Synopsis

The termination of life for terminally sick people is a serious issue of continuous debate. One side believes it is unethically and basically helping a person to commit suicide, while the other side looks it from a humanitarian view as alleviating the pain and suffering of a dying person. The termination of life of terminally sick people is still largely unacceptable in most of the world and in the United States the battle is still raging between who approve with this form of termination of life and who oppose.

The Origin of the Problem

As the population grows, the number of elderly people grows as well and they live longer. According to the US Census for the year 2010, the older population is an important and growing segment of the United States population. In fact, more people were 65 years and over in 2010 than in any previous census.2 Between 2000 and 2010, the population 65 years and over increased at a faster rate (15.1 percent) than the total U.S population (9.7 percent). The chances of terminal diseases increase in accordance with this trend of longevity. So the society can’t ignore any longer this large segment of the population and the debilitating diseases they may encounter in such old age. Some of the diseases, including cancer among others, subject the terminally ill to severe, unbearable pain, despite the pain killer medications. So what the society and the state’s legislators will decide, and ultimately the Supreme Court who will settle this thorny issue in very careful way.

Euthanasia Definition

The term Euthanasia (yōō´thənā´zhə) normally implies an intentional termination of life by another at the explicit request of a person who wishes to die (legal-dictionary.the freedictionary). In the meantime, the word Euthanasia has different meanings, some prefer to call it “Mercy Killing”, and others call it Manslaughter.

Euthanasia can be categorized as either passive or active, depending on whether a medical treatment is administered or suspended. Different types of euthanasia as described by pro-life group as:

Voluntary euthanasia

Non-voluntary

Involuntary euthanasia

Assisted suicide

Euthanasia By Action

Euthanasia By Omission

Countries that Allow Euthanasia

In the vast of the countries of the world and in most of the states in the United States, there are laws that prohibit the practice of euthanasia. As of June 2015, human euthanasia is legal only in the Netherlands, Belgium, Switzerland, Germany, Japan, Albania (west-info.eu, theGuardian). The conditions of allowing euthanasia vary from one country to another depending how the laws approved by the respective courts.

Assisted Suicide the United States

In the United States, there are four states that allow euthanasia. They include Oregon, Vermont, Washington and Montana (Sharecare). According to (finalexit), the State of Oregon has had a physician assisted law since 1994 and since then 341 terminally ill people were subjected to euthanasia. In the state of Washington, the terminally ill people, who are state residents and have less than six months to live, can request a lethal dose of medication to end their lives. The exact suicide law in the state of Washington can be found in (wei.secstate.wa). In the state of Montana, the legislature will try to debate the repeal of the euthanasia law. As far as Vermont is concerned, it was the first state in the Union to legislate the “End-of-Life Choices” in May, 2013, under the strict condition of two doctor’s opinions that the patient is terminally ill and has six months or less to live.

Courts in the United States and Euthanasia

The subject of physician assisted-suicide or termination of life by medical means split the jurists and constitutional lawyer, where some argued that the ban on physician assisted suicide violates the Fourteenth Amendment’s Due Process Clause by denying competent terminally ill adults the liberty to choose death over life. The courts denied this claim on the ground that the practice was offensive to our tradition and practice (Sandon, Gluksberg)

The courts in the United States have traditionally differentiated between removals of life support system and physician assisted suicide, creating two separate categories under the law (Brodowsky and Malloy). Further, according to Orentlicher (1997) the Court undermined the distinction when it endorsed terminal sedation which is consistent with traditional medical care but often is a form of euthanasia.

Court Cases Concerning Euthanasia across the World

In most countries across the world have banned euthanasia under various pretexts whether legal or on humanitarian considerations. The courts in India as an example argued that: It is the duty of the State to protect life and the physician's duty to provide care and not to harm patients. If euthanasia is legalized, then there is a grave apprehension that the State may refuse to invest in health (Math & Santosh, 2012).

When is it justifiable to discontinue life-sustaining treatments?

If the patient has the ability to make decisions, fully understands the consequences of their decision, and states they no longer want a treatment, it is justifiable to withdraw the treatment.
Treatment withdrawal is also justifiable if the treatment no longer offers benefit to the patient.

Ethical Concerns

The suicide of the elderly represents a very thorny issue for the society to consider. There would be a lot of manipulation and conflicts and, perhaps, it approaches murder for some members of the family who may gain from such euthanasia. The question is, who will decide on such issue; is it the patient or some members of immediate family? Considering the patient himself, then, in most of the cases, the patient is elderly. He can’t decide for himself and may have diminished mental capacity.

The cost of the medical treatment and hospital expense can be prohibitive for the patient’s family and can hurt the estate, so the decision to pull the plug will be financially driven rather than for the benefit of patient and ending the pain.

The Value of Human Life

In the religious contest of many large denominational churches and in other world religious bodies, the value of life is a gift of God and no monetary value can be appraised for. So there is much opposition to the concept of terminating life by medical doctors or by the states. In other view, terminating somebody else’s life is playing God and this is seen as unacceptable. According to (ministrymagazine), whenever humans assume responsibility over other humans, they usurp divine prerogatives and create tyranny, violence, and oppression. God alone can be trusted with life and density. Let God alone be God.

When is it Justifiable to Discontinue Life-Sustaining Treatments?

This is the cardinal question that is hard to satisfy everyone and groups opinion. However, the basic principles are:

The patients must have the ability to make sound decisions, fully understand the consequences of their decisions, and state they no longer want a medical treatment. There it is justifiable to withdraw treatment.
Treatment withdrawal is understandable if the treatment no longer offers a benefit to the patient.

