Euthanasia
VII. Arguments Against Euthanasia
VIII. Biblical View of Euthanasia
It comes from two Greek words meaning "good death." It is the practice of ending the life of an individual because he or she desires it in order to avoid pain and suffering.
This is when a physician "assists" a patient in ending their life prematurely. The physician may only prescribe pills that can be used to overdose on or he may actually administer an injection that takes the life of the patient.
In this instance, the patient consents to their being "euthanized."
In this instance, the patient does not consent to being "euthanized." The decision is made by some outside group or the family.
This is the practice of "actively" terminating a life.
This is where you allow nature to "take its course." You allow the person to die without heroic intervention.
The courts have rightly upheld that we have a right to refuse treatment for any illness that we have. However, they have also ruled that we do not have a "right to die" or take our own life or have it deliberately terminated by someone else. There is a vast difference between refusing treatment for an illness and allowing it to run its course and actively terminating one's life.
In the early 1900s, the eugenics movement, which was trying to breed "good" genes and ferret out "bad" genes, caused life to be looked at in a utilitarian manner. Some lives were more "valuable" than others were. This mindset helped lead to the adoption of the mindset that was necessary to allow euthanasia to flourish.
Illus. of "forced" euthanasia
"These cases have real faces. Dr. Gunning tells of one such tragic circumstance:A friend of mine, an internist, was asked to see a lady with terminal lung cancer, who had a short time to live and was very short of breath. After the examination, he asked the patient to come to the hospital on Saturday for a few days so that he could alleviate her distress. She refused, being afraid of being euthanized there. My friend assured his patient that he would be on duty and that no such thing would happen. So the lady came. On Sunday night she was breathing normally and feeling much better. The doctor went home. When he came back on Monday afternoon, the patient was dead. The doctor's colleague told him, "What is the sense of having that woman here? It makes no difference whether she dies today or after two weeks. We need the bed for another case."
Illus. woman with skin cancer euthanized. Not terminally ill or in pain. She was distressed about the scars on her face.
2,300 patients were euthanized (killed) by their doctors upon request, and 400 people died through physician-assisted suicide, for a total of 2,700 doctor-induced deaths.21 That is approximately 3 percent of all deaths involving end-of-life medical care. The equivalent percentage in the United States would be 41,500 deaths.
1,040 died from involuntary euthanasia, lethal injections given without request or consent-three deaths every single day.22 These deaths constitute slightly more than 1 percent of all cases involving end-of-life medical care. (The same percentage in the United States would be approximately 16,000 involuntary killings per year.) Of these involuntary euthanasia cases, 14 percent, or 145, were fully competent to make their own medical decisions but were killed without request or consent anyway.23 (The same percentage in the United States would be more than 2,000 who would be killed.) Moreover, 72 percent of the people killed without their consent had never given any indication they would want their lives terminated?
8,100 patients died from an intentional overdose of morphine or other pain-control medications, designed primarily to terminate life. In other words, death was not a side effect of treatment to relieve pain, which can sometimes occur, but was the intended result of the overdose. Of these, 61 percent (4,941 patients) were intentionally overdosed without request or consent. The equivalent percentage in the United States would be approximately 78,000.
The original guidelines have been expanded…to include chronic ailments and psychological distress. They also found that 60 percent of Dutch physicians do not report their cases of assisted suicide (even though reporting is required by law) and about 25 percent of the physicians admit to ending patient’s lives without their consent.
Chief Justice Oliver Wendell Holmes: "We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the Sate for these lesser sacrifices [sterilization], often not felt by those concerned, in order to prevent our being swamped by their incompetence. It is better for all the world...if society can prevent those who are manifestly unfit from continuing their kind."
[note: insidious view that some are "unfit" and should not procreate will lead to seeing some as unfit that need to be eliminated.]
