Right to die: ethical and legal perspectives

¶ … right to die. The writer uses analytical skills to dissect and argue several right to die cases that have been presented in court in America. The writer discusses the ethics of the practice as well as presents ideas about the future "right to die" arguments and cases. There were eight sources used to complete this paper.

Through the advances of medical science people are living longer than ever before. Those who are chronically ill are being helped in the quest to alleviate symptoms and those who might have become ill in the past are being cured. The medical science advances have also allowed those who would have died in the past from head injuries, car crashes, gun shots wounds and other accidents to live. All of the advances that have been made have worked in favor for millions of people who otherwise would have died. The advances are also providing an improved quality of life for those who experience medical success, but what about those who do not? One of the risks that come with the ability to lengthen life and save those who otherwise would have died is that there are some who are being held in a sort of neutral zone between life and death. In addition there are patients who are diagnosed with terminal illnesses and the advances of the medical community cause them to suffer much longer than they would have in the past.

This has brought a focus on the right to die.

The right to die is not a new issue. It has been debated for many years in the courtrooms of America. The right to die debate focuses on a patient's right to decide their life should end. It is also when a family of a vegetative patient asks for permission to let their loved one die. As the medical community becomes even more advance it will become important to decide the right to die issues. The ability to live longer is a benefit to those who have an acceptable standard of living in the process. But there are many patients who will suffer needlessly and for longer periods because of the advances of medicine.

Those are the patients who are caught in the web of the right to die argument. Advocates of the right to die argument believe that each person should have a right to end their suffering, while detractors believe it is a slippery slope and once started will not end. Each side believes they are right and only the continued focus on a standard protocol will be able to solve the problem.

What has happened thus far?

When it comes to the issue of right to die there are very few who remain neutral. Most people are either strongly it or strongly against it. Those who are against it believe that it is a slipper slope. Before one can decide where they stand on the issue, it is important to first understand what it is about.

The right to die issue is founded in the argument of whether or not a person should have the right to choose to die. This has been a debate for many years but in more recent years there has been a lot of publicity on it because of people like Dr. Jack Kevorkian who assisted patients in their own suicide until he was sent to prison when he crossed a line and actually committed murder instead of letting a patient commit a supervised self death. Right to die issues includes several ways of accomplishing the right.

It can be as simple as unplugging a feeding machine and allowing a patient to either self sustain or die, and it can be as complicated as showing a patient how to commit suicide, supplying the ways and means and watching them do it. It can include knowing a patient is going to kill themselves and doing nothing to try and stop them. There are several ways the right to die issue has been argued and tried throughout the years with each debate escalating in intensity.

Karen Ann Quinlan collapsed on April 15th, 1975. She was twenty-one years old. Within hours, she entered a coma from which she could never recover. Her parents, staunch Roman Catholics, knew their daughter would not want to be kept alive by extraordinary means. A year later, as Karen lay in a "persistent vegetative state," the courts finally allowed her treatment to be stopped; but artificial feeding was continued and she was maintained as a living corpse until June 1985, when she eventually died of pneumonia. Her case spurred thousands of letters of sympathy and fuelled the "right to die" movement (Cases in history (http://www.euthanasia.org/cases.html)."

Physician-assisted suicide is one of the ways that the right to die groups believe it should be allowed to occur.

According to those who advocate the right to die are quick to point out it is not really a right to die that is being questioned but a right to refuse medical treatment. This was the case until recent years when physician-assisted suicide became an issue (Physician-Assisted Suicide: The Legal Slippery Slope from Cancer Control: Journal of the Moffitt Cancer Center (http://www.medscape.com/viewarticle/409026_7).

The so-called "right to die" is actually a right to refuse unwanted medical treatment. In a long series of right-to-die cases, courts have often found that a person's right to refuse medical treatment is not lost even when that person has lost the capacity to exercise the right. This finding, coupled with a strong desire to preserve personal rights, has led courts to find ways for incapacitated persons to be free of unwanted life-sustaining medical interventions.

The view of the courts is that basic rights, such as the right to self-determination, apply to persons per se and thus are not contingent on their capacity to exercise them. In Quinlan, [6] the New Jersey Supreme Court held that Quinlan's right to choose or refuse mechanical ventilation "should not be discarded solely on the basis that her condition prevents her conscious exercise of the choice." In Saikewicz, [35] which involved an adult with mental incapacity, the Massachusetts Supreme Court wrote," We recognize a general right in all persons to refuse medical treatment in appropriate circumstances. The recognition of that right must extend to the case of an incompetent, as well as a competent, patient because the value of human dignity extends to both." Clearly, then, one of the tenets of right-to-die reasoning is that incompetent persons have the same right to refuse medical treatment that competent persons have (Physician-Assisted Suicide: The Legal Slippery Slope from Cancer Control: Journal of the Moffitt Cancer Center (http://www.medscape.com/viewarticle/409026_7)."

