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Euthanasia
“An Eclectic View”
by:
Jesilyn Montgomery
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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