The A.M.A.'s opinion is worth citing:
The medical profession will not tolerate being put in a position to judge the value of human lives .... To allow or force physicians to participate in actively ending the lives of patients would so dramatically and fundamentally change the entire patient/physician relationship that it would undermine the principles we, as a society, hold most dear. We must never lose sight of the caveat that physicians are healers, and where we cannot heal, our role is to comfort,
These opinions are almost universally shared by the medical profession around the world. The British Medical Association (B.M.A.), like its American counterpart, has consistently maintained firm opposition to assisted suicide and euthanasia. In the early 1980s, the B.M.A. responded to calls for a policy change by undertaking a study of euthanasia in the Netherlands. The study resulted in a 1988 report, reiterated in 1993, which concluded:
The law should not be changed and the deliberate taking of a human life should remain a crime. This rejection of a change in the law to permit doctors to intervene to end a person's life is not just a subordination of individual well-being to social policy. It is, instead, an affirmation of the supreme value of the individual, no matter how worthless and hopeless that individual may feel. 7~
Similarly, the World Medical Association, whose members are physicians from forty-one countries, has also adopted a position opposing physician-induced death. It states:
Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically
Scanned U.S. Court of Appeals for the Second Circuit quote
"[T]he right [to assisted suicide,] considered here, cannot be considered so implicit in our understanding of ordered liberty that neither justice nor liberty would exist if it were sacrificed. Nor can it be said that the right to an assisted suicide claimed by plaintiffs is deeply rooted in the nation's traditions and history. Indeed, the opposite is true. Clearly, no "right" to assisted suicide ever has been recognized in any state in the United States?"
[note: they then obliterated this statement by finding a different constitutional justification for PSA]
Michigan Court of Appeals: "As a general matter, the States
¾ indeed, all civilized nations¾ demonstrate their commitment to life by treating homicide as a serious crime. Moreover, the majority of States in this country have laws imposing criminal penalties on one who assists another to commit suicide."It is intriguing how closely many of the concepts advocated in Permitting the Destruction of Life Not Worthy of Life resemble in word and rationale many of the pro-euthanasia sentiments expressed in our current debate. Examples of this can be found by comparing Binding and Hoche's text with the text of the 1996 majority opinion of the U.S. Court of Appeals for the Ninth Circuit when it ruled, in Compassion in Dying v. The State of Washington, that Washington State's law banning assisted suicide is unconstitutional:
Illus. During the Nuremburg trials, a Nazi judge was condemned to death for his role in the Holocaust. The condemned killer broke down and wailed, "How could it have come to this?" The prosecutor pointed out, "Herr Judge, it came to this the first time you authorized the killing of an innocent life."
John Hardwig teaches medical ethics and social political philosophy at East Tennessee State University and wrote Is There A Duty to Die? In it he asks, "modern medicine and an individualistic culture have seduced many [into believing] that they have a right to health care and a right to live, despite the burdens and costs to our families and society." He continues, "A duty to die can go well beyond that….There may be a fairly common responsibility to end one’s life in the absence of any terminal illness." "There can be a duty to die even when one would prefer to live."
If a physician's aid in dying were to become a standard part of terminal care, there is a possibility that patients might feel compelled to request it out of fear of becoming a burden to their families. The right to die could be interpreted by a vulnerable patient as the duty to die. [R.I. Misbin, New England Journal of Medicine]
The second way in which involuntary euthanasia may occur is through "encouraged" euthanasia, whereby chronically ill or dying patients may be pressured to choose euthanasia to spare their families financial or emotional strain. [P.A. Singer and M. Siegler, New England Journal of Medicine]
Will not some feel an obligation to have themselves "eliminated" in order that funds allocated for their terminal care might be better used by their families or, financial worries aside, in order to relieve their families of the emotional strain involved? [Leon Kass, Commonweal]
The elderly are often cited as being particularly vulnerable: If euthanasia becomes the law of the land, how long will it take before the elderly and sick begin to feel an obligation to get out of the way? When will we see the first subtle forms of coercion used on the aging and ailing family members? [J. Farah, Los Angeles Times]
[A question raised is] whether the elderly might choose suicide simply to spare their family's lives and pocketbooks. [The New York Times]
Robert Wendland should die so that his family can "be allowed to live their lives," Dr. Ronald Cranford, a Minnesota neurologist and bioethicist, testified recently in the Stockton courtroom of Superior Court Judge Bob McNatt. The chosen method of death? Intentional dehydration and starvation.
What has Wendland, 45, done to deserve such a fate? He went into a coma in September 1993 from injuries sustained in an automobile accident. Sixteen months later, he awakened from the coma, paralyzed on one side and unable to walk, talk or swallow well enough to eat. He is physically and cognitively disabled and dependent on others for his care. He is not terminally ill. He is not hooked up to machines. He does require a feeding tube to sustain his life.
