| Euthanasia is one of the most controversial issues affecting all realms of society and needs to be closely examined. In order to delve deep enough into the issue, the religious, legal, cultural, ethical, medical, and spiritual ramifications of euthanasia from both proponents and opponents of euthanasia need to be explored. The following discussion of euthanasia will inform people about euthanasia and to help them draw their own conclusions. |
| Euthanasia comes from the Greek and means "painless, happy death." Webster defines it as "an easy and painless death, or, an act or method of causing death painlessly so as to end suffering: advocated by some as a way to deal with victims of incurable disease." Yet one more group, the Euthanasia Society, defines euthanasia as "termination of human life by painless means for the purpose of ending severe physical suffering." What is euthanasia on a more intimate level? Some call euthanasia "mercy killing" an others call it murder. Euthanasia is one of the most controversial issues affecting all realms of society and needs to be closely examined. In order to delve deep enough into the issue, the religious, legal, cultural, ethical, medical, and spiritual ramifications of euthanasia from both proponents and opponents of euthanasia need to be explored. The following discussion of euthanasia will inform people about euthanasia and to help them draw their own conclusions. What should people know about euthanasia before deciding how they view euthanasia? To clarify matters, there are two types of euthanasia, passive and active. Both have the end result of ending the life of a terminally ill person. Passive euthanasia can range from discontinuing life-sustaining medical treatment (such as removing patients who cannot breath on their own from a respirator) to giving pain medications such as morphine in amounts that have the side effect of hastening death (6). Active euthanasia is a direct act by a physician or other person that has the purpose of ending a life. It is often done by giving the patient a lethal chemical injection or IV drip or by inhaling a deadly gas (10). Euthanasia is such a controversial topic because it brings forth questions about the morality of killing, the effectiveness of consent, the duties of physicians, and equity in the distribution of resources (1). It is a topic that is particularly uncomfortable for society to confront, especially in the medical field. However, it is not a new phenomenon brought into the spotlight recently by individuals like Jack Kevorkian. Euthanasia has been both discussed and practiced in both the East and the West from the beginning of civilization to the present. It is a more pressing issue nowadays because of the medical technology (such as dialysis, intravenous feeding, and respirators) that is available to sustain and extend life. In the West, the overall religious culture remains opposed to active euthanasia (though passive euthanasia is not illegal); doctors should not commit an act to end life if it is possible to save life (1). |
| Much of the controversy surrounding issues having to do with death and dying center around America's religious ties with Christianity and Judaism. Since the colonization of this land by Europe, Christianity has influenced almost every aspect of American life. The United States has had strong ties to Christianity from its earliest days thru the present. Despite trying to separate Church and State, many of the laws about issues such as euthanasia reflect Christian morals. It states clearly and explicitly in the Ten Commandments "Thou shalt not kill." Opponents of euthanasia say that this alone should make euthanasia an immoral and illegal act. Life is a "gift from God" and it is not for anyone but God to make the decision as to when a person's time on earth is over (3). Proponents of euthanasia cite that God did not mean to have terminally ill people suffer without reason or to extend the life of someone who will never again lead a conscious life. It is the new technology that allows this to happen, not the will of God (1). Overall, most conservative and moderate religious organizations are opposed to euthanasia. The liberal Christian movement as well as humanists, atheists, and other people of various belief systems support euthanasia. Interestingly enough, the majority of Americans support the idea of euthanasia but are often opposed to how legislation concerning the matter is presented. |
