Euthanasia �An Eclectic View�

by: Jesilyn

The world is divided on the issue of euthanasia and as each side of the conflict defends their point of view using both personal and professional ethics, they seek the power to make legal decisions for all people. One point of view covers the preservation of human life, regardless of the personal preference of the life in question. The other prevalent point of view covers the right of the suffering to escape from the �hell� that their lives have become due to pain and disease. Together they represent the collage of legal limitations that does nothing to help the clients who are requesting medical service; at least not in the way they want it. Therefore, it all boils down to theories, ethics, opinions, and the government whose opinions together show that by helping a patient to die one harms the patient, and yet by not helping them they also harm the patient. Theoretically speaking, one could hypothesize that by using multiple views and ethics, one could find oneself faced with a paradoxical situation of an immoral moral act.

(Note: Most individuals hold and apply personal moral bias when making decisions about euthanasia. This means that they are more apt to use a single or dual view to distinguish what is right from what is wrong.)

The Definition of Euthanasia

Euthanasia is any action or inaction that hastens an individual�s death with the belief that death will end their suffering. There are several forms of euthanasia. The most common of which is passive euthanasia, where an ordinary treatment is with held from a patient that may otherwise extend their life such as an antibiotic, drug or surgery. Then of course, there is the most controversial form, called aggressive euthanasia, which usually pertains to a doctor providing a lethal injection such as a morphine combination (euthanasia, n.d). Lastly, there is the most common form that is called non-aggressive euthanasia. This is when a patient is denied nutrition, hydration, or other extraordinary means of support until their bodies cease to exist. Although ethical debates vary no matter the form, the first and latter of the three are actually not frowned upon as widely as the second, and doesn�t generally result in legal actions.

The History of Euthanasia �With a Theoretic View�

Between 1905 to the present the world has seen many debates both for and against the practice of euthanasia. During these debates it�s probably safe to say that the majority of people believe in Consequentialism. (Schaeffer, 2007) In other words they believe that the practice of euthanasia is carried out by those who weigh the results of their actions by the impact that it will have on the future; good against harm and doing something against doing nothing with the best of everyone�s intentions at heart. Of course, this isn�t always the case. This leads to arguments about �intent� and �rights�.

How are we, as a society, to know the intent of a physician who is willing to grant a patients request to end his or her own life? Is it ethical to fulfill such a request? Does a patient have a right to ask? Basically, �rights� are at stake and a right�s theorist (Schaeffer, 2007) believes that an action (such as euthanasia) is morally right depending on whether it respects or violates a client�s rights (according to individual morals and laws). In the case of euthanasia the law is extremely contradictory. According to a 1965 Supreme Court case (Griswold v Connecticut), citizens have the right to privacy; specifically it recognized an individual�s right to privacy as a fundamental constitutional guarantee. This supposedly allows people to choose what happens to their bodies without the intrusion of the state. (Vail, 1999). However, this right was not guaranteed and this fact was proven 23 years later in 1989 when Dr. Jack Kevorkian was not only arrested but also sentenced 10 to 25 years for second-degree murder in the 1989 poisoning of Thomas Youk.

Debates still flourish over the actions of the man society has grown to call Dr. Death, but the fact is that 52-year-old, Youk had called upon the well-known physician after a five-year losing-battle with Lou Gehrig�s disease that had left him unable to care for himself, and unable to move any part of his body except for his right thumb and forefinger. In fact, according to family members, in the beginning, the sympathetic doctor suggested Youk think about his decision for a couple weeks, and only agreed to proceed after a second call requesting his service. These services, though meant to permanently cease his pain, would end Youk�s life. For this service Kevorkian paid eight years of his life to the Michigan prison system and wasn�t released until June 1, 2007. (AP, 2007) Kevorkian gave up a piece of his life in the name of duty (Schaeffer, 2007); he did what he believed to be the right thing no matter what the consequence. His actions were considered illegal and yet by definition (euthanasia) he has done nothing different than those involved in the next euthanasia case on our list.

