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Jack Kevorkian
Tracy Latimer
Sue Rodriguez
Austin Bastable
Nancy Cruzan
Final Exit
Skyrocketing health care costs
Living wills
The right to die
These personalities and issues are shaping opinions and influencing public policy - making
euthanasia one of the hottest social, medical, legal, ethical, religious and economic
debates of our time. Like abortion, euthanasia reflects a clash of fundamental values.
Pro-life people reject euthanasia, they believe it is intrinsically evil to kill another
human being, even in the name of "compassion" or "mercy," and that any law permitting euthanasia
would lead to killing for reasons other than "mercy."
Advocates of euthanasia argue those current laws against euthanasia; "mercy" killing and
assisted suicide should be changed because they interfere with the "right of privacy."
Other arguments include "quality of life" and economic considerations.
Most other people find themselves somewhere in the middle. While they may find the
grandstanding Kevorkian disturbing or unethical and the promotion of suicide recipe books
like Final exit abhorrent, sympathy for those who suffer may lead them to believe that
euthanasia is a "solution."
When it comes to actual life or death decisions, however, there is no middle ground.
Death is final. To make informed decisions about end-of-life issues you'll need answers
to several questions.
DON'T I HAVE THE RIGHT TO DIE WHEN MY TIME COMES?
Death is not a right but a reality that none of us will escape. When people say they want
the "right to die," they usually mean that they want control over the time, means and
circumstances under which they or a loved one will die and they want laws to protect this
"right."
It is crucial to understand: there is no law, medical association, church or even right to
life group which insists that unnecessary, unduly burdensome, heroic or futile measures be
used to prolong life. When a person has irrevocably entered the process of dying, the focus
becomes palliative care, that is, helping the person to live as comfortably and as fully as
possible until the time of natural death. We are never obliged to use extra-ordinary means.
Competent persons already have the legal right to refuse medical treatment for themselves.
"Right to die" advocates are expanding this right to include the right of "proxy" or "surrogate"
decision-makers to choose death for another. This is sometimes referred to as "substituted judgment."
Autonomy (the right of each person to make decisions without interference) has become the
reigning principle for medical and other decision-making. But legalized euthanasia does
not necessarily translate into individuals having control over their own lives. More likely,
it grants to others the right to control death.
WHAT IS EUTHANASIA?
Euthanasia is an action or omission intended to cause death. That is:
- Euthanasia can be an act of commission, such as administering a lethal agent, or shooting or
smothering. This is sometimes referred to as direct, positive or active euthanasia.
- It can also be an omission, such as causing death by withdrawing ordinary (usual and customary)
and necessary treatment or care or food and water. This is sometimes referred to as indirect,
passive or negative euthanasia.
It is the intent, which we must keep uppermost in our minds. Whether the death is caused by a
lethal injection or from deliberate dehydration, the intent is to cause death. The victim is
equally as dead; there is no moral distinction.
Euthanasia differs from other killings in that the agent of death assumes death will be "a good"
for the person who dies. "Mercy killing" is a common synonym for euthanasia.
Suicide may be considered self-euthanasia. In assisted-suicide, someone provides an individual
with the information, guidance and means to take his or her own life. Physician-assisted suicide
would allow doctors to take direct actions to kill patients (such as by a lethal injection) or
help patients to kill themselves by approving lethal prescriptions. Legalized physician-assisted
suicide would convert every medical license into a permit to kill.
"Aid-in-dying" is a euphemism for euthanasia. It does not mean helping a dying person to live
as comfortable as possible until death comes. It means killing.
WHY IS EUTHANASIA SUCH A HOT ISSUE?
The social-medical-legal-ethical climate in the U.S. and Canada may be compared to a boiling
cauldron.
Imagine a huge kettle over a steady flame. Add, in no particular order, the following ingredients:
- A growing elderly population - and a smaller, youthful population who may be unable
(or unwilling) to support them. There are not only more older people, but older people;
grandparents taking care of their parents.
- Rising health care costs. Medical care costs are rising faster than inflation.
