Euthanasia and Assisted Suicide

This essay has a total of 12095 words and 55 pages.

Euthanasia and Assisted Suicide



I. Introduction

In a 1988 issue of the Journal of the American Medical Association, an article titled
"It's Over Debbie" describes how an anonymous doctor administers a fatal dose of morphine
to a woman dying of ovarian cancer (Anonymous, 1988). In a 1989 issue of the New England
Journal of Medicine, ten doctors associated with the nation's leading hospitals and
medical schools declare their belief that "it is not immoral for a physician to assist in
the rational suicide of a terminally ill person" (Wanzer, et. al., 1989). In 1991, the New
England Journal of Medicine published a detailed account written by Dr. Timothy Quill
which discussed his decision to help a patient suffering from leukemia commit suicide
(Quill, 1991). In 1990, Dr. Jack Kervorkian uses his suicide machine to help a woman
suffering from Alzheimer's disease, one Janet Adkins, end her life in the back of a
Volkswagen bus (Risen, 1990). Janet was the first of twenty patients who have been aided
by Kervorkian in the past three years. He remains committed to his practice. In 1991 the
Hemlock Society publishes a how-to manual on committing suicide. Entitled Final Exit, it
zooms to the top of the national best seller lists and stays there for several weeks
(Altman, 1991).


Each of these events has served to provoke ever widening media coverage of the issues
surrounding euthanasia and physician assisted suicide, and a national debate has arisen
around these practices. This debate is not merely limited to attorneys and physicians.
Suddenly, these issues and this debate are now a part of life in mainstream America, and
many Americans face dilemmas that did not exist in simpler times; dilemmas that many would
rather not have to face.


Euthanasia: The Nature of the Debate

It is this sudden change in the way Americans are dealing with death, the nature and scope
of the debate about dying, which prompts this analysis of the issues surrounding
euthanasia. This debate is largely a debate about what is ethical. Questions the debate
attempts to answer include: Is it right to commit suicide? Is it ethical for someone else
to help? Is it right to put others to death at their own request or at the request of
family members? These questions are important because they help to define our society and
our culture. The way people deal with and respond to issues of life, ritual, and death
serves to shape the nature of our society. This is why society must attempt to decide what
is right; what is ethical conduct for the various actors in our communities when we face
death.


There are several reasons why this debate has surfaced in the 1980's. Death is nothing
new, it has existed for thousands of years. Each culture has developed its own rituals and
mechanisms for dealing with death. These mechanisms serve to provide solace, a sense of
continuity, and allow the culture to continue even as the members of the community cannot.
However, our own culture has experienced many shattering changes that have altered the
nature of dying. Suddenly we are forced to rethink the issue of death and we must decide
what types of behavior are ethical when someone is dying. Before we can examine the debate
about the ethics of dying, we must examine why the debate exists.


Perhaps the main reason that death has changed in western culture has to do with advances
in medicine and technology. Many of the diseases that have historically killed people are
now no longer a threat to most individuals. Medicine has made a variety of advances in the
treatment of diseases such as smallpox, tuberculosis, malaria, pneumonia, polio,
influenza, and measles. People now rarely die of such traditional causes. Life expectancy
has risen to almost 75 years in the United States.


The quality of life has also changed fundamentally during the past 100 years. Not only
does almost everyone in the United States have enough to eat, but people eat higher on the
food chain. There is a great deal more meat and animal fat in modern diets. Just these
differences alone have changed death significantly. People now develop heart disease,
adult onset diabetes, cancers, and AIDS. These types of diseases are more the result of
lifestyle than bacteria. With these new diseases, suffering is often more prolonged and
treatment is frequently quite painful. Also, as people are living longer, the diseases of
the aged have become increasingly prevalent. Many more people now suffer from problems
like senile dementia and Alzheimer's disease. These diseases ruin the mind while
preserving the body, allowing life to continue long after any quality that the life might
have is gone.


If what we die of has changed, perhaps the way that we die has changed even more.
Throughout history, death has been a family affair. People usually died in the home after
a short bout with an illness or as the result of an accident. Today, increasingly, death
occurs in an institutional setting such as a convalescent home or a hospital, after a
variety of technologies are applied in an attempt to prolong the life of the sick person.
Often these technologies can be quite effective. People can now live for months and even
years attached to a variety of tubes and technologies.


"About 75% of all deaths in 1987 occurred in hospitals and long term care facilities, up
from 50% in 1950 . . . The Office of Technology Assessment Task Force estimated in 1988
that 3775 to 6575 persons were dependent on mechanical ventilation and 1,404,500 persons
were receiving artificial nutritional support. This growing capability to forestall death
has contributed to the increased attention to medical decisions near the end of life."
(CEJA, 1992, p. 2229)


People realize that the chances of facing the institutionalization of death increase
daily, and they feel a profound lack of control. Surveys have consistently indicated that
a large majority of people in the United States would like to be allowed to end their
lives before incurable and painful diseases finally kill them (CEJA, p. 2229).


Because of the changes that have impacted death, with regard to both how and where we die,
the debate about how we should be allowed to die has been renewed. This paper will examine
the several facets of this debate. It will define the terms that are relevant to the
debate, examine the legal state of euthanasia today, discuss the ethics of euthanasia by
examining arguments made by proponents and opponents of euthanasia, and by applying
several Normative Ethical Theories to the issue. Finally, it will explore the power
implications that infuse the debate on euthanasia and present arguments in favor of moving
toward a care based ethic of dying and away from the current rights based ethic.

Return to Index



II. Definitions

If we are to effectively understand the debate about the right to die in the United
States, it is imperative that a few basic terms be understood. The first and most
important term is euthanasia. Originating from the Greek terms "eu" (happy or good) and
"thanatos" (death), euthanasia means literally "happy death" or "good death." The American
Medical Association's Council on Ethical and Judicial Affairs defines the term as follows:


"Euthanasia is commonly defined as the act of bringing about the death of a hopelessly ill
and suffering person in a relatively quick and painless way for reasons of mercy. In this
report, the term euthanasia will signify the medical administration of a lethal agent to a
patient for the purpose of relieving the patient's intolerable and incurable suffering."
(p. 2230)


Other sources have defined euthanasia variously: "The act or practice of painlessly
putting to death persons suffering from incurable conditions of diseases." (Wolhandler,
1984, p. 363), ". . . to refuse unwanted medical treatment or to have ongoing care
withdrawn even though the patient will die if treatment is terminated." (Adams, et. al.,
1992, p. 2021). Euthanasia is a general term that can actually mean a variety of different
things depending upon the context in which it is used. For this reason, a number of
supporting terms have become the convention when discussing euthanasia. These terms help
to narrow the subject matter and distinguish between different types of euthanasia.


