Why Euthanasia Should Be Legal

¶ … Euthanasia Should Be Illegal

Euthanasia is the act of putting to death painlessly or allowing death, as by withholding extreme medical measures, a person or animal suffering from an incurable, often painful, disease or condition (Euthanasia, Infoplease.com). Today, medical advances have made it possible to prolong life in patients with no hope of recovery, and the term negative euthanasia has arisen to classify the practice of withholding or withdrawing extraordinary means (e.g., intravenous feeding, respirators, and artificial kidney machines) to preserve life. Positive euthanasia, on the other hand, has come to refer to actions that actively cause death such as administering a lethal drug.

Much debate has arisen in the United States among physicians, religious leaders, lawyers, and the general public over euthanasia (Euthanasia, Infoplease.com). Pro-euthanasia societies were founded in 1935 in England and 1938 in the United States. The Hemlock Society is one group that has pressed for right-to-die legislation on a national level. Positive euthanasia is for the most part illegal in the United States, but physicians may lawfully refuse to prolong life when there is extreme suffering. In the early 1990s, Dr. Jack Kevorkian gained notoriety by assisting a number of people to commit suicide and became the object of a 1992 state law forbidding such activity. Kevorkian, who had been tried and acquitted repeatedly in the assisted deaths of seriously ill people, was convicted of murder in Michigan in 1999 for an assisted suicide shown on national television. In 1997, the Supreme Court upheld state laws banning assisted suicide.

Unfortunately, in 1994, Oregon voters approved physician-assisted suicide for terminally ill patients; the law went into effect in 1997 (Euthanasia, Infoplease.com. In 2001 the Bush administration tried to undermine the law with a directive issued under the federal Controlled Substances Act, but Oregon successfully sued to prohibit the enforcement of it. In 1993, the Netherlands decriminalized, under a set of restricted conditions, voluntary positive euthanasia (essentially, physician-assisted suicide) for the terminally ill, and in 2002 the country legalized physician-assisted suicide if voluntarily requested by seriously ill patients who face ongoing suffering. In 2002, Belgium also legalized euthanasia for certain patients who have requested it.

Growing acceptance of positive euthanasia represents a disturbing trend in medical and social ethics. Those who support the practice of active euthanasia argue that:

Helping the terminally ill to bring about their own deaths, allowing them to determine the how and when, is not only humane, but also allows the person, who is simply "living to die," to maintain dignity by orchestrating their own end, thus letting them die at peace, rather than suffer to the end, perceiving themselves to be a burden and/or disgrace, to those they love." (Active Euthenasia - A Kantian Perspective)

However, this paper will present a strong case for why intentional killing of another person is wrong. It will demonstrate that a profit-driven health care system is really transferring control from patients to the medical profession to save money or possibly others that place their own interests before the best interests of the patient. Rather than pursue adequate training about how to take care of terminally ill patients, it's more cost effective to take advantage of these depressed individuals who have been made to feel that they are wasteful consumers of medical services. As usual, the majority of victims will be the financially disadvantaged and minorities. Once euthanasia becomes accepted, society is well on a slippery slope for preferring cheap lethal medications over more expensive quality health care. The only option that will prevent the victimization of the terminally ill by greedy health care institutions is to keep euthanasia illegal and to continue to fight the legality of physician-assisted suicide in Oregon.

2.0 The Case Against Euthanasia

Fortunately, the American Medical Association (AMA) has not endorsed euthanasia in recognition of the conflict of interest between a physician's responsibility to save lives and participation in euthanasia. In testimony before a congressional committee on April 29, 1996, Dr. Lonnie R. Bristow, president of the AMA, made the following statement (Kennedy, 1996):

The AMA believes that physician-assisted suicide is unethical and fundamentally inconsistent with the pledge physicians make to devote themselves to healing and to life. Laws that sanction physician-assisted suicide undermine the foundation of the patient-physician relationship that is grounded in the patient's trust that the physician is working wholeheartedly for the patient's health and welfare."

Bristow also stated that "No other country in the world, including the Netherlands, has legalized assisted suicide or euthanasia. This is one movement in which the United States should not be a 'leader.'"

