Euthanasia

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Euthanasia
In recent years, Euthanasia has become
a very heated debate. It is a Greek word that means “easy death” but the
controversy surrounding it is just the opposite. Whether the issue is refusing
prolonged life mechanically, assisting suicide, or active euthanasia, we
eventually confront our socity’s fears toward death itself. Above others,
our culture breeds fear and dread of aging and dying. It is not easy for
most of the western world to see death as an inevitable part of life. However,
the issues that surround euthanasia are not only about death, they are
about ones liberty, right to privacy and control over his or her own body.


So, the question remains: Who has the right?
Under current U.S. law, there are clear
distinctions between the two types of euthanasia. One group of actions
taken to bring about the death of a dying patient -withdrawal of life support,
referred to by some as passive euthanasia- has been specifically upheld
by the courts as a legal right of a patient to request and a legal act
for a doctor to perform. A second group of actions taken to bring about
the death of a dying patient -physician-assisted death, referred to by
some as active euthanasia- is specifically prohibited by laws in most states
banning “mercy killing” and is condemned by the American Medical Association.

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Although it is not a crime to be present when a person takes his or her
life, it is a crime to take direct action intentionally designed to help
facilitate death–no matter how justifiable and compassionate the circumstances
may be.1 With active euthanasia, it is the doctor who administers the lethal
drug dose. Since it is tantamount to homicide, the few U.S. doctors who
perform it have been brought to trial but none of them have ever been convicted
and imprisoned.