The important terms that help to subdivide and classify euthanasia by type are voluntary/involuntary and active/passive.

Voluntary euthanasia is a death performed by another with the consent of the person being
killed. This consent may be in writing as in the case of a living will or advance
directive. Involuntary euthanasia is a death performed by another without the consent of
the person being killed. The AMA's Council on Ethical and Judicial Affairs makes three
distinctions concerning consent and euthanasia:


"Voluntary euthanasia is euthanasia that is provided to a competent person on his or her
informed request. Non-voluntary euthanasia is the provision of euthanasia to an
incompetent person according to a surrogate's decision. Involuntary euthanasia is
euthanasia performed without a competent person's consent."(p. 2230)


Wolhandler compares the terms in a different context.

"Those who condemn euthanasia of both kinds would call the involuntary form murder and the
voluntary form a compounded crime of murder and suicide if administered by the physician,
and suicide alone if administered by the patient himself. As far as voluntary euthanasia
goes, it is impossible to separate it from suicide as a moral category; it is, indeed, a
form of suicide. Voluntary euthanasia may involve participation of second parties." (p.
366)


The distinction between active and passive euthanasia is not nearly as clear as the
previous distinction. Although many authors claim that the difference between the two
types cannot be identified or is irrelevant at best, much of the debate on the subject is
over this distinction and most of the current legal issues turn on this distinction. While
this paper will contend that the difference between the two should not be recognized, it
is both useful and important to know where the line is drawn. The AMA, which is strongly
opposed to active euthanasia, has seen fit to endorse passive euthanasia in appropriate
situations. The Council on Ethical and Judicial Affairs makes the distinction as follows:


"The physician is obligated only to offer sound medical treatment and to refrain from
providing treatments that are detrimental, on balance, to the patient's well being. When a
physician withholds or withdraws a treatment on the request of a patient, he or she has
fulfilled the obligation to offer sound treatment to the patient. The obligation to offer
treatment does not include an obligation to impose treatment on an unwilling patient. In
addition, the physician is not providing a harmful treatment. Withdrawing or withholding
is not a treatment, but the foregoing of a treatment." (p. 2231)


According to Wolhandler, (p. 367) it is the nature of the acts performed by the second
party that distinguishes between active and passive euthanasia. The courts have held that
acts of "omission" (removal of respiratory assistance, hydration, and feeding tubes) are
allowable behavior. "Although unplugging a respirator and switching off a dialysis machine
are arguably acts of commission, an increasing number of judges and commentators have
accepted these acts as permissible passive euthanasia in both voluntary and involuntary
settings." Gifford (1993) describes the difference between the two types of euthanasia
this way:


"Passive euthanasia involves allowing a patient to die by removing her from artificial
life support systems such as respirators and feeding tubes or simply discontinuing medical
treatments necessary to sustain life. Active euthanasia, by contrast, involves positive
steps to end the life of a patient, typically by lethal injection." (p. 1546)


The right to passive euthanasia has also been termed "the right to die" by some authors (Adams, et. al., p. 2021-22).

With an understanding of the different types of euthanasia, we can now define some other
key terms. It is important to understand how physician assisted suicide differs from
euthanasia, and it is also necessary to define the terms "advance directive" and
"competence" since they are crucial in determining the difference between voluntary and
involuntary euthanasia.


The term "physician assisted suicide" is somewhat self explanatory. It occurs when a
physician provides aid to a patient so they can commit suicide. However, it is also
necessary to see the difference between this type of action and euthanasia. The AMA's
Council on Ethical and Judicial Affairs states that


"Euthanasia and assisted suicide differ in the degree of physician participation.
Euthanasia entails a physician performing the immediate life ending action (e.g.,
administering a lethal injection). Assisted suicide occurs when a physician facilitates a
patient's death by providing the necessary means and/or information to enable the patient
to perform the life-ending act (e.g., the physician provides sleeping pills and
information about the lethal dose, while aware that the patient may commit suicide)." (p.
2231)


It is important to realize that the difference between euthanasia and assisted suicide
lies in the behavior of the physician. This difference in behavior has recently become a
major legal battleground that will be explored in the following pages.


The advance directive has recently become an important new device to aid the terminally
ill. Many states have legalized the advance directive, partly in an attempt to avoid
dealing with problems associated with active euthanasia, and partly to help ease the
burdens on the dying and their families. Singer (1992) provides a good definition of
advance directive and explains how it is used.


"An advance directive is a written document completed by a competent person that aims to
guide medical treatment after the person becomes incompetent. There are two types:
instruction directives, which focus on the types of life-sustaining treatment that the
person would want under various clinical situations, and proxy directives, which focus on
who the person would want to make health care decisions if the person were unable to do
so." (p. 22)


The advance directive is useful because it can theoretically eliminate the need for
involuntary euthanasia. It ensures that a voluntary decision is made in advance, even if
the individual could not make such a situation at a later date. If everyone made use of
the advance directive, there would be no need to debate policy decisions that must be made
in the case of an incompetent person on life support. Because advance directives have
neither been accepted nor widely used by the general public, many of the problems that
could potentially be solved remain. This situation caused right to die groups in both
California and Washington to propose ballot initiatives that would legalize active
euthanasia (Gifford, p. 1550-51).


Although active euthanasia is not legal in any United States jurisdiction, passive
euthanasia is generally allowed at the request of a "competent" individual. Because of
this it is critical to understand what constitutes competence.