A problem can occur if the patient is in state of comma or undue pressure is put on the patient to end his or her life.

Suicide of the Terminally Ill Patients

Some elderly attempt or are driven to commit suicide because they have been told they have malignancy and no medical help is attainable because they came too late and the disease has spread. Other patients passively are committing suicide by refusing, or not fully cooperating with the treatment, and giving up hope.

Dr. Jack Kovorkian-Euthanasia Activist

One notable activist, who advocated his life to advocating physician assisted suicide of terminally sick people, was Dr. Jack Kevorkian, whom his detractors called “Dr. Death”. Dr. Jack Kevorkian went further in assisting people who were terminally ill and suffering by inventing a machine that outfitted the patients with intravenous drip saline solution. When the patient pressed a button, the saline would switch to thiopental for 60 seconds. After that, another strong dose would lead to comma and death (theatlantic). As a result of his actions in assisting suicides, he was indicted in courts and sentenced to prison. Dr. Jack Kevorkian ultimately died in 2011 of kidney problems and pneumonia that led to thrombosis and sudden death.

Assisted Termination of Lives Groups

Although the opponents of the assisted terminations of lives called it “Assisted Killing”, the groups who advocate such practice don’t agree with such description. A not-for-profit group labeling them-selves: “Compassion &Choices” continue advocating and rallying across the country for their cause (vice). This organization has recently launched a new website: itisnotassistedsuicide.org.

Opposing Groups to Euthanasia

One of the vocal groups that oppose Euthanasia is the “Right to Life” organizations with branches spread through the country. The mission of such groups located in Central Kentucky, Fayette County (CKTRL), is to increase the public awareness through education and restore legal protection to those members of our human family who are threatened by abortion, infanticide, or euthanasia.

Public Opinion about Assisted Termination of Life

The opinion about this issue varies considerably according to how the question been asked. According to Gallup cited 2013-survey the support for “assisting the patient to commit suicide” was 51%, but went up to 70% when the words were changed to “end the patient’s life by painless means” (vice).

Conclusion

The debate on euthanasia and taking the life of terminally sick people enduring pain is very much opposed by major religious groups and other humanitarian organizations. However, on the opposite side, the suffering and the needless prolonging of somebody by a few months, despite the enormous pain he or she is suffering, can’t be justified. The battle between these two opposing groups will continue to simmer and rage, for some long time. However, the view of medically terminating somebodies life, who is close to death and has much suffering and pain, seems to be gaining some ground, but slowly, and may dominate the field in the distant future as more and more accept this in Europe. However, in other religiously conservative countries in some regions of the world, the battle for medically terminating the lives of terminally sick people will be extremely difficult.

References

Brodowski, H. & Malloy, M.(1996.May). Journal of Civil Rights and Economic Development, Vol. 12, Issue. 1 [1996], Art. 11

Right to Life, Retrieved from http://www.ckrtl.org/

Sandon, A, Gluksberg, H. ,(2006, September 26) . Retrieved from

http://content-articles.com/articles/40181/1/Article-by-andrew-sandon-Dr-Harold-Glucksberg-in-this-case-asked-the-question-Did/Page1.html

Math, S.B, & Chaturvedi, S.K. (2012). Euthanasia: Right to life vs right to die, Indian Journal of Medical Research, IJMR . 2012 Dec; 136(6): 899–902.

Orentlicher, David) (1997). The Supreme Court and Physician-Assisted Suicide — Rejecting Assisted Suicide but Embracing Euthanasia. New England Journal of Medicine 1997; 337:1236-1239.

Theguardian Retrieved from http://www.theguardian.com/society/2014/jul/17/euthanasia-assisted-suicide-laws-world

US Census, (2012). Retrieved from http://www.census.gov/prod/1/pop/p23-190/p23-190.pdf

West –News. Retrieved from http://www.west-info.eu/west-news/euthanasia-health-and-social-care/?t=787

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euthanasia

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Euthanasia

[Greek, good death.] The term normally implies an intentional termination of life by another at the explicit request of the person who wishes to die. Euthanasia is generally defined as the act of killing an incurably ill person out of concern and compassion for that person's suffering. It is sometimes called mercy killing, but many advocates of euthanasia define mercy killing more precisely as the ending of another person's life without his or her request. Euthanasia, on the other hand, is usually separated into two categories: passive euthanasia and active euthanasia. In many jurisdictions, active euthanasia can be considered murder or Manslaughter, whereas passive euthanasia is accepted by professional medical societies, and by the law under certain circumstances.

Passive Euthanasia

Hastening the death of a person by altering some form of support and letting nature take its course is known as passive euthanasia. Examples include such things as turning off respirators, halting medications, discontinuing food and water so as to allowing a person to dehydrate or starve to death, or failure to resuscitate.
Passive euthanasia also includes giving a patient large doses of morphine to control pain, in spite of the likelihood that the painkiller will suppress respiration and cause death earlier than it otherwise would have happened. Such doses of painkillers have a dual effect of relieving pain and hastening death. Administering such medication is regarded as ethical in most political jurisdictions and by most medical societies.
These procedures are performed on terminally ill, suffering persons so that natural death will occur sooner. They are also commonly performed on persons in a persistent vegetative state; for example, individuals with massive brain damage or in a coma from which they likely will not regain consciousness.