Modern interest in euthanasia in the United
States began in 1870, when a commentator, Samuel Williams, proposed to
the Birmingham Speculative Club that euthanasia be permitted “in all cases
of hopeless and painful illness” to bring about “a quick and painless death.”
The word “painless” is important: the idea of euthanasia began gaining
ground in modern times not because of new technologies for agonizingly
prolonging life but because of the discovery of new drugs, such as morphine
and various anesthetics for the relief of pain, that could also painlessly
induce death. Over the next three decades Williams’s proposal was reprinted
in popular magazines and books, discussed in the pages of prominent literary
and political journals, and debated at the meetings of American medical
societies and nonmedical professional associations. The debate culminated
in 1906, after the Ohio legislature took up “An Act Concerning Administration
of Drugs etc. to Mortally Injured and Diseased Persons”, which was a bill
to legalize euthanasia. After being debated for months, the Ohio legislature
overwhelmingly rejected the bill, effectively ending that chapter of the
euthanasia debate. 2
Euthanasia reemerged in the 1970’s, when
in 1976 California was the first state to legalize a patient’s right to
refuse life-prolonged treatment. The Legislature passed the Natural Death
Act, which allows for living wills, an advance directive to a doctor requesting
the withholding or withdrawing of life sustaining treatment.3 Today, all
states have some form of living will legislation. In addition, the individual
who wishes to have such a will, may also designate a family member or friend
as a proxy to make the decisions for him or her, should he or she be unable
to make the decisions himself or herself. Some states also require the
individual to sign a power of attorney to do so.4
In 1976, the New Jersey Supreme Court decided
the parents of Karen Ann Quinlan won the right to remove her from a ventilator
because she was in a persistent vegetative state. The justices unanimously
ruled that this act was necessary to respect Quinlan’s right to privacy.5
Some medical ethicists warned then that the ruling was the beginning of
a trend–the slippery slope–which could lead to decisions to end a person’s
life being made by third parties not only on the basis of medical condition
but also on such considerations as age, economic status, or even ethnicity.6
In 1990, the Supreme Court case, Cruzan
v. Missouri, recognized the principle that a person has a constitutionally
protected right to refuse unwanted medical treatment. In 1983, Nancy Beth
Cruzan lapsed into an irreversible coma from an auto accident. Before the
accident, she had said several times that if she were faced with life as
a “vegetable,” she would not want to live. Her parents went to court in
1987 to force the hospital to remove the tube by which she was being given
nutrition and water. The Missouri Supreme Court refused to allow the life
support to be withdrawn, saying there was no “clear and convincing” evidence
Nancy Cruzan wanted that done. The U.S. Supreme Court agreed, but it also
held that a person whose wishes were clearly known had a constitutional
right to refuse life-sustaining medical treatment. After further proof
and witness testimony, a probate court judge in Jasper County, Mo., ruled
Dec. 14, 1990, that Cruzan’s parents had the right to remove their daughter’s
feeding tube, which they immediately proceeded to do. Nancy Cruzan died
Dec. 26, 1990.7
The Cruzan decision sparked a fresh interest
in living wills and in 1990 Congress passed the Patient Self-Determination
Act. It requires health care facilities that receive Medicare or Medicaid
funds (95 percent of such centers) to inform new patients about their legal
right to write a living will or choose a proxy to represent their wishes
about medical treatment, and what kind of measures will be taken automatically
for patients as institutional policy. Where state law permits, these institutions
must honor living wills or the appointment of a health care proxy.8
On March 6, 1996, for the first time in
U.S. history, in the case Washington v. Glucksberg, the U.S. Court of Appeals
for the 9th circuit in San Francisco overturned a Washington State law
that made assisted suicide a felony. The existing ban on assisted suicide
was successfully challenged under the equal protection clause of the Constitution’s
Fourteenth Amendment. The court noted that, under present law, a dying
patient on life support may legally have it removed to facilitate death
while another dying patient, not on life support but suffering under equivalent
circumstances and equally close to death, has no means by which to end
his or her lives. The court, ruled that, bans on assisted suicide constitute
a violation of the second patient’s equal protection rights under the Fourteenth
Amendment.9
In his majority opinion, appellate Judge
Stephen Reinhardt of Los Angeles wrote: “If broad general state policies
can be used to deprive a terminally ill individual of the right to make
that choice, it is hard toenvision where the exercise of arbitrary and
intrusive power by the state can be halted.”10
Reinhardt’s analysis relies heavily on
language drawn from U.S. Supreme Court abortion case, Roe v. Wade, because
the issues have “compelling similarities,” he wrote. Like the decision
of whether or not to have an abortion, the decision how and when to die
is one of “the most intimate and personal choices a person may make in
a lifetime,” a choice “central to personal dignity and autonomy.”11
On April 2, 1996, in the case of Vacco
v. Quill, the U.S. Appeals Court for the Second Circuit in New York struck
down that state’s law making it illegal for doctors to help terminally
ill people end their own lives. But whereas the Ninth Circuit decision
was based on the Fourteenth Amendment and privacy issues, the Second Circuit
ruling in April invoked an “equal protection” argument that people suffering
terminal illnesses should have the same right as those, such as Quinlan,
who are in a coma and have the law on their side in the decision to halt
life-sustaining nourishment or treatment. “Physicians do not fulfill the
role of ‘killer’ by prescribing drugs to hasten death,” wrote Second Circuit
Judge Roger J. Miner, “any more than they do by disconnecting life-support
systems.”12
In 1997, both Washington v. Glucksberg
and Vacco v. Quill went before the Supreme Court. The Court took a look
at the cases and backed away from the “slippery slope” by their unanimous
decision to uphold state laws in Washington and New York, banning doctor
assisted suicide. Chief Justice William Rehnquist wrote, “Throughout the
nation, Americans are engaged in an earnest and profound debate about the
morality, legality and practicality of physician-assisted suicide. Our
holding permits this debate to continue, as it should in a democratic society.”13
However, the Court left open the possibility that such bans might be invalid
when applied to individual cases involving great suffering at the end of
a terminal illness.14
In 1994 a limited right to die measure
squeaked through in Oregon. The Oregon law allowed doctors to prescribe,
but not administer, a deadly dose of medication to terminally ill patients,
defined as those diagnosed as having less than six months to live. By the
Court kicking back the decision to the states in June, the Supreme Court
then refused to hear the challenge on that physician assisted suicide law
on October 14, 1997. Doctors in Oregon are now permitted to prescribe life-ending
medication to anyone who is mentally competent and diagnosed with less
than six months to live. But the patient may only take a lethal dose after
completing a 15-day waiting period. The law does not specify what medication
may be used. Under the approved Oregon law, patients may request doctor
assisted suicide if: 1) They are mentally competent. 2) They are diagnosed
as having less than six months to live. 3) They request a lethal prescription
from a doctor today, and wait the required 15 days. After the waiting period,
during which patients can rescind their request at any time, they are free
to take the drugs. Oregon Board of Medical Examiners will oversee physician
compliance with the law,patients or families with concerns can contact
the board,and a 25-member task force of health and ethics experts will
decide some of the policy questions that will guide the state’s oversight
of the new law. Several experts expect there will be further guidelines
to carry out this new policy.15
Sooner or later, discussions about euthanasia
and assisted suicide in the United States turn to the situation in the
Netherlands. Although euthanasia still is a criminal offense there, punishable
by up to 12 years in prison, it is increasingly tolerated in practice.