"Courts have defined legal competence as the 'mental ability to make a rational decision,
which includes the ability to perceive, appreciate all the relevant facts, and to reach a
rational judgement upon such facts.' In the euthanasia context, legal competence is the
incurable's ability to understand that in requesting active euthanasia he is choosing
death over life. Only clear and convincing evidence should suffice for a finding of an
incurable's competence." (Wolhandler, p. 366-67)

Return to Index



III. The Legal State of Euthanasia

With a knowledge of the meaningful terms that will be involved, it is important to discuss
the legal state of euthanasia in the United States today. As technology has placed more
and more people on life sustaining devices in this country, the courts have had to deal
with several cases that pertain to euthanasia in a variety of ways. This section of the
paper is designed to review those cases briefly and to assess how the rulings in those
cases have set the policy for the practice of euthanasia today.


The courts first dealt with euthanasia in the Quinlan case in 1976. Karen Ann Quinlan
lapsed into a coma after mixing a variety of pills and alcohol at a party. After it became
apparent that she would not be revived, her parents went to court to have her respirator
removed. The New Jersey Supreme Court ruled that her parents had the right to have the
respirator removed and that Karen be allowed to die. Ironically, because her parents did
not request removal of feeding and hydration tubes, she survived nine more years curled in
a fetal position in a New Jersey rest home (Wolhandler, p. 366). In this case, the New
Jersey court effectively sanctioned nonvoluntary passive euthanasia.


The next prominent case was decided by the New York Supreme Court in Superintendent of
Belchertown State School v. Saikewicz. Here the court found that a competent patient had
the right to refuse medical treatment, allowing for a patient to decide in cases of
voluntary passive euthanasia (Gifford, p. 1575-76). Later, in Satz v. Perlmutter, a
Florida District Court of Appeals came to essentially the same conclusion (Wolhandler, p.
372-73).


In Severns v. Wilmington Medical Center, the Delaware Supreme Court gave the husband of a
comatose woman the right of guardianship and the authority to remove her respirator or
withhold other treatment as he saw fit. In this case the court relied on previous
decisions made in Quinlan, Saikewicz, and Satz for its finding (Wolhandler, p. 373). In
Thor v. Superior Court (California), the court granted the request to withhold treatment
from a severely depressed quadriplegic only after a psychiatric evaluation determined that
the request was based on poor quality of life and not just on severe depression (Pugliese,
1993, p. 1326).


The courts have not restricted the right of passive euthanasia to just the terminally ill.
Elizabeth Bouvia was a relatively young woman who suffered from severe cerebral palsy and
attempted to starve herself to death in a California hospital by requesting the removal of
a nasogastric feeding tube. She was denied this request because the hospital feared it
would be party to suicide. The California court of appeals ordered the physicians to
remove the tube and argued that she had the right to enlist the assistance of others in
ending her life (Sprung, 1990, p. 2213).


The courts have also found that doctors and hospitals must at least obtain consent from
third parties who would have a significant interest in the patient's outcome if the
patient is incompetent. In the case of Helga Wanglie, a Minnesota court denied a hospital
administrator permission to disconnect her respirator against the wishes of her husband
(Gifford, p. 1571).


In sum, these cases indicate an emerging consensus that courts will generally allow
treatment to be withheld from patients who are terminally ill if it is in the best
interests of the patient and at the request of patients or family members.


It is this emerging consensus that made the U.S. Supreme Court's decision in the Cruzan
case so interesting. In the only euthanasia case heard to date by the U.S. Supreme Court,
the justices, in a 5-4 decision, allowed to stand the decision made by the Missouri Court
of Appeals not to disconnect the life support apparatus from Nancy Cruzan (Cruzan v.
Director, Missouri Dept. of Health, 1990). Although the court did find that a right to
refuse treatment could be found in the Due Process clause of the Fourteenth Amendment, and
did not prohibit the courts from looking in other areas for this right (Adams, et. al., p.
2025), it also upheld the right of the State of Missouri to require ". . . clear and
convincing evidence that Ms. Cruzan would have desired withdrawal of these treatments."
(Newman, 1991, p. 175).


In the realm of physician assisted suicide, only two major cases have been decided. In the
case against Dr. Timothy Quill that arose because of the publication of his article in the
New England Journal of Medicine, the grand jury for the state of New York refused to
return an indictment (Bender, 1992, p. 524). In the more publicized case of Dr. Jack
Kervorkian, the courts have not yet decided on the constitutionality of the Michigan law
that bans physician assisted suicide. Kervorkian is currently free on bond and continues
to aid other patients who wish to commit suicide (Pugliese, p. 1300-05).(1)


A brief assessment of the cases described above indicates that the courts have essentially
legalized voluntary passive euthanasia, finding justification to refuse or have medical
treatment withheld in the constitutional right to privacy, the common law right of self
determination, or the more general concept of autonomy (Gifford, p. 1575-78). With regard
to involuntary passive euthanasia, the courts are generally supportive of the practice,
but they have the right to insist on a more stringent standard of evidence before
approving such procedures. The courts have generally employed a balancing test that weighs
the patient's right to privacy and self determination against the interest of the state in
preserving life, the interests of potential third parties that might desire that the
patient continue to live, and the ethical image of the medical profession (Adams, et. al.,
p. 2022). In cases of assisted suicide, some states have laws against the practice, the
AMA forbids it, most juries are refusing to find the actors guilty, and the courts have
yet to decide the question. Both voluntary and involuntary active euthanasia remain
illegal.

Return to Index



IV. The Debate About Euthanasia

The movement to legalize active euthanasia has existed for quite some time. Initially
popularized in Britain during the 19th century, it gained some adherents in the United
States during the 1920's. It was the Nazi program of active euthanasia in the 1930's and
40's that cast a pall of disrepute over the practice that remains today. The revival of
this movement today can largely be attributed to the onset of the issues discussed at the
beginning of this paper, and to the efforts of the Hemlock Society, a group of individuals
that actively promotes the right to "dignified death." The Hemlock Society recently
promoted ballot initiatives in both Washington and California that would have legalized
active euthanasia in those states (Gifford, 1993). This revival of the "right to die"
movement has led to hotly contested debate about the practices of active euthanasia and
physician assisted suicide. This paper will attempt to encapsulate this debate by
presenting the arguments made by both opponents and supporters of these procedures. Since
arguments made by both sides are used in cases of euthanasia and assisted suicide, the
generic term "euthanasia" is used for simplicity to suggest the concept of "aided death"
unless otherwise indicated. Those opposed to euthanasia and assisted suicide present a
variety of arguments in support of a ban.

