Euthanasia The thin line between life and death has become an ethical issue many health care providers and the government have long tried to ignore. The understanding that life begins at birth, and ends when the heartbeat and breathing have ceased has long been deemed factual. Medical technologies have changed this with respirators, artificial defibrillators, and transplants (Macionis, 2009). “Thus medical and legal experts in the United States define death as an irreversible state involving no response to stimulation, no movement or breathing, no reflexes, and no indication of brain activity” (Macionis, 2009, p. 36). The process of deciding when a terminally ill patient should die lies within the patient, family members, and the medical staff. Patients who are terminally ill have the right to refuse treatment and nourishment at the time of the illness, or for the future through a living will. The right to not be resuscitated or use any extraordinary measures to prolong life also lies within their rights. The dilemma being faced by patients, medical personnel, and the government is whether or not someone has the “right to die. A patient has the right to refuse treatment to prolong their life, but do they have the right to choose to end their life at their discretion is the question (Macionis, 2009). Euthanasia, also called “mercy killing,” dated back to 1869, is the act or practice of killing or permitting the death of hopelessly sick or injured individuals in a relatively painless way for reasons of mercy (Merriam-Webster, 2010). Euthanasia is an ethical dilemma because it is both an act of kindness and an act of harm.
The desire to have euthanasia legalized varies from doctor to doctor, while some want to help end their patients inevitable misery, others state they became a doctor to prolong life not to end it (Stolberg, 1998). There are many forms of euthanasia, including oral medication overdose, lethal injection, and palliative sedation. Although Oregon have legally assisted suicides according to their state laws, in 1997, The U. S. Supreme Court decided under the constitution a patient does not have the right to die (Macionis, 2009). Euthanasia relates to the sociological paradigm of conflict theory.
The basic definition of conflict theory is groups competing for scarce resources. Marx said the key element to human history is class conflict. A small group controls the means of production and exploits those not in control. It is considered the framework for building theory that sees society as an arena of inequality that generates conflict and change. People in positions of authority try to enforce conformity, resulting in resentment and resistance. This leads to the constant struggle to determine who has the authority (Macionis, 2009).
In Euthanasia, the government is in the position of authority; they are trying to enforce conformity among physicians. They want all physicians to abide by the law of assisted suicide being deemed illegal. The result is resentment by the patients with the terminal illness by being refused what they feel is their “right to die. ” There is also resistance of some physicians to follow the laws that have been enforced due to their personal beliefs on the matter. Conflict theory shows the constant struggle between the government and patients, as well as physician and patients at who has the right to make that call.
Patients have to fight a double battle; first, with the government to make it legal, and secondly, with the doctors by convincing them to follow through with the process. It ignores the shared belief among some patients, and possibly puts the fear in the government that with the legalization of assisted suicide that they are giving physicians and patients an overabundance of interdependence, and power in the concern of doctors being able to choose who lives and dies in these situations (Macionis, 2009). Dr.
Jack Kevorkian – a k a “Doctor Death” for helping chronically ill and terminally ill patients commit suicide – has emerged from prison as deluded and unrepentant as ever. Brushing aside criticism by other supporters of medically assisted suicide that his tactics were reckless and harmful to their cause, Dr. Kevorkian asserted: “I did it right. I didn’t care what they did or didn’t do. When I’m going to do it, I’m going to do it right. (The New York Times, 2007, p. A. 22) The irony in Dr. Kevorkian’s work is he did it wrong, and by performing the assisted suicides so badly he in turn defiled the movement he hoped to einforce. His work showed how much critically ill patients do suffer, and that there is a need for sane and humane laws for assisted suicide. Dr. Kevorkian was first brought into national attention in 1990 when he hooked a 54 year old woman to a homemade suicide device and watched as she pushed the button to release the lethal drugs. Nine years later, he was jailed claiming to have assisted in the death of more than 130 terminally or chronically ill patients. The downfall for Kevorkian was his ego and appetite for publicity and fame.
He gave a 52 year old man with Lou Gehrig’s disease lethal injections to end his life, which moved him beyond assisted suicide to euthanasia. Kevorkian wanted prosecutors to indict him, hoping the trial would cause society to argue his case. However, the judge blocked testimony from family members who supported the death and disallowed evidence about the patients suffering and the consent was deemed irrelevant. He was found guilty of second-degree murder (The New York Times, 2007, para. 7). The fundamental flow in Dr. Kevorkian’s crusade was his cavalier, indeed reckless, approach.
He was happy to hook up patients without long-term knowledge of their cases or any corroborating medical judgment that they were terminally ill or suffering beyond hope of relief with aggressive palliative care. This was hardly “doing it right” as Dr. Kevorkian likes to believe. (The New York Times, 2007, para. 6) By contrast, Oregon being the only law allowing terminally ill adults to request a lethal dose of drugs from a physician requires two physicians to agree the patient is of sound mind and has less than six months to live.