Dutch physicians who put hopelessly ill patients to death after being asked
to do so are not prosecuted if they follow certain guidelines formulated
by the courts.16
In a series of Dutch court cases decided
between 1973 and 1984, two conditions were deemed essential for legitimizing
euthanasia. First, the patient must make the request at his own initiative,
repeatedly and explicitly expressing his wish to die. Second, the patient
must be suffering from severe physical or mental pain, with no prospect
of recovery. Since 1984, Dutch courts have added a third condition–that
a physician intending to perform euthanasia first consult a colleague to
confirm the accuracy of the diagnosis, verify the planned means of bringing
about death and ascertain that all legal requirements are being met. Some
court cases have also cited as requirements the presence of an incurable
disease or a demand that death by euthanasia not inflict unnecessary suffering
on others.17
Typically, a Dutch euthanasia patient is
first given a shot of barbiturates, which causes unconsciousness within
three to five seconds. A follow-up shot of curare produces death in 10
to 20 minutes by paralyzing the respiratory system. A Dutch doctor who
performs euthanasia is not permitted to attribute death to “natural causes”
on the death certificate. Rather, he or the coroner must inform the police
that a medically aided death has occurred. The police, in turn, report
to the district attorney, who decides whether to prosecute.18
Recently, Dr. Jack Kevorkian killed a man
suffering from Lou Gehrig’s disease and gave the videotape to “60 Minutes.”
Thomas Youk, 52, was killed by lethal injection of potassium chloride at
the hands of Dr. Kevorkian. The ex-pathologist has claimed to have taken
part in over 130 assisted deaths, but this time Dr. Kevorkian taken his
work to a new level: he had injected the poisons himself, rather than rigging
up his homemade “suicide machine” so the patient could kill himself.


When Michigan banned assisted suicide in
September, Kevorkian decided it was time for a new– and perhaps final–showdown
in court. This new mercy killing case revived the long and contentious
debate over whether we have the right to die–and whether doctors should
take part in their patients’ deaths. More than 30 states have banned assisted
suicide–the act of helping a person take his own life. Now Kevorkian has
gone a step further, to euthanasia–the act of actually carrying out a
mercy killing.19
With his new step toward active euthanasia,
Dr. Kevorkian may have lost a number of his supporters. A Detroit Free
Press pool showed most Michigan residents were wary of Kevorkian’s latest
move. And some assisted suicide activist who once idolized Kevorkian are
refusing to support his graduation to euthanasia. Even if he is aquitted
of the first degree murder charge, he could find that he is no longer takn
serious and could hurt actually his cause.20
Euthanasia opponents envision a bleak future
for dying patients who don’t have access to health insurance, adequate
pain control treatment, or the money to pay for long term care. Some may
feel forced or be coerced by their families and doctors to opt for euthanasia.


Of course, no law can guarantee that coercion will never occur. We can’t
know for sure what family members’ motives may be in any number of already
legal health care and other decisions in which they participate. But should
we reduce our available choices because we don’t believe people can always
make the right decisions for the right reasons or because we fear possible
abuses? Or should we continue to expand our individual choices and freedoms
while doing our best to prevent inappropriate and coerced influences and
to educate all people in critical decision making?
In fact, abuses are far more likely to
occur within the present unregulated, covert, and occasional practice of
assisted suicide. There is no accountability for such deaths, no procedures,
no safeguards, and no reporting requirements. How much safer would it be
if laws such as those in Oregon were in place nationwide? Can the debate
over legalization of Euthanasia be compared to the debate over legalizing
abortion? Wasn’t the main reason for legalizing abortion because it was
being done anyway. People still had access to abortion, it was just being
done terribly. We’re in exactly the same situation today. People do have
access to assisted suicide, it’s just being done poorly.


