EUTHANASIA SHOULD BE LEGAL


S
uffering from breast cancer for a decade, I am now in the final stage of my illness. It has metastasized into my bones and my condition has been complicated by radiation side effects. I have tried every possible treatment but to no avail. Every breath I take hurts. I want to end my life this very moment. I want to leave this world on my own terms, with dignity. I want to be able to hold my loved one’s hand as I make my quiet exit. But you tell me I can’t. You, the audience, listening as I narrate my story. You, who cannot see or feel my pain.

 

Whose life is it anyway?

 

Introduction

              Euthanasia originates from the combination of two ancient Greek words ‘eu’ and ‘thanatos’ which means a ‘good death’. An easy death that we all yearn for – gentle, peaceful and surrounded by our loved ones. I do not subscribe to the church’s view that ‘illness is a form of suffering that purifies the victims’[1] and I will not stand to be disparaged for that. All I am asking for is the right to exercise personal autonomy, protected by the Fourteenth Amendment, which is ironically being taken away from a patient when he is nearing his life’s end.

 

            It is easy to find support for passive euthanasia, which means to ‘let people die because their lives are an unnecessary burden to them’[2]. Even the most pedantic opponents against the legalisation of euthanasia would not find themselves in favour of employing every technical means available to prevent someone from dying whenever he can be hauled back from death (I am assuming that the opponents I am dealing with are not unreasonable fanatics who cannot see the appeal of such a case). The crux of this debate lies more with the moral permissibility of active euthanasia, ‘an active intervention by a doctor to end life’[3], which is deemed more abhorrent than passive euthanasia. I am arguing for the legalisation of both active and passive voluntary euthanasia.

 

Moral distinction between Active and Passive Euthanasia?

 

            The reason that people are less likely to accept active euthanasia is that they view it as a form of killing as compared to passive euthanasia, which is more akin to letting the patient die. Opponents claim that since killing is inherently bad, active euthanasia is necessarily so as it requires someone taking deliberate steps to end life, as in the case where the doctor administers a lethal dosage of drugs to patients to bring forth death. Passive euthanasia, on the other hand, involves an omission on the doctor’s part to give the appropriate treatment which then leads to the patient’s death. Is the latter really less morally reprehensible than active euthanasia?

 

When a doctor obeys the patient’s wishes and turns the life-support machine off, he is not necessarily more culpable than one who does nothing to help the patient when her life-supporting machine is turned off accidentally by the cleaning lady.[4] Yes, there might be a difference between intervention and lack of intervention but morally, these two doctors should be equally blameworthy.

 

            Extending this line of reasoning, it goes to show that if the public is ready to accept passive euthanasia, there is no reason why active euthanasia should be condemned since they are to be regarded as ‘evaluatively equivalent’[5].

 

My Right to Die

 

            When we talk about having a right to die, the cases of two young women, Karen Ann Quinlan[6] and Nancy Beth Cruzan[7], come vividly to mind. After imbibing some alcohol with drugs, Quinlan sank into a persistent vegetative state and was put on a respirator. Her parents had to go through a prolonged legal battle to get permission from the court to remove the breathing apparatus. Cruzan too, suffered a similar fate and was kept alive by a tube into her stomach providing nutrients and water. She was kept in such a state for seven years before the court decided to free her from her meaningless existence in 1990.

 

            The significance of these two cases lie in the courts’ recognition of a legal right to die that stems from the Fourteenth Amendment’s Due Process Clause which protects liberty interests:

 

No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws

 

Chief Justice Rehnquist in Cruzan’s case stated that “a competent person has a constitutionally protected liberty interest in refusing unwanted medical treatment”. ‘Competence’ is an essential requirement for the courts to consider before declaring the legality of ‘voluntary euthanasia’. Only a competent patient who can appreciate the circumstances surrounding his condition can give an informed consent to the withdrawal of medical treatment. And nothing should stop him from getting assistance from a physician to administer a lethal injection to hasten his death.

 

And what of the patients who are incompetent, as in Quinlan’s and Cruzan’s case? Lawful surrogates who can show some evidence, such as living wills or advance directives, to support their interpretation of the patient’s supposed wishes may be the answer. Opponents would protest against this suggestion, arguing that this practice is open to abuse since the lawful surrogates might be propelled by ulterior motives, especially in cases where they stand to gain from the patient’s death. Desperate despondent families might give up too quickly and try to end the misery of their loved one.

 

 My retort is that this potential abuse is not limited to euthanasia situations. A cancer patient who is not in the terminal stage of his illness may similarly opt out of chemotherapy or radiotherapy under the coercion of avaricious family members. No course of action is foolproof. The potential abuse is not a good enough reason for us to reject the suggestion. A more practical approach would be to take the necessary precautions to avert these eventualities.