Those who seek to end Wendland's life downplay his physical and cognitive abilities. That is because people who are diagnosed as permanently unconscious are being dehydrated in this country, all perfectly legal thanks to several court decisions. Now, "right-to-die" activists such as Cranford who has testified in support of dehydration in most of the nation's major dehydration cases of brain-damaged patients, including that of Nancy Beth Cruzan want to stretch acceptable dehydration to disabled folk with brain damage who are awake and aware. This is the slippery slope in action.
Rose Wendland, Robert's wife, claims Robert would not want to live in his current condition. She bases her claim primarily on her husband's statements made in the aftermath of her father's death, three months before Robert's injury, that he would not want to live if he could not "be a husband, father or a provider."
But is it right to kill someone because he might have said he would not want to live in a dependent state? Is it right to kill someone because he can't work and be productive? Is it right to kill someone because he is disabled? Robert Wendland's mother, Florence Wendland, and half-sister, Rebekah Vinson, say no. They sued to prevent the dehydration.
It is important to note that Wendland has slowly improved in the nearly two years since he awakened from his coma. For example, he:
Has maneuvered an electric wheelchair down hospital corridors and can now maneuver a manual wheelchair with his unparalyzed leg or arm.
Has written the letter "R" of his first name when asked, as well as some other letters of his name.
Has used buttons to accurately answer yes and no questions some of the time. (Is your name Robert? Yes. Is your name Michael? No.) In this regard, one of his doctors asked Wendland if he wanted to die. He didn't answer the question.
According to Cranford, these and other of Wendland's activities mean little. He also opined in his testimony that Wendland's therapists, who believe he has slowly improved, should be disregarded by McNatt because they are only "seeing what they want to see." Perhaps it is Cranford who is not seeking what he does not want to see.
It is disturbing that McNatt did not dismiss Rose Wendland's desire to end her husband's life out of hand when the case first came to his court two years ago. It is especially disturbing that a noted neurologist such as Cranford believes that one reason to dehydrate Wendland is to benefit his family, even though Rose Wendland has said she now only visits her husband once a month for about 30 minutes, and his children do not visit at all.
But the authors of the new study, using an estimate from the Dutch researchers that 80% of the 1995 opiate-induced deaths occurred without the patients' explicit consent, conclude that there has been a "striking increase in the number of cases terminated without request."
"The care of terminally ill people in the Netherlands is worse than what we provide, and it's worse because they have euthanasia," said the article's lead author, Dr. Herbert Hendin of the American Foundation for Suicide Prevention, which opposes the practice. Hendin said he visited the Netherlands four times between 1993 and 1996 researching his book "Seduced by Death."
Co-author Chris Rutenfrans, a criminologist in the Department of Justice in The Hague, said that their analysis shows that nearly half of all doctor-assisted deaths in the Netherlands in 1995 (2,844 out of 6,368) were not voluntary. "In too many cases," he said, "it's the physician who decides."
He said the Dutch researchers slanted their reports to fit their agenda. "They are very much in favor of euthanasia and tried to hide as much as possible the negative consequences that are very clear in their reports."
Ann Landers: supports the establishment of death clinics calling them, "a sane, sensible, civilized alternative to existing in a nursing home, draining family resources, and hoping the end will come soon. Too bad it’s against the law...."
Contrast of the reaction to Susan Smith and Robert Latimer
Susan’s boys were "normal" and we were rightly appalled that she would murder them so senselessly. Robert Latimer’s 12-year-old daughter had cerebral palsy and he was treated like a hero for putting her in his car in the family garage with the car running and "putting her out of her misery" while the family went to church.
86% of spinal cord-injured high-level quadriplegics rated their own quality of life as average or better than average, while only 17% of the doctors and nurses surveyed thought they would have an average or better-than-average quality of life if they became disabled.
When "being a burden" or "living a burdened life" becomes the criteria for deciding euthanasia "Based on that reasoning, life would no longer have an intrinsic value but one subject to the changing tides of feelings and circumstances."
"...anyone who thinks clearly about the whole range of questions I have raised, modern medical practice has become incompatible with belief in the equal value of all human life....It is time for another Copernican revolution. It will be, once again, a revolution against a set of ideas we have inherited from the period in which the intellectual world was dominated by a religious outlook. Because it will change our tendency to see human beings as the center of the ethical universe, it will meet with fierce resistance from those who do not want to accept such a blow to our human pride... The traditional view that all human life is sacrosanct is simply not able to cope with the array of issues we face. The new view will offer a fresh and more promising approach."
