- Introduction
Euthanasia, sometimes called assisted suicide, is the practice of allowing an individual suffering from a significant, terminal illness or injury to end their life before the injury or illness takes them. The idea of euthanasia is to allow the individual freedom from pain and suffering; proponents of the practice suggest that euthanasia allows people to avoid the pain and humiliation that can come from long-term palliative care.
Euthanasia is a process through which medical personnel or families help the patient to end his or her life. There are certain situations that are not considered euthanasia-- such as “Angel of Death” nurses who consider themselves to be euthanizing patients, but are really serial killers-- that are commonly conflagrated with the issue of euthanasia. These individuals may be discussed, but the primary focus of discussion here is the ethical boundary of true, medically-sanctioned euthanasia.
There are two basic types of euthanasia: the first type is passive euthanasia, which is the process of removing some kind of life-sustaining intervention (or refusing to intervene with a life-saving intervention on the patient’s or family’s wishes). The second type of euthanasia is assisted suicide; this is an active type of euthanasia, in which the patient actively takes steps to hasten his or her own death, either via overdosing on medication or some other means (Tamayo-Velasquez 677).
- Historical Issues
Euthanasia has long been a controversial issue in the western world. However, the growth of possibilities of medical science have made it an even more controversial issue in recent years. Medical science has allowed for the preservation of life to an extent that has never been seen before; however, along with this preservation comes the ability to keep someone who is terminally ill alive for a significant amount of time (Dowbiggin 12). When this happens, the patient is often in pain, and has no hope of a full or meaningful recovery; thus, the debate arises, in which some people believe that life should be preserved at all costs, while others postulate that sometimes it is better to allow people to choose their own fate-- even if that means intentionally dying before the disease takes over (Dowbiggin 12).
Before the modern era, the idea of euthanasia was a different one. Humanity did not have the medical knowledge it now has; as a result, euthanasia was merely a way for doctors and loved ones to get an individual as comfortable as possible before he or she succumbed to whatever illness or injury was plaguing them (Dowbiggin 18). However, as previously stated, advances in medical technologies has significantly changed how euthanasia is considered and practiced by medical professionals.
Prior to the 1990s and 2000s, the issue of euthanasia only became prevalent in the news when a doctor was caught performing the procedure. Dowbiggin writes, “In March 1950, more than one hundred reporters, photographers, and radio broadcasters from the United States and around the world descended on Manchester, New Hampshire covering the trial of Dr. Hermann Sander, a physician Indicted on a charge of killing one of his patients, a fifty-nine-year-old woman dying of cancer, Sander was the first physician in U.S. history to stand trial for mercy killing This debate was raging as bitterly as ever on March 31, 2005, when in Pinellas Park, Florida, forty-four-year-old Terri Schiavo died after her feeding tube had been removed” (Dowbiggin 12). Terri Schiavo captured the country’s attention, as she had been effectively comatose and brain-dead for a number of years before her eventual death; her parents were holding out hope, but her husband wanted to remove the feeding tube and allow her to die (Dowbiggin 13).
Today, the debate rages on; there have been a number of high profile cases in the news lately dealing with the issue of palliative care and euthanasia, and the issue continues to be divisive. Morality and ethics are difficult to outline when considering the boundary between life and death; as a result, euthanasia continues to be a difficult policy issue to consider (Dowbiggin 15).
- Physician-Assisted Suicide
Physician-assisted suicide is one of the primary ways that euthanasia has been considered in a legal sense. It can be problematic-- physicians take an oath called the Hippocratic Oath, which prohibits them from doing harm to their patients (Tamayo-Velasquez 679). Before euthanasia can be considered, the question must first be asked: can a doctor perform a euthanasia procedure without breaking his or her Hippocratic Oath? Similar problems arise when doctors are asked to carry out capital punishment procedures (Tamayo-Velasquez 679). However, much of the medical world has shown support for euthanasia policies, although they are unwilling to carry them out without legal support. Tamayo-Velasquez writes that seventy percent of nurses and doctors surveyed in Andalusia favored legislation allowing for euthanasia; they preferred doctor-assisted euthanasia policies to assisted suicide policies, as well, perhaps because procedures were less likely to go wrong if a medical professional was overseeing the process (Tamayo-Velasquez 679).
