Science and technology has allowed humans to treat a myriad of diseases that were previously terminal. This is illustrated in the controversy over the case of Terry Schiavo, the Florida woman at the center of a right to die dispute between her husband and her parents.
Schiavo, who has been in a vegetative state for the past 13 years, brings a face to the legal question of when can a third party decide the fate of patients who cannot decide for themselves. According to Schiavo's husband, Terri would not want to live in her present state. Schiavo's parents, however, disagree (Stern and Goddard).
The conflict illustrates the lack of precedent regarding the legal status of patients like Terri Schiavo. There are many more like her, who are comatose, unconscious and with no hope of recovery. Science and technology has allowed humans to treat a myriad of diseases that were previously terminal. This is no longer a question of whether prolonging life is possible.
Instead, as Schiavo's case illustrates, physicians and scientists must grapple with a more difficult dilemma - whether life should be artificially prolonged in the first place.
This paper thus argues against legally recognizing a "right to die" as a solution to this dilemma. Furthermore this paper argues that proponents of the rights of the terminally ill should instead focus on other programs that will provide comfort and medical care.
The first part of this paper looks at the arguments for recognizing the right to die. The next part then examines the social costs of legal euthanasia or physician-assisted suicide, as seen in the experience in the Netherlands. This part also evaluates the possible consequences of legalizing euthanasia in the United States. In the conclusion, this paper looks alternatives to legalizing euthanasia, such as hospice care and pain management.
Arguments to legally recognize the right to die
Proponents of the right to die movement believe that their actions are a compassionate response to the pain of those who are terminally ill. Others add that euthanasia upholds the rights of many individuals, particularly the elderly, the ill and the handicapped. Many physicians thus believe that a case-to-case approach is necessary where, subject to strict regulation, physician-assisted suicide can be an option for the dying.
Polls in the United States as well as Canada, Great Britain, Australia and other parts of Europe show that 60-80% of people support legalizing physician-assisted suicide. Many of these supporters expressed fears regarding losing control of their bodies and their life decisions to the medical care system. Others who have watched loved ones agonize through the final stages of cancer or multiple sclerosis argue that end of life choices rightly belong to patients and their families (Girsh 208).
In addition, right to die activists argue that experience of countries like Switzerland, where the right to die is legally recognized, belies any fears that allowing physician-assisted suicide will foster a "culture of death." In Switzerland, an estimated 120 people die annually through medical assistance. There is no deluge of patients waiting to be put out of their misery nor are there unscrupulous physicians waiting to take advantage of suicidal people. Even the notorious Dr. Kevorkian has averaged 14 assisted suicides since 1990 (Girsh 208).
Currently, the United States recognizes that people have the right to seek medical treatment for a host of ailments. The law also allows physicians to assist terminally ill patients by disconnecting life support of by prescribing medicine for pain. However, right to die activist argue that both patients and physicians are prohibited from taking the logical next step - medical assistance to produce a death free from pain and protracted agony.
Consequences of legal recognition of right to die: the Dutch experience
In February 2001, after two decades of being practiced underground, the Dutch government enacted a law legalizing physician-assisted suicide.
The law had popular support and, like the health workers who worked with AIDS patients, it had the best intentions. Strict criteria were put in place, limiting physician-assisted suicides to terminally ill patients who possessed adequate mental capacity to decide and make an explicit request for a physician-assisted suicide.
This decision was hailed as right to die activists as an example of how the system should work. They argue that the Dutch system allows a compassionate response to the needs of the elderly and those who are terminally ill.
Since then however, the law has been bent, stretched and expanded beyond its original strict criteria. As Hendin observed, Dutch society progressed from physician-assisted suicide to euthanasia. Eventually, recognizing the right to die for terminal ill patients gave rise to euthanasia for the chronically ill. Then people with psychological problems - many treatable - availed of physician-assisted suicide. This eventually led to physicians practicing involuntary euthanasia, "terminat (ing) patients without specific request." (Hendin: 23).
People who sought physician-assisted suicides included an HIV-positive man who has no symptoms of AIDS. He was not classified as terminally ill. He may have lived long enough to await a cure or he could have lived a full, productive life until the onset of symptoms.
Finally came the most chilling result of a policy that all but legalizes euthanasia. A government-commissioned Remmelink Report found more than 1,000 cases where health workers performed physician-assisted suicides even without the patient's request. These physician's reasons range from the impossibility of treating a patient's pain to the "low quality of life" to "all treatments were withdrawn but the patient did not die." (Hendin: 75-76).
The Dutch experience shows how, even with strict guidelines, the practice of physician-assisted suicide and euthanasia is virtually impossible to regulate. The result was a steady slide towards "involuntary euthanasia," a glaring contradiction in terms. When stripped of its euphemistic language, the practice of terminating a patient's life without a specific request is simply another way to describe a murder.
Alternatives to the right to die
For opponents of the right to die movement, the Dutch experience provides a strong argument against legalizing practices like euthanasia and physician-assisted suicide. This experience shows the dangerous slippery slope that society treads when it legalizes practices such as the right to die.
The strongest reason most right to die activists cite is the debilitating pain that many terminally ill people suffer. In fact, surveys among terminally ill people show that people diagnosed with debilitating illnesses cancer and AIDS fear pain more than anything else. This fear leads many to support the right to die cause. Conversely, studies have shown that when pain and depression were adequately treated in people who are dying or terminally ill, the desire to commit suicide often dissipates (International Anti-Euthanasia Task Force).
However, there are many modern advances being made in the field of pain management. Because of this, critics of the right to die movement believe that effective pain management techniques should be the focus of activists for the dying and the terminally ill.
One problem is that many physicians are not sufficiently trained in the relief of pain and discomfort of terminally ill patients. Many patients get inadequate doses of pain medication, due to the fear of hastening death. This is particularly true for patients suffering from cancer. However, this problem could be addressed with more aggressive pain management techniques. Palliative care should be required of every physician. Furthermore, all critically- or terminally-ill patients should have access to pain management specialists (Emanuel).
Another, more long-term strategy involves changing the way medical students are exposed to issues of death and dying patients. This will help to ensure that physicians will ensure that the seriously ill patients will be involved in making clear decisions regarding their care. Instead of focusing on agitating on the right to die, patients should be given the tools to make critical and informed decisions regarding their palliative care options (American Foundation for Suicide Prevention). After all, most of the patients who ask for assisted suicide and euthanasia are actually requesting a relief from pain and suffering.
Not all cases of euthanasia and physician-assisted suicide are justified according to the compassion yardstick. Roger Magnusson interviewed 49 health professionals working among people infected with HIV / AIDS in communities around San Francisco and several cities in Australia. While Magnusson agreed that health professionals were justified in some instances, he found "some of the experiences...cry out for those prosecutions which the policy of prohibition has failed to deliver." These cases lead him to call for measures to "educat (e) the medical profession and protect...patients from incompetence and recklessness." (Magnusson: 4-5).
It is largely for this reason that the American Medical Association opposes euthanasia and physician-assisted suicides, calling the practices "fundamentally incompatible with the physician's role as a healer." The transient depression aside, many patients want to fight for their life. Doing anything less undermines the trust people place in their medical institutions.
Many patients also turn to euthanasia or physician-assisted suicide in fear that their illness would add to their family's suffering.
This is illustrated in an empirical study conducted…