Return to Index



A. The Case Against Euthanasia

Euthanasia destroys societal respect for life. By becoming commonplace and used in medical
practice along with more traditional methods of healing, society becomes desensitized
toward death to the point where life is no longer valuable. This attitude serves to
degrade humanity and leads to a variety of social ills. In a society that devalues life,
people have no compunctions about committing violent crimes and murdering others. The
overall quality of life becomes seriously undermined and society as a whole deteriorates
(Doerflinger, 1989, p. 16-19, Koop, 1989, p. 2-3).


Once euthanasia becomes legal, opponents contend, the potential for abuse at the hands of
caregivers vastly increases. Closely related to this argument is the argument that those
who enjoy the exercise of power over others might become intoxicated with it and actually
come to enjoy killing.


One step down the path toward euthanasia simply makes it that much easier in the future to
take further steps. This argument is also referred to as the "wedge theory" or the
"slippery slope." One of the most outspoken opponents of euthanasia, University of
Michigan professor of law Yale Kamisar, has articulated a three pronged attack that
utilizes the wedge theory, the risk of abuse, and the risk of mistake. The proponents of
the wedge theory argue that


"Once society accepts that life can be terminated because of its diminished quality, there
is no rational way to limit euthanasia and prevent its abuse. According to this theory,
voluntary euthanasia is just the thin edge of a wedge that, once in place, will be driven
deeply into our society. Kamisar concludes that legalized voluntary euthanasia inevitably
would lead to legalized involuntary euthanasia because it is impossible to draw a rational
distinction between those who seek to die because they are a burden to themselves and
those whom society seeks to kill because they are a burden to others."(2) (Wolhandler, p.
377)


Many who raise the "wedge" or "slippery slope" argument use the Nazi experience with
euthanasia as an empirical example of this process in action. They argue that a public
policy of murder inexorably follows from an initial, limited step, namely the adoption of
a carefully defined euthanasia program, and that a program designed to get rid of those
with "lives unworthy of life" quickly degenerated into the holocaust (Newman, p. 167).
What follows is a description of the Nazi euthanasia program excerpted from Lifton's
(1986) book:


"National Socialist euthanasia or "mercy death" was a program of killing persons with
unworthy lives. These persons were not moribund, and their families, with the rarest
exceptions, wanted them to live. It was not a "good death," as the word denotes, but a
systematic program of killing without any mercy whatsoever . . . The program, referred to
in the National Socialist bureaucracy as T4, was not based on any law, but was initiated
by a secret order traceable to Hitler and his chief physician, Karl Brandt . . . Mental
hospitals were required to report all chronic schizophrenics, manic-depressives, mental
defectives, epileptics, and later, debilitated old persons. A separate division, the
'Public Transport division for the Sick,' took care of the collection and transport of
such patients to institutions where they were put to death . . . Relatives received false
death certificates and even letters of condolence . . . It is estimated that during two
years of this program, ninety thousand persons went to their deaths."


While this description of the Nazi euthanasia program is indeed chilling, it provides
within it a devastating attack against using it as justification for the slippery slope
argument. Proponents of euthanasia in the United States point out that the Nazi program
was not one of euthanasia, but a program of mass murder disguised as euthanasia. Gifford
(p. 1570) sums up the response of several authors by stating that


"The Nazi's hid their racist, eugenic agenda behind the term 'euthanasia,' terminating in
secret the lives of 'undesirables.' It must never be forgotten that the Nazi 'euthanasia'
program was never euthanasia at all. That the Nazi's co-opted the term for their own
purposes should not obscure the fact that their motive was, from the very beginning,
entirely different from that of today's euthanasia proponents. The current euthanasia
movement is anything but covert. The Hemlock Society and other supporters of the right to
receive aid in dying have spent millions of dollars to publicize their efforts. In this
context, death is presented as a positive alternative to pain and suffering, not a
utilitarian tool."


Proponents of euthanasia also attempt to refute the slippery slope argument in a variety
of other ways. They contend that the current mechanisms used by the courts could easily
prevent any slide toward involuntary euthanasia,(3) that the current practice of passive
euthanasia proves that the slope isn't all that slippery since we haven't witnessed any
massive killing programs, and that the example of how forced sterilization in the U.S. has
diminished rather than increased, provides a more appropriate example to rely on. Even
Callahan (1989), a vocal opponent of active euthanasia, admits that the Nazi experience is
not particularly applicable to the U.S. experience and that "Lives are not being
shortened. They are steadily being lengthened, and particularly for those who are the most
powerless: sick children and the very old, the mentally and mentally retarded, the
disabled and the demented" (p. 4).


Newman (1991) also attacks the concept of the slippery slope itself, arguing that just
pointing out that one type of action could conceivably lead to another constitutes a very
unpersuasive argument and that for the premise to hold true, it must be shown that
pressure to allow further steps will be so strong that these steps will actually occur. He
also reminds us that such arguments are frequently abused in legal and social policy
debate (p. 169).


Besides Kamisar, the risk of abuse argument has also been put forth by a host of other
authors who variously claim that assisted suicides might result in flagrant murders that
may be perpetrated by deliberately forcing or coercing self-destruction and that others
may advance personal motives by aiding in suicide (Adams, et. al., p. 2031); that when the
entire medical profession is involved in euthanasia, including the poorly trained, the
insensitive, the less skilled, there becomes the danger that physicians might not do
whatever they can to avoid euthanasia if possible (Newman, p. 177); and that some people
who enjoy the exercise of power over others might become addicted to the process
(Doerflinger, p. 19). It is this fear of abuse that leads the AMA's Council on Ethical and
Judicial Affairs to argue that the ban on active euthanasia is a bright line distinction
that deters this type of potential abuse. They state:


"Allowing physicians to perform euthanasia for a limited group of patients who may truly
benefit from it will present difficult line-drawing problems for medicine and society. In
specific cases it may be hard to distinguish which cases fit the criteria established for
euthanasia. For example, if the existence of unbearable pain and suffering was a criterion
for euthanasia, the definition of unbearable pain and suffering could be subject to
different interpretations, which might lead to abuse of the process in the case of certain
practitioners." (CEJA, p. 2232).