Of course, different doctors answer this question differently, and not only doctors are involved in the process. Nurses are also involved in the process, and have to be able to ethically balance the demands of euthanasia with their commitments to their patients. Tamayo-Velasquez writes about a questionnaire completed by Spanish nurses on the topic of euthanasia: “In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases of euthanasia had occurred in Spain and 11.4% believed the same for assisted suicide” (Tamayo-Velasquez 677). In short, medical professionals recognize the need for euthanasia policies, although they also desire legal protections before they would ever be willing to put medical processes into place.
Tamayo-Velasquez (677) and Draper et al. (114) write that there are a number of ways to address the issue of palliative care for terminally ill patients. The first step is to withhold futile treatment from a terminally-ill patient; the second is withdrawing futile treatment; and the third is a process termed “terminal sedation” (Draper et al. 114). Draper et al. (113) define terminal sedation as “the use of sedative medication to relieve intolerable suffering in the last days of life” (Draper et al. 114). These are passive forms of euthanasia-- not to the level of assisted suicide, but still ways for a doctor or nurse to ease the suffering of an individual who is in pain and is terminally ill. Emanuel et al. (1805) found that oncologists are more likely than other physicians to experience requests for euthanasia; Emanuel et al. (1805) suggest that nearly one in seven oncologists have carried out requests from patients for physician-assisted suicide, while more than half of the oncologists questioned had received requests for euthanasia (Emanuel et al. 1805).
- Family-Assisted Suicide
Physicians are not the only ones who are sometimes asked by patients to assist with their suicides. Families are also sometimes called upon by loved ones to help with the process; rather than participating in passive euthanasia as doctors and other medical personnel are something capable of doing, family members are more likely to engage actively in the process, helping an individual commit suicide rather than passively supporting a painless passing (Banerjee and Birenbaum-Carmeli 639).
Commonly, families assist suicide via drug overdoses, although there are certainly a variety of methods used by family members who are assisting loved ones with suicide (Banerjee and Birenbaum-Carmeli 639). Banerjee et al. (642) write, “Our investigation revealed that the press reports adopted a technological orientation, wherein the complex terrain of FAS was constructed as an orderly or orderable performance This ordered revealing was enabled by containing the complexities of FAS through a number of journalistic strategies, mainly treating degenerative dying as an aberrant condition, smoothing over botched attempts, locating the object of ethical judgment in persons rather than contexts and abbreviating the decision making process to near trivialisation, all in the context of complete conviction on the part of the assisting relative” (Banerjee and Birenbaum-Carmeli 642). Arguably, this form of assisted suicide is even less defensible than a medically-sanctioned assisted suicide; doctors are not even allowed to treat their own family members; family members with little or no medical training should not and legally could not be capable of treating their loved ones. Even medical professionals who are licensed and capable experience too much emotional distress when a loved one is in trouble; untrained individuals without any professional experience to fall back on should not be allowed to make these kinds of decisions for their loved ones.
- Patients and Euthanasia
The final part of the equation insofar as euthanasia and assisted suicide are concerned is the patient aspect. Patients can be complicated, difficult creatures; doctors and other medical professionals are used to seeing patients on some of their worst days. Oncologists and other doctors that commonly work with the terminally ill often see patients at very low points in their lives. The human mind is a complicated thing, and when people begin to experience long-term unrelenting pain, they often become sad or depressed as a result of that pain. Terminal illness is something that can be psychologically devastating on the patient as well as his or her family, and doctors and other medical professionals must be uniquely equipped to deal with this type of psychological distress (Emanuel et al. 1805).
Patients in unremitting pain are more likely than other patients to discuss euthanasia and assisted-suicide options with their doctor, according to a number of studies (Emanuel et al. 1805). Emanuel et al. (1805) describe a phenomenon in which patients experiencing chronic or long-term pain are more than two times as likely as other patients to consider euthanasia as an option. In addition, they were also more likely to have engaged in a number of maladaptive behaviors, including hoarding drugs and refusing medication (Emanuel et al. 1809).
Patients have been known to act irrationally in the face of terminal illness and long-term pain, and this is one of the reasons it is very difficult to consider the patient’s rationality and ability to be rational in the process of euthanasia (Parpa et al.160). Doctors and nurses are trained to deal with patients and their irrationality, but family members are often acting equally irrationally as their loved ones (Parpa et al.160).
