Abstract

A great deal of research has been done on the moral and social dilemmas of euthanasia and assisted suicide in the United States and how different groups of people are most likely to react when confronted with this type of death.
Different studies have been examined and compared to determine to what extent people feel that the practice should be accepted or should be considered murder.


This paper will explore different key topics which include; reactions from health care providers and doctors, reactions from the dying patient and his or her family members, and reactions from society and lawmakers. Are we as a society ready to accept death as a choice? Or should we consider this rite a horrible crime that is carried out against our weak, sick and aged citizens? Results, explanations, and indications for further investigations are discussed.


One of the mental anguishes of suicide is the senseless loss of a life that has ended prematurely. But, in the case of a terminally ill adult who decides to end his or her life in the final stages of an incurable and agonizing degenerative disease, in order to avoid debilitating pain and a humiliating death, is the decision to commit suicide still considered nonsensical and is death untimely? Previously called "mercy killing", euthanasia means, according to Webster's Dictionary (1984), The intentional causing of a painless and easy death to a patient suffering from an incurable or painful disease. Put bluntly, euthanasia means killing in the name of compassion. In euthanasia, one person does something that directly kills another person. For example, a doctor would give a lethal injection to a patient. In assisted suicide, a non-suicidal person would knowingly and intentionally provide the means or act in some way to help the suicidal person kill himself or herself (IAETF, 1998).


In an article published by The Nolo Press (1997), the United States Supreme Court ruled unanimously that terminally ill patients have no constitutional right to doctor assisted suicide. The decision has aroused opinions on both sides of the issue on whether or not doctors should be free to prescribe lethal doses of drugs to terminally ill patients who request them to end their lives. Those opposed to doctor assisted suicide have argued, the article reported, that death is a wrong choice and that pain control is the key to easing the final suffering at the end of life. They decry assisted suicide as an easy way out for greedy relatives or state officials anxious to do away with patients when their care becomes too costly or too inconvenient. However, proponents of assisted suicide contend that it is the ultimate in self-help, and the only hope for those individuals destined to live in pain or carry on in a drug-numbed state in which life itself seems meaningless. Most people, they say in the article, invoke death only as the ultimate last resort. Is there a constitutional right to the assistance of a physician in committing suicide or are we giving our doctors permission to commit murder?


Method


I examined several different studies, reports, and articles in books, magazines, newspapers, and on the internet to find facts and laws governing euthanasia, assisted suicide, and our rights as Americans to choose life or death. I have found many interesting and honorable ideas to support both sides of this argument.


Euthanasia and Lawmakers


According to one article (Repa, 1997), the United States Court of Appeals held that individuals have a privacy interest, protected by the Due Process Clause of the Constitution in choosing how and when to die, similar to a woman's interest in choosing whether to have an abortion. Less than a month later, the Second Circuit Court, in New York, reached a similar conclusion:


That doctors may prescribe drugs to be self administered by mentally competent patients who seek to end their lives during the final stages of a terminal illness.


The court noted that New York law clearly allows terminally ill patients on life support systems to hasten their deaths by directing that the systems be removed. It held that by denying terminally ill patients who are not connected to life support the option of ending their lives, the law made an illegal distinction. The court argued that because doctors were allowed to "assist" patients being sustained by various life-support mechanisms to commit suicide by removing them, patients who do not need these medical interventions to continue to live should also be entitled to the assistance of a physician in committing suicide (Massachusetts Medical Society, 1996). However, a United States Supreme Court decision overturned both circuit courts.