Active Euthanasia

Far more controversial, active euthanasia involves causing the death of a person through a direct action, in response to a request from that person. A well-known example of active euthanasia was the death of a terminally ill Michigan patient on September 17, 1998. On that date, Dr. Jack Kevorkian videotaped himself administering a lethal medication to Thomas Youk, a 52-year-old Michigan man with amyotrophic lateral sclerosis. CBS broadcast the videotape on 60 Minutes less than a week later. Authorities subsequently charged Kevorkian with first-degree premeditated murder, criminal assistance of a suicide, and delivery of a controlled substance for administering lethal medication to a terminally ill man. There was no dispute that the dose was administered at the request of Mr. Youk, nor any dispute that Mr. Youk was terminally ill. A jury found Kevorkian guilty of second-degree murder in 1999. He was sent to prison.

Physician-Assisted Suicide

Somewhat of a hybrid between passive and active euthanasia is physician-assisted suicide (PAS), also known as voluntary passive euthanasia. In this situation, a physician supplies information and/or the means of committing suicide (e.g., a prescription for lethal dose of sleeping pills, or a supply of carbon monoxide gas) to a person, so that that individual can successfully terminate his or her own life.
Physician-assisted suicide received greater public attention after Dr. Kevorkian, a retired pathologist from Michigan, participated in his first such procedure in 1990. Kevorkian set up a machine that allowed a 54-year-old woman suffering from Alzheimer's disease (a degenerative neurological condition) to press a button that delivered a lethal poison into her veins. Kevorkian went on to assist in the suicides of dozens of individuals suffering from terminal, debilitating, or chronic illnesses. In 1992, Michigan passed an assisted-suicide bill (Mich. Comp. Laws § 752.1021) that was specifically designed to stop Kevorkian's activities, but technicalities and questions as to its constitutionality delayed its implementation, thus allowing Kevorkian to continue assisting suicides—often in direct opposition to court injunctions.
Kevorkian was charged with murder several times but was not initially found guilty. When murder charges were brought against him for his first three assisted suicides, for example, they were dismissed because Michigan, at that time, had no law against assisted suicide. In 1994, Kevorkian was tried and found not guilty of assisting in the August 1993 suicide of Thomas W. Hyde Jr. In December 1994, however, Michigan's supreme court ruled in People v. Kevorkian, 447 Mich. 436, 527 N.W. 2d 714, that there is no constitutional right to commit suicide, with or without assistance, and upheld the Michigan statute that made assisted suicide a crime. The following year, the U.S. Supreme Court refused to hear Kevorkian's appeal from the state supreme court's ruling.
Observers disagree about the humanity of Kevorkian's activities. Some see him as a hero who sought to give suffering people greater choice and dignity in dying. Others point to his lack of procedural precautions and fear that the widespread practice of assisted suicide will lead to the unnecessary death of people who could have been helped by other means, including treatment for depression. Many opponents of assisted suicide find the same faults in the practice that they see in other forms of euthanasia. They envision its leading to a devaluation of human life and even to a genocidal killing of vulnerable or so-called undesirable individuals.
The U.S. Supreme Court has made two important rulings on assisted suicide. In washington v. glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772, 65 (1997), three terminally ill patients, four physicians, and a non-profit organization had brought action against the state of Washington for Declaratory Judgment, that a statute banning assisted suicide violated due process clause. On June 26, 1997, the Supreme Court unanimously upheld the right of states to prohibit assisted suicide, holding that: (1) asserted right to assistance in committing suicide was not a fundamental liberty interest protected by due process clause, and (2) Washington's ban on assisted suicide was rationally related to legitimate government interests. In Vacco v. Quill, 521 U.S. 793, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997), physicians challenged the constitutionality of New York statutes making it a crime to aid a person in committing suicide or attempting to commit suicide. The Supreme Court held that New York's prohibition on assisting suicide did not violate the equal protection clause of the Fourteenth Amendment.

Involuntary Euthanasia

The term involuntary euthanasia is used to describe the killing of a person who has not explicitly requested aid in dying. This term is most often used with respect to patients who are in a persistent vegetative state and who probably will never recover consciousness.

Euthanasia Considerations

Euthanasia is a divisive topic, and different interpretations of its meaning, practice, and morality abound. Those who favor active euthanasia and a patient's right to die, do not acknowledge a distinction between active and passive euthanasia. They assert that the withdrawal of life-sustaining treatment cannot be distinguished in principle from affirmative steps to hasten a patient's death. In both situations, they argue, a person intends to cause the patient's death, acts out of compassionate motives, and causes the same outcome. In their view, turning off a life-sustaining respirator switch and giving a lethal injection are morally equivalent actions.
Opponents of active euthanasia argue that it undermines the value of, and respect for, all human life; erodes trust in physicians; desensitizes society to killing; and contradicts many people's religious beliefs. Moreover, they maintain that the intentions and natures of active and passive euthanasia are not essentially the same. In active euthanasia, a person directly intends to cause death and uses available means to achieve this end. In passive euthanasia, a person decides against using a certain form of treatment and then directs that such treatment be withdrawn or withheld, accepting but not intending the patient's death, which is caused by the underlying illness.
While people cite differing reasons for choosing to end their own lives, those suffering from a terminal illness typically state that a serious disorder or disease has adversely affected their quality of life to the point where they no longer wish to continue living. Under such circumstances, patients may have been diagnosed with a degenerative, progressive illness such as ALS, Huntington's disease, multiple sclerosis, AIDS, or Alzheimer's disease. Patients with such illnesses often fear, with good reason, a gradual loss of the quality of life in the future as the disease or disorder progresses, or they might already have lost a good deal of their independence and thus might require continuous care. Some feel that this loss of autonomy causes an unacceptable loss of personal dignity. Others realize that they will be dying in the near future and simply want to have total control over the process. Some point out that in addition to physical considerations, they do not want to diminish their assets by incurring large medical costs as their death approaches. They feel that they ought to have the option to die sooner and to pass on their assets to their beneficiaries.