"The question can be put this way: Is the life of another human being to be respected only because that person (or society) deems or wills it respectable, or is it to be respected because it is in itself respectable? If the former, then human worth depends solely on agreement or human will; since will confers dignity, will can take it away, and permission to violate nullifies the violation. If the latter, then one can never be freed from the obligation to respect human life by a request to do so, say, from someone who no longer values his own life."
Rebecca Badger, his 33rd victim thought she had MS, but did not. Autopsy revealed no sign of disease.
If we are ever to penetrate the mystery of death-even superficially-it will have to be through obitiatry. Research using cultured cells and tissues and live animals may yield objective biological data.., but knowledge about the essence of human death will of necessity require insight into the nature of the unique awareness or consciousness that characterizes human life. That is possible only through obiatric [sic] research on living human bodies [emphasis as in original].
Assisted suicide "is not simply to help doomed persons kill themselves
¾ that is merely the first step, an early distasteful professional obligation....[W]hat I find most satisfying is the prospect of making possible the performance of invaluable experiments or other beneficial medical acts under conditions that this first unpleasant step can help establish."Euthanasia would provide "momentous benefit for humankind….It would do this by allowing doctors for the first time to carry out on living human beings otherwise impossible trials of new and untested drugs, devices, or operations."
"Doctors have got to come to grips with the realities of the times and fill that vacuum with a code of conduct [note his use of the word code. I thought he wanted to do away with a code of ethics] tailored to meet the contemporary demands. And that calls for wrenching the profession entirely free of so-called rule ethics. According to philosopher-theologian Joseph Fletcher, rue ethics mandates a priori what one must do ‘according to some predetermined precept or categorical imperative.’ It is a coercive, nondiscriminatory, [note that his system would ultimately be discriminatory] ‘doctrinaire or ideological method of deciding what is right.’ On the other hand, situation ethics is a posteriori, ‘relative, flexible, and changeable according to variables (from which) the moral agent, the decision maker, judges what is best in the circumstances and in the view of foreseeable consequences."
Kevorkian is usually portrayed as a doctor with compassion who is only attempting to help terminally ill people commit suicide. Nothing is eve said that only 1 in 5 of his patients were actually terminally ill!
Note: This is definitely a reason the Dutch have accepted the practice while the rest of Europe is almost unequivocal in their denunciation of the euthanasia.
"In the nineteenth century, the German philosopher Friedrich Nietzsche declared that God was dead. He was no longer culturally relevant. Man had killed Him and could live without Him. In the twentieth century, man has discovered that one consequence of God’s death is his own. If God is irrelevant, so is man. And if man is irrelevant, superfluous, meaningless, then he can kill and be killed without condemnation."
"A society that believes in nothing can offer no argument even against death. A culture that has lost its faith in life cannot comprehend why it should be endured." This was written after Robert Latimer killed his 12-yar-old daughter who had cerebral palsy by placing her in their car in the garage and letting it run with the windows rolled down.
New York State Task Force on Life and the Law commissioned by Mario Cuomo concluded: "In light of the pervasive failure of our health care system to treat pain and diagnose and treat depression, legalizing assisted suicide and euthanasia would be profoundly dangerous for many individual who are ill and vulnerable. The risks would be most severe for those who are elderly, poor, socially disadvantaged, or without access to good medical care."
"Of greater concern to me is the moral trickledown effect that could result should society ever come to agree with Frances. Life is action and reaction, the proverbial pebble thrown into the pond. We don't get to Brave New World in one giant leap. Rather, the descent to depravity is reached by small steps. First, suicide is promoted as a virtue. Vulnerable people like Frances become early casualties. Then follows mercy killing of the terminally ill. From there, it is a hop, skip and a jump to killing people who don't have a good quality" of life, perhaps with the prospect of organ harvesting thrown in as a plum to society."
Dr. Leo Alexander on the "why" of the Holo
caust "Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of the physicians. It started with the acceptance of the attitude, basic to the euthanasia movement, that there is such a thing as a life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans.""Thus, it came about that not a single euthanasia or nontherapeutic sterilization was recommended or participated in by any Dutch physician. They had the foresight to resist before the first step was taken, and they acted unanimously and won out in the end. It is obvious that if the medical profession of a small nation under the conqueror's heel could resist so effectively the German medical profession could likewise have resisted had they not taken the fatal first step. It is the first seemingly innocent step away from principle that frequently decides a career of crime. Corrosion begins in microscopic proportions."
