Euthanasia as compassionate end-of-life care for the terminally ill

¶ … Euthanasia: The Good Death

"You matter because you are you.

You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die."

-Dame Cicely Saunders, founder of Hospice

The history of the euthanasia debate is long and the debate continues to be hotly contested across the globe. Indeed, as far back as 400 B.C., Hippocrates, the "father of medicine" and Greek physician, set forth the foundation from which the medical community would base its practice: "I will give no deadly medicine to any one if asked, nor suggest any such counsel" ("INFORMATION for RESEARCH on EUTHANASIA, PHYSICIAN-ASSISTED SUICIDE;" "NOVA, Doctors' Diaries"). Accordingly, our modern physicians take this oath upon which they vow that they will not provide deadly medicine nor deadly counsel. As such, the very notion of actually assisting someone to die becomes contrary to the oath by which a physician takes and has a duty to uphold. This paper recognizes the seemingly apparent contradiction, but seeks to take the analysis a step further. From the perspective that euthanasia is a peaceful act of compassion, by assisting in suicide, the physician is merely a vehicle by which the patient's wishes can be respected because even in time of terminal illness, as noted by the founder of Hospice, until the end, "you matter." Inherent in mattering is respecting one's wishes; inherent in compassion is empathy. The practice of medicine should not be so rigid so as to remove the patient's voice and the physician's sense of empathy since patients already deemed terminal should not have to endure incredible pain and, moreover, since the ultimate choice of how to live and/or die should not be taken away because the rights and wishes of the terminally ill do matter.

Euthanasia has many different definitions. Typically, the definition will vary according to the political stance one takes upon the issue itself. For instance, those who do not believe that medical professionals should be able to assist a patient in killing himself or herself state the definition as "the intentional killing by act or omission of a dependent human being for his or her alleged benefit" ("INFORMATION for RESEARCH on EUTHANASIA, PHYSICIAN-ASSISTED SUICIDE). In this definition, the point is made to define the action as "killing" and the patient as a "dependent" human being thereby providing the notion that the patient is weak and the doctor is in a position of superiority. For those whom see the utility and humanity of euthanasia, it is oftentimes defined as a "broad, generic term meaning 'help with a good death'" and physician-assisted suicide, which is oftentimes referred to as euthanasia, as when a medical doctor helps a patient to die by prescribing a lethal overdose. In the latter definition, the verb "help" is used providing a more humane connotation to the definition. For the purposes of this paper, semantics shall try to be placed aside and euthanasia is defined as the action of a physician assisting in the suicide of a patient (Humphrey). Furthermore, this paper shall be limited to defining patients as those individuals whom have already been diagnosed as "terminally ill."

Background of Controversy

Euthanasia has been deemed illegal for most of our modern day history. For instance, Supreme Court Justice William Rehnquist noted in Washington v. Glucksberg (1997) that "for over 700 years, the Anglo American common law tradition has punished or otherwise disapproved of both suicide and assisting suicide" (Washington v. Glucksberg). In addition to the law frowning upon physician-assisted suicide, the medical community is likewise. Specifically, the World Medical Association which includes eighty-two nations has adopted clear resolutions stating their disdain for the practice. In these resolutions condemning physician-assisted suicide, all national medical associations have been vehemently urged to refrain from participating in physician-assisted suicide even in situations where the law of that particular county allows and/or decriminalizes such practice of medicine (World Medical Association Policy). Accordingly, it is not surprising that today physician-assisted suicide is only legal in the Netherlands, Belgium, and the state of Oregon (Mahr). While euthanasia is illegal in most parts of the globe, according to World Values Surveys (2005), the general public typically supports a patient's right to decide whether or not to end his or her life ("Physician-Assisted Suicide: Public Opinion").