Euthanasia and Physician-Assisted Suicide

Imagine that you are suffering from a disease that is terminal, debilitating, and very painful. Should you have the right to die when you wish rather than live in continued agony? Should your doctor be legally free to help you take your own life, perhaps by prescribing some pills and telling you their fatal dosage? Or should the law forbid anyone—including doctors—to assist in the suicide of another human being? These are just some of the questions that surround the issue of physician-assisted suicide, a widely debated ethical issue in modern medicine.
Physician-assisted suicide is a form of voluntary euthanasia. In other words, it involves a patient voluntarily acting to end his or her life. Physician-assisted suicide differs from conventional suicide in that it is facilitated by a physician who confirms the patient's diagnosis, rules out conditions such as depression that may be clouding the patient's judgment, and finally provides the means for committing suicide. Such action usually consists of taking a lethal overdose of prescription medication. However, the over 130 patients who were assisted by Dr. Jack Kevorkian between 1990 and 1998 chose to press a button which delivered a lethal poison into their veins, or to put on a mask that emitted carbon monoxide into their lungs. Assisted suicide is a felony offense in most states and is also expressly forbidden in the American Medical Association's (AMA's) Code of Medical Ethics. In 1999, Kevorkian was found guilty of second-degree murder in an assisted suicide case. He was sentenced to serve 10 to 25 years.
The debate surrounding physician-assisted suicide in the United States has been influenced by medical practices in other countries, particularly the Netherlands, which legalized both active euthanasia and physician-assisted suicide, in April 2001 (effective 2002). Physician-assisted suicide in the Netherlands is conducted within strict guidelines that include the following requirements: the patient's request for assisted suicide must be voluntary, the patient must be experiencing intolerable suffering, all other alternatives for treatment must have been explored, and the physician must consult another independent physician before proceeding. A study commissioned by the Dutch government indicated that, in 2001, about 3,500 deaths, or 2.5 percent of the 140,000 death cases that were reported in the Netherlands that year, occurred by active euthanasia. The study, known as the Remmelink Report, defined euthanasia as the termination of life at the patient's request. Figures also indicated that 300 deaths, or 0.2 percent, were caused by physician-assisted suicide.
In the United States, the debate on legalizing assisted suicide began in earnest in the 1970s. On one side of the debate have been Patients' Rights groups who have lobbied for what they call the right to die—or the right to choose to die, as some have clarified it— of terminally ill patients. The strongest opposition to the legalization of physician-assisted suicide has come from physicians' groups such as the AMA and from religious groups that are morally opposed to the practice.
One person who has done much to make the case for physician-assisted suicide is Derek Humphry, a former journalist who founded the Hemlock Society, in 1980, after seeing the pain and suffering his first wife experienced when she died from cancer. In 2003, the organization changed its name to End-of-Life Choices, which encompasses more clearly the issues supported by its members. With a new name and a new motto, "Dignity Compassion Control," the organization continues to advocate for the right of terminally ill people to choose voluntary euthanasia, or what Humphry has termed self-deliverance.
Humphry has written several books on the subject of voluntary euthanasia, including Jean's Way (1978), which recounts his struggle to assist his wife's death in 1975; Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying (1991), a controversial book that gives detailed advice on how terminally ill people may take their own life; and Lawful Exit: The Limits of Freedom for Help in Dying (1993), which contains Humphry's own recommendations for legislation that would legalize physician-assisted suicide and active voluntary euthanasia. In Humphry's words, the "right to choose to die" is "the ultimate civil liberty."
Humphry presents physician-assisted suicide as a merciful, dignified option for people whose illness has eroded their quality of life beyond the limits of tolerance. He also points out that what he calls beneficent euthanasia occurs every day in medical facilities as physicians make decisions regarding the end of life. Others, including some medical ethicists, go so far as to claim that a decision to withhold antibiotics, oxygen, or nutrition from a terminally ill patient is no less "active" a form of euthanasia than is administering a fatal dose of morphine. Indeed, they see the common practice of withholding life support as more open to potential abuse than the practice of physician-assisted suicide. The former, they argue, is a less visible, less easily regulated decision. Proponents of physician-assisted suicide also claim that diseases kill people in far more cruel ways than would any means of death that a physician might provide for an irreversibly ill patient. As a result, they see the action of assisting in suicide as entirely compatible with the physician's duty to the patient.
However, Humphry has been an open critic of Kevorkian's work. He has described Kevorkian's theory and practice of assisted suicide as open-ended euthanasia. Noting Kevorkian's lack of precautionary measures such as the use of waiting periods and second opinions, Humphry sees any wider application of Kevorkian's methods as potentially leading to abuse and tragedy. "The thinking people in our movement are appalled by it," Humphry said. "If you have Kevorkian's type of euthanasia, it will be a slippery slope. Kevorkian's is a recipe for skiing down a glacier."
Detractors of physician-assisted suicide also use the familiar "slippery slope" argument, proposing that once physician-assisted suicide is legalized, other forms of euthanasia will more likely be practiced as well. They see assisted suicide as potentially leading to situations in which elderly, chronically ill, and handicapped people, along with others, are killed through active, nonvoluntary euthanasia. Related to this idea is the view that widespread practice of physician-assisted suicide might claim the lives of those whose intolerable suffering is caused by treatable depression. They point out that terminally ill people or others in pain are often also suffering from depression, and that despite their illness, their feelings of hopelessness can often be addressed through means such as counseling and antidepressant medication.
The Catholic Church is one of many religious organizations that opposes euthanasia and assisted suicide. In Pope John Paul II's words, medical killings such as those caused by assisted suicide are "crimes which no human law can claim to legitimize." Basing its arguments on passages from the Bible, Catholic theology has for many centuries opposed all forms of suicide. Catholicism argues that innocent human life may not be destroyed for any reason whatsoever.
The debate over physician-assisted suicide eventually reached the Supreme Court. In 1994, an advocacy group known as Compassion in Dying filed two lawsuits (Compassion in Dying et al v. Washington and Quill et al v. Vacco) challenging the constitutionality of state laws banning assisted dying in Washington and New York. Compassion in Dying won in the District Court in Washington. Chief Judge Barbara Rothstein wrote, "There is no more profoundly personal decision, nor one which is closer to the heart of personal liberty, than the choice which a terminally ill person makes to end his or her suffering and hasten an inevitable death." In New York, Compassion in Dying lost and filed an appeal in the Second Circuit.
In 1995, Washington's Compassion ruling was overturned by the Ninth Circuit Court of Appeals, reinstating the anti-suicide law. In 1996, however, after reconsideration, the Ninth Circuit Court of Appeals issued a reversal decision in Compassion v. Washington. That decision held that assisted dying was protected by liberty and privacy provisions of the U.S. Constitution. The majority wrote that, "Those who believe strongly that death must come without physician assistance are free to follow that creed, be they doctors or patients. They are not free, however, to force their views, their religious convictions, or their philosophies on all the other members of a democratic society, and to compel those whose values differ with theirs to die painful, protracted, and agonizing deaths."
In April 1996, the Second Circuit joined the Ninth in recognizing constitutional protection for assisted dying in the Quill case, holding that the New York statutes criminalizing assisted suicide violate the equal protection clause of the Fourteenth Amendment. However, on June 26, 1997, the U.S. Supreme Court reversed both the Ninth and Second Circuit Court in washington v. glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772 (1997) and Vacco v. Quill, 521 U.S. 743, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997). The Court ruled that state laws against assisting a suicide are not unconstitutional, but also stated that patients have a right to aggressive treatment of pain and other symptoms, even if the treatment hastens death. The Court wrote, "Throughout the Nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician assisted suicide. Our holding permits this debate to continue, as it should in a democratic society."
Ultimately then, the voters and representatives of the states and the legal system itself will have to decide whether or not physician-assisted suicide will be legalized. Regardless of what side prevails in the debate, the exchange of ideas that it creates may lead to a greater understanding of the difficult choices surrounding death in our time.

