Debating Voluntary Human Adult Euthanasia

One of the fastest growing medical phenomena is that of human euthanasia. No matter what the argument or the entity involved, the common question seems to be whether or not the act of human euthanasia is an ethically acceptable practice. Frequently a person takes a stand on human euthanasia that is established on misinformation and lack of knowledge regarding the subject. When considering the definition of euthanasia and comparing it to what many people believe it is, there is a vast range of differences between the two.

Euthanasia is defined as “[T]he act or practice of killing or permitting the death of hopelessly sick or injured individuals…in a relatively painless way for reasons of mercy” (“Euthanasia,” 2010). Often surrounded by heated arguments from both those in favor of and those against the practice, human euthanasia spurs the most conflict within political circles, differing cultural and religious attitudes, and the healthcare system.

While there are certain guidelines that regulate when and how these life-ending measures can be used, it is generally based upon the expressed wishes of the person on whom they will be applied. There are two forms of human euthanasia, passive and active. “Passive euthanasia occurs when a person is allowed to die by withholding available treatment, such as withdrawing a life-sustaining device” (Santrock, 620).

An advance directive Do Not Resuscitate (DNR) order is specific to the person who it is to cover. There are many different types of DNR orders available that allow a person to specifically make known which medical procedures that they do not wish to have done in the case of life threatening situations. Although they are not often viewed as being related to the practice of human euthanasia by most people, DNR orders are, by definition a form of euthanasia.

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Active euthanasia is most commonly associated with and frequently debated form of the practice. “Active euthanasia occurs when death is deliberately induced, as when a lethal dose of a drug is injected” (Santrock, 620). The most commonly referred to terms that come to mind when a person thinks of human euthanasia is not advanced directive or DNR orders but rather assisted suicide and physician-assisted suicide, also sometimes referred to as mercy killing. Euthanasia is almost always associated with an action that is performed on a patient to end their life rather than inaction in the form of withholding medical treatment that will ultimately lead to the end of their life. Assisted suicide by someone other than a medically licensed physician is illegal in all U.S. states, but there are three states where physician-assisted suicide is legal.

Should it really be a public discussion to decide whether a person has the right to die?

According to a list of state laws regarding assisted suicide, there are thirty-eight states that specifically prohibit assisted suicide by both licensed medical physicians as well as the general public (“Legal Status,” 2009). Oklahoma is one of those thirty-eight states with laws in place that prohibit the act of physician-assisted suicide. Even though these laws are in place they are not very specific to the guidelines of what the state considers euthanasia and what it considers palliative care. For example, the Oklahoma State Statute regarding the practice of euthanasia states that:

A licensed health care professional who administers, prescribes, or dispenses medications or procedures for the purpose of alleviating pain or discomfort, even if their use may increase the risk of death, shall not be deemed to have violated…Oklahoma Statutes so long as such medications or procedures are not also furnished for the purpose of causing, or the purpose of assisting in causing, death for any reason (63 O.S. § 3141.4-A).

The wording of this Statute affords a licensed healthcare professional a cushion of discretion when prescribing or administering drugs that can be potentially lethal and would be very difficult to prove that they were administered with the intent of ending someone’s life. Laws that specifically regulate the practice of human euthanasia should be put into place where there are none, that give a person who is terminally ill the right to decided to end their own life while at the same time not violating the physician’s political or spiritual convictions by creating laws that would require physicians to perform such procedures against their personal beliefs.

Anti-euthanasia groups fear that if laws are enacted that allow a licensed medical physician to participate in human euthanasia that it will create a slippery slope ultimately lending a helping hand to increase legally covered physician misconduct. Some even believe that all that will be gained by legalizing the act of euthanasia is an excuse to end the lives of people for reasons other than their wellbeing. “When the states legalize the deliberate ending of certain lives…it will eventually broaden the categories of those who can be put to death with impunity” (Hentoff, 1).

Money has also been a factor that some people say has had a negative impact on the debate of euthanasia. When political opinions concerning human euthanasia become wrapped up in something such as monetary gain it is easy to see there is a serious ethical and moral dilemma involved. It has also been argued that there should be an age limit that dictates how old a person has to be before euthanasia can even be considered, if legal, in that particular area.

If a person is suffering from a debilitating illness that causes nothing but pain and obviously a very poor quality of life and there is an expressed wish to end one’s life, should we make them live with that type of pain and suffering until they have reached the “magic age” of euthanasia? There is no doubt that physician-assisted suicide is a practice that needs to be highly regulated by law, but there should not be a cut-and-dry mentality when it comes to euthanasia.