| As a general rule, active euthanasia is illegal in the United States (7). However in a state such as Oregon, physician assisted suicide is endorsed. In Measure 16, the Oregon Death with Dignity Act says that terminally ill patients can legally obtain a prescription for lethal drugs to end their lives. It includes the following provisions: the patient must be capable and a resident of Oregon, an attending and consulting physician must agree that the patient suffers from a terminal disease, the disease must be incurable and irreversible and the patient expecting to die within six months, the uncoerced patient must make the request at least fifteen days before the physician writes out the prescription, and the physician must put it in writing at least forty-eight hours beforehand. Also, two other witnesses, not related by blood or interest to the patient must sign for the procedure. If it is believed that the patient suffers from a mental disorder such as depression, the patient must attend counseling session to determine if they of sound mind to make the decision before the doctor will write the prescription (12). Other states such as California, Maine, and New York are debating whether to pass a law similar to Oregon's on the matter of euthanasia. The issue was brought to the legislative bodies in California as recently as February of 1999 as is still being debated (8). High profile cases continue to cause states to reexamine their legal stance on euthanasia. Many of these cases reach the highest court of the land, the U.S. Supreme Court. On June 26, 1997 the Supreme Court reached a unanimous 9 to 0 decision on two cases in Washington and New York. Its ruling was that it was not unconstitutional for states to pass laws banning physician assisted suicide (8). However, the ruling also implied that it was also not unconstitutional for states to pass laws permitting physician assisted suicide. Active euthanasia is not illegal in all countries. In the Netherlands and Holland, active euthanasia is legal to a certain extent. Assisting in suicide is a still a crime in these countries and is punishable by imprisonment. However, decisions by several lower courts that were supported by the Supreme Court and the Royal Dutch Medical Association have said that when euthanasia meets a specific set of conditions it may be defended under a plea of force majeure. When defended under this plea, prosecution rarely follows. That means that while euthanasia is technically illegal by law, a physician who fulfills and meets the guidelines in practicing it, he or she can be sure of not being prosecuted. These guidelines are called "rules of due care" (although they are not part of an official statute) and are used by the Ministry of Justice to see if the physician in question has met all of the measures. Together, these guidelines define the Dutch consensus as to whether or not euthanasia is permitted (1). Cases such as these do occur in the Netherlands. In 1990, of the 130,000 deaths reported 4.6 percent or roughly 6,000 cases were the result of physicians practicing active euthanasia. Some provinces of other countries have actually passed laws permitting active voluntary euthanasia. In Australia, the Northern Territory passed a law permitting this type of euthanasia so long as the patient has given their consent. It was passed on June 25, 1995 and was called the Rights of the Terminally Ill Bill. Other Australian provinces soon followed suit. Similar measures were passed in Japan and Colombia in recent years. In all of these countries, the majority of the public supported these new measures concerning euthanasia (8,9). |
| Doctors have a particularly sticky situation when it comes to euthanasia. Not only do they have their own moral conscience to consider, but they must also look at the situation from a medical ethics point of view. Much of this view stems from the famous oath written by Hippocrates in the fifth century B.C. When Hippocrates wrote this, medicine was tangled with superstition and self-indulgent religiosity. He was largely responsible for desacralizing medicine and his writings have influenced physicians for centuries. The most influential of all of his works is the Hippocratic Oath. Part of this oath states, " I will neither give a deadly drug to anybody, if asked for, nor will I make a suggestion to this effect."(10) Many people cling to this oath when refuting the idea of death by choice. They say that according to this oath, no person has the right to decide death by choice. Proponents of death by choice contradict this argument by stating that it is too simplistic. This approach to medical ethics, they say, is deficient. Joseph Fletcher has opened the discussion of this topic by finding contradictions in the oath. He states that the oath promises two things: first, to relieve suffering, and second, to prolong and protect life (10). However, he argues, when a person is in "the grip of an agonizing and fatal disease, these two promises are incompatible."(10) To prolong life, in this case, is to go against the promise to relieve pain and to relieve pain is to breach the promise to prolong and protect life. Most proponents say that the oath itself is good, but they also state that it is perfectible. They say that it is not "oracular" and not a "divine substitute" for doing ethics. In 1948 the General Assembly of the World Medical Association met in Geneva and adopted a modified version of the Hippocratic Oath. This version of the oath was then incorporated into the 1949 International Code of Medical Ethics and is used by medical schools and physicians. Not included in this form of the oath is the part that swears against giving or counseling the use of something that would cause death. (Of course, it is important to understand that this omission is not an endorsement of mercy killing in any form.) This leaves the debate open to either a pro or con position on the topic (11). |