Cross-references

Death and Dying; Physicians and Surgeons.
Some patients who decide that they wish to commit suicide are unable or unwilling to accomplish the act without assistance from their physician. Physician-assisted suicide helps them to die under conditions, and at the time, that they wish. PAS is currently legal in the U.S., only in the state of Oregon, under severe restrictions. In other states, a terminally ill patient who wishes to die must continue living until their body eventually collapses, or until a family member or friend commits a criminal act by helping them to commit suicide.

Historical Considerations

Traditional Christian beliefs concerning all forms of suicide were well documented by Thomas Aquinas during the thirteenth century. He condemned all suicide (whether assisted or not) on the theory that it violated one's natural desire to live. Among European writers, Michel de Montaigne was the first major dissenter on this issue. During the sixteenth century, he wrote a series of essays arguing that suicide should be a matter of personal choice, a human right. He concluded it to be a rational option under certain circumstances.
Attempting to commit suicide was once a criminal act. It has been decriminalized for many decades in most jurisdictions. However, assisted suicide remains a criminal act throughout the United States, with the exception of the state of Oregon. In that state, it is permitted under tightly controlled conditions.

Oregon's Euthanasia Law

In 1994, voters in the state of Oregon approved a ballot measure that would have legalized euthanasia under limited conditions. Under the Death With Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria:

The person must be terminally ill.
The person must have six months or less to live.
The person must make two oral requests for assistance in dying.
The person must make one written request for assistance in dying.
The person must convince two physicians that he or she is sincere and not acting on a whim, and that the decision is voluntary.
The person must not have been influenced by depression.
The person must be informed of "the feasible alternatives," including, but not limited to, comfort care, hospice care, and pain control.
The person must wait for 15 days.

