Euthanasia Has Long Been Considered a Compelling

Euthanasia has long been considered a compelling issue based on religious beliefs for which there are serious legal and ethical consequences. Those who support Euthanasia argue that it is the only viable solution for many people who do not desire to end their lives in a miserable fashion. They believe that terminating life by choice is the best possible resolution. On the other hand, many individuals believe that Euthanasia is a criminal act and that the behaviors surrounding the event are unethical. They argue that physicians who assist in the events leading up to a death by Euthanasia are immoral and should be punished for their crimes. However, another viewpoint exists that combines the two basic perspectives, created by Father Ned Cassem. If a person chooses to end life at the hands of Euthanasia, has settled all affairs, has been surrounded by family and friends at the time of death and has resolved all conflicts to restore peace, then death by Euthanasia is a fulfilling end to life. Furthermore, a good death is described as one that is not supported by technological means, including life-saving medical equipment. In a general sense, a death can be defined as a good event for an individual who is suffering from illness or injury but is a tragedy for the living that were close to that person. Therefore, all deaths that take place after suffering can be considered good deaths under the appropriate circumstances. However, if these deaths are hurried by physicians or other individuals and do not take place naturally, then they are no longer good; in fact, they are intentional. Euthanasia strives to end the pain and suffering of individuals without a chance for a quality life, but this process is rarely a good event, particularly when the method interferes with the prospects of a peaceful death.

Father Cassem makes several valid points regarding the end of life. It is critical for the living and dying to settle all outstanding affairs so that when a person dies, the survivors are able to concentrate on remembering the person rather than possessions and financial matters.

Furthermore, by settling all personal conflicts before death, the dying person can leave the world in peace and the living will not possess any regrets regarding what might have been said or done. Finally, a dying person who is surrounded by friends and family before death is likely to die in peace, and the survivors will have a chance to say their goodbyes and prepare themselves for imminent death. Father Cassem states that "A good death is one in which the person was able to depart with the maximum acknowledgement of the importance and meaningfulness of their having been among us" (Stein 20). This perspective regarding death is not that unusual for many people to accept because making peace with the person is often the most beneficial aspect of a person's passing. In addition, if a dying person can leave the world with a sense of peace and fulfillment, then life was a gratifying experience. Cassem's argument is valid and useful to persons who may have difficulty accepting death and grieving. As a result, this viewpoint provides a sense of relief and tranquility to an otherwise heartbreaking event.

On the other hand, Cassem's philosophy regarding death does not discuss Euthanasia as the foundation of a good death. However, this concept does not consider the ways that death occurs; rather, it is primarily concerned with how the person spends the last moments of life.

Therefore, is the broadest sense, Euthanasia could also describe a good death, particularly when the dying person requests death in this way. It is entirely possible that a suffering person who has chosen to die at the hands of Euthanasia can achieve all of the priorities of a good death. However, since death should be natural, Euthanasia interferes with the possibility that a genuinely good death can take place.

James Rachels major argument in the article "Active and Passive Euthanasia" discusses the viewpoint that two types of Euthanasia exist that contribute to early death. According to Rachels (1), "The idea is that it is permissible, at least in some cases, to withhold treatment and allow a patient to die, but it is never permissible to take any direct action designed to kill the patient." A person that is allowed to die through by the withholding of treatment may suffer tremendously at the expense of the physician and their own personal choice. This form of passive Euthanasia can be construed as a form of negligence, regardless of whether or not the person chose this end, because in theory, letting a person die is no more ethical than intentionally causing death through murder. It can be argued that both methods are premeditated and both can be considered homicide, even though the circumstances are very different. According to Rachels (4), "It is not exactly correct to say that in passive Euthanasia the doctor does nothing, for he does do one thing that is very important: he lets the patient die."

In relation to the Cassem theory, it is likely that a person will not feel fulfilled at the end of life because the thought of suffering is not rewarding to a dying person. Furthermore, dying with a clean conscience is very different from dying while enduring pain and suffering, in contrast to the Cassem theory of good death. A person that dies a good death does not suffer and possesses a clean conscience at the end of life. In either case of active or passive Euthanasia, it is difficult to justify that a person will die a good death because according to Rachels, neither situation is in the best interests of the dying person, and as a result, death is hurried and may be painful.

Sidney Hook's piece entitled "In Defense of Voluntary Euthanasia" possesses a different viewpoint regarding the voluntary end of life. Mr. Hook experienced a stroke several years before this article was written. As a result, he possesses some minor disabilities and other restrictions that still permit him to perform his work. His personal understanding of the suffering that many people endure with the onset of devastating illness has provided him with a new perspective on Euthanasia: "I am mindful too of the burdens placed upon the community, with its rapidly diminishing resources, to provide the adequate and costly services necessary to sustain the lives of those whose days and nights are spent on mattress graves of pain. A better use could be made of these resources to increase the opportunities and qualities of life for the young. I am not denying the moral obligation the community has to look after its disabled and aged. There are times, however when an individual may find it pointless to insist on the fulfillment of a legal and moral right. What is required is no great revolution in morals but an enlargement of imagination and an intelligent evaluation of alternative uses of community resources" (6-7). Mr. Hook is mindful of the responsibility of family and friends to watch over the dying person and to make certain that the final days are made as pleasant as possible. However, it is nearly impossible for many to sustain any type of pleasure when their final days are plagued by suffering and pain. Mr. Hooks believes that under these circumstances, it is acceptable to consider a premature termination of life in order to end the suffering. Furthermore, Hooks' viewpoint is that to continue a person's life that is vulnerable to pain and misery is perhaps selfish, because it does not benefit the dying person at all; rather, it provides family and friends with extra time to prepare for the loss. It can be noted that a person who lingers at the expense of a mechanical device may not physically suffer, but the quality of life is poor and dishonorable to that person who likely lived a gratifying life. Finally, Hooks ends his article with the following premise: "Scientific medicine is not infallible, but it is the best we have. Should a rational person be willing to endure acute suffering merely on the chance that a miraculous cure might presently be at hand? Each one should be permitted to make his own choice - especially when no one else is harmed by it" (7). This final statement confirms the conclusion that Hook has drawn regarding the utilization of Euthanasia as a means of ending life. Mr. Hook argues that for a person that is suffering at the expense of a disease such as cancer, ending life through such measures is perhaps the most acceptable means of terminating life with a sense of dignity, as the person is beyond the stage where a miraculous treatment (if ever discovered) may prolong life.