| Often forgotten in the tangle of legality and morality surrounding the issue of euthanasia is the patient. Should the patient's autonomy be the final governing body in whether he or she chooses to terminate their life (5)? (The finer points of this argument will be covered later on.) In the United States, people can have a living will drawn up by their attorney long before one might be necessary. Often these wills have to do with the removal or suspension of life sustaining treatment should the patient become terminally ill or injured. This usually entails the removal of medical devices such as respirators, dialysis, or intravenous feeding tubes. These are perfectly legal so long as the person in question was in sound mind when they signed the will. A bit more difficult situation comes into play when the patient does not have a living will but wishes to end or forego life-sustaining treatment. Drawn out arguments often happen between the patient, his or her family, the insurance companies, and the medical staff. It must be determined whether or not the patient is of sound mind to make the decision to forego or end life-sustaining treatment. Even if the patient and the families agree to the decision, the battle is not always over. Uninvolved parties (ie: special interests groups) sometimes take the case to the judicial system to try and prevent the removal of life-sustaining devices. Or, sometimes, family members disagree with their kin's decision and fight the battle out in court to continue treatment. Occasionally just the opposite happens and an investigation ensues to see if family members coerced the patient into the request. The family members may not want to continue paying costly medical bills (and see their inheritance being drained) or perhaps they are simply tired of caring for their sickly relative (2). |
| The condition of a terminally ill patient is also taxing of family members who mean well. Some of the problems were alluded to in the previous paragraph. What is especially difficult though, is what to do with a terminally ill family member when he or she is not competent to make the decision. The choice usually falls to the closest relative if that person is cited in legal document to make decisions like this on the patient's behalf or to the attending physician who is supposed to have the patient's best interest in mind. In cases like this, the complication falls on the fact that the patient cannot tell the doctor to not put him or her on dialysis or intravenous feeding. The doctor is then obliged to give life-sustaining treatment whether the patient wants it or not (2). It is a hard choice to make; family members may be torn between letting a loved one go and wanting to hang on to that person. |
| Spiritually, there are also ramifications for everyone when it comes to issues surrounding death and dying. As discussed above, family members are pulled by opposing forces. It can generate hard feelings if the entire family does not agree on what to do with their terminally ill kin and lead to the separation of a family. The patient does not want to be a burden financially or spiritually on their families. The doctor often has his or her hands tied by what they would like to do and what they are obligated to do morally. The death of a beloved family member is not easy to bear, and it is harder for everyone if the parting occurs in the midst of conflict. There are feelings of frustration as the fate of a terminally ill patient is sometimes decided by the courts instead of those closest to the loved one. It tugs at the strings of the Christian faith that so many people live by. Except for the extremists on either side of the topic of euthanasia, those in the middle are torn by what the Bible says and what might be best for the patient. Their conscience is divided. |
| Is there a "right" answer for the question of euthanasia? While passive euthanasia (although doctors do not openly refer to it as such) is legal in some instances and an overall acceptable act, active euthanasia is not. Some people would disagree with the legality of even passive euthanasia. Proponents of euthanasia will cite five principle arguments in favor of active euthanasia. Overall they say that passive and active euthanasia end in the same result and so does it matter how the patient got there? They state that the distinction between active and passive euthanasia is only an argument about technique (5).
The first argument is that respect for a patient's autonomy should govern what treatment they do or do not receive. They say if people legally ban active euthanasia then those persons are in direct violation of the patient's liberty and freedom to exit how he or she chooses. If a patients requests or consents to active euthanasia, then they are not harming anyone else. Legally banning "mercy killing" then seems unjustified and arbitrary (5). Opponents of euthanasia will say that this does not justify voluntary active euthanasia. Daniel Callahan once said, "Consenting adult killing, like consenting adult slavery or degradation, is a strange route to human dignity."(5) They say that people should not confuse respect for a person's autonomy and dignity with willingness to permit or assist him to do whatever he or she wants. Doing whatever he or she wants does not always reflect respect and refusing to go along with him or her does not necessarily convey disrespect. The second argument states that active euthanasia is an act of compassion and that "mercy killing" is justified. If people do not have the option of active euthanasia, they cite, then others cannot act with as much compassion as they might want to and impose unnecessary suffering on the terminally ill (5). In rebuttal of this argument, opponents state that "mercy killing" would be abused, especially for the elderly poor. They say that is hypocrisy to push compassionate killing when this country has starved many of the elderly and dying. This country has not earned the moral option to kill in the name of mercy because it has not supported and sustained life with compassion and mercy. (Also, they are quick to point out that the U.S. is the only industrialized country besides South Africa who denies a major portion of its citizens acute care.) Furthermore, they say that active euthanasia might provide those in dire straights (like the elderly poor) with an appealing option that they cannot refuse given their situation (5). Thirdly, proponents argue that patients who are deprived and completely dependent on others for care might rather die than lose their independence. This position also cites the moral importance of liberty. The terminally ill do not wish to be burdens and wish out of compassion for their caregivers to go quickly. Euthanasia mercifully relieves caregivers of their burdens and patients of being a burden. The terminally ill wish to end their lives because they are part of a greater whole. They do not wish to be a burden on their "community" and die for the benefit of others (5). Opponents refute this argument by stating that it is the community's fault that the terminally ill would feel this way. Society is not providing the caregivers with enough support and rest from their labors. If society were to do this, then the caregivers would not feel so overwhelmed or exhausted from their efforts. This would relieve the terminally ill from feeling as though they are a burden. They close by saying that it is hard to admire the moral commitments of a nation that would push individuals and families to such a desperate act (5). The fourth argument states that dying is a private, personal, intimate event that should involve at the most the patient's family, friends, and physician. Other people and their political representatives have no place putting restrictions on dying. They cannot justify regulating or interfering in this event (5). Those who are against active euthanasia will cite that dying is a public event just as being born is. Birth is the first public event for every person and the funeral their last. They say that society cannot wash its hands of the practice of active euthanasia simply because it is a private matter. The public has a huge investment in the training of doctors and placing medical equipment at their disposal. The decision to permit active euthanasia implicates society as a whole; so dying is not exclusively a private matter (5). The final argument is closely related to the first. It stems from a claim upon the patient's autonomy. The fear of losing control, they say, also violates this autonomy because the terminally ill are not in command of their fate. The need to be in control is a very American trait. From a very young age, Americans are taught that they need to be independent and self-sufficient. That is why Americans prize their independence and despise losing control. That is why "how to" books are so popular in American bookstores. Lastly, proponents of active euthanasia say that it aids in restoring that feeling of control to both terminally ill patients and their physicians who are at their medical limits in treating them (5). Refuting this, opponents say that the ideal of absolute control is morally wrong. Active euthanasia is not justified by wanting to control one's exit in the face of losing control when dying. Those in the middle of this pro and con argument state that perhaps it is not learning to deal with losing control that matters or removing the mortality markers from human kind, but learning to deal with death and the limitations it presents (5). |
| What does society decide on the topic of euthanasia, particularly the active form? Is it morally correct to press Christian beliefs that are against euthanasia on an entire nation that is partly made up of non-Christians? What do Christians do who feel that they come out somewhere in the "gray" area? They may see both sides of the argument and end in a draw. This is where most Americans probably fall and with good reason. What about doctors and the oath that they use as a guide? The oath is not always clear on how the doctors should proceed. What of the patient and their families? No one envies or wishes to be in the situation of dealing with and caring for a terminally ill family member. Can the American system of medicine be reformed to relieve some of this burden from both the patients and their families? There are spiritual consequences for everyone when it comes to the topic of euthanasia. While not everyone is touched directly with the topic of euthanasia and caring for the terminally ill, it is an issue that affects the entire society. As one can see, the subject of euthanasia raises more questions than it does answers. The purpose of this paper though was to stimulate thought on the matter and to serve as a guide by providing both the pros and cons of euthanasia. Proponents argue mainly from the perspective of an individual's autonomy and dignity. They also argue that euthanasia is a merciful act that is justified by compassion. Opponents state that these reasons are not enough and that participating in euthanasia is not necessarily and act of compassion. It does not necessarily preserve dignity and dying is not completely a private matter. Perhaps each person will not be able to find where he or she stands on this issue of euthanasia until they are directly confronted with it. |