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Bill of Right in Action

Winter 1999 (16:1)

Matters of Principle

BRIA 16:1 Home | John Adams and the Boston Massacre Trials | The Murder of an Archbishop | Should We Have the Right to Die?

Should We Have the Right to Die?

Although attempting to take one's life is not a crime, assisting in the suicide of another is illegal in most states. Some argue, however, that the right to die is a basic civil right. They believe physician-assisted suicide for persons suffering from terminal diseases should be legal.

Thomas Youk, age 52, suffered from amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease. ALS gradually weakens nerves to muscles, causing difficulty in breathing, paralysis, and finally death. Youk had suffered from ALS for two years and increasingly had trouble breathing and swallowing. He then contacted Dr. Jack Kevorkian from Michigan.

Kevorkian, called "Dr. Death" in the media, is the most well-known advocate of physician-assisted suicide for people suffering from incurable diseases like ALS. Dr. Kevorkian, a pathologist, claims that since 1990 he has assisted more than 100 such individuals to take their own lives. He even invented a suicide device he calls the "Mercitron." This enables a person to die peacefully by self-administering a lethal dose of potassium chloride provided by Kevorkian. The Michigan doctor argues that competent patients experiencing prolonged suffering from fatal diseases have a right to die if they so choose.

Kevorkian had been charged and tried in three assisted-suicide cases. But juries refused to find him guilty of homicide. Then in the fall of 1998, Thomas Youk asked Kevorkian to inject him with the potassium chloride. Unlike his other cases, Kevorkian himself would inject the lethal dose for the first time.

Challenging the laws against such "mercy killing," Kevorkian videotaped the entire procedure and made the tape available for broadcast on the "60 Minutes" TV program. Charged with first-degree murder, Kevorkian was convicted of second-degree murder and sentenced to 10-25 years in prison.

Should Dr. Kevorkian be commended for standing up against laws that make peaceful, dignified deaths impossible for suffering patients who want the right to die? Or is "Dr. Death" promoting something that would inevitably lead society down a path ending with people being put to death against their will?

Euthanasia

In general, euthanasia (YOUTH uhn ay zhuh) refers to merciful killing, or allowing hopelessly sick or injured persons to die in a relatively painless way. There are several forms of euthanasia:

1. Right to Refuse Treatment: A competent adult has the legal right to refuse treatment even if this will result in his or her death.

2. Double Effect: A patient may request his or her physician to administer powerful drugs such as morphine to ease unbearable pain and suffering, knowing this is also likely to hasten his or her death.

3. Passive Euthanasia: Under certain circumstances, family members may request that life-sustaining machines or treatment be stopped for patients with little or no hope of regaining consciousness.

4. Physician-Assisted Suicide: A physician assists in the suicide of a dying patient, usually by supplying him or her with a lethal drug and the means to take it. In the United States, only Oregon permits this practice today.

5. Active Euthanasia: A physician performs the death-causing act after determining the wishes of the patient or the patient's family. This form of euthanasia is illegal in every state, although only a few physicians like Dr. Kevorkian have been prosecuted.

Recent polls indicate that a majority of Americans favor physician-assisted suicide when unbearable pain is involved. But support drops when pain is not a factor and when doctors themselves administer lethal drugs to end a patient's life (active euthanasia).

The debate over euthanasia goes back at least to the time of Hippocrates, the ancient Greek physician known as the Father of Medicine. The famous Hippocratic Oath says in part, "I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect." Some American medical schools still use the original Hippocratic Oath, but most have adopted other oaths, which may or may not permit physicians to participate in euthanasia.

During World War II, the Nazis perverted the idea of humane euthanasia. Nazi doctors started by euthanizing "impaired" adults and children and ended up participating in the mass murder of millions of Jews and others who they considered racially inferior.

Since World War II, The Netherlands has been the only country to permit euthanasia on a large scale. Euthanasia is still technically a crime in The Netherlands, but since the 1980s Dutch courts have allowed this practice if certain guidelines are met:

• The patient must make an informed, free, and explicit request that is repeated over time.
• The patient must be experiencing unbearable physical or psychological suffering that cannot be cured.
• The patient's physician must consult with another doctor to confirm whether the request for assisted suicide or another form of euthanasia is appropriate.

In 1996, the Dutch Supreme Court released a study on euthanasia. The study found that nearly 10,000 requests for some form of euthanasia are received each year. About a third are granted. For most of these deaths, a doctor injects a patient with a lethal drug (active euthanasia).

The study found some disturbing facts. It showed that the guidelines have been stretched to include patients with long-term, but not fatal, diseases. It also found cases of non-voluntary euthanasia involving incompetent elderly persons, newborns with severe disabling defects, and even a 6-year-old with diabetes who died when his parents chose not to authorize regular injections of insulin. These developments illustrate what critics of the right to die call the "slippery slope," gradually leading to cases of individuals who seemingly have a "duty to die."

Death With Dignity

In 1975, a New Jersey 21-year-old, Karen Ann Quinlan, was in a "persistent vegetative state" caused by her taking a mixture of drugs and alcohol. Doctors told her parents that there was little hope she would ever regain consciousness.

The New Jersey Supreme Court eventually agreed with Karen's parents that she be taken off the respirator that was apparently keeping her alive. The court ruled that a person had a privacy right to refuse medical treatment. In 1990 in another case, the U.S. Supreme Court affirmed the right of patients to refuse or discontinue life-sustaining medical treatment (Cruzan v. Missouri).

