson). However, it is so common in some areas that the family must actively prevent it, or it will occur (Stacy). However, contrary to the rest of the United States, Oregon has legalized PAS (but not euthanasia in the sense of a physician or anyone else causing death): residents voted for it in 1994, and voted against repealing it in 1997 (“End of Life Choices”). Oregon’s law has been attacked by various organizations, and federal government parties that support those organizations, ever since it was first enacted. However, since 1998, 171 Oregonians have relied on the assisted suicide law. Most reported cases concerned cancer patients and, in most cases the procedure was applied at home (Robinson).
Jack Kevorkian is a controversial American medical doctor who is most famous for his vocal support for the “right to die,” and for assisting the suicides of over 100 people (Yount 127). On March 26, 1999, a jury in Michigan found Dr. Kevorkian guilty of second-degree murder and delivery of a controlled substance, for administering a lethal injection to a Thomas Youk, an ALS sufferer. The incident had been videotaped was aired on the September 17, 1998 edition of 60 Minutes. Kevorkian was sentenced to 10 to 25 years in prison (Leon 134).
Praise for Dr. Kevorkian’s work has come from many sources. Those who were seeking his services, as well as family members of the terminally ill people he helped die expressed deep gratitude for his assistance. Other supporters include those who generally support the legalization of the voluntary euthanasia or suicide of a terminally ill patient, especially when the patient is in pain (Robinson). Studies have indicated that most doctors seem to support a terminally ill patient volunteering to end his own life and that euthanasia is often carried out “sub rosa” especially for those able to afford private medical care (“End of Life Choices”).
Criticism of Dr. Kevorkian has also been heavy. Some critics categorically oppose the terminally ill (or those in constant pain) taking their own lives (Robinson). Beyond these criticisms, critics have stated that Dr. Kevorkian has primarily practiced as a pathologist, has relatively little experience with live patients, has had all his licenses to practice medicine revoked, and in the end is not equipped to evaluate whether a prospective client is clinically depressed and therefore, according to accepted medical (and legal) thought, incapable of deciding to end his or her life (Wickett and Humphry 98).
Terri Schiavo is a severely brain damaged American woman whose husband’s efforts to remove her feeding tube and forbid anyone from attempting to feed her by mouth have prompted a fierce debate over euthanasia, guardianship, and the rights of the disabled (Lipper). On March 18, 2005, her feeding tube was removed for the third time (Stacy). Michael Schiavo, Terri Schiavo’s husband, is her legal guardian. He contends that Terri is in a persistent vegetative state and that he is carrying out her wishes to not be kept alive in that state (Stacy). Terri Schiavo’s family contests both of Michael’s claims. They say she is responsive and in no discomfort, that her condition does not meet the medical definition of “vegetative,” and that she would not wish to die. They also contend that Terri was a victim of domestic violence, both before and after her injury, and that Michael does not have her best interests at heart. They seek to revoke his legal guardianship of Terri, arguing, among other things, that his living with another woman since 1995, with whom he has two children, makes him legally estranged from her (Lipper).
Although the courts that have heard this case have generally sided with Michael Schiavo, her family has vigorously appealed the courts’ decisions and sought to prevent her death (Lipper). The ACLU has joined the legal battle, siding with Michael Schiavo, but numerous disability rights organizations, religious organizations, the Florida legislature, the Vatican, and both houses of the United States Congress have joined the legal battle, siding with Terri’s family (Lipper). Republican congressmen Dennis Hastert, Tom DeLay, and Tom Davis opened a congressional inquiry of the House Government Reform Committee, to take place in Clearwater on March 25, and issued subpoenas for Terri, Michael, and several hospice workers. According to the lawmakers, harming Schiavo or preventing her from appearing at the hearings would be a violation of federal law, and thus they would be forced to keep her alive until the court date. The judge said he saw no reason to change his earlier permission allowing Schiavo’s husband to remove her feeding tube. Judge Greer defied the congressional subpoenas, and letting the order stand which gave Michael Schiavo permission to remove Terri’s feeding tube (Stacy). However, on March 19, 2005, congressional leaders announced that they were drafting a bill that would order the reinsertion of Schiavo’s feeding tube and allow a federal court to review the case. If passed, President Bush plans to sign it (Stacy).
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Stacy, Mitch. Schiavo Kin Wants Feeding Tube Reinserted. 20 Mar. 2005. MSNBC Wire Services, The Associated Press. .
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Wickett, Ann, and Derek Humphry . The Right To Die: Understanding Euthanasia. New York: Harper and Row, 1986.