"In regard to selective euthanasia, we must be concerned with what the next step is likely to be. Societies always tend to expand the number of conditions and groups targeted for this ‘special treatment’ or ‘final solution,’ and I agree with the concerns…about the impact of medically sanctioned suicide on the poor and handicapped."
"Moreover, euthanasia and assisted suicide are socially disastrous. They are not containable by placing legal limits on their practice. Arguments to the contrary, the ‘slippery slope’ is an inescapable logical, psychological, historical, and empirical reality."
C. Everett Koop: "Nothing surprises me anymore. My great concern is that there will be 10,000 Grandma Does for every Baby Doe."
"It will be shown that this particular ‘slippery slope’ is not merely a theoretical possibility; it is a present reality. The practice of euthanasia will necessarily facilitate this ongoing evolution along at least two dimensions simultaneously: the scope of indications ( beginning with terminal illnesses and ending with euthanasia '‘n demand'’ and the degree of voluntariness (beginning with voluntary euthanasia and ending with involuntary ‘euthanasia’ for the benefit of others)."
Nancy Cruzan
Christine Busalacchi
Peter Singer: "The lives of such patients [unconscious] are of no benefit to them, and so doctors may lawfully stop feeding them to end their lives. With this decision the law has ended its unthinking commitment to the preservation of human life that is a mere biological existence....In doing so they have shifted the boundary between what is and what is not murder....Now, conduct intended to end life is lawful."
Dr. Foster Kennedy, president of the Euthanasia Society: "If the law sought to restrict euthanasia to those who could speak out for it, and thus overlooked those creatures who cannot speak, then I say as Dickens did, ‘The law is an ass.’"
Kennedy "defective children" up to the age of five should be permitted to be killed upon the request of parents or guardians "if after careful board examination" it was determined that the child had no "future or hope."
"…if a competent, terminally ill patient is suffering from tremendous physical pain and requests that a physician aid in his or her death, that physician is morally obligated to honor the patient’s request."
"The pro-life groups are right about one thing: the location of the baby inside or outside the womb cannot make such a crucial moral difference. We cannot coherently hold that it is all right to kill a fetus a week before birth, but as soon as the baby is born everything must be done to keep it alive. The solution, however, is not to accept the pro-life view that the fetus is a human being with the same moral status as yours or mine. The solution is the very opposite: to abandon the idea that all human life is of equal worth."
"We may not want a child to start on life’s uncertain voyage if the prospects are clouded. When this can be known at a very early stage in the voyage, we may still have a chance to make a fresh start. This means detaching ourselves from the infant who has been born, cutting ourselves free before the ties that have already begun to bind us to our child have become irresistible. Instead of going forward and putting all our efforts into making the best of the situation, we can still say no, and start again from the beginning?"
After wrongly expounding the "right to privacy" provisions found in the Constitution, Patricia Phillips argues that "If a potential parent possesses a right of privacy to choose to terminate a pregnancy that may result in a completely normal, high functioning, intelligent, healthy human being, then it follows that this same right of privacy should be extended to a parent faced with the decision of whether to sustain or withhold treatment from an infant who would exist with minimal cognitive functioning, little, if any interaction with other human beings, and who would live a life of extreme pain and suffering."
"Minimal intelligence is also an important prerequisite [for being a person]: ‘Any individual of the species homo sapiens who falls below the I.Q. 40-mark in a standard Stanford-Binet test… is questionably a person; below the 20-mark, not a person… This has bearing, obviously, on decision-making in…pediatrics, as well as in general surgery and medicine.’"
This concept has broadened to include what would normally be considered quality care. Quality care has been changed to treatment and can thus be withheld. The decision as to futile care is to be made by the physician, not the patient or family or community.
p. 165 Forced Exit "Changing the current presumption in favor of life for the cognitively disabled to an explicit presumption in favor of death."
Allen J. Bennett, M.D. vice chairman of the Committee on Bioethical Issues of the Medical Society of the State of New York: "The decision about futile therapy cannot and should not be abdicated by the physician to the patient, family, surrogate, court, or society in general...To abdicate a decision about the futility of a procedure or medical treatment is to abdicate professional responsibility for the patient....Futility decisions should be left to physicians."