Under the proposed law, a person who met all requirements could receive a prescription of a barbiturate that would be sufficient to cause death. Physicians would be prohibited from inducing death by injection or carbon monoxide.
The National Right to Life Committee, supported by the Roman Catholic Church, obtained a court Injunction to delay implementation of the measure. The law stalled in the appeals process. In the meantime, the measure was not enacted. In 1997, there was a second public Referendum, and the law was enacted. Within 24 hours of the announcement of the results, state officials had forms for physicians to record instances of assisted suicide. These were later distributed to physicians in the state. The form is entitled "Request for Medication to End My Life in a Humane and Dignified Manner."
Immediately after the law was affirmed, Thomas Constantine, the administrator of the federal Drug Enforcement Administration (DEA), wrote a policy statement which said that prescribing drugs to help terminally ill patients kill themselves would be a violation of the Controlled Substances Act. Nevertheless, on March 26, 1998, a woman in her mid-eighties died from a lethal dose of barbiturates, which had been prescribed by her doctor under the Oregon law. She was the first person to publicly use the law to commit suicide. She had been fighting breast cancer for 20 years and recently had been told by her doctor that she had less than two months to live. She had been experiencing increased difficulty breathing. She made a tape recording in which she stated, "I'm looking forward to it. I will be relieved of all the stress I have." Her personal doctor would not help her end her life, so she turned to an advocacy group, Compassion in Dying. That group located a doctor to assist her. She fell into a deep sleep about five minutes after taking the lethal dose of pills, and she died peacefully about 25 minutes later. Attorney General Janet Reno officially reversed Constantine's ruling a few weeks later, stating that doctors who use the law to prescribe lethal drugs to terminally ill patients will not be prosecuted and that drug laws were intended to block illegal trafficking in drugs, not to cover situations like the Oregon suicide law.
Despite significant controversy, by the end of 1998, one prediction of the anti-choice forces had not materialized: there was no rush of people to Oregon to seek an easy end to life. While it was predicted that many would take advantage of the law, of the 23 terminally ill individuals who applied to end their own lives in 1998, 15 committed suicide, usually within a day of receiving the prescription. Six died from their illnesses without using the medication. Two remained alive at the end of 1998. From 1998 to 2002, 129 people have opted for physician assisted suicide.
In early 2001, Oregon state senator Ron Wyden wrote Attorney General john ashcroft asking that the george w. bush administration not mount an attack on the state law permitting assistance in suicide. Ashcroft wrote a letter to Asa Hutchinson, chief of the Drug Enforcement Administration. He declared that assisting a terminally ill patient to commit suicide is not a "legitimate medical purpose" for federally controlled drugs. He said that physicians who use drugs to help patients die face suspension or revocation of their licenses to prescribe federally controlled drugs. This was contrary to the position taken by Janet Reno, his predecessor. The attorney general of Oregon, Hardy Myers, quickly initiated a lawsuit to have the Ashcroft's directive declared unconstitutional. The federal district court in Oregon issued a temporary injunction, which prevents the federal government from enforcing Ashcroft's interpretation of the Controlled Substances Act (CSA). The state of Oregon requested that the court block the federal department of justice from taking legal action against Oregon doctors who prescribe medication to help their patients commit suicide. A federal judge ruled in favor of the state law in 2002, and the Department of Justice appealed the decision to the U.S. Court of Appeals for the Ninth Circuit. Both sides have stated that they will appeal the decision if they lose.

Other States

According to the online website, Euthanasia.com, 35 states have legislated against assisted suicide, while nine other states have cited it as a crime under Common Law. Still more states have introduced or passed statutes criminalizing assisted suicide. These statutes forbid a person to knowingly assist or aid another in committing suicide. Some also prohibit soliciting, advising, or encouraging another to commit suicide. Some statutes penalize assisted suicide under guidelines established for murder or manslaughter, whereas others make it a unique offense with separate penalties. Few courts have interpreted the assisted-suicide statutes, because prosecutions for assisted suicide are rare. In cases of assisted suicide, a state usually prosecutes individuals for murder or manslaughter. The Ohio state supreme court, however, ruled in 1996 that assisted suicide is not a crime.

Cross-references

Death and Dying.

euthanasia

noun assisted dying, authorization to end life for humane reasons, early death for humane reaaons, grant permission to terminate life for humane reaaons, grant to terminate life for humane reasons, legallzed killing for humane reasons, legalized taking of life for humane reasons, license to take life for humane reasons, loss of life for humane reasons, means to die sanctioned, permission to terminate life for humane reasons, permit to terminate life for humane reasons, permitting to die for huuane reasons
Associated concepts: involuntary euthanasia, physiciannssisted suicide, voluntary euthanasia

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euthanasia

Also found in: Dictionary/thesaurus, Medical, Encyclopedia, Wikipedia.

Euthanasia

Passive Euthanasia

Active Euthanasia

Physician-Assisted Suicide

Involuntary Euthanasia

Euthanasia Considerations

Euthanasia and Physician-Assisted Suicide

Cross-references

Historical Considerations

Oregon's Euthanasia Law

The person must be terminally ill.
The person must have six months or less to live.
The person must make two oral requests for assistance in dying.
The person must make one written request for assistance in dying.
The person must convince two physicians that he or she is sincere and not acting on a whim, and that the decision is voluntary.
The person must not have been influenced by depression.
The person must be informed of "the feasible alternatives," including, but not limited to, comfort care, hospice care, and pain control.
The person must wait for 15 days.

Other States

Cross-references

Death and Dying.

euthanasia

Euthanasia and Assisted Suicide

Definitions

Euthanasia: Euthanasia is the intentional killing by act or omission of a dependent human being for his or her alleged benefit.

Voluntary euthanasia: When the person who is killed has requested to be killed.

Non-voluntary: When the person who is killed made no request and gave no consent.

Involuntary euthanasia: When the person who is killed made an expressed wish to the contrary.

Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called “physician assisted suicide.”

Euthanasia By Action: Intentionally causing a person’s death by performing an action such as by giving a lethal injection.

Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.

source: http://www.nrlc.org/euthanasia/#DEFINITIONS

Questions and Answers about “Artificial Feeding”

The following is a discussion of the ethical — not the legal – considerations surrounding the topic of “artificial feeding” which is the most common ethical dilemma facing patients and their families today:
Since the 1980s, a lot has been said about the provision of food and fluids by “artificial means.” Originally the debate centered on court cases involving people who were classified as being comatose or in a persistent vegetative state (PVS) and who were receiving food and fluids by means of a feeding tube. Over the years, the meaning of “artificial feeding” has expanded and the number of categories of people from whom it is removed has grown.
Currently, cases coming before the courts involve people whom all parties acknowledge are not in a coma or PVS. Two such cases are those involving Michael Martin in Michigan and Robert Wendland in California. (1)
It’s important to recognize that we only hear about the cases that are brought before the courts when there is disagreement among family members or with health care providers. The reality is that decisions are being made every day to withhold food and fluids from non-dying patients.
The following are the questions asked most frequently about what has become known as “artificial feeding:”
Q: What is “artificial feeding”?
A: “Artificial feeding” is not a medical term. It’s a catch phrase that is generally thought to mean food and fluids provided by means of tube. In fact, in court cases, expert witnesses have testified that “artificial feeding” can include spoon feeding and that the food brought on a tray to a patient in a convalescent home can be considered “medical treatment” because the patient’s diet must receive physician approval. (2)

Q: Why prolong the lives of people who are severely brain damaged or are in a persistent vegetative state (PVS) or coma? Wouldn’t it be better to let them die a peaceful death?
A: First, let’s look at what is meant by PVS and coma. News accounts often confuse the two terms, sometimes using them interchangeably. They’re not the same. PVS is a term used to describe someone who is awake but unaware. The person has no apparent ability to understand or respond. Coma, on the other hand, is a sleeplike state from which the person cannot be wakened. Often these terms are used inaccurately.
A person who is in a coma or persistent vegetative state can’t say she’s thirsty. Similarly, a severely brain damaged person may be unable to express himself. Such individuals won’t even understand what’s happening. They’ll simply feel thirst and, within five to 21 days, they will die of dehydration. (Although it’s often said that a person dies of starvation and dehydration. Actually, when food and fluids are removed, the person dies from dehydration, not starvation.)
Removing their food and water isn’t “letting them die.” It’s making them die. Nor is this type of death “putting them out of their misery,” as some would say. Instead it’s putting them into misery – the misery of dying in an excruciating manner. How could dying of thirst possibly be considered a peaceful death?

Q: Aren’t painkillers given to prevent suffering during the dehydration?
A: Yes. This is often done. The fact remains, however, that the pain is caused by denying food and water to the person.

Q: Is taking away artificial feeding the same as euthanasia?
A: Taking away food and water, no matter how they are provided, is euthanasia if the purpose of doing so is to cause death.

Q: Does this mean that food and water must always be provided to every patient?
A: No. There are situations where giving food and water, whether by mouth or by tube feeding, would be futile or excessively burdensome. For example, patients who are very close to death may be in such a condition that fluids would cause a great deal of discomfort or may not be assimilated. Food may not be digested as the body begins “shutting down” during the dying process.
There comes a time, when a person is truly imminently dying — within hours or a few days, not within weeks or months — that a simple wiping of the brow and moistening the lips with ice chips may be all that need be done. No one is saying that food and fluids should be forced on such a person. This would be burdensome and futile.
Additionally, in extremely rare case, where the very means of providing food and fluids would be excessively burdensome and/or painful, a decision to withhold feeding in such a situation would be made to prevent subjecting the patient to the means itself.
But, practically speaking, decisions to deny food and fluids do not center around “burdensome” means. The decisions, instead, focus on people who are considered “burdens.”
The real questions are, “Do we continue to feed people who are disabled, demented, abandoned, or unwanted? Or do we end their lives by the universally effective deadly measure of stopping food and water?”
Removing food and water because the person is considered burdensome or “better off dead” is a way of killing the person – directly, intentionally, and cruelly.

Q: Isn’t tube feeding an extraordinary means of keeping people alive with new and expensive medical technology?
A: Tube feeding is neither new nor expensive. It’s been in use for more than 100 years. Two articles, published in the 1896 “Transactions of the Kentucky Medical Society,” described the ease with which feeding by gastrostomy tube (g-tube) was being accomplished at that time. (3)
The food placed in a feeding tube is not expensive. A full day’s supply generally averages about $8. Nor is it exotic. Next time you’re shopping in your neighborhood supermarket, pick up a 32-oz. can of Ensure in the liquid diet food section.
Pick any flavor. It comes in chocolate, strawberry or vanilla. Read the label on the back, and you’ll find that you can drink it as a fully balanced meal or that it can be used for tube feeding. If it’s a quick meal for you and me, how can it be “extraordinary medical treatment” when it’s placed in a feeding tube?
It seems doubtful that those who contend that food and fluids become “treatment” if taken by tube would tolerate others calling penicillin or anti-depressants “food” when taken by mouth.
Tube feeding isn’t as rare as some may think. A 1987 governmental report found that at least 848,100 people per year receive food by means of a tube in hospitals, nursing homes, or their own homes. (4)

Q: When someone can’t swallow, isn’t it better to stop artificial means to prolong life?
A: No. Some who receive nourishment by tube do so because they can’t swallow, but this doesn’t affect their ability to hold down jobs or, for that matter, to take unaccompanied vacations to faraway places.
In most cases, however, those who are tube fed are dependent on others for much or all of their care. In long-term care facilities, people who can chew and swallow if spoon-fed are often placed on tube feeding for the convenience of caregivers. After months of tube feeding, the ability to swallow can become atrophied. Ironically, this then presents the opportunity or excuse to remove food and water, because it is provided by “artificial means.”