- The Ethics of Euthanasia
Because there are two different types of euthanasia, for the purposes of discussion on ethics, passive euthanasia will be referred to as “euthanasia,” whereas active euthanasia will be referred to by the moniker “assisted suicide.” Euthanasia, in the passive sense, is the type of euthanasia practiced most frequently. When a patient has a “Do Not Revive” order, doctors and nurses are prohibited from engaging in life-saving measures on the person; often this forbids CPR, medication, and so on (Parpa et al.160).
However, not all physicians are comfortable with “Do Not Revive” orders and other similar orders for passive euthanasia. Parpa et al. (160) describe this process: “3.3% physicians and 41.3% relatives would agree in advance that in case of heart and/or respiratory arrest there would not be an effort to revive a terminally ill cancer patient. 20.5% physicians had a request for euthanasia. Significant associations were found between physicians, relatives and lay people on their opinions regarding withdrawing treatment The majority of the participants were opposed to euthanasia and physician assisted suicide. However many would agree to the legalization of an advanced cancer patient's hastened death” (Parpa et al. 160). While passive euthanasia in the form of DNR orders and other prohibitions against extreme lifesaving measures are allowed in many parts of the United States and elsewhere in the western world, there are still doctors who see this kind of behavior as unethical.
Moral stands against these kinds of orders come in a variety of different shapes. Some doctors claim that DNR and other similar orders may be considered, but that there is no proof strong enough that the order came from the patient. In this case, if the doctor does not revive the patient and the patient was coerced into signing the order or something equally terrible, the doctor has violated his Hippocratic Oath. In a similar vein, some medical professionals see it as their duty to preserve life, regardless of the wishes of the patient or family. These professionals are similarly unwilling to honor a do not revive order.
Other doctors, however, will honor these orders to the best of their ability. These individuals will often claim that their oath to do no harm includes prolonging someone’s pain; by prolonging that pain, the doctor is doing something unethical. However, this begs the question of when the patient is capable of making this type of decision. If a patient is capable of claiming that he or she wants to kill him or herself, many physicians consider that to be a sign of mental instability. The presence of chronic pain in one’s life can easily lead the individual to depression, where he or she feels as though his or her only or best option is to commit assisted suicide. Fosarelli, writing about the Dutch manner of thinking about euthanasia, considers “two study findings: (1) that euthanasia in practice is predominantly a discussion, which only rarely culminates in a euthanasia death; and (2) that euthanasia talk in many ways serves a palliative function, staving off social death by providing participants with a venue for processing meaning, giving voice to suffering, and reaffirming social bonds and self-identity at the end of Dutch life” (Fosarelli). In this way, the discussion with a medical professional and the community at large can, in and of itself, become a healing balm for the individual suffering from the terminal or chronic illness.
The western world accepts bodily autonomy as a natural right. However, the society as a whole balks at the idea of allowing an individual to choose to end his or her life; even in the context of a terminal illness, people are expected to continue living as long as their organs continue to work. Despite advances in modern medicine, the quality of life people can have with certain terminal illnesses declines sharply. Doctors must adjust their policies to respect the wishes of their patients, as long as their patients are expressing their desires with a clear mind and without coercion. If doctors are capable of involving themselves in the death penalty process in the United States, then they should be capable of helping terminally ill patients find a quiet, peaceful ending.
Family and friends, on the other hand, have no business participating in assisted suicide. There are too many emotions involved in the process; family and friends rarely have the ability to be dispassionate when a loved one is in trouble. As a result, if assisted suicide is to be an option, it should be an option discussed with a medical professional and carried out in a safe, healthy manner.
- Media Impact on Euthanasia Policies
The press often makes euthanasia cases much worse than they would have been without media involvement. The media, for instance, got hold of the Schiavo case and caused a sensation with it; the discussion often misses the crucial ethical questions, and seeks a black-and-white answer to the issue of euthanasia. However, there is no clear answer for the problem, and more discussion-- discussion in every potential case, in fact-- should be the norm.
Even if euthanasia is accepted for use in the medical profession, it should always be a last resort, and not something that a doctor recommends to patients. Instead, policies should be in place that strictly control euthanasia, much in the same way that gender reassignment therapy is strictly controlled and monitored by both doctors and mental health professionals. With the correct monitoring, the process could be overseen rigorously enough for it to be helpful to those most affected by it.
References
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