The Hippocratic Oath was formulated in 400 B.C. By Hippocrates because he believed that the doctor was a powerful man who could decide on life or death (Gunning). As the patient could not know whether a white powder was meant to kill or cure him, he had to simply trust his doctor. That is why Hippocrates made doctors swear that they would never use their knowledge and experience to kill, before or after birth; not even at the patient's own request. In this humanitarian ethic, the well being of the individual is central. Today, euthanasia advocates are asking doctors and patients to accept a new utilitarian ethic where the well being of others prevails over the well being of the patient (Gunning). The doctor judges the quality and the sense of a patient's life whether he is a burden or useful to society, etc. In the past, medical ethics had been based on the notion that all men's lives had equal value. But now, utilitarianism maintains that this can no longer be maintained as over population makes it impossible to accept every quality of life. Choices would now have to be made on the basis of medical evaluation. During World War II, euthanasia was considered to be a solution for over 100,000 German patients who were killed as unwanted by doctors under Nazi Germany. Many people think that legalizing euthanasia will make them autonomous. But, in fact, it is the doctor who is made free to do as he thinks right. In the end, it is not the patient, but the doctor who decides when life should be ended.

Physicians should lavishly dispense compassion, time, and understanding; but physicians should never dispense death. Killing, even in the name of compassion and mercy, is wrong. Section 14 of the Criminal Code maintains that no person is entitled to consent to have death inflicted on him, and such consent does not affect the criminal responsibility of any person by whom death may be inflicted on the person by whom consent is given. "To create a new law that would sanction mercy killing; and grant impunity to the person(s) who takes a life, whether or not the person is competent, non-competent and/or disabled for reasons of suffering would be to cross the Rubicon and consummate a partnership with a statute that would undermine the constitutional right of all individuals to security and protection." (Eckstein, 1995).

Some argue that the euthanasia required as a last resort, when the individual can no longer manage the pain of their illness. However, pain should never justify euthanasia considering the advanced medical techniques currently available to manage pain in almost every circumstance. The real problem is that there are fundamental physician-related barriers to appropriate, humane, and compassionate care for the dying. According to research by Foley (1997), physicians are inadequately trained to assess and manage the multi-factorial symptoms commonly associated with patients' requests for physician-assisted suicide. Only five out of 126 medical schools in the United States require a separate course in the care of the dying. And, of 7048 residency programs, only twenty-six percent offer a course on the medical and legal aspects of care at the end of life as a regular part of the curriculum and fifteen percent of the programs offer not formal training in terminal care. Each resident or fellow coordinates the care of ten or fewer dying patients annually.

In a survey of fifty-five residency programs and over 1400 residents conducted by the American Board of Internal Medicine, the residents were asked to rate their perception of adequate training in care at the end of life (Foley, 1997). Seventy-two percent reported that they had received adequate training in managing pain and other symptoms. Sixty-two percent said they had received adequate training in telling patients that they are dying; thirty-eight percent in describing what the process will be like; and thirty-two percent in talking to patients who request assistance in dying or a hastened death. So, it's not surprising that terminally ill patients don't have access to the quality of care that they need to cope with their illness.

The objective should be to better educate healthcare professionals instead of promoting euthanasia.

Research Bopp and Coleson (Oregon Right to Life) shows that a major reason people seek euthanasia is because they are suffering from depressive illness or some other emotional or psychiatric problem that prevents them from making rational decisions.

For example:

In one study of terminally ill patients, of those who expressed a wish to die, all met diagnostic criteria for major depression. Like other suicidal individuals, patients who desire suicide or an early death during a terminal illness are usually suffering from a treatable mental illness, most commonly depression."

Depression coincides with medical conditions for several reasons (Bopp and Coleson, Oregon Right to Life):

The medical condition may biologically cause depression.

The medical condition may trigger depression in patients who are genetically predisposed to depression.

The presence of illness or disease can psychologically cause depression, as is often observed in patients with cancer.

Some treatments or medications have side effects that cause depressive moods or symptoms, especially those involving cancer.

Few terminally ill patients wish to commit suicide unless they have depressive illness as well.

Despite the danger and pervasiveness of depression in terminally ill patients, it is seldom diagnosed (Bopp and Coleson, Oregon Right to Life). Many physicians are not competent to accurately assess depression, especially in complex cases such as patients who are terminally ill. Even psychologists and psychiatrists who routinely treat and diagnose depression may have limited experience doing so for patients who are terminally or chronically ill. And, even when depression is diagnosed, it is often under treated. As a result, terminally ill persons with undiagnosed and/or under treated depression are at risk for seeking suicide.

