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Introduction
Euthanasia, otherwise known as mercy killing or assisted suicide, has been a controversial subject for many centuries. Proponents of the practice believe that individual freedoms of choice that exist in life also extend to the end of life. They also argue that the sentiment of humane treatment afforded animals that are terminally ill or injured and are suffering should be given to humans as well. Opponents suggest that euthanasia is a slippery slope that would allow increasing instances of coerced suicide, family members pressuring the elderly not to postpone their inevitable demise for financial reasons. In addition, the practice would lessen the urgency to develop new medicines designed to prolong life. Those who oppose the practice on religious grounds argue that it is playing God therefore sinful. Health care professionals cite the Hippocratic Oath which forbids them from carrying out this procedure. This paper will examine the moral and ethical concerns surrounding euthanasia, clarify the meaning of the term, present arguments both for and against the practice and conclude with a recommendation to resolve the issue.
Main body
The word euthanasia is from Greek origin meaning good death. Writers of 1700s Britain referred to euthanasia as a being a preferential method by which to die well. Euthanasia describes a situation in which a terminally ill patient is administered a lethal dose of medication, is removed from a life-support system or is simply allowed to die without active participation such as by resuscitation. A doctors involvement in the procedure could be to either prescribe a lethal dose of drugs with the express intent of ending a life or by intravenously inserting a needle into the terminal patient who then activates a switch that administers the fatal dose (Naji et al, 2005).
Physicians, lawmakers and philosophers have debated the notion of euthanasia since the beginning of recorded history but the wide public debate regarding its legalization has only surfaced over the past three decades. In the 1970s it became lawful to draft living wills which allows a patient to refuse heroic life saving medical assistance in the event they were incapacitated and could only survive by artificial means (Rich, 2001). In other words, it gave the next of kin the right to direct doctors to pull the plug if the patients condition was considered hopeless, a practice which is now broadly accepted. However, these wills did not eliminate the potential problem of individuals being kept alive for incredibly lengthy periods of time in permanent unconscious states as there were often no provisions for withdrawing nutrition and hydration when no other life support interventions were necessary. This oversight has been largely addressed through power of attorney. The durable power of attorney allows an individual to designate in writing a proxy or surrogate decision maker (the attorney-in-fact) who has the same degree of authority to consent to or decline life-sustaining treatment as the patient would if he or she were competent (Rich, 2001: 68-69).
While this, too, has its drawbacks in that there is frequently no room to designate the individuals wishes to any great extent, the debate regarding euthanasia has moved beyond the realm of the unconscious patient and into the realm of patient rights. Today, the debate centers on individual autonomy, whether or not patients who suffer from extreme pain and have a terminal or degenerative disease such as Alzheimers, AIDS and multiple sclerosis have the right to an assisted death of the type and time of their own choosing. (Rich, 2001).
Only one state, Oregon, and three countries, Switzerland, Belgium and The Netherlands, allow assisted suicide. The law in Oregon was challenged in the U.S. Supreme Court early last year and was upheld by a vote of six to three. In 2001, former President Bush attempted to derail the Oregon law permitting euthanasia stating that assisted suicide wasnt a legitimate medical purpose. The justices, however, were not convinced by Bushs argument. The Oregon laws are shaped after those in the Netherlands and are designed to ensure second opinions have been consulted and there is an imminent presumption of death within a reasonable time frame of when the procedure is requested. In addition, the patient must make multiple requests for the procedure, all spaced out over a period of weeks and must be willing to administer an overdose of drugs themselves. (Hurst & Mauron, 2003).
Assisted suicide by physicians and non-physicians has been legal in Switzerland since WWII. In addition, three organizations within the country have been established to aid terminally ill patients. They provide patient counseling as well as the drugs for use in the procedure. Lethal injections, however, are not allowed. The unusual situation in Switzerland holds that assisted suicide is allowed as long as a physician is not a part of the process. Euthanasia has been legal in Belgium since 2002. Each case must be reviewed by two physicians before the procedure is carried out by either ingestion or injection. In The Netherlands, euthanasia has been legal for four years but has been tolerated for two decades. (Hurst & Mauron, 2003).
The euthanasia debate embraces compelling and impassioned arguments on both sides of the issue. Proponents of euthanasia are concerned with human suffering. Many diseases such as cancer cause a lingering and excruciatingly painful death. Watching a loved one as they wither away from the disease eating away at their organs is tough enough on family members, but to see them suffer even when drugs are administered is unbearable not to mention what the patient must endure. This emotionally and physically torturous situation is played out in every hospital, every day of the year but serves no purpose. To many, it is unimaginable to allow anyone, for example, a sweet old grandmother who has spent her life caring for others to spend the last six months of their life enduring constant pain, unable to control bodily functions, convulsing, coughing, vomiting, etc.
The psychological pain for both the family and patient is unimaginably horrific as well. If grandma were a dog, most all would agree that the only humane option would be to put her to sleep. U.S. citizens are guaranteed certain rights but not the right to die with dignity. This right is not prohibited by the Constitution but by religious zealots who evidently put the quality of life of a dog above grandmas. Patients suffering from Alzheimers may not suffer physical pain but endure a different type of pain and usually for a long period of time. Alzheimers is a degenerative disease causing the patient to ramble incoherently and lose their memory. Many people who led vibrant, active and purposeful lives are remembered by their family members in this state. Proponents of euthanasia also argue that the time of health care professionals, of which there is a perpetual shortage, especially nurses, could be used in a more productive manner such as on patients who are not certain to die. Numerous studies have established that understaffed medical care facilities provide a diminished quality of care to all ( Massachusetts Patients , 2005).