In March 2005, the Terri Schiavo case divided our country in a unique �Right to Life� situation. To some, she was a profoundly disabled woman who had a loving supportive family who were more than ready to care for her for the rest of her natural life; others believed her to be operating on spontaneous movement where the quality of life had ended. Schiavo�s husband and parents stood on opposite sides of this fence. Her husband, Michael, stated that his wife had expressed verbally that she wouldn�t want to be kept alive by artificial means. Her parents on the other hand, used Terri�s Catholic values, stated that she would have offered her suffering up to Christ by living. This dilemma caused �fourteen appeals and numerous motions, petitions, and hearings in the Florida courts; five suits in Federal District Court; Florida legislation struck down by the Supreme Court of Florida; a subpoena by a congressional committee to qualify Schiavo for witness protection; federal legislation (Palm Sunday Compromise); and four denials of certiorari from the Supreme Court of the United States� (Schiavo, 2007), after which Michael eventually gained the right to sign the consent for his wife�s life to end via euthanasia. In this case doctors did not use lethal injection as the means to kill Schiavo, but rather chose a non-aggressive form. The doctors removed the feeding tube that supplied Schiavo�s body with nutrients and fluids; in other words �forced dehydration�, a process that took over thirteen days! (Terri�s Story, n.d.)

While examining the difference between the practices of active verses non-aggressive euthanasia one must inquire what a caring individual would support. Certainly, they would prefer the method that would allow the individual to pass in the least demeaning way. After all, who would want a friend, family member, or associate to die a slow or painful death when something quick and painless is available. This is associated with what is called the caring theory (Schaeffer, 2007) and could very well be compared to how people treat pets. Legally, pets are considered personal property rather than viable family members with rights. Pets are, however, often considered family members to those who chose to have them and when viewing animals as family, we find that it is completely legal, and even considered merciful to euthanize a suffering pet. This could lead one to wonder if we, as a civilized society, should have as much respect for people as we do for pets! (Swift, 2007) For that matter, should we have the right to seek such compassionate services for ourselves?

Food for thought: How many people in their twenties discuss end of life issues like this? Also, if euthanasia is acceptable under government standards using only the hearsay testimony of a spouse, one must question why individuals are not allowed to select the same result for themselves?

This is where narrative therapists (Schaeffer, 2007) would focus on history and the individuals involved in the situation because an informed decision requires an evaluation of euthanasia on the grounds of morals that are built according to the patient�s (and euthanasia�s) history and culture rather than on the American society�s opinion. This could be part of the debates whole problem. Basically, by not looking deep enough into history and by allowing one�s own bias to override the values of the patient, the subject becomes taboo and is �shoved under a rug�. This produces unethical intellectual wars which does nothing to assist the patient in their quest for service.

As an example of the way that we as a society selectively chose to publicize and persecute the physicians and victims of euthanasia (taboo subject), one should only need to research the father of Psychoanalysis Sigmund Freud. Did you know that Sigmund Freud was the first reported case of death by physician-assisted suicide? That�s right! Freud was a heavy cigar smoker who had more than 30 surgeries because of mouth cancer and when he felt he had lost his quality of life he called upon his doctor and friend Max Schulur. Wikipedia, the free encyclopedia quotes Freud as saying �My dear Schur, you certainly remember our first talk. You promised me then not to forsake me when my time comes. Now it is nothing but torture and makes no sense any more.� After this, Schulur gave Freud three injections of morphine that caused Freud's death on September 23, 1939 (Freud, 2007).

Ethical Views

So when all routes of pain control have been exhausted, and death becomes viewed as liberation from pain, the question of ethics is of primary concern. The question remains however, as to whose hands should the patient�s excruciating fate be placed in? Should the decision be that of the individual who is suffering, a physician who has a medical degree, a society composed of strangers, or the government, who in reality knows less than anyone else? Well, under the study of ethics the answer to this question could vary.

For starters let�s examine personal ethics and euthanasia from the eyes of a person who may be considering asking their doctor�s assistance in committing suicide. Some of their thoughts may be centered on responsibility, self-respect, dedication, loyalty, honesty, accountability, empathy, accomplishment, courage, independence, security, challenge, influence, compassion, friendliness, persistency, optimism, dependability, and flexibility. They often feel they have lost their quality of life and with that goes a percentage of self respect. They have normally undergone numerous attempts at controlling their illness or disease and due to the progression have lost their optimism and are now dependant on others to survive. The emotional pain and suffering can become incomprehensible to the point that they simply see only one way to control it and that is to seek assistance from a compassionate source. In their opinion, they have already died, they have simply forgotten to stop breathing and this is where they need help.