Proponents of euthanasia argue that the risk of abuse, while certainly present, is not
really much of a threat. This is true first, because laws against homicide are severe
enough to provide a strong deterrent (Newman, p. 178); second, because a clear set of
guidelines prescribing when active euthanasia is allowed will prevent confusion (Adams,
et. al., Gifford); third, because we already risk the practice of abuse by allowing
passive euthanasia, and such abuse has not occurred (Newman, p. 178); and finally, that
the current state of illegality promotes an absence of discussion and actually encourages
the practice of clandestine euthanasia (Newman, p. 177). As Gifford (p. 1572) succinctly
puts it, "what slope could be more slippery than one with no guardrails whatsoever?"
Additionally, the balancing tests already in place by the legal system should serve to
eliminate this problem. Adams, et. al., (p. 2034) explain:


"For example, some opponents of physician-assisted suicide argue that permitting some
assisted suicides may lead to the killing of patients who want to live. This "slippery
slope" argument expresses a utilitarian rationale for prohibiting suicide assistance.
Others argue that suicide and the assistance of suicide is "intrinsically evil," and that
the fabric of social morality will be damaged by sanctioning them. These and other
utilitarian and moral considerations are encompassed within the state's interest in
preserving the sanctity of all life and affect its weight in the balance against the
patient's interest in self-determination."


Opponents of euthanasia contend that there is no guarantee that euthanasia will be
strictly voluntary. The potential for subtle coercion will threaten from several different
angles. Family members faced with the overwhelming burden of caring for an ill person may
unconsciously impart a feeling of worthlessness, thus hastening a "voluntary" decision
toward euthanasia. The pervasive societal attitude in a "euthanasia culture" might convey
that the infirm, disabled, and unproductive are worthless and a burden to society.
According to Doerflinger, (p. 17) "Elderly and disabled patients are often invited by our
achievement-oriented society to see themselves as useless burdens on younger, more vital
generations. In this climate, simply offering the option of "self-deliverance" shifts a
burden of proof, so that helpless patients must ask themselves why they are not availing
themselves of it. This situation might lead some to "voluntarily" decide to end a life
that is perceived as worthless."


The ever increasing costs of health care, especially for the terminally ill and those on
life support systems, might also serve to influence some toward a decision for an early
death. "The growing incentives for physicians, hospitals, families, and insurance
companies to control the cost of health care will bring additional pressures to bear on
patients." (Doerflinger, p. 17) Proponents contend that carefully drawn laws and the use
of balancing tests already in place can effectively eliminate such concerns (Gifford, p.
1563-64).


Widespread active euthanasia might also serve to destroy the ethical image and trust of
the medical profession. The public might fear that doctors are too eager to use the new
techniques at their disposal and be scared away from proper health care. People could
become frightened of their doctors and would no longer view them as friends and helpers,
but as potential enemies.


"The prohibition of killing is an attempt to promote a solid basis for trust in the role
of caring for patients and protecting them from harm. This prohibition is both
instrumentally and symbolically important, and its removal would weaken a set of practices
and restraints that we cannot easily replace." (Beauchamp & Childress, 1989).


Newman declares:

"Some writers contend that legalization will reduce the public's trust in doctors and in
the health care system. Michael Levy warns of the erosion of 'trust that the health care
delivery system will do everything possible to relieve suffering prior to terminating
life.' Dr. Alan Stone claims that 'it is destructive to the public good to make people
worry that when they go to a hospital the doctor is thinking about whether to allow them
to live or die. When I go to the emergency room, I want to know that the doctor is going
to do everything to keep me alive. I do not want to go to somebody who has had a class on
ethics and is thinking maybe I would prefer to die.'" (p. 170)


However, Newman goes on to present some convincing arguments against this position,
stating that the public already views the medical profession with distrust and that this
distrust is likely to grow since doctors frequently have poor communication skills, and
spend little time with individual patients. As overreliance on technology increases and as
hospitals and nursing homes continue to increase already exorbitant fees, this distrust is
likely to increase. Newman even contends that a caring program of active euthanasia and
physician assisted suicide might actually serve to increase public trust in the medical
profession and serve to reduce some of the impression that doctors and health care
institutions only care about the bottom line (p. 170-171).


Perhaps the most intriguing argument against legalizing active euthanasia is presented by
Elizabeth Wolf (1989). She argues that legalization will destroy the gains made in the
domain of passive euthanasia, especially for those who are not considered terminally ill.
Continues for 28 more pages >>