In 1991, voters in the state of Washington turned down a ballot initiative that would have permitted "physician aid in dying." Shortly afterward, the Washington state legislature passed a law banning physician-assisted suicide. Opponents challenged the law in the courts, arguing that competent terminally ill adults had a "fundamental liberty right" to have physician assistance in committing suicide. In 1997, the U.S. Supreme Court disagreed and basically left the right to die issue up to each state to decide (Washington v. Glucksberg).

Oregon voters in 1994 approved a ballot initiative called the Death With Dignity Act. This law allows Oregon physicians to prescribe, but not administer, drugs to assist the suicide of terminally ill patients who expect to die within six months. Such persons may or may not be experiencing pain. The law, however, prohibits physician-assisted suicide for those suffering from psychological disorders such as depression. As it turns out, depression (which can be treated) is a greater factor in requests for physician-assisted suicide than unrelieved pain.

The National Right to Life Committee challenged the Oregon law in the courts. But in 1997, the U.S. Supreme Court dismissed the case without a decision. Oregon Governor John Kitzhaber, a medical doctor and supporter of assisted suicide, vowed to implement the law. "As a physician," he said, "I can tell you there's a clear difference between prolonging someone's life and prolonging . . . death."

Oregon is the only state permitting doctors to assist the suicide of terminally ill persons. During the first full year of legalized assisted suicide in Oregon, 23 individuals requested lethal drugs from their doctors. Fifteen of these patients, average age 69, actually used the drugs and died. Most of these persons indicated that they wanted the right to die because they had lost personal control over their lives.

Critics point out that the Oregon law fails to require doctors to try "palliative care" to ease the death of their patients. They say that medication to control pain and depression, caring hospice facilities, and the love of family and friends may all help a person die in peace with dignity without having to resort to suicide. Medical schools in the United States are beginning to train doctors in palliative-care strategies.

Dr. Faye Girsh, a psychologist, is the executive director of the Hemlock Society, an organization that promotes efforts like the Oregon initiative to legalize physician-assisted suicide. Girsh maintains that what people fear the most is a time toward the end of their lives "when they are suffering, when they have lost control, when life has no meaning or quality, and they are not able to end it."

The debate will continue. More than 2,000 years ago, Hippocrates said this about the art of medicine: "Life is short and the art long, the occasion instant, experiment perilous, decision difficult."

For Discussion and Writing

1. Review the five forms of euthanasia described in the article. Which, if any, do you believe should be illegal? Why?

2. What do you think is the strongest argument for physician-assisted suicide? What is the strongest argument against it?

3. Do you think Dr. Kevorkian should have been convicted for killing Thomas Youk? Why or why not?

For Further Information

Bai, Matt. "Death Wish." Newsweek. 7 Dec. 1998:30-33.

Euthanasia And Physician Assisted Suicide: All Sides of the Issues

Euthanasia and End-of-Life Links from Ethics Updates

Annas, George J. "Death by Prescription" The New England Journal of Medicine, November 3, 1994, Vol. 331, No. 18.

Frontline: The Kevorkian Verdict An examination of the life of Dr. Jack Kevorkian, his cases, and his controversial fight for doctor-assisted suicide.

Pro-Euthanasia or the Right to Die

Angell, Marcia, M.D. "The Supreme Court and Physician-Assisted Suicide -- The Ultimate Right" The New England Journal of Medicine, January 2, 1997, Vol. 336, No. 1.

Dworkin, Ronald, Thomas Nagel, Robert Nozick, John Rawls, Thomas Scanlon, and Judith Jarvis Thomson "Assisted Suicide: The Philosophers' Brief" New York Review of Books March 27, 1997.

Dr. Jack Kevorkian and Attorney Geoffrey Fieger speak at a National Press Club Luncheon, Monday, July 29, 1996.

Kaminer, Wendy "Moving Beyond Dr. Death" IntellectualCapital.com Thursday, April 15, 1999

Open Directory--Pro-Euthanasia Sites

Death with Dignity National Center

Right to Die Organisations Worldwide

Anti-Euthanasia or the Right to Die

Corry, John "Who Is Jack Kevorkian, Really" From Reader's Digest.

Emanuel, Ezekiel "Whose Right to Die?" Atlantic Monthly March 1997.

Foley, Kathleen M., M.D. "Competent Care for the Dying Instead of Physician-Assisted Suicide" The New England Journal of Medicine, January 2, 1997, Vol. 336, No. 1.

Herbert Hendin, M.D. Suicide, Assisted Suicide and Euthanasia: Lessons From the Dutch Experience

Orr, Robert D., M.D., David B. Biebel, and D.Min "Why Doctors Should Not KILL" Christian Medical and Dental Society.

International Anti-Euthanasia Task Force

Euthanasia Corner Anti-euthanasia links

Not Dead Yet Disability activists opposed to euthanasia.

ACTIVITY: A Right to Die?

In this activity, students decide on whether the Oregon physician-assisted suicide law should be adopted in every state.

1. After reading the article, each student should write a response to this question: Should Oregon's physician-assisted suicide law be adopted by all states? Why or why not?

2. Next, form small groups to discuss the following alternatives and to try to agree on one of them:

xxxxxa. The Oregon law should be adopted, as is, by all the states.

xxxxxb. The Oregon law should be adopted by all states,
xxxxxxxbut only after certain changes are made.

xxxxxcC. Physician-assisted suicide should be illegal in every state.

3. Finally, each group should defend its choice before the rest of the class.