There are also the personal issues that support and defend euthanasia that are theologically based. For instance, voluntary euthanasia has been rejected as a violation of the sanctity of human life. Specifically, some Christians argue that our lives belong to God, so we shouldn�t be allowed to choose whether or not to end a life. In the Catholic perspective, we can offer up our sufferings to Christ. Orthodox Judaism basically believes the same thing, only this faith is generally more open-minded. By the tenets of this faith, under certain circumstances, passive or non-aggressive euthanasia may be used. In general however, a lot, if not most, religious thinkers consider euthanasia (and suicide in general) a wrongful act, i.e. unjustified killing. Of course for every negative there are positive and with that comes those who use religion to justify euthanasia. They question why their God/ a loving spirit would punish His creation by allowing such misery and claim he doesn�t. They state that he provides freewill and they point to the Bible in First Corinthians 10:13, where it says, that God shall not give you more than you can bear without also providing a way out, so you can withstand it. (Bible, 2007). �These individuals see scientific knowledge as God given, and because of such, view the practice of euthanasia as a way out of pain and suffering. This is not an illogical point of view for those who value it, after all scientists discovered the different combinations that physicians use during euthanasia and some people believe that all knowledge is a gift from a higher power. Basically with this said one could assume that although a doctor�s personal/ religious morals may vary they are all blessed with the knowledge or at least the knowledge availability of how to assist a patient to end their life.

Many Physicians refer to either �Medical� ethics or the �Hippocratic Oath� (which most interpret as explicitly excluding euthanasia) to support their position on the subject. In this case we will discuss Ethics because the Hippocratic Oath has become outdated as the original no longer is in use or deemed appropriate. Furthermore, there are so many versions today that it would be impossible to deem one more important than the other. Therefore when looking at simple medical ethics (Ipedia, 2004), one can see that physicians should act in the best interest of the patient and never �do harm�. This seems to place medical professionals in one really tough situation because here they have a patient who is in either severe physical or emotional pain/anguish and is begging for help to end this pain by ending their life. This gives the professional a choice. 1.) The doctor can help their patient, which ends the pain but also ends the life (harm). Or 2.) Stand by and do nothing, allowing the patient to continue to be in pain (harm). Either way they are violating their own code of ethics. Not to mention that by refusing treatment, the physician violates �autonomy� which states that the patient has the right to refuse or chose his or her own treatment, which in this case is euthanasia. (Ipedia, 2004) Of course there is always the popular �dignity�, but then no matter whom you talk to everyone believes dignity has a different definition.

So what if a doctor chooses to turn away from active euthanasia because they interpret that it is wrong? What if instead they chose to continue to treat physical pain and provide comfort measures along with maybe getting a social worker involved to assist with any emotional aspects that the patient is facing? Then by all means a new set of ethics appears and despite popular belief it�s this set of ethics that should probably be offering the patient the most help in their mission. But then as always with all ethical codes interpretation plays a big role.

According to NOSHE, Human Service providers carry out a variety of different services. In some states such as Virginia, social workers hold M.S.W.�s and work as counselor�s performing the same duties as psychologists, others go to homes and do individual services. In either aspect they have the obligation to know the laws (NOSHE, statement 15) and advocate for changes in those laws when they affect the rights of their clients. (NOSHE, Statement 10) Of course, if this is being done then hasn�t had much positive impact to date. This brings up two topics of real concern.

Real Concerns:

Real people suffer with real medical problems that lead them to seek medical services that are taboo in nature. Once publicized these cases create huge public debates that no more helps the suffering patents than the publicized case did. So basically, real concerns continue to to be censored. What�s needed is for people to get involved; however they need to know what all the issues surrounding euthanasia are before doing so. Now, this document has covered many of the views and answered many questions but there are other issues that are still left to discover answers for and I�m only going to explore two more in order to give an example of how one would critically analyze a topic.

1. Consent under pressure: Critics of voluntary euthanasia are concerned that patients may be pressure to consent to euthanasia rather than be a financial burden on their families. These same critics are fearful that pressure could also come from family members who stand to inherit large sums of money or other forms of monetary values.

AND

2. Feasibility of implementation: Euthanasia should only be viewed as "voluntary" if a patient is mentally competent at the time they make the decision, i.e., has a rational understanding of options and consequences. Of course competence can be difficult to define and is often diagnosed by a biased therapist.

In both cases, the answer could have been simply handled by the individual securing an �Advanced Directive� (Advanced, 2007). Advanced directives are any statement that is made by a competent person about the medical treatment they wish to receive should they become incapable of communicating their desires their self. Although verbal statements are sometimes accepted as �gold�, it should be noted that not all people are trust worthy therefore the best way to guarantee one�s wishes is by filing a living will or a health care proxy (a.k.a. Durable Power of Attorney for Health Care). In layman�s terms a living will allows a person to chose ahead of time whether or not in the event of a crisis if they would wish for life sustaining procedures to be preformed. It allows a person to avoid medical heroines when death is imminent. But over all it gives the patient the right to say for his/her self what they wish to except or deny as part of a treatment plan in the case of an emergency. Basically, a Living will would stop evil family �Vultures� from robbing a grave before the death has happen, or it may place the medical staff in a position to deny common treatments (Euthanasia) that would allow a patient to die instead of face unknown amounts of time hooked up to machinery simply because their family can�t let go. (Schaivo, 2007) As for a Durable Power of Attorney, it can be a written back up, used to name a person that will see to it that your wishes are carried out. It can be used alone or with a living will. Either way it will keep family and friends from long emotional court battles over custody of a body that may or may not wish to remain. Obviously, downloading a simple form from http://www.caringinfo.org/ , filling it out, and making your wishes known would be a lot better than the alternative.

