Euthanasia

Within the parameter of my paper I will discuss the history of euthanasia and the legislation that has taken place in the past and more current legislative provisions including the Oregon Death with Dignity Act. There are many different types of euthanasia including active, passive, voluntary and involuntary. I will discuss physician-assisted suicides, which can take and active or passive form. Opponents and their views will be looked at, along with reasoning behind these views. I will focus on court cases of doctor Jack Kevorkian and his reasoning behind euthanasia. I will point out how the state of Oregon supports their doctors in practices of euthanasia while Michigan has created laws specifically to criminalize the performing of euthanasia because of Kevorkian. I will conclude with the legislation in the Netherlands on euthanasia being the first country to legalize it, and look into whether the United States will follow. The reason I chose euthanasia as a topic for this paper is because of the controversy over it. I wanted to learn the viewpoints of the opponents and the supporters to understand more clearly what euthanasia actually meant. Also, with the baby boomer generation entering into senior citizenship, the health care system is going to be extremely burdened over the coming decades, and euthanasia may be an option for those who are terminally ill and willing to take that course. Legislative History Euthanasia is a Greek term referring to allowing a person to die a “good death”, whether that meant with dignity, without pain, or with honor. The first modern proposal for euthanasia legislation was made in Ohio in 1906, provided that when an adult of sound mind had been fatally hurt or was terminally ill, his physician would be permitted to ask him in the presence of three witnesses if he wished to die. Then, three other physicians were required to confirm the original prognosis before the individual could be put to death. The bill was defeated 23 to 79. In the 1930’s, Great Britain and the United States witnessed a burst of pro-euthanasia activity, including the founding of euthanasia societies. In the United States a bill was introduced in Nebraska in 1937, then in New York in 1939, and again in 1947, all of them were rejected. The next significant effort to pass a euthanasia bill did not take place until 1969 in Britain. This bill provided models for bills introduced in Idaho, Oregon, and Montana between 1969 and 1974. Then the euthanasia debate was quieted until the 1980’s, when the Hemlock society began their national campaign of euthanasia advocacy (Urofsky 84). Derek Humphry, a former journalist, founded the Hemlock society after seeing the pain his wife experienced in her death from cancer (Death 26). On November 24, 1992 the Michigan House of Representatives passed a provisional anti-euthanasia measure that outlawed assisted suicides for two years beginning March 30,1993, while a committee on death and dying provided recommendations for the legislation. The measure was a felony punishable four years in prison and a $2000 fine. Physician involvement in patient suicides remains an offense in most states, though the degree to which prosecutors, juries, and courts will tolerate the practice depends largely on the circumstances of the case (Urofsky 76,77). Euthanasia is emerging as a significant public policy issue at a time when health care policy-making is in turmoil. Most states now recognize that patients have the right to refuse medical treatment, including artificially supplied nutrition and hydration, either themselves if competent, or through the use of advance directives (Urofsky 61,68). The current common law is that a person has the right to bodily self-determination and the doctrine of informed consent. Self-determination means that a person has a right to control what is done with his or her body. In 1997 the Supreme Court ruled unanimously against a constitutional right to assisted suicide or euthanasia. Since the ruling three more states passed laws specifically criminalizing physician-assisted suicide, joining the 35 states that already have these statutes (Ezekiel 2). Currently, United States criminal law classifies mercy killings as murder (Urofsky 96). Legislation is trying to federally control substanc! es that at lethal levels are intended to assist suicides, because of Oregon’s Death with Dignity Act. Opposition Views The debate on legalizing assisted suicide began intensely in the 1970’s. On one side the debate have been patients’ rights groups, lobbying for what they call the right to choose to die. The strongest opposition has come from physicians’ groups such as the American Medical Association and religious groups that are morally opposed to the practice (Death 26). Opponents maintain that medicine should remain a profession dedicated to healing. Legalizing euthanasia presents problems in legal, moral, ethical, and medical issues. The three major arguments against euthanasia include the sanctity of life argument, the slippery slope, and the danger of abuse. The sanctity of human life argument emphasizes the sacredness of our culture prohibition against killing. The slippery slope argument envisions the legalization of voluntary euthanasia leading to forms of involuntary euthanasia and a devaluation of human life. The danger of abuse argument predicts the coercion of patients by their families, doctors, or health care workers to request euthanasia and disregard the guidelines. Power may then be extended to allow euthanasia where the patient is not in pain but wishes to die for other reasons, including a deterioration of quality of life, the loss of dignity, or the wish not to burden his family financially with a prolonged hospital or nursing home stay. Opponents also fear that patient confidence will erode if physicians have assisted-suicide as an option at their disposal in troublesome cases or with troublesome patients (Hoefler 161). If euthanasia is legalized in the United States the incentives to find cures and