Hook's perspective is in agreement with Cassem's theory of good death in that persons that choose to end their lives through measures involving Euthanasia may choose to do so because they believe that they have a chance to end their lives with dignity. In addition, they may be given the opportunity to make amends, finalize their affairs, and die in the presence of family and friends. However, in order for the end of life to be considered good, it is critical for the choice to be made by the dying person, not a physician or a family member. Furthermore, death by euthanasia may provide comfort to the survivors because they are aware that the person died at their choosing and they have been given the opportunity to say goodbye and make peace with that person, resulting in a good death.

Leon R. Kass' article entitled "Why Doctors must not Kill" begins with a series of questions, including the following: "Do you want your doctor licensed to kill? Do you want your doctor deciding, on the basis of his own private views, when you still deserve to live and when you now deserve to die? Speaking generally, shall the healing profession become also the euthanizing profession?" (7). These questions are harsh to the reader because most people would disagree with them, but these issues may be the wave of the future. The potential opportunity for doctors to obtain the right to perform Euthanasia in daily medical practice will result in the destruction of the patient-doctor relationship because all semblances of trust will disappear. Imagine if a male patient enters the hospital with a serious illness that his doctor believes is terminal. Upon review of test results, three possibilities exist: a surgical option, from which the patient has a 25% survival rate for three years, a combination of chemotherapy and radiation treatments that will increase survival for nine to twelve months, or taking no action at all, which will likely result in death within six months. A doctor that possesses the right to prematurely end life may not even offer the person the first two options; rather, he may weigh the options and believe that with the surgical option, the likelihood for survival is relatively slim, the recovery time is extensive, and the quality of life would be poor. A combination of chemotherapy and radiation treatment would result in many side effects and a poor quality of life. Finally, taking no action at all will result in a shorter life span, but this would provide the patient with an opportunity to settle affairs and come to terms with the idea that the end of life is near. Another possibility is that the doctor may offer the patient all three options but convince them that the third is the only alternative that is worth the risk. If a doctor possesses the freedom to influence his patients in such a way, it is likely that many patients will choose to end life prematurely by withholding treatment. If even a remote chance exists that a patient will be able to prolong life through treatment and that the remainder of life can be lived with dignity, then that option should be the doctor's primary concern. After all, doctors are in the business of healing, not killing or allowing death without treatment.

Physicians may consider the following defense if such actions occur: "Physicians get tired of treating patients who are hard to cure, who resist their best efforts, who are on their way down - 'gorks,' 'gomers,' and 'vegetables' are only some of the less than affectionate names they receive from the house officers. Won't it be tempting to think that death is the best 'treatment' for the little old lady 'dumped' again on the emergency room by the nearby nursing home?" (8). A current change in law proposes that doctors would assist only those who request such action be taken to encourage death. However, in many of these instances, the dying person is in no emotional or psychological condition to make a rational decision. According to Kass, "Often a demand for Euthanasia is, in fact, an angry or anxious plea for help, born of fear of rejection or abandonment, or made in ignorance of available alternatives that could alleviate pain and suffering" (8). If this is indeed the case, a doctor has no right to accept such a decision because the consequences may be difficult to bear: "The physician-euthanizer is a deadly self-contradiction" (11). Legalized Euthanasia interferes with the natural progression of death, and this is generally not acceptable.

Physicians are trained to take whatever means necessary in order to heal a patient. They must commit to a code of ethics and the following underlying moral principle exists: "The physician as physician serves only the sick. He does not serve the relatives or the hospital or the national debt inflated due to Medicare costs. Thus he will never sacrifice the well-being of the sick to the convenience or pocketbook or feelings of the relatives or society. Moreover, the physician serves the sick not because they have rights or wants or claims, but because they are sick. The healer works with and for those who need to be healed, in order to help make them whole" (10).

A physician that is practicing with high moral standards is committed to healing patients and if that is impossible, his job is to make them feel as comfortable as possible while they are under his care, particularly in the final days. As a result, persons that are cared for by physicians that possess these ethical principles will be given the opportunity to die a good death, as theorized by Cassem. Supporting this theory, Kass presents the following statement towards the end of his article: "The present crisis that leads some to press for active Euthanasia is really an opportunity to learn the limits of the medicalization of life and death and to recover an appreciation of living with an against mortality. It is an opportunity for physicians to recover an understanding that there remains a residual human wholeness - however precarious - that can be cared for even in the face of incurable and terminal illness" (13). This statement supports the idea that physicians must apply their code of moral principles and perform whatever tasks are necessary to ensure that patients who are suffering from terminal illnesses are cared for and are made comfortable so that they may die with dignity and peace, surrounded by family and friends.