Why Euthanasia Should Remain Illegal: Key Arguments

Introduction: Defining Euthanasia and Its Legal Landscape

Euthanasia is the act of putting to death painlessly, or allowing to die by withholding extreme medical measures, a person or animal suffering from an incurable, often painful, disease or condition. 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 — such as intravenous feeding, respirators, and artificial kidney machines — to preserve life. Positive euthanasia, on the other hand, refers 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. Pro-euthanasia societies were founded in 1935 in England and in 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. 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 its enforcement. 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 to those they love.

However, this paper presents a strong case for why the intentional killing of another person is wrong. It demonstrates that a profit-driven health care system is effectively transferring control from patients to the medical profession in order to save money — or to serve the interests of those who place their own interests before the best interests of the patient. Rather than pursue adequate training in how to care for terminally ill patients, it is more cost-effective to take advantage of 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 toward preferring cheap lethal medications over more expensive, quality health care. The only option that will prevent the victimization of the terminally ill by profit-driven health care institutions is to keep euthanasia illegal and to continue fighting the legality of physician-assisted suicide in Oregon.

The Case Against Euthanasia

Fortunately, the American Medical Association (AMA) has not endorsed euthanasia, recognizing 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.'"

Physician Ethics and the Hippocratic Tradition

The Hippocratic Oath was formulated around 400 B.C. by Hippocrates, who believed that a doctor was a powerful figure who could decide on matters of life or death (Gunning). Because a 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, and 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 in which the well-being of others prevails over the well-being of the patient (Gunning). The doctor judges the quality and meaning of a patient's life — whether the patient is a burden or useful to society. In the past, medical ethics had been based on the notion that all human lives had equal value. Utilitarianism, however, maintains that this can no longer be sustained, as overpopulation 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 a solution for over 100,000 German patients who were killed as "unwanted" by doctors under the Nazi regime. Many people think that legalizing euthanasia will make patients more autonomous. But in fact, it is the doctor who is made free to act 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 upon them, and such consent does not affect the criminal responsibility of any person who inflicts that death. "To create a new law that would sanction mercy killing and grant impunity to the person or persons who take a life — whether or not the person is competent, non-competent, 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).

Depression, Coercion, and Inadequate Medical Training

Some argue that euthanasia is required as a last resort when an individual can no longer manage the pain of their illness. However, pain should never justify euthanasia given 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 multifactorial 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. Of 7,048 residency programs, only twenty-six percent offer a course on the medical and legal aspects of end-of-life care as a regular part of the curriculum, and fifteen percent offer no formal training in terminal care at all. Each resident or fellow coordinates the care of ten or fewer dying patients annually.

In a survey of fifty-five residency programs and over 1,400 residents conducted by the American Board of Internal Medicine, residents were asked to rate their perception of the adequacy of their training in end-of-life care (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 only thirty-two percent in talking to patients who request assistance in dying or a hastened death. It is not surprising, then, that terminally ill patients often lack access to the quality of care they need to cope with their illness. The objective should be to better educate healthcare professionals rather than promote euthanasia.

Research by Bopp and Coleson (Oregon Right to Life) shows that a major reason people seek euthanasia is that they are suffering from depressive illness or some other emotional or psychiatric problem that prevents them from making rational decisions. In one study of terminally ill patients, all of those who expressed a wish to die met the diagnostic criteria for major depression. Like other suicidal individuals, patients who desire 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 it. 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 used in cancer treatment. Few terminally ill patients wish to commit suicide unless they also have a depressive illness.

Despite the danger and prevalence 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 with terminally or chronically ill patients. And even when depression is diagnosed, it is often undertreated. As a result, terminally ill persons with undiagnosed or undertreated depression are at significant risk for seeking suicide.

Many patients 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 an option to end their lives — if they had an incurable and significantly painful illness — was that they did not want to be a burden to their families (Balch and O'Steen). 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. 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 as individuals worthy of good health care.

In addition to medical issues, the euthanasia debate raises many ethical questions about the morality of euthanasia, particularly when a person other than the terminally ill patient is to make the decision. Key questions that give pause when considering legalization include: 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 is suffering from an illness with no apparent hope of recovery, yet is unable to make a choice for themselves, how can 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 certain what the individual would have chosen, a person making that decision is playing God — and may well have gone against the patient's will, thus committing what amounts to murder.

Conclusion

Our profit-driven health care system has become so focused on cost reduction that it is now promoting the notion that some people simply are not worth the effort to protect or rehabilitate. Rather than stating this directly and risking public outrage, proponents have sold the idea under the banner of individual autonomy over one's own health care. This could not be farther from the truth. While patients may voluntarily request euthanasia, they are often doing so in a depressed state and under conditions where they have been made to feel like a financial burden to their families. The Hippocratic Oath — once the moral foundation guiding conduct in the medical profession — is being replaced by a utilitarian notion that health care must be rationed based on the doctor's medical evaluation. Criminal law and the protection of human rights under the United States Constitution are being set aside, leaving patients without adequate protection of their best interests. Slowly but surely, it is becoming accepted to dispense death rather than adequate care for the terminally ill, particularly for the financially disadvantaged and minorities who already receive inferior health care.

The only protection patients have from the profit-driven health care system is to keep euthanasia illegal and to fight laws in Oregon that have approved physician-assisted suicide. Training for the treatment of the terminally ill should be a major priority for the medical profession, given our aging population. Pain can and should be managed in a way that allows terminally ill patients to cope with their condition. Terminally ill patients need thorough psychiatric evaluations and treatment for depression when it is identified. Although many patients may attempt suicide on their own when euthanasia is illegal, euthanasia is not the calm and peaceful process it has been made out to be — and legalizing it would only open the door to far greater abuses against the most vulnerable members of society.

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