California is in the works of voting on a similarly careful measure. One of its sponsors cites Dr. Kevorkian as “the perfect reason we need this law in California. We don’t want there to be more Dr. Kevorkians” (The New York Times, 2007). ” Dr. Kevorkian’s assisted suicides and euthanasia is an example of structural functionalism Structural functionalism is a framework for building theory that sees society as a complex system whose parts work together to promote solidarity and stability.
A social function is the consequences of a social pattern for the operation of society as a whole. Types of social functions are manifest function, latent function and dysfunctions. Manifest function is the recognized and intended consequences of any social pattern. Latent function is the unrecognized and unintended consequences of any social pattern. Dysfunctions are any social pattern that may disrupt the operation of society (Macionis, 2009).
Kevorkian’s situation is a form of manifest function in the aspect that he did illegal acts, which in turn caused him to be arrested and convicted of the crime. It is also a dysfunction, due to the harmful consequences of his reckless behavior. By working against the social structure set forth for him and doing things his way, he pushed back the idea of assisted suicide deeming it wrong and unethical due to his encounters. Death is a function all on its own and falls into the three types of social functions.
Death is a Manifest function in regards to euthanasia because it is intended by the patient to die. It is a latent function for society and for the family of the patient. Both the aspect of society where death is an inevitable and required thing to keep populations under control, someone who has a chronic or deadly illness is enabling the natural process through euthanasia. It is unintended in regards of the family not expecting it to occur. It is also a dysfunction for the family, because it disrupts their lives and changes them forever.
I believe that social structure has set forth the proper behavior physicians should have in situations like euthanasia and physician assisted suicide. Also, Dr. Kevorkian allowed his dysfunctions to show others the consequences of taking things into one’s own hands when there are rules and laws set forth otherwise. I believe that the government responded appropriately in Dr. Kevorkian’s situation, he over stepped the boundaries of a movement many physicians, who would use proper techniques are trying hard to bring into effect.
The universal test laboratory for euthanasia has been the Netherlands, making United States efforts look like mere baby steps. The first moves toward permitting assisted deaths were taken there in the early 1970s, were sanctioned by the Supreme Court in 1984, and finally approved by Parliament in 1993 (Humphry & Clement, 1998). No one could accuse the Dutch of rushing secretly into the practice of euthanasia: Over some thirty years, they have called numerous commissions of inquiry, held conferences, carried ut academic studies, taken doctors to court to establish whether they broke any rules, and made themselves available for critical studies by visiting foreign medical experts and writers (Humphry & Clement, 1998). Termination of life is now in three categories: termination of life at the request of the patient (euthanasia); assisted suicide: The doctor supplies a drug which the patient administers to themselves; and termination of life without a request from the patient (Humphry & Clement, 1998). All three actions are felonies under the criminal code, with penalties ranging from a fine to life imprisonment for murder.
Doctors in the Netherlands are for the most part not prosecuted, under a doctrine called force majeure- necessity or duress- because of the conflict between their duty to preserve life, and their duty not to allow the patient to suffer (Humphry & Clement, 1998). There must be clear exonerating circumstances before immunity from prosecution is granted, and even then the doctor must have obeyed preordained criteria, and also made the statutory notification of an unnatural death giving full reasons for action taken (Humphry & Clement, 1998).
Criteria a doctor must observe are: The patient must have made voluntary carefully considered, and persistent requests [to his doctor] for euthanasia; The attending physician must know the patient well enough to assess whether the request is indeed voluntary and whether it is well considered; A close doctor-patient relationship is a prerequisite for such an assessment; According to prevailing medical opinion, the patients suffering must be unbearable and without prospect of improvement; The doctor and the patient must have considered and discussed alternatives to euthanasia; The attending physician must have consulted at least one other physician with an independent viewpoint who must have read the medical records and seen the patient; and Euthanasia must have been performed by a doctor in accordance with good medical practice. (Humphry & Clement, 1998, p. 143) In a country with a population of fifteen million, and approximately 130,000 deaths a year, surveys ordered by the government indicate that 2,300 people annually die via euthanasia, with a further 400 dying by assisted suicide (Humphry & Clement, 1998). The essential difference between how the Dutch and Americans have handled the debate is early on the Dutch government and medical and legal institutions recognized the extent of public sympathy for euthanasia, proceeding immediately to examine the situation and seek a solution (Humphry & Clement, 1998).