- Health problems such as catastrophic and long-term illness, AIDS and Alzheimer's disease are
demanding unanticipated, huge portions of our health care budget.
- The "technological imperative." new technologies and procedures offer hope, but not without
significant cost. While these advancements have greatly improved life for many, there is sometimes
an unrealistic and impractical insistence that "what can be done, must be done." this has resulted
in fear of technology and waste of medical resources.
- A clash of values. While a majority of citizens still claim Judeo-Christian based religious
beliefs, the classic "Sanctity of Life" ethic is losing ground. "Quality of Life" is now a decision
making standard. In practice, many have turned from God as Author of Life to the gods of freedom,
autonomy and choice.
- Stir in hostile and elitist prejudices against those who are old, weak or medically vulnerable
throw in the all-too prevalent defense that "it's better to be dead than disabled or dependent."
- Recognize that we have not always done a very good job of meeting the needs of others. Then
add very real, very human fears of pain, suffering or abandonment.
Euthanasia proponents have exploited these and other factors to mould public opinion. With the
help of the popular media (which tends to reduce complex issues to sensationalism or slogans),
many people have erroneously concluded that suicide, assisted suicide and euthanasia are necessary.
School children receive "death education" where they learn that suicide and euthanasia can be
"rational" choices.
Many have failed to respond to these combustible ingredients. The cauldron is boiling. It's
near explosion.
ISN'T EUTHANASIA A VOLUNTARY CHOICE LIMITED TO DYING PEOPLE?
- With voluntary euthanasia, the person gives informed consent to be killed.
- With non-voluntary euthanasia, the person who is killed is incapable of giving consent or
refuses consent. I.e. cases involving decisions to dehydrate and starve to death persons whom
were severely physically and/or mentally disabled and unable to express their wishes.
COULDN'T WE LEGALIZE EUTHANASIA, BUT WITH SAFEGUARDS?
There is real danger in legalizing euthanasia, even with carefully controlled guidelines.
"A most effective tactic used by euthanasia advocates is to distract opponents and voters from
considering the moral and ethical nature of their proposals by luring them into discussions
about safeguards. Before anyone realizes it, the issue is no longer whether killing patients
ought to be allowed, but who can be killed and how to prevent 'abuses.
HOW IS THE PRACTICE OF EUTHANASIA WORKING IN HOLLAND?
ALTHOUGH TECHNICALLY ILLEGAL, THE DUTCH GOVERNMENT HAS APPROVED GUIDELINES FOR DOCTORS TO
EUTHANIZE PATIENTS. The Board of the Royal Dutch Medical Association (KNMG) has endorsed euthanasia and infanticide for handicapped children; the Pharmacists Association published a list of lethal compounds for the purpose.
WHAT IS A LIVING WILL?
A "Living Will" is a declaration or directive instructing a physician to withhold or discontinue
medical treatments from the signer if he or she is terminally ill and unable to make decisions.
WHAT IS A DURABLE POWER OF ATTORNEY?
Proponents admit that living wills are riddled with problems and are not very effective, many
now suggest a Durable Power of Attorney for Health Care (DPAHC) in conjunction with (or in lieu of)
a living will.
The DPAHC allows individuals to select a spokesperson ('agent' or proxy') from a circle of family
and friends. The agent agrees to represent the patient's wishes if/when the patient cannot
communicate them personally.
However, like living wills, DPAHCs have problems with vague and elastic terminology. Like living
wills, DPAHCs may be interpreted to permit withdrawal or withholding of ordinary and necessary
care, including food and water - something the signer may not have intended!
IS THERE AN ALTERNATIVE TO THE LIVING WILL?
- The Protective Medical Decisions Document (PMDD), from the International Anti-Euthanasia
Task Force; and
- The Patient Self-Protection document (PSPD), from the Center for the Rights of the Terminally Ill.
- Explicitly defines and prohibits euthanasia.
- Specify that nutrition and hydration are to be provided unless one is unable to assimilate
food and fluids.