While advance directive DNR orders are now accepted as legal in all fifty U.S. States, there are only three states that currently have laws specifically authorizing physician-assisted suicide. Oregon was the first state to adopt a law allowing licensed medical physicians to assist a patient in the process of ending their life. Fourteen years after Oregon enacted those laws the state of Washington adopted a similar law. “…[T]he state consultants said [Washington] was demographically most like Oregon, therefore, most likely to favor assisted suicide” (“Attempts to Legalize,” 1).

This brings into consideration the culture of these two areas. The decision to adopt laws authorizing physician-assisted suicide may possibly be due to the different cultural and religious values of different locations and the similar demographic characteristics of both states. Thirdly, Montana now has laws allowing physician-assisted suicide; a state that is both geographically and demographically similar to the previous two states. “Between January 1994 and June 2009, there were 113 legislative proposals in 24 states.

All were either defeated, tabled for session, or languished with no action taken” (“Attempts to Legalize,” 1). It is troubling to me that there are more regulations for physician-assisted suicide than there are for abortion, it should be the other way around. In the state of Oregon from 1998-2008 there were 739 legal abortions performed (Johnston, 2009), while during the same time there were only 401 deaths by physician-assisted suicide (“Death with Dignity,” 2009). Many people believe that abortion is the killing of a human being without their consent yet society seems to justify it more often than when a person expresses a desire to end their life for legitimate reasons. Also going hand-in-hand with the factor of cultural values towards euthanasia are those of religious and spiritual beliefs.

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Religious institutions are probably the most well known oppositions of human euthanasia. Both Christian and Catholic theologies maintain the same basic doctrine concerning human euthanasia; the killing of another human being regardless of their physical health is a sin. The process of dying or “transitioning” is believed to be a highly spiritual experience that should not be tampered with and the decision to refuse medical treatment at end-of-life should be respected and not interfered with. Christian theology has made the act of dying something that has already taken place in the lives of those who are believers. The Bible says that “…it is appointed for men to die once...” (NKJV Bible, Hebrews 9:27), and that “[We] have been crucified with Christ; it is no longer [us] who live, but Christ lives in [us]…” (NKJV Bible, Galatians 2:20).

This means that if a person is a Christian and is “saved” and “born again,” spiritually, the process of dying took place when Jesus was crucified on the Cross and therefore will never again die but rather move or transition into another place called Heaven. When a person moves from one place to another, in this case from earth to heaven they are no longer bound by worldly things but are now citizens of the kingdom of heaven. An example that is commonly used to explain this phenomenon is how if a person were to move from one state such as Texas to another state, say Oklahoma. While in Oklahoma that person is no longer living under the laws of Texas but rather the laws of Oklahoma.

The principle is the same in Christian theology; the only difference is that the “state” in which we move to and from is a state of mind rather than a geographical location. The Bible does not specifically address the issue of euthanasia but it does make it clear, all throughout the text, that the human life is something that is sacred and should be respected as such with dignity at all times and the unjustified act of deliberately taking the life of another human being would not be dignified. Probably the most used argument of the opposition is that euthanasia devalues human life.

The most feared event in life is when it ends. Traditionally, the subject of death has been viewed as one that should be ignored, not dwelled upon and in some instances not even spoken of. So, people go through life fearing something that they cannot prevent, it is an inevitable occurrence. Life as we know it will come to an end for every person at some point. Regardless of this fact society has labeled it in such a way that there will forever be a negative connotation associated with the process of dying.

Probably one of the most profound views of death that has ever been made known was that of Morrie Schwartz in tuesdays with Morrie by Mitch Albom. Morrie believed that “Once you learn how to die, you learn how to live” (Albom, 82). It is evident that Morrie had in fact learned how to die and because of it he was allowed to live his life to the fullest, something I think many people fail to do resulting in a feeling of inadequacy and dissatisfaction with the life they have lived leading to the desire to end their life by euthanasia. Most everyone has heard the old scenario of how if we could pinpoint when and how we were going to die, what would we do between now and then?

Many think about this but few actually live through it. Morrie viewed his illness as a chance to surround himself with the people whom he loved and who loved him. He never stopped living even though he knew he was rapidly dying. Albom writes in the book of how up to the very time of his death Morrie was always giving of himself, always trying to better others before himself believing that giving, not taking is what makes us feel alive. Morrie felt as though he still had meaning to his life. The stance on dying taken by Morrie is most definitely an individual value. How many people actually think of others rather than themselves after being diagnosed with a fatal illness?