 

My Life, My Choice

 

            The right to die can be traced to the old common law notion of self-determination, or autonomy. The freedom of choice in an individual is cherished greatly and in turn leads to the right of privacy   which is constitutionally protected and central to a democratic system. Society should respect the right of an individual to control his or her own life. Zones of privacy that society should not intrude upon without good reason are ‘a person’s body, possessions, beliefs, values, actions and associations, as long as they are within his private sphere of interest and conduct[8]’.

 

            Patients have a right to refuse treatment. This is a long recognised right that physicians are legally and ethically required to honor. A cancer patient might decide, after much deliberation with his doctor and family members, that he does not want to go through with the painful procedure of chemotherapy just to delay death for a few years.  He might prefer a shorter life with more purpose to one where he loses his bodily autonomy and control to medical treatment. The doctor gives the green light. But when the doctor turns around and faces a terminally ill patient who seeks his assistance in releasing him from the unendurable suffering in his final days, he says no. Why should the patient’s right of control over his body be suspended precisely when death is imminent?  What real freedom of choice does a patient have when he cannot even control this crucial phase of his existence?

 

            I am not proposing that personal autonomy is an absolute right. Yes, the state does have an interest in preserving life and if it wants to limit autonomy, it should give a good reason. This might come in useful in the case of a handicapped where he might have been coerced into making his decision. However when we are dealing with a competent person, who, after a reflective decision, has opted for voluntary active euthanasia, the state has no right to interfere with such a personal decision where life is at stake. Who better to decide than the person suffering the intolerable agony?

 

Personal autonomy however, is not a convenient licence for people to commit suicide. This has to be balanced by the need to serve human dignity[9]. Compare these two scenarios: a girl slits her wrists after her boyfriend ditched her; a terminally ill woman takes a lethal dose of barbiturates when she loses her entitlement to a meaningful existence. Surely the latter does not deserve the same moral censure as the former.

 

Sanctity of life v quality of life

           

What is the human worth? Is life so intrinsically valuable that its self-destruction is an act of murder and therefore wrong? Opponents of euthanasia subscribe to the notion of the ‘sanctity of life’ because human beings are special, even unique, and being alive is of infinite value and can never be trumped by any amount of suffering. Coming from a religious angle, they also argue that it is a gift of God and since ‘only God can give life, then only God may end it’[10]. Hume’s rebuttal to that lies in the free will bestowed by God upon mankind, which should include freedom to take one’s own life, especially when life has become intolerable[11].

 

How about the quality of life? What happened to leading a meaningful life? Advocates of euthanasia believe that if the quality of life is compromised due to debilitating illness or great despair, then life no longer has any worth. We believe in the inherent importance of one’s life to the extent that one has to make his life a good and meaningful one while it lasts. We do not, however, believe in this absolute intrinsic value of life such that it should be preserved at all costs.

 

 Look at the technologically resplendent world today, a place that our predecessors would never have dreamt of a hundred years ago. Doctors can now cure “incurable” diseases and undoubtedly, society has benefited from this advancement. People live longer, and healthier lives. On the downside, the wonders of medical progress have proven to be a bane to those who wish to die a natural death. There are those who have no wish to be kept alive in terminal illness or a comatose state for long periods of time, those who see this desperate prolongation of life as dehumanizing and degrading.

 

 What is the worth in just keeping the bodies that these patients once inhabited technically alive?   

           

Where do the physicians stand?

 

            The talk about the physician-assisted deaths usually starts with Dr. Jack Kevorkian’s activities, in assisting more than 130 people to end their lives. He also aired the controversial homemade videotape of Mr Youk’s death on the CBS television programme 60 minutes in November 1998. Mr Youk, 52, suffered from Lou Gehrig’s disease and wanted to die on his own terms before the illness so progressed that he would choke to death. Murderer? Benevolent Saviour? Call him any name you want, but families of the deceased definitely feel that Kevorkian did not deserve the 10 to 25-year sentence he is serving now.

 

Kevorkian’s case forces us to face up to the fact that many people are suffering needlessly and if they so desired, they ought to be allowed to die with the help of a doctor. It also forces us to examine whether the legalization of physician-assisted deaths would really undermine a physician’s professional ethics.

 

            Doctors are sworn to protect life, but far more than most people in society, they see death. They see people so diseased and wrecked with pain that death is preferable to life. The archaic Hippocratic Oath prohibits doctors from the giving of ‘deadly medicine’ to anyone who asks. Fortunately, science and technology have come a long way from the time of the Hippocratic Oath when doctors had very limited resources to work with. Unfortunately, rules governing the medical practice are lagging far behind compared to the pace of advancing technology in the new century.