In the United States- as well as in most other western countries- the government and institutions have instinctively and immediately opposed dealing with the subject, except when forced to by the pressure of events, such as the Oregon law, Doctor Kevorkian’s actions, or some legal cause celebre such as Quinlan or Cruzan, which aroused public awareness. Once those matters were dropped from the headlines, it was back to the status quo. The knee-jerk reaction of the establishment has been to say that any form of assisted death is never acceptable, thus stifling inquiry into ethical and practical problems, and development of safeguards. (Humphry & Clement, 1998, p. 144) This is an example of the Symbolic Interaction Approach, a framework for building theory that sees society as the product of everyday interactions of individuals (Macionis, 2009). Such as with the Dutch and their surveys and interviews to find what the public and doctors feelings were on the matters of euthanasia.
With symbolic interaction, individuals evaluate their own conduct by comparing themselves with others (Macionis, 2009). Like the Dutch did with the way they handle euthanasia by trying to find answers and the appropriate actions to take, as compared with the United States approach of ignoring the situation when possible. “Reality” is how we define our surroundings and interactions with other people (Macionis, 2009). What kind of reality would an individual have if it is full of pain and suffering, which is why the Dutch have my full support on how they deal with euthanasia. They have a very structured and researched way of doing things. They accepted the reactions of others (society) with being pro euthanasia, and developed a civilized way of carrying it out.
They used what other countries are doing wrong and used them to benefit their own. Arthur W. Wilson sits in his study, breathing oxygen through a nose clip and pausing frequently for the coughs that rack his body. “I’m not suicidal,” he said. “I’m sane. ” Mr. Wilson, 86, has been living with the profound pain of chronic obstructive pulmonary disease for years. Now he wants to end his life – not today, not tomorrow, but when he chooses – under the provisions of Oregon’s Death With Dignity law. “When the time comes,” he said, “I’m going to swallow that bottle of Lethe and say goodbye. ” He is no stranger to death, having fought in World War II and in Korea. And he craves being in control.
His house is snaked through with a clear plastic tubing system that he devised to carry his oxygen from room to room without having to drag a tank around behind him. He does not seem, in other words, to be the depressed, languishing patient many might expect to see applying for the Oregon program. (Schwartz & Estrin, 2004, para. 1-6) The state’s law allows adults with terminal disease who are likely to die within six months to obtain lethal doses of drugs from their doctors. In the years since it went into effect, surprisingly only a small number of people who have sought lethal drugs under the law and an even smaller number have actually used them (Schwartz & Estrin, 2004). In surveys and conversations with counselors, many patients say that what they want most is a choice about how their lives will end, a finger on the remote control, as it were” (Schwartz & Estrin, 2004, para. 15). While there is still strong opposition around the country to laws like Oregon’s, support within the state has grown over the years. Oregon voters passed the law into two separate referendums. Even some former opponents say the widespread abuses predicted by some have not emerged. Studies are also helping researchers and policymakers understand how the process really works (Schwartz & Estrin, 2004). Perhaps the most surprising thing to emerge from Oregon is how rarely the law has actually been used. We estimate that one out of a hundred individuals who begin the process of asking about assisted suicide will carry it out,” said Ann Jackson, executive director of the Oregon Hospice Association. Since 1997, 171 patients with terminal illnesses have legally taken their own lives using lethal medication, compared with 53,544 Oregonians with the same diseases who died from other cause during the time, according to figures released by the Oregon Department of Health Services in March. (Schwartz & Estrin, 2004, para. 10-13) More than 100 people begin the process of requesting the drugs in a typical year. Doctors wrote 67 prescriptions for the drugs in 2003, up from 24 in 1998. Forty-two patients died under the law in 2003 compared with 16 in 1998 (Schwartz & Estrin, 2004). Many patients say they want to have the option to end their lives if the pain becomes unbearable or if they are sliding into incompetence while still thinking clearly” (Schwartz & Estrin, 2004, para 14). Another surprise is that for most of those who seek assisted suicide, the greatest concern appears not to be fear of pain but fear of losing autonomy, which is cited by 87% of the people who have taken their lives with the drugs. Only 22 percent of the patients listed fear of inadequate pain control as an end-of-life concern, perhaps a sign that pain management has improved over the years (Schwartz & Estrin, 2004). Opponents of the Oregon law like Dr Kenneth Stevens, chairman of the department of radiation oncology at the Oregon Health and Science University in Portland, say it violates the fundamental tenet of medicine. Dr.
Stevens argues that doctors should not assist in suicides because to do so is incompatible with the doctor’s role as healer. “I went into medicine to help people,” he said. “I didn’t go into medicine to give people a prescription for them to die” (Schwartz & Estrin, 2004, para 25). Dr. Stevens heads an organization, Physicians for Compassionate Care, which opposes assisted suicide and the Oregon law. Members of his group, he said, tend to be “people of faith,” who believe that assisted suicide violates their religious principles. But they base their opposition to the law on moral and ethical grounds, arguing that it leads down a slippery slope toward euthanasia and patient abuses. He recalled the struggle of his wife, who died of cancer in 1982.