  • Euthanasia
    euthanasia Euthanasia Euthanasia is just another word for “mercy killing” as some people put it but it also means good death. I look at it as more of a good death if it is performed with the right procedures and if a person has a legitimate reason to be put to death but many people would not agree with me that it should be legal. There are several categories of euthanasia but in general they are all somewhat alike, the kind I think should be allowed and not looked bad upon to give the doctors th
  • Assisted Suicide
    Assisted Suicide Kalem 1 Walking through the corridors of any hospital would show one several things. There would be people healing, hurting, dying, and coping with all sorts of problems. Even though some of them may share the same misfortunes, they are separated into two categories: those who are still fighting for their lives and those who have given up. To those who have given up, the thought of suicide always arises because one no longer has the desire to deal with a problem and they just wa
  • Death Penalty1
    Death Penalty1 For years, capital punishment has been a controversial issue in our society. Many arguments can be made in favor and against it. It ultimately, however, comes down to personal beliefs and opinions. Personally, I feel that the death penalty is a very serious punishment, and should be used very carefully and sparingly. The death penalty is unremediable. What is done can’t be corrected. This aspect of the sentence plays a heavy part in my opinion. The death penalty also is more costl
  • EUTHANASIA To Help or Hinder
    EUTHANASIA To Help or Hinder Personally, I disagree with euthanasia. I don\'t think God intended for man to decide when, where, and how to take anyone\'s life. Sometimes we as humans feel we are helping others and in actuality end up hurting more than anything. A prime example is Dr. Kevorkian. Kevorkian assisted approximatley thirty people with euthanasia. He and his patients thought they were helping to end a life of pain and misery. In reality, they left behind more pain and misery than peace
  • Assisted Suicide
    Assisted Suicide DAT NGUYEN ENGL: 100 A RIGHT TO DIE SHOULD NOT BE DENIED Forty-one year-old Peter Cinque was in the terminal stages of diabetes. He was blind, had lost both legs, and suffered from ulcers and cardiovascular problems, as well. He was being kept alive by a kidney dialysis machine. Then one day he asked his doctors to stop the treatment. As a conscious, rational adult, he had the legal right to determine what should or should not be done to his body. But the hospital authorities re
  • Billy Budd
    Billy Budd As portrayed in the Bible, Adam and Eve were the perfect human species. This was only a result because of their complete innocence. God let them remain in his presence because of this reason. After the devil conned them into eating fruit from the Tree of Good and Evil they became unclean. In Herman Melville’s Billy Budd the question this apparent: Is innocence and ignorance dominant over knowledge and power? To emphasize the importance of this theme, Melville uses the character Billy
  • Billy Budd
    Billy Budd As portrayed in the Bible, Adam and Eve were the perfect human species. This was only a result because of their complete innocence. God let them remain in his presence because of this reason. After the devil conned them into eating fruit from the Tree of Good and Evil they became unclean. In Herman Melville’s Billy Budd the question this apparent: Is innocence and ignorance dominant over knowledge and power? To emphasize the importance of this theme, Melville uses the character Billy
  • Euthanasia in our society today
    Euthanasia in our society today Euthanasia is a controversial subject, not only because there are many different moral dilemmas associated with it, but also in what constitutes its definition. At the extreme ends of disagreement, advocates say euthanasia (which in Greek means "easy death") is a good, or merciful, death. Opponents of euthanasia say it is a fancy word for murder. Between the two extremes, there are various positions for and against euthanasia. One position opposes cases of "active
  • Animal testing
    Animal testing This theme song to a popular cartoon is a farce dealing with experiments carried out on animals. In the cartoon one mouse is made very smart and wants to take over the world while the other is clearly not as smart. While the cartoon makes jokes, the reality is that mice and other animals re being used for medical tests every day. For some people this testing brings up ethical questions. One of the biggest questions: is it really necessary to take the lives of animals in the name o
  • Ethics of Animal testing
    Ethics of Animal testing This theme song to a popular cartoon is a farce dealing with experiments carried out on animals. In the cartoon one mouse is made very smart and wants to take over the world while the other is clearly not as smart. While the cartoon makes jokes, the reality is that mice and other animals re being used for medical tests every day. For some people this testing brings up ethical questions. One of the biggest questions: is it really necessary to take the lives of animals in
  • Ethics of Cloning
    Ethics of Cloning Running head: Downside of Cloning The Ethical Downside of Cloning Ethics in Health Care October 17, 1998 Introduction For the first time the cloning of a whole human being seems really possible. It is absolutely necessary to consider the harm that can be done and move to curb abuses. Also, it is important to understand some of the theory underlying the desire to build a better human. The Ethical Downside of Cloning With recent developments in the cloning of the first whole mamm
  • Euthanasia
    Euthanasia The word euthanasia is derived from the Greek word "eu" for good and "thantos" which means death and originally referred to intentional mercy killing. But the word it euthanasia has acquired a more complex meaning in modern times. Proponents of euthanasia believe that a dying patient has the right to end their suffering and leave the world in a dignified manner. Those who contest euthanasia believe that man does not have the right to end another person\'s life no matter what pain they
  • Censor the Internet
    Censor the Internet Censor the Internet? The freedom of speech that was possible on the Internet could now be subjected to governmental approvals. For example, China is attempting to res5trict political expression, in the name of security and social stability. It requires users of the Internet and e-mail to register, so that they can monitor their activities (Gates). In the United Kingdom, state secrets and personal attacks are off limits on the Internet. Laws are strict and the government is ex
  • Euthanasia1
    Euthanasia1 Euthanasia is clearly a deliberate and intentional aspect of a killing. Taking a human life, even with subtle rites and consent of the party involved is barbaric. No one can justly kill another human being. Just as it is wrong for a serial killer to murder, it is wrong for a physician to do so as well, no matter what the motive for doing so may be. Many thinkers, including almost all orthodox Catholics, believe that euthanasia is immoral. They oppose killing patients under any circum
  • Euthanasia2
    Euthanasia2 Euthanasia Synopsis Euthanasia is used to describe the practice, which a doctor or other carer might undertake that might result in shortening a person’s life. This definition could include, withdrawing life-sustaining treatment or the administration of a lethal, non-therapeutic drug. The Greek meaning for euthanasia is “easy or happy death.” The practice of euthanasia has become illegal, and is recognized in no nation. Euthanasia continues to be regarded as contrary to humanitarian
  • Euthanasia3
    Euthanasia3 Euthanasia continues to be an extremely controversial issue in society, and there are many opposing viewpoints concerning this specific subject. The case of Sue Rodriguez versus the province of British Columbia, is one that demonstrates the high degree of debate over such a sensitive topic, as euthanasia. The following is an analytical examination of the case at hand, and a critical comparison of it, to the theories of Patrick Nowell-Smith. When relating the theories of Patrick Nowel