treatments for painful diseases will be weakened taking the drive out of research (Hoefler 162). Types of Euthanasia Opponents of active euthanasia argue that it undermines the value and respect for all human life. They maintain that the intentions and nature of both active and passive euthanasia are not essentially the same. In active euthanasia a person directly intends to cause death and uses available means to achieve this. In passive euthanasia a person decides against using a certain form of treatment, and directs that such treatment be withheld accepting but not intending the patients death, which is caused by the underlying illness. The American Medical Association considers euthanasia to be different from the removal of life sustaining medical care. Euthanasia is sometimes referred to as mercy killing, which is the ending of a person’s life without his or her request. The greatest number of mercy killing cases have involved the killing of a spouse, parent, or child by a non-physician (Urofsky, 70) Active euthanasia can consist of a physician giving a patient a lethal injection of medication. A physician can also prescribe a drug knowing that it will be used by the patient to commit suicide. In the United States active euthanasia is generally recognized as murder, or manslaughter. Professional medical societies and the law in certain circumstances accept passive euthanasia. Generally, those who favor euthanasia do not acknowledge a distinction between active and passive euthanasia (Death 24). Dr. Jack Kevorkian Physician assisted suicide is a form of voluntary euthanasia; it involves the patient acting voluntarily to end his or her own life. The patients who were assisted by Jack Kevorkian chose to press a button that sent lethal poison into their veins or put on a mask that released carbon monoxide into their lungs. After Kevorkian, a retired pathologist from Michigan, participated in physician-assisted suicides the topic gained great public attention. In 1990, Kevorkian set up a machine that allowed a fifty-four year old women suffering from Alzheimer’s disease to take her life (Death 29). Kevorkian’s suicide machine consisted of an intravenous tube connected to three bottles, one containing harmless saline solution, one containing thiopental, and one containing potassium chloride. Kevorkian would insert the intravenous tube into the patients arm and begin the saline solution, then the patient would press a button, which would switch the line to thiopental, and then a timing d! evice would switch the line to the potassium chloride which would stop the patients heart. Kevorkian’s device was designed to take advantage of the then existing gaps in Michigan law (Urofsky 73). However, in 1992 Michigan passed an assisted suicide bill specifically designed to stop Kevorkian’s activities (Death 29). Kevorkian criticizes modern medicine claiming that medicine should be just as concerned with alleviating suffering as it is with prolonging life. He also feels that by not legalizing euthanasia back alley suicides will take place. These back alley suicides will not provide the dying individual with the opportunity to leave this world with dignity. Kevorkian also believes that the only people allowed to administer euthanasia should be retired physicians on a salaried basis, this would allow for the physician patient relationship to be sustained (Hoefler 161). Supporters of euthanasia suggest that a patient requesting medical assistance in dying is the ultimate extension of patients’ rights (Urofsky 63).In March 1999, Dr. Jack Kevorkian was convicted of second-degree murder, sentenced to ten to twenty-five years in prison (Ezekiel 1). Kevorkian had been charged with murder several times, but the charges were dismissed because Michigan at the time had no law against assisted suicide (Death 29). Kevorkian made a video of the euthanasia of Thomas Youk, which ultimately led to his conviction (Ezekiel 2). Derek Humphrey, founder of the Hemlock society has openly criticized Kevorkian’s work. He says, “Kevorkian’s lack of precautionary measures will lead to abuse and tragedy� (Death 27). Oregon Death With Dignity Act There is a lot of euthanasia and physician-assisted suicide going on outside the law, undermining the notion that legalization is the only way to ensure regulation and the enforcement of safeguards (Ezekiel 3). In 1994, the Oregon Death With Dignity Act was passed. This legalized physician-assisted suicide by allowing a physician to prescribe a lethal dose of medication for a mentally competent, terminally ill patient for the purpose of self-administration (Ganzini 2363). Only 15 patients ended their lives by assisted suicide in the first 14 months under the new law. In 1998, 28,913 Oregonians died, fifteen patients represent 0.05 percent of all dying patients (Ezekiel 3). There is much evidence that the care for terminally ill patients in Oregon has improved since the passage of the bill. For example, more than one third of Oregonians who die are enrolled in a hospice program and two thirds have completed an advance directive before death (Ganzini 2363). In a comparison of the Kevorkian case to Oregon assisted suicide cases, only 25% of Kevorkian’s patients were terminally ill, as compared to 100% of the Oregon cases. In the Kevorkian cases one third of them had a neurological disease; multiple sclerosis and Parkinson’s disease were also included in the Kevorkian cases. Where in the Oregon cases nearly all of the persons in 1998 and 1999 were cancer patients, and the others had end stage heart disease or lung disease (Roscoe 442). Oregon physicians reported that they had made efforts to improve their knowledge of palliative care since 1994. 