I believe, that if in this great country,
we have the right to life, liberty, and the pursuit of happiness then why
shouldn’t a person have the right to control the conditions of their death
as much as they have the right to control the conditions of their living.


If procedures similar to the Dutch model can help us avoid unnecessary
suffering, it would be worthwhile to work out with the legal and medical
professions. By firmly establishing the right to die in America, an extension
of the right to privacy, we are safeguarding such fundamental rights against
governmental exploitation. If not a legal law, there is certainly a moral
law over one’s own body and our life should be subject to our own self-determination.


We have a right to end our own life; and if we cannot accomplish the task
on our own, at our discretion, another person should have the right to
end it for us, as an act of compassion.


History of Euthanasia in America
1973- The American Medical Association
issues the Patient Bill of Rights. The groundbreaking document allows patients
to refuse medical treatment.


1976- The New Jersey Supreme Court rules
that the parents of Karen Ann Quinlan, who has been in a tranquilizer-and-alcohol-induced
coma for a year, can remove her respirator. She dies nine years later.


1979- Jo Roman, a New York artist dying
of cancer, makes a videotape, telling her friends and family she intends
to end her life. She later commits suicide with an overdose of sleeping
pills.


1985- Betty Rollin publishes “Last Wish,”
the story of her mother’s battle with ovarian cancer. The book reveals
that Ida Rollin killed herself with a sedative overdose.


1990- Dr. Jack Kevorkian performs his
first assisted suicide, using a homemade machine, to end the life of Alzheimer’s
patient Janet Adkins. Meanwhile, after protracted legal wrangling, the
parents of Nancy Cruzan, who has been in a coma for seven years, are allowed
to remove her feeding tube. Friends and co-workers testify in court that
she would not have wanted to live.


1991- Hemlock Society founder Derek Humphry
first publishes “Final Exit.” The controversial suicide “how-to” book later
becomes a national best seller.


1994- Voters in Oregon pass a referendum
making it the only state in the country that allows doctors to prescribe
life-ending drugs for terminally ill patients. The hotly contested law
was not put into effect until last year.


1995- George Delury publishes “But What
If She Wants to Die?” a diary chronicling his wife’s long battle with multiple
sclerosis. The book describes the couple’s agonizing decision to end her
life with a drug overdose. Delury served four months in prison for attempted
manslaughter for his role in her death.


1997- In a unanimous decision, the Supreme
Court rules that the Constitution does not guarantee the right to commit
suicide with the help of a physician. The decision upholds laws in New
York and Washington state making it illegal for doctors to give lethal
drugs to dying patients.


1998- In November, Michigan voters defeat
a measure that would have made physician-assisted suicide legal.