Those lawmakers opposed to euthanasia do not believe it is a private act as they conclude it's all about letting one person facilitate the death of another. They also believe that it is a matter of very public concern since it can lead to tremendous abuse, exploitation, and erosion of care for the most vulnerable of people among us. They believe that euthanasia is not about giving rights to the person who dies but, instead, is about changing the law and public policy so that doctors, relatives, and others can directly and intentionally end another person's life. They want laws against euthanasia to be in place to prevent abuse and to protect people against unscrupulous doctors and others (IAETF, 1998). Euthanasia and Health Professionals Modern medicine has definitely lengthened the life spans of the present population more than at any other time in history. Antibiotics, immunizations, surgery and many of today's routine therapies or medications were all unknown before (IAETF, 1998). But, should new medical technology be forced upon people to keep them alive? Neither law nor medical ethics requires that "everything be done" to keep a person alive. Insistence, against the patient's wishes, that death be postponed by every possible means available is contrary to law and medical practice. It also would be cruel and inhumane. There comes a time when continued attempts to cure are not compassionate, wise, or medically sound (IAETF, 1998). However, is assisting in a suicide against medical ethics? Ask any doctor or other health professional and he or she should be able to recite for you the section of The Hippocratic Oath (cited in Chung, 1997) which states: I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Attorney General Janet Reno has made a decision that the federal Controlled Substances Act does not prohibit doctors from prescribing lethal doses of medications to dying patients. In her decision, Reno said the federal government would not stand in the way of doctors who help terminally ill patients kill themselves in Oregon, the only state where physician assisted suicide is legal. Oregon's 1994 Death With Dignity Act permits doctors to prescribe lethal doses of medicine to patients expected to live only six more months. Two doctors must share the dire prognosis and agree that the patient is mentally competent to ask for medical assistance in committing suicide (Lash, 1998). According to a confidential study (cited in Repa, 1997), many doctors in other states acknowledge anonymously they have helped seriously ill patients end their own lives, often by writing large prescriptions for Seconal and other drugs. Another confidential study, by the American Society of Internal Medicine, cited in the same release reported that one doctor in five admitted to helping in a patient's suicide. And in a 1995 study of San Francisco doctors specializing in treating AIDS patients, more than half acknowledged helping at least one patient to die. One in four of Washington doctors surveyed last year said they received requests for help in dying, and many admitted they responded by prescribing lethal drugs. So, while many doctors freely help their patients to die behind closed doors, most are reluctant to get caught in the act. In 1989, a group of physicians published a report in the New England Journal of Medicine (cited in IAETF, 1998) in which they concluded that it would be morally acceptable for doctors to give patients suicide information and a prescription for deadly drugs so they can kill themselves. However, Dr. Ronald Cranford, one of the authors of the report, publicly acknowledged that he believed this would be the same as killing the patient. Euthanasia and the Dying Patient and Family Congress acted against euthanasia with a proposal to require the Drug Enforcement Administration to revoke the prescription license of any physician who intentionally causes a patient to die with a medication. If it becomes law, the Lethal Drug Abuse Prevention Act of 1998 will put a damper on progress now being made in providing pain relief to dying patients. The proposed bill would allow physicians free rein in prescribing drugs to alleviate pain, but the amount of morphine, for example, required to relieve the severe pain of bone cancer may also repress respiration to a point that may become lethal. Physicians in fear of losing the licenses are likely to err on the side of caution and under-prescribe medications. The message that this bill sends to patients and their families is that pain control is dangerous and that expecting to be comfortable near the end of life is unrealistic (Carson, 1998). When a dying patient complains of unbearable pain, the doctor needs to be able to provide relief without fear of being prosecuted. People at the end of life have a right to treatment of pain since persistent discomfort effects the quality of the last few weeks and months (Carson, 1998). There are inherent problems with the way patients die while under physicians care. Sadly, what worries people most about death is the prospect of dying in misery. The SUPPORT Study (cited in Annas, 1996), for example, found that the families of 50% of a sample of patients who died while in the hospital believed that the dying patient experienced moderate to severe pain at least half of the time during the last three days of life. Emotional and psychological pressures could also become overpowering for depressed or dependent people. Financial