Arguments Against Euthanasia

Many individuals who oppose euthanasia believe that if it is legalized and/or not restricted or banned that it will lead to more people wanting to kill themselves. However, research done in areas which have allowed access to physician-assisted suicide reveals that such a contention is not supported by data. According to the October 2007 edition of the Journal of Medical Ethics, an analysis of physician assisted deaths in Oregon and the Netherlands reveals that the rates of assisted death were no higher than average in those groups whom people traditionally deem are vulnerable to being "coerced" into taking his/her life such as the impoverished, the elderly, and women. Actually, the only group who sought physician-suicide more frequently was that of white men, a group which traditionally is not thought of as being susceptible to coercion. A professor at UCLA's School of Medicine, Russel Korolbkin explains

that the people who take advantage of such laws (such as the 292 people who have done so in Oregon in the past 13 years) are well educated about their options; and, the option of physician-assisted suicide generally provides peace of mind as well as a sense of control to them in this critical and turbulent time (Mahr).

Additionally, as recently as 1997, the U.S. Supreme Court utilized historical notions of physician-assisted suicide as a crime and a moral wrong to support a modern day issue (William v. Glicksberg). If we were to fall back upon historical arguments, then our society would still outlaw intermarriage between whites and blacks and we would still have separate public facilities for whites and blacks. Sometimes history needs to be rewritten so as to comport with modern sensibilities. Today, we live in an era where the average life span has been increases as a result of modern technology; however, sometimes our lives our being prolonged (e.g. given more quantity) at the expense of quality of life. The founding fathers of our nation did not have such technological and ideological issues to debate. In fact, we did not even have penicillin until relatively recently in our history. In short, given that we have been able to live longer, we must understand that there may be times when the quantity of life should not be chosen over the quality of life. Both are equally important, but if there is no quality in one's life, what good is the quantity anyway?

A similar argument may be made against those whom believe that physician-assisted suicide is anti-thetical to Christian values. In fact, when the Bible was written, there was no penicillin to stop an infection and there was no such thing as a respirator or a feeding tube. In the modern era, we have extended the quantity of lives. Was this intended? Even assuming that the addition to life complies with biblical notions, how can we say that a physician's treatment of a terminal illness that ends the additional life is contrary to the life intended by God. Perhaps, God did not intend for us to have medical treatment which artificially sustains life and by artificially sustaining life, that is where the actual contradiction to the Bible occurs. Likewise, the ending of life would also contradict the normal life without medical intervention. Which one is more appropriate or less appropriate is up to the individual's sense of morality and definition of life and death.

Others contend that giving a patient a treatment which is lethal will deter and diminish the palliative care of the patient upon discharge and may lead to the physician just giving up on the patient ("Physicians for Compassionate Care" Pro-Con.org). Thus, the patient may spend his or her days prior to death without receipt of adequate medical care. Indeed, this is an issue to be treated just like any other issue of medical malpractice. The giving of a lethal prescription does not cease a physician's duty of care toward the patient; in fact, some scholars might say it enhances. However, we cannot base the medical care that we provide to patients based upon the fear of potential malpractice. To do so, would mean that doctors in other disciplines would also stop providing medical care for risk of the one or two doctors whom do not live up to his or her duty under the law.

Conclusion

As a result of the disparity between the medical community's opinion and the legal opinions of most courts across the globe which do not support the right to allow patients to partake in euthanasia and the general public's opinion that such a right should be recognized, this is a debate that is not going away. Indeed, as recently as a few months ago, a prominent British journalist was imprisoned for admitting his involvement with a friend's assisted suicide, and modern American audiences are looking forward to Al Pacino's portrayal of "Dr. Death" or Dr. Kevorkian in an upcoming film. It seems that perhaps with added media attention coupled with education of the general public regarding the facts behind euthanasia that the laws may evolve so as to reflect the wishes of the terminally ill. If we believe that humanity involves the quality of compassion or consideration for others and we believe that physicians should treat patients with humanity, then it seems logical that we must allow physicians to respect the wishes of the terminally ill to choose the course of their treatment. To do otherwise amounts to adding insult to these patients' already existing injury and to add suffering to their last days. Medicine should support the needs and the wants of the ill; and, above all, it should promote humanity as well as treat every patient with dignity and respect.