One of the first and most famous cases in the right to die debate was the case of Karen Quinlan. Quinlan slipped into a coma and was pronounced in a permanent vegetative state. For many years she was kept alive by tubes and machines though her brain was not showing activity and her body could not fend for itself even in the most simple of tasks such as eating or breathing. Her family wanted her suffering to end not to mention that the financial burden was almost never ending for a person who was never going to recover or improve. The family took the caregivers to court to get the court to give them the right to unplug her feeding tube and allow her to die a natural death. They were refused. It was the first such case in the courts in the nation in recorded history and it received worldwide media attention (Physician-Assisted Suicide: The Legal Slippery Slope from Cancer Control: Journal of the Moffitt Cancer Center (http://www.medscape.com/viewarticle/409026_7).

The court sided with the family when it ruled: "Our affirmation of Quinlan's independent right of choice, however, would ordinarily be based upon her competency to assert it. The sad truth, however, is that she is grossly incompetent (Physician-Assisted Suicide: The Legal Slippery Slope from Cancer Control: Journal of the Moffitt Cancer Center (http://www.medscape.com/viewarticle/409026_7)."

Her case was not the only one to come before the United States judicial system however.

There were other cases including the case of Bludworth vs. The hospital the patient was being kept alive by machines in. In that case the court again believed that the patient had a right to refuse medical treatment even if they are unable to verbalize it at the time of question. "This right of terminally ill patients should not be lost when they suffer irreversible brain damage, become comatose, and are no longer able to personally express their wishes to discontinue the use of extraordinary artificial support systems (Physician-Assisted Suicide: The Legal Slippery Slope from Cancer Control: Journal of the Moffitt Cancer Center (http://www.medscape.com/viewarticle/409026_7)."

Once the person has become irreversibly comatose the court is left trying to decide if the family has the right to allow the loved one to die. In the case of Karen Quinlan the court decided the family could make the decision on behalf of the patient though it has not always been ruled in favor of the family in later cases. "In Quinlan, the court wrote, "The only practical way to prevent destruction of the right is to permit the guardian and family of Quinlan to render their best judgment." They concluded that, "Quinlan's right of privacy may be asserted on her behalf by her guardian." [6] In Bludworth, the Florida Supreme Court stated that,"The primary concern of these cases is that this valuable right should not be lost because the noncognitive and vegetative condition of the patient prevents a conscious exercise of the choice to refuse further extraordinary treatment." In order to "ensure this right,"the court held that" the right of a patient, who is in an irreversibly comatose and essentially vegetative state to refuse extraordinary life-sustaining measures, may be exercised either by his or her close family members or by a guardian of the person of the patient appointed by the court (Physician-Assisted Suicide: The Legal Slippery Slope from Cancer Control: Journal of the Moffitt Cancer Center (http://www.medscape.com/viewarticle/409026_7)."

The basis for such decisions are founded in the following beliefs held by the court at the time of the ruling:

If a competent person has a basic personal right, then so does an incompetent person, incompetent persons lack the ability to exercise their rights, rights that cannot be exercised are extinguished, rights must be preserved, not extinguished, and to prevent rights from being extinguished, another person must exercise the incompetent person's right on his or her behalf (Physician-Assisted Suicide: The Legal Slippery Slope from Cancer Control: Journal of the Moffitt Cancer Center (http://www.medscape.com/viewarticle/409026_7)

When the patient has expressed previous wishes to have the right to die the case is much easier to decide. When a patient has no previous directive in place it is more complicated as the courts try and decide what the patient would want if they could speak and make the choice.

In England it has also been a heated debate that was triggered following a decision a patient's doctors made."1992 Dr. Cox openly defied the law and assented to 70-year-old Mrs. Boyes' persistent request for voluntary active euthanasia. Mrs. Boyes' was so ill that she "screamed like a dog" if anyone touched her. Conventional medicine did not relieve her agony. In her last days, when she repeatedly requested to die, Dr. Cox finally gave her an injection of potassium chloride, bestowing on her the boon of a peaceful death so many of us feel we are entitled to. Dr. Cox, although given a suspended sentence, was hauled through the courts like a common criminal (Cases in history (http://www.euthanasia.org/cases.html)."

The family stood behind the doctor and was grateful that their loved one no longer suffered. It is cases such as these, and the case of Quinlan that mandate an agreed upon standard be reached when it comes to the right to die (Cases in history (http://www.euthanasia.org/cases.html).

When it comes to a coma patient who has lain in a hospital for years there are not as many arguments about what should be done but a patient who has been diagnosed with a terminal illness and wants to die to avoid the suffering the debates get very heated.

Sue Rodriguez, a mother in her early thirties, died slowly of Lou Gehrig's disease. She lived for several years with the knowledge that her muscles would, one by one, waste away until the day came when, fully conscious, she would choke to death. She begged the Courts to reassure her that a doctor would be allowed to assist her in choosing the moment of death. They refused. She lived on in terror, helped eventually by a doctor who, in February 1994, covertly broke the law to help her die in peace. A law on assisted suicide with rigorous safeguards could have saved her the nightmare during those months before her death, given her the confidence to carry on - with the reassurance that when it got too bad she could rely on a compassionate doctor to follow her wishes at the end (Cases in history (http://www.euthanasia.org/cases.html)."