considerations, and the worry of "being a burden", could serve as a powerful force that would lead a person to "choose" euthanasia or assisted suicide (IAETF, 1998). Adequate pain control has been an option since 1989, when Texas became the first of several states to pass an Intractable Pain Act that authorized physicians licensed by the Board of Medical Examiners to prescribe or administer dangerous drugs to treat intractable pain (Carson, 1998). Although physical pain is almost always treatable, some pain can not be relieved by analgesia. According to a brief by the American Medical Association (cited in Orentlicher, 1997): The pain of most terminally ill patients can be controlled throughout the dying process without heavy sedation or anesthesia. For a very few patients, however, sedation to a sleep-like state may be necessary in the last days or weeks of life to prevent the patient from experiencing severe pain. Those opposed to euthanasia believe that with good family support, good nursing care and adequate pain control, dying in misery is not necessary (Carson, 1998). They believe that hospice, including in-home hospice care, can be of help to the patient during the final stages of death. Instead of killing the patient, there comes a time when all efforts should be placed on making the patient's remaining time comfortable. Then, all interventions should be directed to alleviating pain and other symptoms as well as providing emotion and spiritual support for both the patient and the patient's loved ones (IAETF, 1998). Results Fear of unrelieved pain ranks among the main reasons people give for requesting help in ending their lives (Carson, 1998). According to International Anti-Euthanasia Task Force (1998), euthanasia activists exploit the natural fear people have of suffering and dying, and often imply there are only two alternatives: death or unbearable pain. In a 1994 Harris Poll (cited in Repa, 1997) it is found that 73% of Americans favor physician-assisted suicide and many doctors have obliged their patients. Discussion Public awareness of the need for end-of-life planning is growing. Choosing the right course when the choice is between prolonging life and maintaining life's quality happens one patient, one family member, one doctor at a time. More people are realizing how important it is to talk with them closest to them and with their doctors about how they want to be treated when the end is near (Carson, 1998). Should assisted suicide and euthanasia be considered a choice or is it murder? Whether or not it is right or wrong has as much to do with personal ideals as it does with the law. But, as more doctors and family members hear the pleas of patients kept technologically alive through long illnesses, many have softened their stances against assisted suicide and euthanasia. Cancer and AIDS often lead to "hard deaths" and patient dying of these two diseases make up a vast majority of patients in hospices as well as those who seek the assistance of physicians in committing suicide (Annas, 1996). Intimidating doctors into being stingy with painkillers is not the solution (Carson, 1998). The opinion of the Ninth Circuit Court (Annas, 1996) ruled that only a narrow category of patients may lawfully exercise euthanasia or assisted suicide: competent, terminally ill adults who have lived nearly a full measure of life and who want to die with dignity. For such patients wracked with pain and deprived of all pleasure, a state enforced prohibition on hastening their deaths condemns them to unrelieved misery and torture. In the courts words: Like the decision of whether or not to have an abortion, this decision how and when to die is one of the most intimate and personal choices a person may make in a lifetime. A choice central to personal dignity and autonomy. Another important development worth researching further is the is the increasing emphasis placed on health care providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment. In the United States, thousands upon thousands of people have no medical insurance and studies have shown that the poor and minorities generally are not given access to available pain control, and managed-care facilities are offering physicians cash bonuses if they don't provide care for these patients. With greater and greater emphasis being placed on managed care, many doctors are at financial risk when they provide treatment for their patients. Legalized euthanasia raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled patient "chooses" to die rather than receive long term care. Savings to the government may also become a consideration. This could take place if governments cut back on paying for treatment and care and replace them with the "treatment" of death (IAETF, 1998). Regardless of where one stands on the question of whether physicians should be able to help dying patients voluntarily end their lives, a consensus is growing that your doctor should be able to ease your passage (Carson, 1998). I believe there should be more research into what factors cause so many Americans to be in favor of euthanasia and assisted suicide. Is it fear of the unknown that drives us to end our suffering before we even begin to suffer, or is it just our nature to find a "cure" for any ailment, including old age and death. Is euthanasia and assisted suicide murder? I do not believe our society is ready to answer that question yet.


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