Right to Die Legal and Ethical Issues Concerning the Withdrawal Withholding of Treatment Term Paper

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Right to Die

For the last few decades, the issue of a person's right to choose the time and method of his or her own death has been one of passionate debate in the United States, with emotions running high on both sides of the controversy as the meanings of liberty and freedom of choice, the morality of taking one's own life, the ethics of people involved in such actions, and the laws related to this issue take center stage in the arguments.

Since civilization began, suicide has existed in one form or another, with varying degrees of acceptance, such as the ancient Greeks who held tribunals for elderly people who requested to die, and if approved, were given hemlock and during the first century B.C. actually held annual banquets where the elderly were allowed to attend and drink poison if they felt they had lived long enough.

Moreover, "traditional Oriental society viewed suicide as a dignified way of dealing with overwhelming problems, and Indian society believed in life after death and encouraged wives to kill themselves when their husbands died." However, St. Augustine condemned suicide because "it prevents repentance, it breaks the sixth commandment - thou shalt not kill, and it takes the life of one who had done nothing worthy of death."

Furthermore, during the Middle Ages, Europeans believed that suicide was caused by the devil and thus, the practice was taboo due to social and religious reasons and if one committed suicide, the body was 'buried profanely' and any property was given to the crown. Suicide was illegal in Ireland until 1993, and those who committed suicide could not be buried in hallowed ground and in early America, if one committed suicide, state governments confiscated the family property. Actually, religion was and still is the major factor concerning the issue of suicide and the right to die, sending the message that "God is the giver of life and only God can take that life away."

By the twentieth century, suicide was decriminalized in America, however, laws against assisting in a suicide remain in place and it is this "issue of a 'right to die' and the ability and legality of obtaining medical help for this action" that have been so passionately contested in the courts for nearly thirty years.

There are several terms associated with assisted suicide. The first term is called terminal sedation in which "the patient is sedated to unconsciousness, usually through ongoing administration of barbiturates or benzodiazepines," leaving the patient to die of "dehydration, starvation, or some other intervening complication as all life-sustaining interventions are withheld." With the second term, the patient voluntarily stops eating and drinking even though he or she is capable of taking nourishment, yet is allowed to die after choosing to discontinue nourishment. The third term is called voluntary active euthanasia in which a "physician provides the means and also physically helps the patient end his or her life." And the final term is physician-assisted suicide which is defined as the "physician providing the means for a patient to die, for example a large dose of barbiturates, but the patient ends his or her life without physical help." Although physician-assisted suicide is illegal in most states, studies in Washington and Oregon revealed that of the 12% of physicians responding to the survey who had received requests for physician-assisted suicide, 24% of those request were granted" and it is believed that the practice is much more prevalent.

The right to die has been an issue for centuries, however, it was not until the 1970's that the first legal challenges came before the American courts and since then, "over 200 judgments have been declared regarding medical intervention in the dying process."

The first case that drew national attention was that of Karen Ann Quinlan in 1976. In 1975, due to a combination of drugs and alcohol, Quinlan's heart and respiration stopped, yet was revived within the hour by paramedics, however, by that time she had lapsed into a profound coma and showed few outward signs of life. Her brain was permanently damaged from lack of oxygen during her cardiopulmonary arrest and her family was told by physicians that she would never recover, however, fearing a malpractice suit, the doctors refused to take her off the ventilator that was assisting her breathing. Her parents, Joseph and Julia Quinlan, petitioned a New Jersey court to have the ventilator turned off and in 1976 the court granted their request. Quinlan by this time had entered a persistent vegetative state and remained in PVS for another nine years, finally dying of massive infections in 1985.

In a similar case, Nancy Beth Cruzan was left in a persistent vegetative state with no sign of recovery following an automobile accident in 1983. Her life support system consisted of artificial feedings through a gastronomy tube and like the Quinlans, Cruzan's parents attempted to "terminate the life-support system based on statements Nancy had made before the accident that she would not want to live 'as a vegetable,' however, state hospital refused arguing they were bound to preserve human life. In 1989, Cruzan v. Director, Missouri Dept. Of Health was heard before the Supreme Court of the United States and in 1990, in a 6-3 decision the Court found:

that a person did have a liberty interest under the due process clause of the Fourteenth

Amendment to refuse medical treatment, provided they were competent and there was "clear and convincing" evidence the person did not want artificial support to keep them alive. Without this evidence a state obligation to preserve human life overrules the wishes of the patient or parents.

In this case, the Cruzans had no clear or convincing" evidence like "living will" to terminate the life support system."

Furthermore, the Court proclaimed "this is the first case in which we have been squarely presented with the issue of whether the United States Constitution grants what is in common parlance referred to as a right to die."

Other cases include the 1993 Busalacchi Case, that was dismissed by the Missouri Supreme Court after the election of Attorney General Jay Nixon who had promised to end the state's involvement, thereby allowing Peter Busalacchi to order the starvation and dehydration of his daughter on January 26, 1993 and she died less than three months later from cardiac arrest due to imposed dehydration.

When Dr. Jack Kevorkian helped Alzheimer's patient Janet Adkins commit suicide in 1990, criminal charges were brought against him and then later dropped because "Michigan law did not specify that facilitating a suicide is criminal." He then proceeded to assist twenty individuals commit suicide, "five of them after Michigan passed a ban on assisted suicide in February 1993," and in November 1993, he was jailed on murder charges. Circuit Judge Richard Kaufman ruled the Michigan law against assisted suicide was unconstitutional on December 13, 1993, however, one year later the Michigan State Supreme Court upheld the ban. Kevorkian appealed to the United States Supreme Court, but the Court rejected the appeal on April 24, 1995, and on March 26, 1999, after nine years and six trials, Kevorkian was "convicted of second-degree murder and sentenced to 10-25 years in prison for the death of Thomas Youk by lethal injection. He admitted to assisting in over 130 deaths.

In Washington v. Glucksberg, June 26, 1997:

the United States Supreme Court considered constitutional challenge to a Washington statute that criminalized acts of deliberate assistance of another in committing suicide. The Court ruled that an asserted right to physician-assisted suicide was not a fundamental liberty interest protected by the Fourteenth Amendment of the United States

Constitution. Chief Justice Rehnquist, writing for the Court, concluded the influential decision with strong statement: 'the opinion should not restrict the continuation of the open debate in our society about all aspects of physician-assisted suicide.'"

In November 2003, a Florida judge named Jay Wolfson as Terri Schiavo's guardian, and to independently investigate her case and recommend whether Governor Bush should lift the stay he enacted to keep her alive after a court ruled her feeding tube removed.

Schiavo has been in a persistent vegetative state since she suffered severe brain damage in 1990 when her heart stopped due to a chemical imbalance/heart attack. Her husband, Michael, has fought to have her feeding tube removed claiming his wife never wanted to be kept alive artificially, however, her parents, Bob and Mary Schindler, dispute the claim and say she can be rehabilitated. Her feeding tube was removed for six days in October "before the Florida Legislature gave the governor the authority to intervene," and required the appointment of a guardian. Wolfson will report to the Governor Bush in thirty days as to whether there is any value in giving Schiavo tests to see if she can be rehabilitated.

In 1999, Proposal B. was defeated in Michigan, where public opinion was said to favor assisted suicide, by more than a two-to-one margin. In 1994, Oregon voted 51% to 49% to legalize assisted…

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