  • Euthanasia4
    Euthanasia4 Euthanasia continues to be an extremely controversial issue in society, and there are many opposing viewpoints concerning this specific subject. The case of Sue Rodriguez versus the province of British Columbia, is one that demonstrates the high degree of debate over such a sensitive topic, as euthanasia. The following is an analytical examination of the case at hand, and a critical comparison of it, to the theories of Patrick Nowell-Smith. When relating the theories of Patrick Nowel
  • Legalization of Active Euthanasia
    Legalization of Active Euthanasia The term Euthanasia has become well known throughout the United States. Euthanasia is derived from the Greek words eu and thantos, these words come together to form the phrase easy death. Today, euthanasia is referred to by many names such as mercy killing, and assisted suicide. There is much controversy over whether or not the practice is right. Euthanasia raises many religious, legal, medical and ethical issues. The question of euthanasia being right or
  • Physician Assisted Suicide
    Physician Assisted Suicide Many voters throughout the United States are taking the measure to legalize physician assisted suicide to the polls. If it is legalized, the United States will have legalized a much quicker, more humane method(as opposed to terminal sedation) of ending the suffering of terminally ill patients. The only legal process of this sort in the United States is terminal sedation, a method that can oftentimes add to a patient’s problems. Although Oregon is the only state to have
  • Physician Assisted Suicide1
    Physician Assisted Suicide1 Many voters throughout the United States are taking the measure to legalize physician assisted suicide to the polls. If it is legalized, the United States will have legalized a much quicker, more humane method(as opposed to terminal sedation) of ending the suffering of terminally ill patients. The only legal process of this sort in the United States is terminal sedation, a method that can oftentimes add to a patient’s problems. Although Oregon is the only state to hav
  • Why Should Euthanasia Be Legalized
    Why Should Euthanasia Be Legalized It is apparent that euthanasia should be permitted everywhere for the following reasons: individual liberty; one’s undesired pain, suffering, and misery; and the individual’s frustration from having a valueless life. First of all, one should be able to understand the term euthanasia. “In ancient Greece, eu thanatos meant ‘easy death.’ Today’s euthanasia generally refers to mercy killing, the voluntary ending of the life of someone who is terminally or hopelessl
  • Assisted Suicide
    Assisted Suicide Physician assisted suicide presents one of the greatest dilemmas to the medical profession. Should someone who is mentally competent, but deemed terminally ill, be allowed to engage in physician-assisted suicide? According to the First Amendment of The Constitution of The United States, "one has the freedom to petition the government for a redress of grievances." The Fourteenth Amendment states, "The State cannot deprive any person of life, liberty or property, without due proce
  • Morality and Practicality of Euthanasia
    Morality and Practicality of Euthanasia Morality and Practicality of Euthanasia Euthanasia is defined by The American Heritage Dictionary as "the action of killing an individual for reasons considered to be merciful" (Leonesio 292). Here, killing is described as the physical action where one individual actively kills another. Euthanasia is tolerated in the medical field under certain circumstances when a patient is suffering profoundly and death is inevitable. The word "euthanasia" comes from th
  • A critique of cultural relativism
    A critique of cultural relativism A critique of cultural relativism In his article "Cultural relativism and cultural values", Melville Herkovits defines the principle of cultural relativism as "judgements are based on experience, and experience is interpreted by each individual in terms of his own enculturation" (26). This is the basic premise of cultural relativism, that beliefs, values, and morals are all based on one\'s culture. Therefore, since morality is based on society and different soci
  • A Critique of Neil Campbells Problem with Voluntar
    A Critique of Neil Campbells Problem with Voluntary Euthanasia A Critique of Neil Campbell\'s Problem with Voluntary Euthanasia Dr. Neil Campbell, author of "A Problem for the Idea of Voluntary Euthanasia," questions whether there can be a such thing as voluntary euthanasia. Euthanasia, or physician-assisted suicide, is the intentional termination of life by another at the explicit request of the person who dies. Dr. Campbell\'s main argument is that "if the pain and suffering are by definition
  • A Time to Die
    A Time to Die Joel A Time To Die Active euthanasia is a necessary course of action and should be allowed as long as the decision is being made by the family members or the patient themselves. The American Medical Association claims active euthanasia is against it’s policy, but improving the quality of life for a patient is, so what happens if the patients life could be made better by ending it? In a statement by the American Medical Association, they claim “the intentional termination of the lif
  • ACTIVE EUTHENASIA
    ACTIVE EUTHENASIA The difference between active and passive euthanasia are not quite as cruel and malicious as commonly thought. Passive euthanasia is the fairly common practice of withholding medical treatment from a patient whose biological chances of surviving are obsolete. This is often considered to be morally correct. This because the patient or immediate families decide whether life is worth the pain and agony. However, this act of withstanding from medical amenities is quite often more p
  • AntiChoice RTLProchoice
    AntiChoice RTLProchoice Human life begins at conception. Therefore, abortion is murder of a person. Personhood at conception is a religious belief, not a provable biological fact. Mormon and some Fundamentalist churches believe in personhood at conception; Judaism holds that it begins at birth and abortion is not murder; ensoulment theories vary widely within Protestantism. The religious community will never reach consensus on the definition of a "person" or when abortion is morally justified. U
  • Assisted Suicide
    Assisted Suicide Should assisted suicide become totally legal in the U.S.? Well, that is the question that Mr. Stephen Carter seems to brutally review in his article “Rush to a Lethal Judgement,” where it appears that he takes a stance against assisted suicide. He makes a very week argument though, and I feel he would fail at convincing most anyone. His thoughts are well organized, but he fails to really take a side on the debate until the very end and at that point it is no longer very useful.
  • Assisted Suicide1
    Assisted Suicide1 Let Them Die Physician-assisted suicide should be a legal option for terminally ill patients, that is my beleif. A perfect example of this statement is the case of forty-one year-old Peter Cinque who was in the terminal stages of diabetes several years ago. He was blind, had lost both legs, and suffered from ulcers and cardiovascular problems, as well. He was being kept alive by a kidney dialysis machine. Then one day he asked his doctors to stop the treatment. As a conscious,
  • Assisted Suicide
    Assisted Suicide Should assisted suicide become totally legal in the U.S.? Well, that is the question that Mr. Stephen Carter seems to brutally review in his article “Rush to a Lethal Judgement,” where it appears that he takes a stance against assisted suicide. He makes a very week argument though, and I feel he would fail at convincing most anyone. His thoughts are well organized, but he fails to really take a side on the debate until the very end and at that point it is no longer very useful.