Professor Margaret P. Battin: "It is not at all difficult to imagine the development of social expectations around the notion that there is a time to die, or, indeed, that it is a matter of virtue or obligation to choose to die." It should not be "viewed as a violation of rights. In an age-rationing society there is no right to live maximally on."
Derek Humphrey: "Aid to the elderly in dying [will] by sheer force of public opinion [be] addressed ethically and legally" once PAS is legalized.
Richard Lamm former Gov. of Colorado: old people "have a duty to die and get out of the way." "We must ask ourselves, in a world of limited resources, does it make sense to spend ten thousand dollars a year to educate a child to roll over?"
"The manufacture of a ‘right-to-die,’ ostensibly a gift to those not dying fast enough, is, in fact, the state’s abdication of its duty to protect innocent life and its abandonment especially of the old, the weak, and the poor."
"Requests will be engineered and choices manipulated by those who control the information, and, manipulation aside, many elderly and incurable people will experience a right to choose death as their duty to do so."
Derek Humphrey was asked the reason that euthanasia has gained momentum in recent years. He responded by saying that Roe v. Wade was the turning point. Its right to privacy and right to choose emphasis gave credence to the euthanasia argument.
(1986) It is ethical to terminate life-support treatment even if "death is not imminent but a patient’s coma is beyond doubt irreversible and there are adequate safeguards to confirm the accuracy of the diagnosis and with the concurrence of those who have responsibility for the care of the patient....Life prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition and hydration."
(1994) "Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment [including food and fluids] in accordance with a proper substituted judgment or best interests analysis."
The two most used arguments for PAS are (1) personal choice or autonomy and (2) to relieve suffering. However, "the limits will not stay in place for long if we press either side of the argument." If suffering is used as a criteria, then autonomy may be lost because there may be situations in which people suffer and have already lost their autonomy to choose. On the other hand, if autonomy is used as a criteria, then why restrict euthanasia to only the suffering? Why not allow anyone the choice to die?
Derek Humphrey: the right to die is the "ultimate civil liberty."
Question? Who Chooses? The patient? The doctor? The family? The ethics committee? Society? "When assisted suicide is legitimated, it places the patient at immense risk from the ‘compassion’ of others. Misdirected compassion in the face of human suffering can be as dangerous as indifference."
Using willful slavery and dueling as an example, Daniel Callahan reminds us that "even free, competent individuals should not have the power to kill each other, whatever their motives, whatever their circumstances. Consenting adult killing, like consenting adult slavery or degradation, is a strange route to human dignity."
Kevorkian stated that "the highest principle in medical ethics
¾ in any kind of ethics¾ is personal autonomy, self-determination. What counts is what the patient wants and judges to be a benefit or a value in his or her own life.""The great American tradition of freedom of religion should protect free choice. Many of us are religious, and we seem to become increasingly religious as we approach the great mystery of death. Different religions have different teachings about how dying people should conduct themselves. Some are quite specific, but none can legitimately bind nonadherents. So tolerance for a wide range of choice at the end of life is a necessary part of living together in a religiously pluralistic community. As an American, I am for tolerance."
Even pro-euthanasia advocate Judy Harrow warns that there "is a real danger, with the advent of profit-driven ‘managed care’ that case managers will press the more vulnerable (poor/or solitary) patients to commit suicide early in order to improve the ‘bottom line.’"
Every choice a person makes affects others. As one person whose 18-year-old cousin committed suicide said, "He didn’t just take his own life. He took part of theirs too."
"Once the right to intervene actively and bring about death is established, there is almost no way to prevent the rest of the chapters of this book from being written [slippery slope]."
In commenting on Judge Rothstein’s decision John Leo rightly observes that "using the language of the Casey decision, the ruling says that ‘choices central to personal dignity and autonomy…[are] central to the liberty protected by the 14th Amendment.’ But if it’s a basic right, how can it be denied to those who aren’t terminally ill?"
"The existing laws against assisted suicide do not save lives; they cruelly prolong deaths. They hold people in needless physical and emotional anguish."
"Compassion is a virtue, not a principle. Morally weighty as it is, compassion can become maleficent unless it is constrained by principle. In the world’s history, too many injustices have been committed in the name of someone’s judgments about what was compassionate for his neighbor. Compassion, too, must be subject to moral analysis, must have its reasons, and those reasons must also be cogent."