It is cases such as these that have promoted nation and world wide debates as well as sparked the advent of various organizations such as Exit. Exit is an organization that was developed for the purpose of supporting people who believe in the right to die.

There have been cases in which a person has all of their mental capacities with them and they still wish to die. These are the cases that a right to die argument divides most strongly about. The right to die in a vegetative state is not usually argued at this point in history. Those who are terminally ill are still battling to get the right to die, and there have been many media and television shows focused on such patients. The outside perimeter of supported patients includes the patients who are not dying, are not in a coma but want to be able to choose to die.

Patients such as Ramon Sanpedro have worked their way through the court system for the right to die and in that quest have opened the doors for others to follow in their path (Cases in history (http://www.euthanasia.org/cases.html).Each time a case comes before a court, whether they win or lose, they loosen the restraints that came before them thereby making the path a little less crooked for the next hiker.

Ramon Sanpedro sought, through the courts, the assistance of a doctor to help him die with dignity. He was paralysed in Spain as a result of a swimming accident during his youth. He described himself as "a head attached to a corpse." He wrote: "Why die? Because every journey has its departure time and only the traveller has the privilege and the right to choose the last day to get out. Why to die? Because at times the journey of no return is the best path that reason can show us out of love and respect for life, so that life may have a dignified death (Cases in history (http://www.euthanasia.org/cases.html)."

Ramon Sanpedro made no suggestion as to what the wishes of others in a similar physical condition might be. In fact, some people who are so paralysed take enjoyment in life and want to go on living. Their choice should be respected and they should be given every support. But Ramon Sanpedro made his choice and choice should be respected (Cases in history (http://www.euthanasia.org/cases.html)."

The topic is a heated one in America as well. There are many who have become terminally ill, or permanently and totally disabled who do not wish to wait out the suffering that will occur if they cannot choose to die. The drain on their family financially is a consideration as is the amount of suffering their families will watch them go through otherwise.

The first U.S. Supreme Court Case in the right to die was the case of Nancy Cruzan who was in an accident and was in a coma for years. She reacted to pain and noise but her brain would never function again in the capacity that would allow any hope of a standard of living. "They said that Missouri had "arrogated to itself" the power to define life, and Nancy Cruzan's life and liberty consequently put into disquieting conflict. She had not made a living will, and the court case paved the way for a uniform, national Patient Self- Determination Act that regulated living wills and made them more widely available (Cases in history (http://www.euthanasia.org/cases.html)."

When it comes to cases such as these it is easy to argue that there is no life, will never again be a life and can never be a hope of a life. Though there are people who believe it is God's will to decide the time of death who will fight each and every right to die case the cases such as these at least have some measure of strength about them. The division becomes much wider when it comes to the right to die by terminally ill patients who are actively living and functioning at the time of their decision.

Those who are against right to die legislation being passed believe that patients such as these will be on a slippery slope that does not end. Guilt over the financial burden they have become to their family as well as the natural depression that a terminally ill patient often faces can influence their decisions in right to die questions according to those who are against it. Depression can be treated and self murder to save their family money is still murder according to the detractors of the right.

The concerned believe that the right to die, if allowed, will change into the right to kill to make it easier for those around the patient.

Robert Wendland should die so that his family can "be allowed to live their lives," Dr. Ronald Cranford, a Minnesota neurologist and bioethicist, testified recently in the Stockton courtroom of Superior Court Judge Bob McNatt. The chosen method of death? Intentional dehydration and starvation. What has Wendland, 45, done to deserve such a fate (CAN A "RIGHT TO DIE" BE TURNED INTO A FORCED FATE? By Wesley Smith (http://www.prolifeinfo.org/fact002.html)?He went into a coma in September 1993 from injuries sustained in an automobile accident. Sixteen months later, he awakened from the coma, paralyzed on one side and unable to walk, talk or swallow well enough to eat. He is physically and cognitively disabled and dependent on others for his care. He is not terminally ill. He is not hooked up to machines. He does require a feeding tube to sustain his life (CAN A "RIGHT TO DIE" BE TURNED INTO A FORCED FATE? By Wesley Smith (http://www.prolifeinfo.org/fact002.html)." Those who want to end his life believe his standard of living will never improve. Those who want to fight his death accuse the family and the attorneys of downplaying the patient's cognitive and physical abilities though impaired.

Courts have waffled on the issue. At times it supports the method of dearth while at other times it deems it cruel.

Those who support right to die choices believe if the legislation were passed to make the right to die legal then extremely humane methods would move to the forefront and suffering would no longer be an issue. The right to die physician of recent history was Dr. Jack Kevorkian. He assisted patients who were terminally ill by setting them up with a lethal injection and they pushed the button to release the meds when the moment came to die. This allows the patients to set their affairs in order, say goodbye to their loved ones and have a say so in the planning of their services after they died.

Those who are against the effort to pass right to die laws point to cases such as this to argue against it. The argue that Wendland has improved since coming out of his coma and to allow him to die would be murder. He has learned to do the following: