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Euthanasia 1 Running head: EUTHANASIA AND THE RIGHT

Euthanasia and the right to die Jehna K., Lisa W., Ben Q., Janice M., Ashley R., and Audrey F. Pacific Lutheran University

Euthanasia 2 Abstract Euthanasia is a long-debated ethical and political issue surrounding the medical field, and is defined as the deliberate ending of the life of people with incurable or terminal illnesses or unbearable suffering (Venes 2005). There are many different arguments against the use of euthanasia. They include: euthanasia is a rejection of the importance and value of human life, it may become not only for people who are terminally ill, euthanasia can become a means of healthcare cost containment, and many fear that euthanasia could become non-voluntary. Those for euthanasia argue that not only does everyone have a right to choose death in the face of great suffering, but also the time and resources used on terminally ill patients could be more sufficiently utilized with patients who have a better prognosis.

Euthanasia 3 Euthanasia and the right to die Euthanasia is a long-debated ethical and political issue surrounding the medical field, and is defined as the deliberate ending of the life of people with incurable or terminal illnesses or unbearable suffering (Venes 2005). There are several different forms of euthanasia, but all revolve around the same question: Do people have the right to choose death? This is a very difficult question to answer for many people, which is what makes euthanasia so controversial. Perhaps the most well-known advocate for euthanasia, Dr. Kevorkian, is famous for saying dying is not a crime (Wikipedia 2007). When put into the hands of a medical official, this idea of death being a crime is exactly what is called into question. Euthanasia Euthanasia is recognized as ending the life of a terminally ill patient when the condition is incurable. In Belgium and the Netherlands, it was legalized in 2001. In the United States, it is now legal only in the state of Oregon. In ancient Greece, euthanasia was accomplished by drinking a poison called hemlock, which would preserve a man`s dignity while letting him die peacefully. Active and passive euthanasia are two different ways through which many terminally ill patients, either in a hospital or in their homes, end their lives. Active euthanasia involves the termination of life as painlessly as possible such as by an injection of lethal medications. Passive euthanasia involves withholding artificial life support, such as breathing or feeding tubes. It is often called the right to die` (Answers 2007). In addition, there are three subcategories of euthanasia which consist of voluntary, non-voluntary, and involuntary euthanasia. Voluntary euthanasia involves a consenting, competent adult; non-voluntary euthanasia is done with the consent of a surrogate of an incompetent person; and involuntary

Euthanasia 4 euthanasia is of a person who has given no consent--otherwise known as murder. Heated debates around the world ensue concerning the rights of patients and the use of voluntary and non-voluntary euthanasia. The Case Against Euthanasia We will begin our discussion of euthanasia by presenting the views held by those against it. The side against euthanasia tends to take on a more personal ambiance than the side for it because it fights for the importance of sustaining all human life. Those who are pro-euthanasia fight for the quality and use of care for those patients with a better prognosis than someone deemed terminally ill. There are many different arguments against the use of euthanasia. A major concern held by those who do not support euthanasia is that it is a rejection of the importance and value of human life. Many are also concerned that if legalized, euthanasia would be used for a means other than that of ending the suffering of a terminally ill patient. There are also speculations that euthanasia can become a means of healthcare cost containment. Finally, many fear that should it be legalized, non-voluntary euthanasia will become culturally accepted and possibly the norm for those who are ill. The most difficult concept surrounding euthanasia is that many believe it is a rejection of the importance of human life. This is one of the many ethical issues involved. Euthanasia is viewed as being morally wrong for several reasons. Additionally, from a physician`s standpoint 39% held that assisted suicide is never ethically justified (Pullicino 1997). Many other health care professionals, the patients` relatives, and people in the community also feel this lack of ethical justification. Those opposed to euthanasia view it as a way of desensitizing individuals to the significance of death. As aforementioned, many believe that if euthanasia were to become

Euthanasia 5 legalized in the United States, then there is the potential that people would be treated as objects and their human value would be forgotten: Once euthanasia becomes legal, opponents contend, the potential for abuse at the hands of caregivers vastly increases. Closely related to this argument is the argument that those who enjoy the exercise of power over others might become intoxicated with it and actually come to enjoy killing (LeBaron 1999). The risk that these scenarios could take place if euthanasia is legalized makes it unethical and immoral in the eyes of many citizens. Another argument against euthanasia would be used as a means of ending the suffering of a patient who is not terminally ill. One of the main concerns of those opposed to the use of euthanasia is what exactly the definition of being terminally ill is. They fear that the many different definitions will lead to a vague understanding of when euthanasia is appropriate: Jack Kevorkian said that a terminal [illness] was any disease that curtails life even for a day. The co-founder of the Hemlock Society often refers to terminal old age. Some laws define a terminal condition as one from which death will occur in a relatively short time. Others stated that terminal means that death is expected within six months or less (Pullicino 1997). Even if a universal definition of terminal is adopted, there is still the issue that it is virtually impossible to predict a patient`s life expectancy--someone diagnosed to live six months may die after a few years or not at all. A third argument against euthanasia is that it can become a means of healthcare cost containment. This stems from the statistic that drugs in assisted suicide cost only about $40, but it could take $40,000 to treat the patient properly ... (Pullicino 1997). Hospitals spend billions of dollars every year on healthcare costs and they are constantly encouraged to implement money saving measures. It is from this financial dilemma that those opposed to assisted suicide conclude it could become just another means to save money in the hospital setting. Furthermore,

Euthanasia 6 if euthanasia became legalized physicians could find themselves far better off financially if a seriously ill or disabled person chooses` to die rather than to receive long-term care (Pullicino 1997). The final argument against euthanasia is that it could become non-voluntary. If a patient is ill or depressed and as a whole is not at a psychological state of well-being, then the overpowering influence of healthcare workers may lead that patient to want to end his or her life. If euthanasia becomes a norm in society, people might be expected to accept the advice of physicians. The following illustrates an example of this conundrum: If a doctor told you your mother`s quality of life was not worth living for and asked you, as the closest family member, to approve a quick, painless ending of her life and you refused how would doctors, nurses and others, conditioned to accept euthanasia as normal and right, treat you and your mother (Pullicino 1997). In this scenario, the son or daughter declined the use of euthanasia in a health care facility full of employees habituated to accept it; care for the mother may no longer be welcomed or adequate. In this situation a relative would feel pressured to accept this course of action, making euthanasia no longer voluntary. Terri Schiavo In the case of Terri Schiavo, her husband`s wishes clashed with those of her parents. Many physicians independent of each other diagnosed Terri as being in a persistent vegetative state (PVS), meaning that Terri had severe brain damage in which her coma had progressed to a state of wakefulness without detectable awareness. This means that her eyes could be open, but she was unresponsive to external stimuli: Schiavo's parents contended that her behavior in [an] image from one of the videos they released showed that she was aware of the people around her. Most neurologists who examined Schiavo

Euthanasia 7 disagreed, saying that her behavior represented reflex or instinctive actions (Wikipedia 2007). Her parents disagreed with all of the physicians` diagnoses and declared that their daughter was aware of her external surroundings. In court, they challenged the assertion that Terri was indeed in a persistent vegetative state. Their claim was that she was instead: ... in a minimally conscious state. Her parents argued that at times her actions indicated responses to external stimuli, not instinctive or reflex behavior. For example, the Schindlers claimed that their daughter smiled, laughed, cried, moved, made childlike attempts at speech, and attempted to say Mom or Dad; or yeah when they asked her a question. They claimed that when they kissed her, she looked at them and sometimes puckered her lips (Wikipedia 2007). Terri`s parents had several other reasons why they believed their daughter should remain on life support. From their perspective, the Schindlers thought Terri`s husband, Michael, should not have guardianship over her because his decisions were based on ulterior motives. During the course of Terri`s illness, Michael had a relationship with another woman, with whom he had a child. With this in mind, her parents felt that Michael wanted to inherit the remainder of Terri`s estate because there was no living will present at the time she collapsed. The Schindlers also believed that Michael had failed to provide his wife with adequate care. Another one of the parents` claims was that by the definition of terminal within Medicare guidelines, Terri was not at a terminal stage. This resulted in a five-year struggle of whether or not Terri should be removed from life-sustaining measures. The decision process regarding Terri`s fate was hindered by the protests of her parents. Among many other reasons for their refusal to withdraw life support, her parents did not want her to die an inhumane death by dehydration. The Schindlers were devout Catholics and felt that removing Terri`s feeding tube was a form of mercy killing, which went against all of their religious beliefs.

Euthanasia 8 In this particular case, the two sides that were argued for over ten years could be interpreted as pro- and anti-life positions. Terri`s husband argued to end the suffering of his wife while her parents argued to keep her alive as long as possible. The legislators of the state of Florida went back and forth between supporting both her husband and her parents. In the end, however, even the Federal Judge and the Supreme Court would not intervene in her husband`s decision to end Terri`s struggle. In 1994, while Terri was in a long term care facility, Michael filed a DNR (do not resuscitate) order with the facility through her doctor, who also happened to be the lawyer for the couple. Terri died on March 31, 2005, thirteen days after they removed her feeding tube. Since she could only receive nourishment through her feeding tube because her ability to swallow had diminished over the years, she died from dehydration. The Case for Euthanasia This unfortunate circumstance drew the attention of many people to the ethics of euthanasia. Terri`s parents wanted her to remain in her vegetative state for as long as possible. Michael Schiavo disagreed and saw that it was in his wife`s best interest to end her suffering. Many people take side with Michael`s decision on the topic of euthanasia. They argue that not only should an individual have the right to choose the care (or lack thereof) they receive, but in many cases the time and resources used on terminally ill patients could be more sufficiently utilized with patients who have a better prognosis. In other words, they believe we should focus on curing the people capable of being cured and end the suffering of those who cannot. Michael Schiavo did what he thought was right to end the suffering of his wife. If he had been allowed to end Terri`s life after the first five years of her condition when he first filed the petition to remove the feeding tube, then the legal struggle that ensued would never have taken place. Terri also would never have dwindled to the state that she was in. At the age of 38 years,

Euthanasia 9 her brain had shrunk to one fourth of an average 25 year olds brain size. In this condition, she was expected to live on as a vegetable and in her parents` eyes this was acceptable. Michael, however, who went through the therapy and suffering with her when she first collapsed, knew that this was not how she wanted to live and was just trying to put his wife at rest once and for all. Passive euthanasia has been legalized through the New Jersey Supreme Court since the Sleeping Beauty case of Karen Ann Quinlan in 1976 after she had overdosed on alcohol and barbiturates, resulting in a coma from which she would never return (Answers 2007). Because she was still under her family`s care and jurisdiction when her parents took her off life support, their decision was supported by the laws already in place. If this case held up almost thirty years ago for a 21 year old, then should not have Michael Schiavo been given the same rights for his wife? If Terri Schiavo had been taken off her feeding tube when her husband had petitioned for it then she would not have been using resources that could have been made available to patients who had the potential to recover. When a person lives in a vegetative state for years on end with no improvement or evidence of any life, it is as though we are pouring money down the drain. Why would we continue to do this when the person does not want us to or when we could put the money and resources into someone who could have a better quality of life or benefit from the services? The media has brought the issue of the right to die movement into the limelight over the last 30 years. When looking at the issue of euthanasia, many moral and ethical questions are brought to attention. What is the definition of quality of life, and who gets to decide what is best for a patient when a debilitating problem occurs? Perhaps a physician who looks at the

Euthanasia 10 patient in a physiological aspect? Or rather a family member who has been given the power to decide what is best for their loved one? Or should a patient decide for themselves when they are ready to give up on their life? Choice is a fundamental democratic principle and is the basis of the free enterprise system (Wikipedia 2007). A case that has been in the forefront of the media since 1970 is that of Dax Cowart. Dax had burns consuming over 90% of his body and had to have his right eye removed and several fingers amputated. He was in excruciating pain and he felt as if he was being tortured by the medical staff that was taking care of him. Dax begged the physicians to stop his treatments and to let him die. His wishes, however, we not granted. He was deemed incompetent to make decisions, due to the amount of excruciating pain he was in, and was therefore forced to endure the pain. Did Dax have the moral and legal right to refuse care? The so-called health professions have an indirect sickening power, a structurally health denying effect. They transform pain, illness and death from a personal challenge into a technical problem and thereby expropriate the potential of people to deal with their human condition in an autonomous way (Illich 1974). Dr. Jack Kevorkian Jack Kevorkian became the catalyst for the right to die movement when he became incarcerated in 1999 for assisting in over 130 suicides. He is famous for the quote dying is not a crime (Wikipedia 2007). After recognizing the need that many people had to end their life because of chronic pain and suffering, Kevorkian became involved in assisted suicide. He first began assisting people in his vehicle by hooking an exhaust hose to a face mask and allowing his patients to breathe in the carbon monoxide. This method of suicide brought immediate death and relief. He was also responsible for making several types of death machines that would inject a lethal dose of potassium chloride into the patient to stop their heart, thus ending their life

Euthanasia 11 and suffering. Kevorkian`s persistence for retaining a person`s dignity, even to the point of death, is what drives his motives for creating and campaigning towards a humane way to die. The pain and suffering a person feels during a disease can be incomprehensible, even with pain relievers, to a person who has not gone through it. Society should not force them to endure such hardship (Wikipedia 2007). When comparing moral and ethical beliefs to the freedom of choice, the patient has the right to be their own advocate since they are the ones who are enduring the suffering. If freedom of choice is taken away then we are ultimately being stripped of our dignity and constitutional rights. Legalization No one should have the authority to keep another person from being able to end the misery many terminal illnesses bring. From an ethical viewpoint, death should be seen as part of a life-continuum. Since every individual has the right to live with dignity ­ however often this right may in fact be violated ­ every individual has the right to die with dignity (Pauling 1974). It should be the individual`s choice, but in most places of the world it is the choice of the government. The only four places in the world to authorize active assistance in dying of patients are Oregon, Switzerland, Belgium, and the Netherlands (Humphry 2005). The methods and circumstances of euthanasia in these four places are not entirely consistent. In Oregon, Belgium, and the Netherlands there must be two doctors present, along with a psychologist if the patient`s competency is in question. Switzerland usually has only a single doctor involved. Another inconsistency is that Oregon and Switzerland bar death by injection. The methods by which euthanasia can be accomplished are by oral, intravenous, and intramuscular administration of lethal doses of certain drugs. Switzerland and Oregon prefer prescribing controlled oral drugs,

Euthanasia 12 such as morphine, to be taken in lethal doses. Belgium and the Netherlands utilize a procedure in which thiopental is injected to induce a coma, and then the patient is given a mega dose of a neuromuscular muscle relaxant such as pancuronium dibromide or vecuronium bromide. The combination of these drugs euthanizes the patient in a calm, easy, and painless way. Washington, California, Texas and Michigan have all pushed to obtain the same rights that Oregon has gained by giving the right to die to the patient. With over half the population in the U.S. siding with the belief that people should have the right to a dignified death, there will surely be other states to follow in the path that Oregon has taken. America has always prided itself with the fact that we are a free nation, with a freedom of choice. Just as a person has the right to live, a person who is unable to endure a terminal illness should be able to end his or her life in a way that is comfortable and painless. Conclusion Euthanasia continues to be a source of debate between the legal and medical realms. It is hard to say if it will indeed ever become legalized across the United States. There are many reasons for and against the use of euthanasia to end the suffering of someone`s life. Yet the question still remains, Do humans have the right to choose death?

Euthanasia 13 References Answers. (2007). Euthanasia. Retrieved March 2007 from http://www.answers.com/topic/euthanasia Euthanasia.com. (2007). Arguments Against Euthanasia. Retrieved March 2007 from http://www.euthanasia.com/argumentsagainsteuthanasia.html Humphry, D. (2005). Tread Carefully When You Help to Die. Euthanasia Research & Guidance Organization. Retrieved March 2007 from http://www.assistedsuicide.org Illich, I. (1974). The Politics of Naural Death. Hastings Center Studies. 2. Retrieved March 2007 from http://www.links.jstor.org Jonsen, A., Siegler, M., Winslade, W. (1998). Case Analysis in Clinical Ethics. Clinical Ethics. Retrieved March 2007 from http://www.depts.washington.edu/bioethx/tools/ceintro.html LeBaron Jr., G. (1999). Rethinking the Ethic: A Possible Solution. The Ethics of Euthanasia. Retrieved March 2007 from http://www.quantonics.com/The_Ethics_of_ Euthanasia_ By_Garn_ LeBaron.html#Case_Against_Euthanasia Pauling, L. (1974). A Plea for Beneficent Euthanasia. The Humanist. Retrieved March 2007 from http://www.americanhumanist.org/about/euthanasia.php Pullicino, P. MD, PhD. (1997). Physician-Assisted Suicide. American College of Physicians, 127, 174. Retrieved March 2007 from http://www.annals.org/cgi/content/full/127/2/174-b Venes, D. MD, MSJ. (2005). Taber`s Cyclopedic Medical Dictionary. Wikipedia. (2007). Euthanasia. Retrieved March 2007 from http://en.wikipedia.org

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