Those that could benefit from quality care sacrifice their health for those that are suffering a slow, agonizing and undignified death. The cost of health care overall would be reduced as people with no hope of survival no longer drain the available resources and manpower which translates to lower insurance rates. Health care costs have skyrocketed over the past decade and as the baby boom generation ages, this problem will increase exponentially which does not benefit anyone. Its a burden on everyone especially on the family that must pay it. Elderly, terminal patients do not want to be responsible for the financial ruin of their children, but do not have the option to call for an end. Economic factors must be considered in terms of the patient, their families and society. Patients may have depleted their insurance due to an extended illness, have no insurance and may be a financial burden on their families. (Simon, Rita J. Scherer, 1999 p. 21)
Euthanasia also allows for organs such as livers, hearts and kidneys to be harvested for transplant into otherwise healthy individuals with a potential for many more years of life. While it may be emotionally morbid to think of things in such terms, in a world where medical miracles can occur everyday that permit another human being a chance at a more fulfilling life, these considerations must also be made. In the real world, it is more likely that an individual will opt first to save the young child from an oncoming bus rather than an old man. By the same token, it seems incredible that todays society would opt to allow a child to die so that a terminal patient might be forced to live a few more agonizing months. This, in effect, is the result of not allowing people to die with dignity. Many terminally ill people choose to end their own life to evade the previously discussed detriments of a terminal illness. Suicide rates are by far the highest among the elderly population for this reason.
Opponents to legal euthanasia rightly claim that the practice would be in violation of the Hippocratic Oath. (Kisha, 2005 p. 87 )It also would cause a devaluation of human life. Life is held as sacred in the U.S. more so than in many other countries therefore the decisions other countries make regarding euthanasia are not relevant. The legalization could lead to the assisted suicide of patients whose conditions are not necessarily terminal. Though the vast majority of doctors are ethical beyond reproach, not all are. It is common knowledge that some doctors write prescriptions to drug addicts. Diet pills are handed out to patients who do not have a weight problem but are simply feeding a habit and the doctor is well aware of this. If a minority of doctors can be convinced to prescribe illicit drugs then it is not difficult to imagine a situation where a doctor can be convinced to assist in the suicide of a person who is temporarily depressed due to emotional or psychological reasons. There is a big difference in the two situations, however.
A person can decide to end their drug abuse but suicide is irreversible. While most doctors are ethical and are dedicated to quality patient care, insurance companies are concerned with profit, not patients, and may begin to pressure doctors into ending the lives of patients who are costing them thousands of dollars per week. The evidence of this possible eventuality is universally understood by health insurance paying Americans. Because of the nature of managed health care in America, we are presented with a serious dilemma. Who should be the judge of who should live and who should die? Should insurance conglomerates and powerful HMOs determine who is worthy and who is not? (Kisha, 2005 p. 95) Insurance companies already have too much power to influence health care decisions. Legalized euthanasia would only increase this power.
Another likely scenario of legal suicide involves patients who are told that they have a few months to live and decide to not endure this remaining time and end their life sooner rather than later. This not only deprives the family precious time with the patient, but eradicates any chance of recovery or remission of the disease. Plus, suppose the doctor made a mistake in their diagnosis? No one could ever know if they did or didnt but this possibility would always weigh heavily on the minds of the loved ones left behind. Another consideration is one of religion. If a patient decides to depart this life expeditiously, many of his or her family members could be against this decision based on personal religious convictions. What may have been a good relationship with loved ones throughout an entirety of life would be soured at the very end. (Campbell, 1992)
The unfortunate reality is the majority of people in the U.S. die a bad death. A study determined that more often than not, patients died in pain, their desires concerning treatment neglected, after spending 10 days or more in an intensive care unit (Horgan, 1996). Opponents of a doctor-assisted suicide law often cite the potential for doctor abuse. However, recent Oregon and UK laws show that you can craft reasonable laws that prevent abuse and still protect the value of human life. For example, laws could be drafted that requires the approval of two doctors plus a psychologist, a reasonable waiting period, a family members written consent and limits the procedure to specific medical conditions.
Works Cited
Campbell, Courtney S. Religious Ethics and Active Euthanasia in a Pluralistic Society.
Kennedy Institute of Ethics Journal Volume 2, Number 3, 1992, pp. 253-277.
Horgan, John. Right to Die. Scientific American p. 36. Scientific American, Inc. 1996.
Hurst, Samia A. & Mauron, Alex. Assisted Suicide and Euthanasia in Switzerland: Allowing a Role for Non-Physicians. British Medical Journal. Vol. 326, N. 7383, pp. 271-27. 2003.
Kisha, Madeline Free Rein to Kill: Euthanasia in America iUniverse, Inc. 2005
Massachusetts Patients Say Nurse Understaffing Harms Patient Safety, Undermines Quality Care. Massachusetts Nurses Association. 2005.
Naji, Mostafa H; Lazarine, Neil G. & Pugh, Meredith D Euthanasia, the Terminal Patient and the Physicians Role. Journal of Religion and Health. Vol. 20, N. 3, pp. 186-200. 1981.
Rich, Ben A. Strange Bedfellows: How Medical Jurisprudence has Influenced Medical Ethics and Medical Practice. New York: Springer. 2001.
Simon, Rita; J. Scherer Euthanasia and the Right to Die: A Comparative View Rowman & Littlefield Publishers, Inc.; 1 edition, 1999.
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