On July 26, 1997, the U.S. Supreme Court unanimously upheld decisions in New York and Washington State that criminalized assisted suicide. As of April 1999, physicians-assisted suicide is illegal in all but a couple of states. Over thirty states have established laws prohibiting assisted suicide, and of those who don’t have statues, a number of them prohibit it through common law. In Michigan, Jack Kevorkian was initially charged with violating the state statue. He was charged with first-degree murder and delivering a controlled substance without a license. The assisted suicide charge was dropped, however, he was eventually convicted of second-degree murder and delivering a controlled substance without a license. Only one state, Oregon, has legalized assisted suicide. The Oregon law, which went into effect in October 1997, provides that a doctor may prescribe, but not administer, a lethal dose of medication to a patient who has less than six months to live. As of April 1999, 23 patients were given the drugs under the statue, and 15 of them used the drugs to commit suicide. A report released by the Oregon State Health Division found that the law was working well and had not been subject to abuse (REED A9).
The word Euthanasia originated from the Greek language: eu means “good” and thanatos means “death”. The term euthanasia normally means that the person who wishes to commit suicide must initiate the act (WORLD BOOK). However, some people define euthanasia to include both voluntary and involuntary termination of life. Euthanasia has many meanings so it is important to differentiate among the vaguely related terms.
These meanings of terms were cited from George Lundberg, M.D. in Views of Assisted suicide.
Involuntary Euthanasia: This term is used by some to describe the killing of a person in opposition to their wishes. It is basically a form of murder and not a popular view among most people.
Passive Euthanasia: Hastening the death of a person by withdrawing some form of support and letting nature take its course. For example: removing life support, stopping medical procedures, stopping food and water and allowing the person to dehydrate or starve to death, and not delivering CPR.
Active Euthanasia: This involves causing the death of a person through a direct action, in response to a request from that person. A well-known example would be the process that Dr. Kevorkian took on the Michigan resident and was found guilty of 2nd degree murder.
Physician-Assisted Suicide: A physician supplies information and the means of committing suicide to a person, so that they can easily terminate their own life. The term “voluntary passive euthanasia” is becoming commonly used.
Except for involuntary euthanasia, all these terms are closely related because the victim requests the action. The only discrepancy is who is actually committing the act, and that is insignificant since the choice is up to the victim. So when physician-assisted suicide is mentioned in my argument it will also include passive and active euthanasia.
Qualities of death issues are constantly bringing upon arguments on whether or not physician-assisted suicide should be legalized. The people who want it to become legalized have a very worthy reason: it is a pro-choice decision. That is the majority’s opinion. Recent polls done in the U.S. claim 57% are in favor of the euthanasia choice while 35% oppose this view (CNN/USA Today poll of 1997-JUN). On the other hand the 35% who oppose these views come with the law on their side and also a way to justify their point of view.
The main opposition comes from three established groups who seem to promote their objection for different reasons. The first organizations are the conservative religious groups; they are often the same organizations that oppose access to abortion. The second establishments are the medical associations whose members are dedicated to saving and extending life, and feel uncomfortable helping people end their lives. The third and last group are the ones concerned with disabilities, who fear that euthanasia is the first step towards a society that will kill disabled people against their will. Many faith groups and various religions believe that God gives life and therefore only God should take it away. Suicide would then be considered as a “rejection of God’s sovereignty and loving plan”(DOBSON 2). This is an important belief for this member of one of these religious groups. They would probably never choose any type of suicide, including physician-assisted suicide, for themselves. For each deeply religious person in North America, there are many non-religious or secular people.
A large number of adults who have liberal religious beliefs treat euthanasia as a morally desirable option in some cases. There are also many secularist, atheist, and agnostics who disagree with religious based arguments. Many of these people would like to use suicide as an option in case they develop a terminal disease and life becomes unbearable. Do religious groups have the right to take their own personal beliefs and demand them to the entire population. Should the personal beliefs of some religious people decide public policy for all adults, including religious liberals, Humanists, Atheists, Agnostics, and rest of the population. Dr. Abraham Halpern, an ex-president of the American Association of Psychiatry and the Law, wrote an article in the New York Times stating that “Oregon’s Death with Dignity Act….should be repealed. It greases the slippery slope and will surely result in undignified and unmerciful killings”(HALPERN).