"In the future, if our nation moves as it should toward a more just system of health care distribution and health insurance, it will be right for society to decide that its insurance will not include certain beneficial treatments which the nation simply cannot afford, given other social needs."
"But opposition to physician-aided dying has been well-organized and well-financed, mostly by the Roman Catholic Church and radical-right religious organizations."
Nat Henthoff:
"It's a moral issue, an ethical issue, an issue involving medical ethics and managed care. It is a political issue about who has power and who does not, who is expendable and who is important. It is an issue about protecting the most weak and vulnerable among us. When you are near death, that is when you are the most vulnerable to coercion, intimidation, and to powerlessness. Allowing euthanasia would victimize the poor, the uneducated, minorities, and anyone without the ability or support to insist on receiving the best of medical care.'' "I can’t base my opposition to euthanasia on religion. I am an atheist!"Cheryl Smith, former staff attorney for the Hemlock Society: "Legalization, with medical record documentation and reporting requirements, will enable authorities to regulate the practice and guard against abuses, while punishing the real offenders."
As we have seen, both in the pre-Nazi era and during Hitler's rule the Germans assured themselves that "protective guidelines" would prevent euthanasia abuses. Indeed, the medical profession, the driving force behind euthanasia in prewar and wartime Germany, established the policy under supposedly rigorous guidelines. But the guidelines, such as they were, soon broke down, leading to "wild euthanasia," where doctors killed any disabled patient they wanted to kill-even though the euthanasia policy had been canceled by Hitler, even though their activities violated previous methods of determining who received "treatment," and eventually, even though the war had ended.
"The memorandum…proposed that ‘it shall be made possible for physicians to end the tortures of incurable patients, upon request, in the interests of true humanity.’ Incurability would be determined not only by the attending physician, but also by two official doctors who would carefully trace the history of the case and personally examine the patient…the patient himself shall ‘expressly and earnestly’ asks it, or ‘in case the patient no longer is able to express his desire, his nearer relatives, acting from motives that do not contravene morals, shall so request.’" This sounds like today’s guidelines and proposals but was actually taken from a memorandum sent out by Hitler’s German Justice Ministry in 1933. (Compare on a slide this wording to modern day "protective" guidelines)
The above proposal sanctioned PAS/euthanasia on competent people with terminal illnesses who requested it, then slipped to mentally incompetent patients, and eventually anyone economically ideologically unprofitable to the state. "Between 1933 and 1941, over seventy-thousand ‘futile or terminal’ patients were killed in German hospitals…To the state, the main benefit of the ‘T4 Euthanasia Program’…was economic. It saved 88 million Reichmarks per year…To increase efficiency, the Nazis moved the technology developed in the T4 killing hospitals to specialized centers
¾ death camps."In the much ballyhooed case of Louise, we find him "violating the limits they themselves set. The organization’s guidelines state that its representatives evaluate the patient prior to making the decision to assist suicide, do not encourage patients to choose assisted suicide, and are never actively the agent for suicide." Yet he violated these principles by agreeing to help before ever meeting her for an evaluation, by advising her to act quickly, and told her he would be there to "help" if the pills did not work!
"Despite the noble intent that prompts such an action, mercy killing is proscribed as an unwarranted intervention in an area that must be governed only by God himself."
"Our society, basing its view primarily on the fundamental values of Judaism and Christianity, ahs always forbidden the taking of innocent life and has considered that act one of the most serious, if not the most serious, breaches of morality possible."
"Whether or not man finds value in the life he is commanded to 0preserve is, in this fundamental sense, irrelevant; man’s obligations vis-à-vis sustaining life are not predicted upon his aptitude for fathoming divine secrets."
Proponents often try to convince us that proper guidelines will protect society from abuses. However, an examination of the Dutch model will show otherwise. As Nat Hentoff reminds us the "Remmelink report on euthanasia in the Netherlands revealed that at least 1,040 people die every year from involuntary euthanasia. Their physicians were so consumed with compassion that they decided not to disturb the patients by asking their opinion on the matter."
"An unusual medical study that bear on the growing debate over how to care for people at the end of life has come to a chilling conclusion: Out of 40 British patients diagnosed as being in a persistent vegetative state, 17, or 43%, were later found to be alert, aware and often able to express a simple wish.