In the weeks before she died, he said, her doctor offered her an “extra-large prescription” for painkillers. “As I helped her into the car, she said, ‘He wants me to kill myself,’” Dr. Stevens recalled. “It just devastated her that her doctor, her trusted doctor, subtly suggested that. ” (Schwartz & Estrin, 2004, para. 24-26) Doctors have long made lethal doses of drugs available to patients inclined to end their struggle against disease, said Eli Sututsman, president of the board of the Death With Dignity National Center. “We took something that was already happening, and we wrote a law around it,” he said (Schwartz & Estrin, 2004, para 36).
Opponents had argued that Oregon would become a magnet for people seeking suicide, so the law’s provisions were restricted to the state’s residents. The law also sets a high barrier to getting the life-ending medications, giving patients the chance to change their mind up to the last moment. A patient must make two oral requests for the drugs and one written request after a 15-day waiting period. Two doctors must determine that the patient has less than six months to live, a doctor must decide that the patient is capable of making independent decisions about health care and the doctor has to describe to the patient alternatives like hospice care (Schwartz & Estrin, 2004).
The law also requires that the drugs be self-administered by the patient, rather than given by a doctor or family member, to avoid involuntary euthanasia. The death certificate, under law, must state the cause of death as the underlying disease, not suicide (Schwartz & Estrin, 2004). That provision pleases Mr. James. “I don’t like the word ‘suicide,’” he said, because “if I’m really on a path, the natural path” toward death, and “just hastening it a little bit, I don’t call that suicide” (Schwartz & Estrin, 2004, para 38). The Oregon law is an example of Structural Functionalism. Individuals evaluate their own conduct by comparing themselves with others, such as with the legislation of the law getting passed (Macionis, 2009).
By hearing stories of patients suffering with these horrendous illness, they were able to put themselves into the patient’s shoes and understand their need for such a law (Schwartz & Estrin, 2004). “As we interact with others, we constantly adjust our views of who we are based on how we interpret the reactions of others” (Macionis, 2009). Many doctors that were opposed to the law in Oregon have changed their minds to their interactions with patients (Schwartz & Estrin, 2004). This is a positive example of Symbolic Interaction. It is helping physicians and medical personnel get into the patients mind and understand a little more of what they are experiencing.
This should be a prime example for the government that this needs to be a nationwide law, not just in the state of Oregon. Not only is Oregon permitting patient assisted suicide, they are doing so in a manner that is structured and regulated. The sociological theories play a great role in the health field. Structural functionalism for example has both social structure and social function. The social structure would be the everyday duties of an individual in healthcare, the social function would be the disruption of the social pattern such as with euthanasia as I discussed above. It deals with manifest function, with the intended consequence (Macionis, 2009). For example, you take your antibiotics you get better.
Latent function relates to healthcare where by treating illness individuals have discovered new cures and ways to do so. It is also a dysfunction when you have corrupt people working in healthcare, such as a doctor writing narcotic prescriptions when the patient should not have them or it is not time for a refill. Symbolic interaction relates to healthcare in the sense that it is a framework for building theory that sees society as the product of everyday individuals (Macionis, 2009). Healthcare workers interact with patients every day. They also compare themselves with others, by putting themselves in the patient’s shoes in some situations. Conflict theory simply defined is groups competing for scarce resources (Macionis, 2009).
With the economy in the state it is, many are competing for jobs which come with healthcare benefits. Health insurance is becoming scarce for some, and in situations where it is available an individual may not be able to afford it. Sociology is an important class because it explains how people interact as groups in society. This can lead to understanding and acceptance of different cultures. It is important to learn about things such as social interaction, culture, and media and influence because the information and understanding gained can positively impact public policies. It invites us to examine aspects of the social environment that we often ignore, neglect, or take for granted.
References Humphry, D. , & Clement, M. (1998). Freedom To Die. New York, New York, USA: St. Martin’s Press. Macionis, J. M. (2009). Society the Basics. Upper Saddle River, New Jersey: Pearson. Merriam-Webster. (2010). Retrieved July 10, 2010, from Merriam-Webster OnLine: www. merriam-webster. com Schwartz, J. , & Estrin, J. (2004, June 1). In Oregon, Choosing Death Over Suffering. The New York Times , F. 1. New York, NY. Stolberg, S. G. (1998, April 23). The New York Times. Assisted Suicides Are Rare, Survey of Doctors Finds . New York, N. Y. The New York Times. (2007, June 5). Dr. Kevorkian’s Wrong Way. New York Times , A. 22. New York, N. Y, USA.