Dr. Gibson, the founder and president of Focus on the Family, also agreed, saying “We will eventually be killing those who aren’t sick, those who don’t ask to die, those who are young and depressed, those who someone considers to have a poor quality of life, and those who feel it is their obligation to get out of the way”(DOBSON 5). These two intellectuals are making it seem that the Oregon law would permit roaming gangs of bureaucrats to visit nursing homes and decide which residents deserve to live and which to die. Of course, future legislation cannot be predicted, but the present statues passed by Oregon are very specific in application. This process will never be used unless a patient specifically requests assistance in dying. For that reason many suffering patients and their families want it to be legalized. The big question is: Who will the set the standards and does it involve the potential for abuse should it become legal?
The Mappe’s and DeGrazia’s Biomedical Ethics book, reviewed and used for reference by the Oregon Health Division, contains the proposed clinical criteria for physician-assisted suicide. These are the conditions one must follow before going through with the procedure (QUILL400-410).
The patient must have a condition that can not be cured be cured and must have severe suffering. In the first condition the patient must know and understand what is going to happen to them. Someone must explain to them other comfortable alternatives. One cannot get assisted suicide if they have diseases such as amyotrophic lateral sclerosis or multiple sclerosis. A doctor is not allowed to make a make final decision if there is any doubt about the patients condition or prognosis (401).
- The physician must be sure that the patient is not requesting death because his or her comfort care is not good enough. In the second condition the request can not be a result of inadequate care. All measures of comfort must be considered if not tried before the physician-assisted suicide can be prepared (402).
- The patient, of his or her own free will, must clearly repeat their request to die rather than suffering. If both the patient and doctor decided that death is the best possible outcome then the doctor should encourage the patient. The physician must be certain that the patient is serious (402-403).
- The patient’s judgement can not be distorted. The patient must be rational and able to understand the choice that he or she is making. Depression is a major factor that causes a patient’s judgement to be altered. Therefore the primary physician must request an expert psychiatric evaluation before proceeding with the process (403).
- Physician-assisted suicide should only be carried out on the context of a meaningful doctor-patient relationship. This then helps the doctor understand the reason for the request. It is also highly recommended that the doctor actually witness the patient previous to his or her current condition(404). “The physician who has helped the patient throughout his illness, should be there for the patient at the time of death”(LUNDBERG).
- Finally there must be clear documentation to support the condition. A system must be developed for reporting, reviewing, and studying such deaths and clearly separating them from other forms of suicide. Not only does the patient have to sign a consent form, but the physician and consultant must sign one as well. The last step assures that the physician, consultant, and the family members will be free from criminal prosecution as long as the conditions are in good faith (QUILL405-408).
- If the proper guidelines are followed, this will not only benefit the families, but also benefit the insurance companies and hospitals perhaps leading to cut backs concerning patient expenses.
Oregon, similar to the Netherlands, are considered pioneers to some by facing this issue considering the circumstances. Oregon has made the first step into supporting the individual right for assisted suicide. Whether or not this view is unpopular to some, people should still have the right to make that decision concerning their own welfare. Since this was a country built on Christian beliefs this will be an on going debate and might never come to a consensus.
- Dobson, James. “Dr. Dobson’s Study.” Focus on the Family. 1998. 17p. Online. Internet. 17 JAN. 1998. Available http://www.family.org/docstudy/newsletters/ a0000580. Html.
- “Death.” The World Book Encyclopedia. 1990
- “Euthanasia.” The World Book Encyclopedia. 1990
Halpern, A.L. and A.M. Freedman. Letter. New York Times. 2 NOV. 1997: n. pag.
- Lundberg M.D. George D. Views of Assisted Suicide from Several Nations. 1997.
- New York: JAMA, 1997. Online. Medical News and Perspectives. Internet. 24 Sept. 1997 available http://www.asst.suicide.com/html.
- Quill, Thomas A. Bio Medical Ethics: Proposed Clinical Criteria for Physician-Assisted Suicide. New York: McGraw-Hill, 1996
- Glover, J. Causing Death and Saving Lives. New York: Penguin Books, 1997.