The study, published in the July 1996 British Medical Journal, is one of the largest, most sustained analyses yet of severely disabled people presumed to be incapable of thinking consciously, communicating or sensing their surroundings. The report raises troubling questions about the ability of doctors to accurately arrive at such a diagnosis, which forms the medical basis for withdrawal of life support."
"The issue [euthanasia, PSA] touches medicine at its very moral center; if this moral center collapses, if physicians become killers or are even merely licensed to kill, the profession
¾ and, therewith, each physician¾ will never again be worthy of trust and respect as healer and comforter and protector of life in all its frailty. For if medicine’s power over life may be used equally to heal or to kill, the doctor is no more a moral professional but rather a morally neutered technician."Allowing doctors to end life will change the whole trust relationship of the medical profession between the patient and his or her doctor. Is the doctor’s advice truly in my own best interest? Maybe it is to benefit the hospital or the HMO or his reputation? Who knows?
Edmund D. Pelligrino give s a good synopsis of the usual criticisms of the Oath when he states, "Another criticism is that he oath is now morally irrelevant. Its authoritarianism and fixed moral rules are inconsistent with contemporary mores. Modern skepticism and pluralism in morals, together with the preeminence of privacy, autonomy, and free choice, make the oath a cultural irrelevancy and an impediment to social progress. Critics also denounce the sexism and elitism of the oath, which they perceive as instruments of professional privilege, power, and oppression."
Dr. Carlos F. Gomez, assistant professor of medicine at the University of Virginia School of Medicine told a congressional committee: "We now have it well within our technical means to alleviate, to palliate and comfort and control the worst symptoms of those of our fellow citizens who are terminally ill. The question before...the country at large is whether we have the heart, the courage, and the will to make it so, or whether we will opt for expediency and call it mercy."
"It is a disgrace that the majority of our health care providers lack the knowledge and the skills to treat pain and other symptoms of terminal disease properly. The absence of palliative caretraining for medical professionals results in sub-optimal care for almost all terminally ill patients and elicits the wish to hasten their own deaths in a few."
Even pro-euthanasia advocate Timothy Quill agrees that "because patients with such severe medical conditions are usually sad if not clinically depressed, it can at times be difficult to determine whether emotional responses to their illnesses are distorting their decision making."
Dr. Joanne Lynn, professor of medicine and of community and family medicine at the Center for the Evaluation of Clinical Sciences, Dartmouth Medical School, testifying before the Senate Finance Committee in 1994, said:
There is a widespread myth that enormous resources are wasted on the dying. The evidence for this is actually quite frail About one quarter of payments under Medicare are directed at the care of those who die during that year. This seems to be a reasonable proportion-after all, persons are commonly quite sick in the year before they die .... Very few dying persons now have resuscitation efforts or extended stays in intensive care?
"The Economics of Dying," an article published in the New England Journal of Medicine in 1994, is even more to the point. Its authors, Drs. Ezekiel Emanuel and Linda Emanuel, reviewed studies of the cost savings that could be achieved by Medicare if more people signed advance directives (such as durable powers of attorney for health care; see pages Z40-42), if there were broader use of D.N.Ls ("do not resuscitate'' orders), if futile care guidelines advocated by C.C.M.D. were enacted, and the like. Although the studies were not definitive, the Emanuels concluded:
The amount that might be saved by reducing the use of aggressive life-sustaining interventions for dying patients is at most 3.3 percent of total national health care expenditures. In 1993, with $900 billion going to health care, this savings would amount to $29.7 billion ....We must stop deluding ourselves that advance directives and less aggressive care at the end of life will solve the financial problems of the health care system.
Even rationing advocates admit that there is little money to be saved by forcing people out of desired end-of-life treatment opportunities. Dr. Murphy himself admits it will not save the health-care system a lot of money.
NY State task force found that euthanasia and PAS are unnecessary. "Contrary to what many believe the vast majority of individuals who are terminally ill or facing severe pain or disability are not suicidal. Moreover, terminally ill patients who do desire suicide or euthanasia often suffer from a treatable mental disorder, most commonly depression. When these patients receive appropriate treatment for depression, they usually abandon the wish to commit suicide."
If we can’t trust doctors to adequately treat our pain, why do we trust them to kill us?
"most practicing physicians in the United States have not seen first-rate cancer pain management and the optimal control of the physical symptoms of cancer and AIDS. They don’t know that they don’t know how to do it."