Although Morrie did not claim to accept any one of a large number of religious doctrines, his views on death and dying had a strong spiritual connection. The part of death that is the most frightening to people is the inability to control when and how it happens. Those in favor of human euthanasia no doubt believe that they can somehow make the transition easier by allowing people some form of control regarding when they will die but “We get so blinded by our fears of mortality we forget that death is just the price of living, as natural as every breath you take” (Garretson, 1).

The healthcare system is where the debate of human euthanasia begins and ends. There are doctors on both sides of the human euthanasia argument. Where legal to perform euthanasia, a doctor should have the option whether or not to participate. Any person regardless of age should be allowed to seek life-ending medical treatment. A person who is believed to be mentally or emotionally unstable however, should be the exception. For example, someone who is otherwise physically healthy but is suffering from depression should not be granted a right to physician-assisted suicide.

Unfortunately, the biggest problem with ending one’s life is that non-assisted suicide is something that is not very easily regulated and the enforceability of laws regarding suicide is nonexistent. Anyone who has suffered the unexpected loss of a friend or loved one because of suicide will say it was a sad thing that they wish they could have prevented. A large number of opponents of assisted suicide are suicide survivors and those who have been affected by another person’s suicide. Suicide is an immense waste of potential; every person has the potential to do great things. This belief is one that is presented in James Allen’s book, As a Man Thinketh.

Allen writes that whatever a man thinks in his mind is what he will become and that our behavior is first generated from a thought and then is placed into action saying that “A man is literally what he thinks, his character being the complete sum of all his thoughts” (Allen, 7). This statement piques the curiosity with the idea that maybe euthanasia is a psychological product of how an individual views them self as a person and how their thought process affects their decision to end their life. Allen asserts that by first controlling and regulating our thoughts we can dictate the quality of our own life including our mental as well as physical health and that “The people who live in fear of disease are the people who get it” (Allen, 33).

This suggests that the psychological is greater than the biological and that by simply controlling our thoughts we can eliminate illness altogether regardless of biological factors. If this is really the case, it would seem to be more feasible and ethical to attempt altering the thought process through psychological treatment as an alternative to euthanasia for biological reasons, such as illness and severe pain. I am not disagreeing completely with Allen’s position on thought and the human psyche, I am just provoked to delve deeper into the idea before taking a definite stand one way or another, something I think Allen was trying to get his readers to do in the first place.

The idea that psychology plays a major role in a person’s desire to end their own life is also supported by Viktor Frankl in his book Man’s Search for Meaning. Frankl uses examples of the men who were prisoners with him in the concentration camps. He recalls that “…one could have witnessed that those who knew there was a task waiting for them to fulfill were most apt to survive (Frankl, 104). He also expresses the idea in his theory of logotherapy that each person has a specific purpose and meaning in life but when they begin to feel as though that meaning is no longer beneficial to themselves or to society they begin to lose the desire to live giving up on life altogether.

While there is truth to this, I believe it is possible for a person to regain meaning in their life avoiding a premature ending of their life. This has become a popular argument for those against assisted suicide because they feel that “A request for assisted Suicide is typically a cry for help. It is in reality a call for counseling, assistance, and positive alternatives as solutions for very real problems” (“Key Points,” 1).

A major setback to the healthcare system’s arguments against euthanasia is that human, medical science has been effective in discovering ways of prolonging life but not prolonging the quality of life. I cannot understand why a healthcare professional would think a person would want to prolong their life knowing that it will get worse before it gets better and that they will endure a longer more intense period of pain and suffering before they die. The reason advocates for euthanasia use this argument so often is because it makes us ask which is more important, quality of life or quantity of life.

Palliative care has become an increasingly favored alternative to euthanasia but this still presents the issue of quality of life. When choosing palliative care over physician assisted suicide I think it would be an important question to ask whether life will be enjoyable and not simply tolerable. In situations where palliative care can only guarantee a life that is tolerable, I think euthanasia is a legitimate option. Probably the most well known name associated with the practice of physician-assisted suicide is Jack Kevorkian. The family members of those who Kevorkian assisted in the process of ending their lives regard him as a hero for allowing their loved ones to die with dignity as they wished.

The only people who see him in a negative light are those who were not directly involved with his actions and would have more than likely done the same thing had they been placed in that situation themselves. Pride can play a major role in a person’s decision to commit suicide, although many people do not believe that saving someone from an embarrassing death should be a legitimate reason for ending one’s life. A person’s pride can be the sole reason for opting for assisted suicide because they would rather end their life than to be on so many pain management drugs that they are “vegetables.”

