The committee then informs the family about the decision and, when the request is granted, discusses with the patient how he or she will go through the procedure of euthanasia or PAS. When possible, the patient is asked to sign a declaration of will, which, together with a report on the procedure, will be included with his or her hospital records (Scheper 1994).
Some debaters have called attention to the significant moral difference between terminating life by euthanasia/PAS and allowing death by the withdrawal of life-sustaining, cure-oriented but useless equipment and treatment. Charles MckHann and other advocates advanced that respect for an autonomous and informed patient's request entitles his or her to respect for a request for help in dying (Gula 1999). But opponents insisted on the moral difference between the withholding or withdrawal of treatment when nothing more can be done to significantly reverse the patient's physical state and actually and actively intervening in ending the patient's life. They contended that lethal intervention as the cause of death is killing and there is culpability, while allowing a patient to die means that death occurs as a natural biological process because this does not make anyone culpable and answerable for the death. Injecting or ingesting legal medication involves human action or intervention and, therefore, means that someone is culpable for the death (Gula).
Those in favor of allowing euthanasia/PAS argued on the basis of kindness or beneficence, the desire to relieve senseless pain and suffering and to show compassion and pity to the sufferer. They offered the three dimensions of beneficence to consider or incorporate into the dispute: the character of medicine as a profession, the suffering to be relieved or prevented, and the compassion that must be shown (Gula 1999). While Manning and his team asserted that terminating a patient's life was contrary to the very aim of medicine, McKhann and his team did not limit the medical profession to preventing, diagnosing, treating disease and promoting wholeness. It must also relieve suffering without addressing the nature, causes and uses of suffering because these are unknown. Many sufferings are beyond bodily limits, which are outside the purview of medical responsibility and to involve or request a physician to release a patient from a life made meaningless or purposeless by an incurable or terminal illness meant that the physician possessed the competence to determine what kind of life is worth living and what is not (Gula). And a physician does not have this competence or responsibility Eric Cassell, a physician-philosopher, proposed that the roots of suffering could and often do go beyond the level of physical pain and that personal attitude has a lot to do with the degree to which a person suffers. Christian opponents believed that suffering can be a transforming force that can make him or her value life more strongly, confront the reality that we are mere creatures, and come to terms with our dependence on a Creator. They rejected the assumption of pro-euthanasia/PAS disputers that a person ought not to suffer and that, should suffering come, the solution should be to remove the sufferer. While they agreed that suffering should be avoided at all costs and should not be glorified or brought upon oneself, it can and does become part of life and people must learn how to live with it for a higher purpose (Gula). But what if the senseless and ceaseless suffering is the direct and entire outcome of a physical illness or aging?
Proponents of euthanasia/PAS, such as the Hemlock Society of Oregon and Americans Against Human Suffering or AAHS of Washington scored success with their major campaign in California in October 1991 after losing in 1988 (Capron and Michel 1992). The campaign managed to gather 10% more than the required 385,000 valid signatures in sponsoring Proposition 161. California's Proposition 161 would be viewed as the "swift bullet" legislation to end unendurable suffering and life to Californians and others from elsewhere. It primarily and prominently features a Directive, which the patient must sign to indicate his or her desire for a quick and painless death and that the statute, meant for patients whose pain and suffering could be remedied short of being put to death, applies to him or her. The Proposition provides for a medical procedure to make it possible to terminate life painlessly, humanely and with dignity, either as administered by a patient or self-administered by a qualified patient. A qualified patient is a competent adult who has been determined by two physicians as suffering from an irreversible physical condition that will lead to death within six months. In comparison, PAS is to be administered only upon the contemporaneous request of a competent patient. Supporters of Proposition 161 and other endorsers of euthanasia/PAS make that option mainly because of the inhumane-ness of intractable pain. Those who oppose the Proposition argued that, in many cases or many physicians are unable to control intractable pain at a particular period and that time would come when better means can be developed to reduce the number of patients still suffering from it. The Dutch reserve permission for euthanasia/PAS to patients or people with a certified prognosis of six months or less to live, but not reserving it for the few cases of untreatable and really unbearable suffering.
Proposition 161 has been criticized for its loopholes, despite assurances of strong safeguards against abuse. These loopholes are in provisions for informed choice, voluntary choice, stable wishes, a physician as guardian, fallible diagnoses, expanded practice and misused language (Capron and Michel 1992).
Advocates and proponents of Proposition 161 and euthanasia/PAS can agree that, despite technology, combined efforts and discoveries, not all terminally or incurably ill can acquire adequate pain control or access to appropriate care and management of their condition. This suggests that our society as care-givers has failed somewhere. But the premise of Proposition 161 that the only way to maintain the dignity of a dying and extremely suffering patient is to legalize euthanasia/PAS appeared to be downright wrong and points only to the inadequacy of adequate care for these patients. It seemed only and more of a social problem rather than moral, legal or practical one (Capron and Michel).
Gleaning from experience and the whole range of information and arguments, it is solid reality that people who are terminally or incurably ill or too old reach the verge of intolerable pain and suffering, yet useless because there is nothing that modern medicine can do to alter their condition or reduce their pain and suffering. We can all hope for greater discoveries and more effective means but these people cry out for an end to their condition now. We all believe that we should show compassion and respect for their dignity at the same time, on the one hand, and insist that the person or patient does not have complete autonomy over his or her life. People need to know how to suffer in order to go on living and respecting that life that God gave. Life is the basic good in each person and it will take repeat struggles with the loss of meaningful existence and senseless suffering to come to a decision to request that this basic good be ended. Too few will ask for the end of their lives just because they want to escape suffering. The greater number come to that ultimate decision because of the intimate, direct and persistent realization and experience from within and without that the basic good is no longer a good but a burden and perhaps even an evil that has outweighed the basic good. The decision only follows the realization only they can have because their essence has changed beyond dignity and integrity. #
1. Capron, Alexander Morgan and Michel, Viki. Will California Legalize Euthanasia? Commonweal, September 25, 1992 http://www.findarticles.com/p/articles/mi_m1252/is_n16_v119/ai_12302893
2. Gula Richard, reviewer. Euthanasia and Physician-Assisted Suicide: Killing or Caring? By Michael Manning. Christian Century: Paulist Press, May 5, 1999. http://www.findarticles.com/p/articles/mi_m1058/is_14_116/ai_54588537
3. Philippsen, Bregje D. Onwuteak. Euthanasia and Old Age. Age and Ageing, November 1997. http://www.findarticles.com/p/articles/mi_m2459/is_n6/_v26/ai_0206885
4. Scheper, TMJJ olde. Euthanasia: the Dutch Experience. Age and Ageing, January 1994. http://www.findarticles.com/p/articles/mi_m2459/is_n1_v23/ai_14904640
5. Schmidt, JE. Five Perspectives in Personal and Social Ethics. From Chapter 3 of "Personal Ethics in an Impersonal World." Philadelphia: Westminster Press, 1975