Of course there are going to be people who don�t follow that advice so for those people it would be logical to protect the individual with a mandatory psychological evaluation by a qualified therapist much like the type of therapy done to test for witness coercion in a trial, one could nearly (if not completely) eliminate the chance of the patient being pressured and would also ensure the patient�s competence level the time of the decision.

CONCLUSION

So you see, by evaluating every aspect of euthanasia one can make an informed decision but once you have done this and really know what to believe what should you do? (Schaeffer, {Narrative} 2007) Well, assuming that you are an average red-blooded American citizen, you have the same choice as the all professionals do. You can reach out, get involved and either support or fight physician-assisted suicide, or do nothing. You can write to your local legislator, form groups, send letters to the media, or contact existing support groups and offer your assistance. (Schaeffer, {Caring} 2007) For the most part, you don�t even have to leave the comfort of your own home. Just remember, average citizens can peacefully force change when they try. Situations like the civil rights movement, the women�s rights movement, and the sexual rights movements all began when ordinary people took a stand. The reality is we (the tax payers) pay the Government officials to represent our voices when they make decisions. The American public has a responsibility to its citizens. (Schaeffer, {Duty}, 2007) We have a responsibility to mankind as a whole. IF no one speaks then no one hears! The fact is, tomorrow you could be the next Thomas Youk begging for assistance to die, or the next Terri Schiavo who never gave consent to be euthanized. Remember it�s a catch twenty-two situation and the terminally ill have limited power. All you�re being asked to do is take protective measures and get involved. Wont you?

Special Note: In 1994, Oregon became the only state to make doctor assisted suicide legal here in the United States. (Euthanasia, 2007)

References

Advance Directive. (n.d.). Download a state-specific living will or healthcare power of attorney. Retrieved June 23, 2007, from the Caring Connections website: http://www.caringinfo.org/

AP. (2007).Kevorkian Release Stirs Grief, Gratitude. Retrieved on June 19, 2007.

From cbsnews website:

http://www.cbsnews.com/stories/2007/05/31/national/main2872812.shtml?source=RSSattr=U.S._2872812

Bible (2007). 1 Corinthians 10:1-13 (New International Version). Retrieved June 23, 2007

From The Gospel Communications Website:

http://www.biblegateway.com/passage/?search=1+corinthians+10:1-13;&version=31;

euthanasia. (n.d.). The American Heritage� Dictionary of the English Language, Fourth Edition. Retrieved June 19, 2007, from Dictionary.com website: http://dictionary.reference.com/browse/euthanasia

Freud, Sigmond. (2007). Wikipedia, the free encyclopedia. Retrieved June 19, 2007,

From Wikipedia, the free encyclopedia website:

http://en.wikipedia.org/wiki/Freud#Life

Ipedia. (2004). Medical Ethics. Retrieved June 18, 2007,

from the ipedia.com website:

http://www.ipedia.com/medical_ethics.html

(NOSHE). (1996). Ethical Standards of Human Service Professionals. Retrieved June 19, 2007, from the National Organization for Human Services website: http://nationalhumanservices.org/ethics

Schaeffer, Cyndi. (2007). �Psy313 Ethics Session 2 Power Point Presentation�, City University Online. Seattle, Washington Retrieved June 21, 2007, From City University Bulletin Board website:

Schiavo, Terri. (2007). Wikipedia, the free encyclopedia. Retrieved June 20, 2007, From Wikipedia, the free encyclopedia website:

http://en.wikipedia.org/wiki/Terri_Schiavo

Swift, Kenneth. (2007). Commentary; Voices/ A Forum for Community Issues; The Right to Choose Death. Retrieved June 21, 2007, From Okie on the Lam website:

http://www.okieonthelam.com/?p=628

Terri�s Story. (n.d.). Terri�s Story. Retrieved June 20, 2007, From the Terri Shaivo Foundation website:

http://en.wikipedia.org/wiki/Terri_Schiavo

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