The American Medical Association as a whole opposes physician-assisted suicide and strongly advocates for palliative care stating that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks” (“30 Logical Reasons,” 2009). Most physicians do have a great deal of passion for what they do and for the wellbeing of their patients. Because of the compassion they feel for their patients, doctors are sometimes placed in a very difficult position when someone requests their assistance with ending their life, especially in the 47 states where physician-assisted suicide is prohibited by law.

I strongly believe that in some cases, voluntary euthanasia is the most logical and benevolent option for the patient and if that is the case a person should be able to make that decision for themselves without the interference of the government telling them how they should die.

While it is no doubt true that the mind is closely intertwined with the physical, there are some biological diseases that have nothing to do with the mind. When it comes to biology, microbes that cause a vast array of diseases that can cause illness and severe pain do not care if you are a positive thinker or not. Diseases are not respecters of men. They do not care who you are or how old you are. It is not the microbe that determines the severity and outcome of an illness; it comes down to the physical condition of our bodies and its ability to fight off disease.

The reason many elderly people become debilitated by a seemingly common disease is the fact that their bodies are no longer physically able to defend itself against the invasion. However, this does not mean we have to allow our mental health to succumb to our physical health either.

We may not always be able to control biological illness from plaguing our bodies but we do have the ability to control how those illnesses affect our lives. Morrie Schwartz viewed his battle with terminal illness as both a learning experience and a teaching opportunity to enhance his life and the lives of those around him. Morrie was the minority when it came to the outlook of one’s life. When faced with circumstances that can immensely alter one’s life such as an illness in their own body, it seems to be commonplace that they spiral into a deep depression and the one time in life that is meant to be the most spiritual becomes the greatest tormentor of the soul.

Well known psychoanalyst Erik Erikson’s eight stages of development sets forth a specific outline of the ages at which certain psychological developments should take place in a person’s life. The eighth stage, integrity versus despair, states that “If one or more of the earlier psychosocial crises have not been resolved, he may view himself and his life with disgust and despair” (“Child development,” 2010).

Both sides of the fence have legitimate arguments that hold weight; the only problem is that many people plunge head first into the argument with there mouths open and their ears closed. An essential part of a good and healthy argument or debate involves the consideration of your opponent’s views. It is not a surprising concept that, for the most part our ethical beliefs are individually oriented not only towards euthanasia but everything else that goes on in our lives. Until we have been in a position where euthanasia is a very real thing and a serious consideration, legal or illegal, I don’t think we can ever know for certain what we would do when placed in that situation, regardless of political, religious, or spiritual views.

Should it really be a public discussion to decide whether a person has the right to die? I find it strange that society as a whole generally has no problem deciding for a person whether they should live or die as means of punishment for capital offenses, but when a person expresses a desire to bring their own life to an end voluntarily, that is when morality becomes a factor. It makes the statement that it is acceptable for someone else to make that decision for you but you are not allowed to make it for yourself which is thought to be yet another way to place governmental restrictions on peoples’ lives.

Cases of euthanasia should be decided on a case-by-case basis between a person, their family, and their physician. This is not to say that a physician or any other medical professional should have the right to make recommendations for or against voluntary human adult euthanasia. The decision should ultimately be that of the patient.

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References

"Euthanasia." Merriam-Webster Online Dictionary. 2010. Merriam-Webster Online. 19 Feb. 2010.

Child Development Institute. 2010. Erikson’s Eight Stages of Development.

New King James Version Bible. Nashville: Thomas Nelson Publishers, 1982.

Hentoff, Nat. “The Slippery Slope of Euthanasia.” The Washington Post 3 Oct. 1992.

Key Points for Debating Assisting Suicide. Euthanasia.com.

St. Clair, Jane. 30 Logical Reasons Against Physician-Assisted Suicide. 29 July 2009. 4 Mar 2010.

Albom, Mitch. tuesdays with Morrie: an old man, a young man, and life’s greatest lesson. New York: Broadway Books, 1997.

Allen, James. As A Man Thinketh. New York: Peter Pauper Press.

Frankl, Viktor E. Man’s Search for Meaning. Boston: Beacon Press, 2006.

Santrock, John W. Life-Span Development. 12th ed. Ed. Michael Ryan. New York: McGraw-Hill, 2009.

Legal Status of Assisted Suicide/Euthanasia in the United States. 2009. 4 Mar. 2010 .

“Attempts to Legalize Euthanasia/Assisted Suicide in the United States.” International Task Force on Euthanasia & Assisted Suicide. 2009.

Johnston, William Robert. Oregon Abortion Percentages by County. 31 Dec. 2009. 24 Mar. 2010.

Death with Dignity Act. 2009 annual report. 24 Mar. 2010 .