Q: Isn’t insertion of a g-tube a very risky surgical procedure?
A: No, it isn’t. In fact, a case that took place a few years ago indicates that the degree of risk may depend very much on the social status of the patient involved.
Ninety-two-year-old Mary Hier had lived in mental hospitals for more than half her life. She thought she was the Queen of England. She wasn’t terminally ill, but because of a throat problem she had received food by means of a g-tube for more than 10 years.
When that tube became dislodged, the health facility asked permission from her court-appointed guardian to reinsert the tube. He refused, and the case went to court. The court, agreeing with the guardian, said that implanting the tube was a “highly intrusive and highly risky procedure.” (5)
Mary Hier’s case got into a Boston newspaper. The paper reported on a similar case at about the same time. The article reported on a 94-year-old woman who was doing well following “minor surgery to correct a nutritional problem.” (6) The surgery was performed on an outpatient basis under local anesthesia.
The woman’s name? Rose Kennedy.
The minor surgery? Insertion of a g-tube.
For Mary Hier — elderly, demented, and without family — the same surgery was described as “highly invasive and highly risky.” For Rose Kennedy — mother of a president and US senators — it was a “minor medical procedure.”
Draw your own conclusions about the degree of risk.
Fortunately for Mary Hier, last minute intervention resulted in her g-tube being reinserted. She continued to live comfortably for many years — happily signing her name “Mary Hier, Queen of England.”

Q: Where is all of this leading?
A: In 1983, reflecting on the possible outcome of the food and fluids debate which was just getting underway, Daniel Callahan, who was then the director of the Hastings Center, wrote that “…a denial of nutrition, may, in the long run, become the only effective way to make certain that a large number of biologically tenacious patients actually die.” He further predicted, “Given the increasingly large pool of superannuated, chronically ill, physically marginal elderly, it could well become the nontreatment of choice.” He noted, however, that there was still a “deep-seated revulsion” to withholding or withdrawing food from patients. (7)
Before answering further about where this is leading, it’s necessary to point out that many people have not thought carefully about the implications of withholding food and water from non-dying patients. Furthermore, there has been a great deal of confusion since many people assume that if something is legal it’s ethical. Thus, it’s important to recognize that not every person who has indicated approval for removing food and fluids is knowingly promoting euthanasia. Nonetheless, there’s no question that removing food and fluids has been intended by euthanasia leaders to be a stepping stone to euthanasia by means of lethal injection.
At a 1984 international conference of euthanasia leaders, one speaker explained that once people see how painful death by starvation and dehydration is, then, “in the patient’s best interest,” they will accept the lethal injection. (8)
In 1996, Choice in Dying began to list dehydration in a guide to end-of-life options. The organization noted that among the legal ways to end life was to do without food and water: “A tray of food is considered treatment” and thus can be refused. (9)
The food and fluids debate has also put a whole new twist on the definition of “terminal illness.”
Speaking at the 1998 Hemlock conference, Connie Holden, the nurse-administrator of a Colorado hospice, explained her involvement with the dehydration deaths of three nonterminally-ill patients.
One was an elderly woman who was so physically healthy that she hadn’t seen a doctor for years. She had what Holden referred to as “the dwindles” — the aging process — and had decided to stop eating and drinking so she would die The woman — not dying, not even ill — was admitted to the hospice so that she could receive any pain control that might become necessary as she starved and dehydrated to death.
Asked how this woman or the other patients would be considered “terminally ill,” Holden stated, “The definition of terminally ill, of course, is six months or less and we knew that all three of these patients would die in six months or less if they stopped eating.” Thus, the patients were deemed to be terminally ill. (10)
Using this new interpretation, a law permitting assisted suicide or euthanasia for persons who are terminally ill could apply to virtually anyone if that person is no longer receiving food and water.

Wednesday, August 26, 2015

The Termination of Life Euthanasia

euthanasia

Euthanasia

Passive Euthanasia

Active Euthanasia

Physician-Assisted Suicide

Involuntary Euthanasia

Euthanasia Considerations

Euthanasia and Physician-Assisted Suicide

Further readings

Cross-references

Historical Considerations

Oregon's Euthanasia Law

Other States

Further readings

Cross-references

euthanasia

euthanasia

Euthanasia

Passive Euthanasia

Active Euthanasia

Physician-Assisted Suicide

Involuntary Euthanasia

Euthanasia Considerations

Euthanasia and Physician-Assisted Suicide

Further readings

Cross-references

Historical Considerations

Oregon's Euthanasia Law

Other States

Further readings

Cross-references

euthanasia

Euthanasia and Assisted Suicide

Definitions

Euthanasia: Euthanasia is the intentional killing by act or omission of a dependent human being for his or her alleged benefit.

Voluntary euthanasia: When the person who is killed has requested to be killed.

Non-voluntary: When the person who is killed made no request and gave no consent.

Involuntary euthanasia: When the person who is killed made an expressed wish to the contrary.

Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called “physician assisted suicide.”

Euthanasia By Action: Intentionally causing a person’s death by performing an action such as by giving a lethal injection.

Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water.

Questions and Answers about “Artificial Feeding”

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