- Specify that the signer is to be provided with ordinary nursing and medical care, including
pain relief and comfort care.
- Confer immunity on the agent(s) who acts in accord with the signer's instructions but do not
confer immunity on any physician, health care provider or institution who will not honour
these instructions.
WHAT IF A PERSON IS IN TERRIBLE PAIN AND SUFFERING?
Suffering is more difficult to assess than pain because it is so subjective. One may suffer
as a result of physical pain, but it can also be an extremely personal, emotional reaction
to one's individual perception of what is happening in their life. We must acknowledge the
reality of physical, mental, emotional and spiritual suffering.
Although most people would not choose to suffer, suffering is a natural and often unavoidable
part of life through which humans may grow in grace, strength and compassion for others.
WHERE'S THE LINE BETWEEN KILLING PAIN AND KILLING THE PATIENT?
Sometimes, an unintended side effect of massive painkillers is to shorten life. For example,
large amounts of morphine may suppress respiration. But the intent is to alleviate pain and
not to cause death. This is sometimes referred to as the principle of "double effect." Most
ethicists agree that administration of analgesics and opiates is not euthanasia.
WHAT IS PALLIATIVE CARE?
Palliative care is for people who are expected to die. It does not seek to lengthen or shorten
their last days, but rather, to help them to live as comfortably and as fully as possible. The
patient remains as involved as is possible in decision- making.
Palliative care recognizes that the time has come when we can no longer cure; the emphasis is
now on care. Pain and other symptoms are managed so that the patient remains comfortable.
Palliative care is a part of hospice care. In its pure form, the hospice/palliative care concept
addresses body, mind and spirit, meeting physical, emotional, social and spiritual needs. Hospice
care is team-oriented, with the team (patient, family, primary physician, nurses, social worker
and, usually, a priest, rabbi or minister) identifying and meeting the needs of the patient and
often, the family. The approach is loving, skilled compassionate and common sense, allowing
each person to live until the moment of natural death.
WHO IS PROMOTING EUTHANASIA?
Its root organization, the Euthanasia Society of America (ESA) was formally organized in 1938
to legalize active and involuntary euthanasia.
In 1974, the Euthanasia Society was renamed "Society for the Right to Die." They established a
program of legal services and an educational arm called the Euthanasia Educational Council
and in 1979 split to reunite in 1990 becoming the National Council for the Right to Die,
"Choice in Dying."
The National Hemlock Society was formed in 1980 by Derek Humphry (Final Exit) to legalize
"aid-in-dying."
In Canada, dying with Dignity (DWD) formed in 1980 promotes voluntary euthanasia and the
living will. In 1991, DWD supported five initiatives at Federal and Provincial levels to
legalize euthanasia. In 1993, it joined with the Right to die Society of Canada modeled
on the Hemlock Society.
The World Federation of Right to Die Societies, formed in 1980, is an umbrella organization
for 32 euthanasia organizations in 19 countries, including the U.S. and Canada.
THE HIPPOCRATIC OATH (THE ANCIENT FOUNDATION FOR THE PRACTICE OF ETHICAL MEDICINE) EXPLICITLY
PROHIBITS EUTHANASIA. THE AMERICAN MEDICTAL ASSOCIATION (AMA) REJECTS ACTIVE EUTHANASIA AND
PHYSICIAN ASSISTED SUICIDE, BUT SUPPORTS EUTHANASIA BY OMISSION (FOR EXAMPLE, BY STARVATION
AND DEHYDRATION).
THE CANADIAN MEDICAL ASSOCIATION HAS NO EXPLICIT POLICY ON EUTHANASIA OR PHYSICIAN-ASSISTED
SUICIDE. HOWEVER, THE ASSOCIATION HAS ALWAYS IMPLICITLY CONDEMNED THESE PRACTICES.
The public policy implications of legalized euthanasia are profound; those who care about
human rights and justice must speak against euthanasia.
Now, before it is too late.
- Compiled from "What You need to Know About Euthanasia and the Right to Die" by Mary Senander
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