Michigan Poll On Dr. Kevorkian and Euthanasia22
1. After watching that segment which showed
Jack Kevorkian administering a lethal injection of drugs, do you think
it was appropriate or not appropriate for “60 Minutes” to show that scene
on television?
56%Appropriate
35% Not appropriate
10% Undecided/Don’t know/Refused
2. Did the experience of watching Dr. Jack
Kevorkian cause a man’s death influence your opinion about assisted suicide,
or would you say that your opinion about assisted suicide was not influenced
at all by the “60 Minutes” program?
11%Influenced opinion about assisted suicide
84%DID NOT influence opinion about assisted
suicide
5%Undecided/Don’t know
3. Did the experience of watching tonight’s
“60 minute” segment on Jack Kevorkian influence you to be more supportive
of assisted suicide or more opposed to assisted suicide?
6%Much more supportive of assisted suicide
31%Somewhat more supportive of assisted
suicide
13%Somewhat more opposed to assisted suicide
38%Much more opposed to assisted suicide
12%Undecided/Don’t know
4. Generally speaking, do you favor or
oppose laws that would allow physician assisted suicide for terminally
ill people who are in a sound state of mind?
31%Strongly favor
14%Somewhat favor
10%Somewhat oppose
40%Strongly oppose
5%Undecided/Don’t know
5. Dr. Kevorkian has invited law enforcement
authorities to arrest him and charge him with a crime for his actions in
the death shown on television. What do you think? Should Dr. Jack Kevorkian
be arrested and charged with a crime for his actions, or do you think authorities
should do nothing?
50%Kevorkian should be arrested and charged
34%Authorities should do nothing
16%Undecided/Don’t know
6. If Dr. Kevorkian is arrested for his
involvement in the death of the man shown on “60 Minutes,” for what crime
do you think he should be charged–violating Michigan’s new law banning
assisted suicide, for committing a more serious crime, such as murder,
or for committing a different crime?
30%Violating law banning assisted suicide
45%More serious crime – such as murder
16%Something else
9%Undecided/Don’t know
7. If he was charged with violating Michigan’s
new law banning physician assisted suicide instead of murder, based on
what you saw on television tonight, would you find Dr. Jack Kevorkian guilty
or not guilty of that crime?
62%Guilty of assisting a suicide
26%Not guilty of assisting a suicide
12%Undecided/Don’t know
8. Dr. Jack Kevorkian has publicly stated
that he is trying to force the issue of assisted suicide and euthanasia
by his actions, and, if necessary, he will starve himself in prison to
become a martyr for his beliefs. Do you believe that Dr. Kevorkian is doing
what must be done for the cause of assisted suicide, do you think he has
gone too far and is hurting his cause, or, do you think he should do even
more to force changes in assisted suicide laws?
28%Doing what must be done
55%Has gone too far and is hurting his
cause
8%Should do even more to force changes
9%Undecided/Don’t know
9. In the recent November 3rd election,
did you vote YES in favor of Proposal B, the assisted suicide proposal,
did you vote NO to oppose it, did you vote in the election but skip that
proposal, or were you unable to vote at all on November 3rd?
24%Yes
56%No
5%Did not vote on that proposal
11%Did not vote in the election
2%Can’t remember
2%Refused
Works Cited
1. Dority, Barbara. “The Ultimate Civil
Liberty”. Humanist. July/August 1997. p. 17.


2. Emanuel, Ezekiel. “Who’s Right to Die?”.


Atlantic Monthly. March 1997. p. 75.


3. Henry, Sarah. “The Battle over Assisted
Suicide: A Time to Die”. California Lawyer. January 1996. p. 1.


4. Ubell, Earl. “Should Death Be a Patient’s
Choice?”. Parade. February 9, 1992. p. 25.


5. Birenbaum, Arnold. “The Right to Die
in America”. USA Today. January 1992 p. 28.


6. Hallock, Steve. “Physician-Assisted
Suicide:”Slippery Slope” or Civil Right?” Humanist. July/August. 1996.

p. 9.


7. Worshop, Richard L. “Assisted Suicide”.


Congressional Quarterly Researcher. February 21, 1992. p. 153.


8. Martinez, Elizabeth. “Going Gentle
into That Good Night: Is a Rightful Death a Feminist Ideal?” Ms. July/August.


1993. p. 67.


9. Dority, Barbara. p. 18.


10. Weinstein, Henry. “Assisted Deaths
Ruled Legal: 9th Circuit Lifts Ban on Doctor- Aided Suicide”. Los Angeles
Times. March 7, 1996. p. A1.


11. Hallock, Steve. p. 12-13.


12. Hallock, Steve. p. 13.


13. Beck, Joan. “Backing Away from a Very
Slippery Slope”. Chicago Tribune. June 30, 1997. p. A1.


14. Johnson, Tim. “Legal Eythanasia Unsettles
Colombia”. Miami Herald. June 30, 1997. p. 7A
15. Maier, Thomas. “Death By Choice”.


Newsday. November 6, 1997. p. A5.


16. Emanuel, Ezekiel. p. 73.


17. Worsnop, Richard L. p. 59.


18. Worsnop, Richard L. p. 59.


19. Bai, Matt. “Death Wish”. Newsweek.


December 7, 1998. p. 31.


20. Bai, Matt. p. 33.


21. Frehm, Ron. Newsweek. December 7,
1998. p. 32-33.


22. Detroit Free Press poll of 300 Michigan
residents conducted November 22, 1998 by Epic/MRA, of Lansing.

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