76% of the physicians report that they had made efforts to improve their knowledge of the use of pain medications in the terminally ill. Only 18% of physicians agreed that since the “Death with Dignity Act� was enacted that some patients expected the doctor to provide them with a lethal prescription. Overall, physicians in Oregon have made care of the dying a focus for their own professional education since 1994 (Ganzini 2369). Contrary to what many feared the passage of the Death with Dignity Act has not brought swarms of people to Oregon to die. The Netherlands On April 10, 2001 the Netherlands became the first country to decriminalize euthanasia. Under the new legislation a doctor will not be prosecuted for terminating a person’s life providing he or she follow guidelines (Wise 1). The legalization response was to the helplessness of a person with a terminal illness who was also in unbearable pain, as well as to the growing sense of many physicians that they should not abandon their patients in this final time of need. There are two provisions to the legislation. The first is that the physician reports the death to the coroner with the cause listed as euthanasia or physician-assisted suicide. The case can then be reviewed to determine if the proper procedures had been followed. Secondly, the physician must practice due care. This includes the physician has the certainty that the request is voluntary and well considered, the physician must be convinced that the patient is suffering interminable and unbearable pain, there must be no other reasonable solution, and the process must be in writing. The physician must also help the patient die with appropriate medical care. The Netherlands have gone a step further in allowing patients with an “interminable and unendurable� mental condition to qualify for euthanasia also. The legislation identifies the age of legal consent to be 18. Although a child 16 or 17 will be recognized as able to make their own decisions the parents must be involved in the decision making process as well. Will The United States Follow' The conditions that exist in Holland do not exist here in the United States with an inadequate health care system and a pluralistic culture. The common assumption here in the United States is that the market will solve medical problems. The United States seems to be willing to spend millions of dollars to delay or prolong death using the most sophisticated medical technologies, but unwilling to put money into hospice care or even physician training for pain management (Shannon 1). The best possible care should be given before the issue of euthanasia arises. This issue is likely to remain on the medical ethical agendas of many countries in the coming years with patients in many countries having the final say. Conclusion I believe the quality of life and a good death are important, and a fully competent and informed adult should be allowed to choose death when life becomes unbearable. As the rising costs in all areas of the health care industry continue the care of the uninsured and underinsured will place a burden on hospitals, employers, and federal and state governments. The rising costs have also caused hospitals and nursing homes to set limits on costs that will end up effecting the patient in the long run. I think that the financial survival of health care facilities depends directly on controlling costs. These costs come directly from patient care. I agree with the legalization of euthanasia, it seems to be working well in Oregon, according to my research. If euthanasia were legalized I think physicians would talk more openly to patients about dying. I also believe that doctors could initiate their patients to use advance directives, talk to them about dying at home, and using hospice. The physicians could also discourage the use of intensive care units for dying patients. Also, as it seems to be happening in Oregon the physicians are becoming more educated on the care of the dying, using pain management as an option. The use of this practice as noted is not being abused as many opponents thought that it would be. If it works in Oregon and the Netherlands it can work throughout the country. However, if we as a country fail to implement a plan, we will face another “Dr. Death”. I don’t necessarily agree with Dr. Kevorkian’s practices, some of his points did seem to ring true. He said that the medical profession should help alleviate suffering not just heal. I also think that it is possible that we could move toward legalizing euthanasia because the cases where a family member wanted to euthanize their spouse or child, the cases generally got dismissed. I believe that it is possible to image a safe and compassionate administration of euthanasia, with physicians and families working together to create a supportive and loving atmosphere in which to make the crucial decision about the appropriateness of euthanasia. Over the coming decades the elderly population is going to increase drastically, leaving the health care system in even more trouble. If the practicing of euthanasia will help alleviate the problem then I think this country should go for it. Also, on a not so political note, my uncle just passed away and he suffered through an excruciating struggle with colon cancer. The last couple months of his life were very painful, and if I were going through that I would want the option of euthanasia. Bibliography: 1. “Death and Dying.” West Encyclopedia of American Law, Volume 4. West Group, United States 1998. 2. Ezekiel, Emanuel J. “The end of euthanasia' Death's Door.” The New Republic, May 17, 1999 p16. 3. Ganzini, Nelson, Lee, Schmidt. “End of Life Care in Oregon.” Jama.com. May 9, 2001, v285, No.18. 4. Hoefler, James M. “Deathright.” Westview Press. Boulder, 1994. 5. Roscoe, Lori A. “A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon.” The Gerontologist, Vol. 41, No.4, 2001. 6. Shannon, Thomas A. “Killing Them Softly with Kindness: Euthanasia Legislation in the Netherlands.” America, American Press. October 15, 2001, v185, p16. Infotrac. galegroup.com. 7. Urofsky, Melvin I. “The Right to Die, Definitions and Moral Perspectives.” Volume I. Garland Publishing Inc. New York, 1996. 8. Wise, Jacqui. “Netherlands, first country to legalize euthanasia.” Bulletin of the World Health Organization. June 2001, v79, p580. infotrac.galegroup.com.