    

              It is hard to deny in a secular world that suffering and illness are necessarily bad in themselves and thus any attempt to alleviate the burden is always justifiable. In some cases, the cure can be worse than the disease itself. We should not be quick to condemn the doctor who hastens death upon the voluntary request by the patient - to do what is in the best interest of the patient[12].

           

Some might say that palliative care should be the right approach in dealing with patients in excruciating pain, assuming that it is pain that drives terminally ill people to resort to death. We are then faced with the uncomfortable principle of “double effect” of palliative care. Consider this. Doctors are allowed to administer heavy doses of morphine to relieve the patient’s immeasurable pain, with full knowledge that there is a risk that this might kill the patient. The patient dies. The doctor then conveniently indicates on the patient’s death certificate that he died from ‘natural causes’. This is condoned, since the doctor had not intended to kill. On the other hand, if the doctor performs the very same act with the primary aim to hasten death while the secondary effect is the relief of pain, it is morally abhorrent.

 

With the present state of law, doctors find themselves in a strange situation where honesty with regards to the purpose of their administration of drugs is the very way that will expose them to prosecution. The guideline thus evolved: ‘Practice euthanasia covertly, and you will be alright[13]’.                              

                                                                                                                                                                                                                                                                

Conclusion

 

            When a patient (or his lawful surrogate) decides to pull the plug or makes a final request for a lethal dosage of drugs, it should not be dismissed merely as a cowardly way out.  Pain is not the sole reason for a decision of such finality. The loss of control and the degradation of the quality of life are the main cries.

 

Opponents of euthanasia on the moral high ground refuse to look at the facts as they are. They refuse to acknowledge the widespread practice of physician-assisted deaths under the guise of palliative care. They cannot even imagine why such a deteriorated existence is not worth living.

 

            Legalisation of both active and passive voluntary euthanasia is necessary for us to give effect to the patient’s right to choose. No solution is infallible. It is more important for us to identify the dangers and provide the necessary safeguards. One such measure would be the legalisation of euthanasia only under very restricted conditions. This addresses the opponents’ fear of the society degenerating into one that sanctions the killing of the old, disabled and anyone who becomes a burden to society.

 

Let us give certainty to the medical practice where physicians can carry out their duties safely, free from fear of prosecution. Let us have some faith in mankind and the values that prevail in our society. Let us not deprive the patient’s right to die with dignity.

 

Lying on my bed with a tube inserted into my arm, I place my finger over the button that I would press in a moment to start the flow of solution that would finally release me from my agony and put me into a deep sleep. I pan the room to have a final look at the faces of all my loved ones, and I pause at the face of one man- the doctor who has shown me the ultimate act of mercy and kindness. Thank you.

Bibliography

 

1.         “Lethal Judgments: Assisted Suicide and American Law”; Melvin I Urofsky; Lawrence, Kan; University Press of Kansas, 2000

 

2.         “Dying With Dignity: Understanding Euthanasia”; Derek Humphry; Secaucus, N.J; Carol Publishing Group, 1992

 

3.         The Right to Die : A Two-volume Anthology of Scholarly Articles”; Series Editors: Melvin I. Urofsky, Philip E. Urofsky; New York : Garland Pub. , 1996.

 

4.                   “The Right to Die : Understanding Euthanasia”; Derek Humphry, Ann Wickett; London : Bodley Head , 1986.

 

5.                   http://www.choices.irg/issues.htm

 

6.                   http://www.cp.duluth.mn.us/

 

7.                   http://www.dailynews.yahoo.com/

 

8.                   http://www.ves.org.uk/

 

9.                   http://www.frontiernet.net/~kenc/

 

10.        http://spot.colorado.edu/~oddie/



[1] Urofsky, Melvin I. “Lethal Judgments” University Press of Kansas, 2000, p.18

[2] http://spot.colorado.edu/

[3] ibid

[4] This interesting illustration is provided by Graham Oddie in his bare difference argument in the article “The moral case for the legalisation of voluntary euthanasia” Victoria University of Wellington Law Review28 (1998) 207-224

[5] ibid

[6] In re Quinlan 355 A.2d 647 (N.J. 1976)

[7] Cruzan v. Director, Missouri Department of Health 497 U.S. 261 (1990)

[8] For a fuller discussion of the right to privacy, you can refer to Paul Kurtz, “Forbidden Fruit: The Ethics of Humanism” pp.63-96 (1988)

[9] This is qualified by Richard Momeyer, an advocate of suicide who does not see suicide as an unlimited right.

[10] Supra n.1, p. 3

[11] David Hume reasons that suicide is not always wrong in his essay “On Suicide” (1777)

[12] http://www.frontiernet.net/~kenc/

[13] Thomas Preston, a cardiologist at the University of Washington, condemns morphine drips as just another name for euthanasia.

 

Any comments or questions regarding this essay can be addressed to: Radhika Prabhakar

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