Many consider suicide primarily because they are pressured into seeing themselves as burdens on their families or society. A Boston Globe survey discovered that the main reason people said they would consider some option to end their lives if they had an incurable and significantly painful illness was because they don't want to be a burden to their families (Balch and O'Steen). And, family members who support the suicide of a terminally ill patient often unwittingly reinforce the notion that the ill family member's life has lost all meaning and value and is nothing but a burden. Regrettably, in an era of concern over escalating medical costs, "unproductive" consumers of medical services are increasingly made to see themselves as drains on society and the economy rather than an individual worthy of good health care.

In addition to medical issues, the euthanasia debate also raises many ethical issues that call to question the morality of euthanasia, particularly when a person other than the terminally ill patient is to make the decision. For example, Active Euthenasia - A Kantian Perspective poses the following queries that give one pause when considering legalization of euthanasia:

For whose benefit is the euthanasia actually taking place?

Ought we allow family members to make a life-or-death decision on behalf of a loved one who may never have expressed a desire to die, simply because they could not vocalize a will to live?

If a person should be suffering with an illness of which there seems no hope of recovery, yet they are unable to make a choice for themselves how do we know what that person would voluntarily choose?

Is it our right to decide whether or not they have a desire to live?

Without knowing for sure what the individual would have chosen, a person is playing God. By doing, the person may well have gone against their will, and thus have committed murder.

The case of Terri Schiavo clearly indicates the possibility for conflict of interest between the terminally ill patient and those acting in the person's behalf (Chastain, 2003).

In 1990, Terri Schiavo collapsed and suffered brain damage. Her husband, Michael Schiavo, became her guardian. He filed a malpractice lawsuit against the doctors who attended her and won $1.3 million which was placed in a trust fund for her care and rehabilitation. But, instead of allocating the money to Terri's rehabilitation, her husband hired a right-to-die advocate as his lawyer and began petitioning the courts to have her feeding tube removed, which would kill her.

Michael Schiavo would inherit any money left in Terri's trust and is living with another woman with whom he has a child and plans to marry once Terri dies.

It doesn't appear that Schiavo is in the best position to do what's best for Terri.

While euthanasia supports claim that it offers a choice to people who want it, it has huge potential to victimize minorities and poor people. "Choice" is an appealing word, but inequity in health care is a well documented reality. "If policies or laws permitting assisted suicide are approved, assisted suicide could become the only type of "medical treatment" to which certain people -- those who are members of minority groups, those who are poor, or those who have disabilities -- would have equal access." (Inequities in Health Care for Minorities and the Poor) So, the last to receive health care could very well be the first to receive assisted suicide.

Contrary to popular believe, euthanasia doesn't ensure that patients can die peacefully surrounded by their families and doctors (Marker and Hamlon). In Oregon, troubling events are raising doubts about this myth such as the following incident:

After he took it [the drug overdose], he began to have some physical symptoms.

The symptoms were hard for his wife to handle. Well, she [the wife] called 911. The guy ended up being taken by 911 to a local Portland hospital. Revived. In the middle of it. And taken to a local nursing facility. I don't know if he went back home. He died shortly -- some period of time after that time." (Marker and Hamlon).

During the campaign to legalize euthanasia in Australia, supporters painted pictures of a calm, peaceful death with the patient surrounded by loved ones (Market and Hamlon). Yet, draft guidelines for its implementation recommended that family members should be warned that they may wish to leave the room when the patient is being killed since the death may be very unpleasant to observe. For instance, lethal injections often cause violent convulsions and muscle spasms.

Finally, if society legalized euthanasia then what's next? Once voluntary euthanasia for sick adults becomes common practice, acceptance for of euthanizing elderly, uninsured, or physically handicapped people could easily follow suit. Advocates of euthanasia such as Egendorf (1998) states that if "one believes that the legalization of euthanasia is the beginning of the slippery slope in killing off our burdensome,...you have no faith in the goodness of human nature or the ability of the American democratic system to protect the weak." Egendorf (1998) also believes that guidelines such as waiting periods, doctor's confirmation etc., will protect patients and increase physician accountability. However, "Any society that loses its belief that life is sacred and that only God can decide when to give or take a life has taken a risky step down the road to totalitarianism. In time, life in such a culture will become meaningless, and death will be incredibly cheap." (Kennedy, 1996).