  • Buck v Bell
    Buck v Bell People make decisions throughout their everyday lives whether they are good or bad. Parents make the decisions for their children. Parents do this in order for their children to live better lives. If a parent made decisions that could potentially hurt their child, they would be considered unfit parents. Therefore, parents are put in situations that force them to do what is “morally” right. The point being made is that people interpret morals differently than other people. How can one
  • Cmparing different views on Euthanasia
    Cmparing different views on Euthanasia COMPARING DIFFERENT VIEWS ON EUTHANASIA Euthanasia is a controversial subject, not only because there are many different moral dilemmas associated with it, but also in what constitutes its definition. At the extreme ends of disagreement, advocates say euthanasia is a good, or merciful, death. Opposites of euthanasia say it is a fancy word for murder. The author James Rachels provides a clear argument in defense of euthanasia in his article, “The Morality of
  • Cmparing different views on Euthanasia1
    Cmparing different views on Euthanasia1 COMPARING DIFFERENT VIEWS ON EUTHANASIA Euthanasia is a controversial subject, not only because there are many different moral dilemmas associated with it, but also in what constitutes its definition. At the extreme ends of disagreement, advocates say euthanasia is a good, or merciful, death. Opposites of euthanasia say it is a fancy word for murder. The author James Rachels provides a clear argument in defense of euthanasia in his article, “The Morality o
  • Comparing Different Views On Euthanasia
    Comparing Different Views On Euthanasia COMPARING DIFFERENT VIEWS ON EUTHANASIA Euthanasia is a controversial subject, not only because there are many different moral dilemmas associated with it, but also in what constitutes its definition. At the extreme ends of disagreement, advocates say euthanasia is a good, or merciful, death. Opposites of euthanasia say it is a fancy word for murder. The author James Rachels provides a clear argument in defense of euthanasia in his article, “The Morality o
  • Death
    Death Right to Die Physician-assisted suicide presents one of the greatest dilemmas to the medical profession. Should someone who is mentally competent, but deemed terminally ill, be allowed to engage in physician-assisted suicide? According to the First Amendment of The Constitution of The United States, “one has the freedom to petition the government for a redress of grievances.“ The Fourteenth Amendment states, “The State cannot deprive any person of life, liberty or property, without due pro
  • Death and dying
    Death and dying 1. How would you go about teaching a child about death? To explain death to a young child is hard in many ways. They may not comprehend what death is and might not realize that the person or thing they love is not coming back. Almost every child deals with death at one point or another. It might be a hamster, rabbit, dog, even a loved relative or friend that died. To some, death might seem like a long game of hide and go seek game, in which, you’ll never find the person. To teach
  • Death penalty3
    death penalty3 Author: Clarke, Kevin. Source: U.S. Catholic v. 65 no10 (Oct. 2000) p. 27 ISSN: 0041- 7548 Number: BRDG00052997 Copyright: The magazine publisher is the copyright holder of this article and it is reproduced with permission. Further reproduction of this article in violation of the copyright is prohibite A GROUP OF DISTINGUISHED ILLINOIS CITIZENS, including former Senator Paul Simon and attorney-novelist Scott Turow, did something remarkable last August. They sat in silence while so
  • Death
    Death Right to Die Physician-assisted suicide presents one of the greatest dilemmas to the medical profession. Should someone who is mentally competent, but deemed terminally ill, be allowed to engage in physician-assisted suicide? According to the First Amendment of The Constitution of The United States, “one has the freedom to petition the government for a redress of grievances.“ The Fourteenth Amendment states, “The State cannot deprive any person of life, liberty or property, without due pro
  • Die or Not
    Die or Not Physician-assisted suicide presents one of the greatest dilemmas to the medical profession. Should someone who is mentally competent, but deemed terminally ill, be allowed to engage in physician-assisted suicide? According to the First Amendment of The Constitution of The United States, “one has the freedom to petition the government for a redress of grievances.“ The Fourteenth Amendment states, “The State cannot deprive any person of life, liberty or property, without due process of
  • Dieing
    dieing Physician-assisted suicide presents one of the greatest dilemmas tothe medical profession. Should someone who is mentally competent, but deemed terminally ill, be allowed to engagein physician-assisted suicide? According to the First Amendment of The Constitution of The United States, “one hasthe freedom to petition the government for a redress of grievances.“ The Fourteenth Amendment states, “The Statecannot deprive any person of life, liberty or property, without due process of law; nor
  • Euthanasia and Assisted Suicide
    Euthanasia and Assisted Suicide I. Introduction In a 1988 issue of the Journal of the American Medical Association, an article titled "It\'s Over Debbie" describes how an anonymous doctor administers a fatal dose of morphine to a woman dying of ovarian cancer (Anonymous, 1988). In a 1989 issue of the New England Journal of Medicine, ten doctors associated with the nation\'s leading hospitals and medical schools declare their belief that "it is not immoral for a physician to assist in the rationa
  • Euthanasia and Assisted Suicide
    Euthanasia and Assisted Suicide I. Introduction In a 1988 issue of the Journal of the American Medical Association, an article titled "It\'s Over Debbie" describes how an anonymous doctor administers a fatal dose of morphine to a woman dying of ovarian cancer (Anonymous, 1988). In a 1989 issue of the New England Journal of Medicine, ten doctors associated with the nation\'s leading hospitals and medical schools declare their belief that "it is not immoral for a physician to assist in the rationa
  • Euthanasia10
    Euthanasia10 Euthanasia A thesis statement for those who support the concept of euthanasia could be: Euthanasia, also mercy killing, is the practice of ending a life so as to release an individual from an incurable disease or intolerable suffering. Euthanasia is a merciful means to an end of long-term suffering. Euthanasia is a relatively new dilemma for the United States and has gained a bad reputation from negative media hype surrounding assisted suicides. Euthanasia has a purpose and should b
  • Euthanasia10
    Euthanasia10 Euthanasia A thesis statement for those who support the concept of euthanasia could be: Euthanasia, also mercy killing, is the practice of ending a life so as to release an individual from an incurable disease or intolerable suffering. Euthanasia is a merciful means to an end of long-term suffering. Euthanasia is a relatively new dilemma for the United States and has gained a bad reputation from negative media hype surrounding assisted suicides. Euthanasia has a purpose and should b
  • Euthanasia11
    Euthanasia11 In the United States, by current individual state laws, any form of euthanasia is murder and considered a criminal offense (ACT). At this time there are still no federal laws prohibiting the practice of euthanasia as a country. Euthanasia, by definition, is the intentional killing of a person, for compassionate motives, whether the killing is by a direct action such as a lethal injection, or by failing to perform an action necessary to maintain life. When discussing euthanasia there
  • Euthanasia12
    Euthanasia12 Euthanasia is defined as, “The action of killing an individual for reasons considered to be merciful.” People feel that if they are suffering or they feel the need that they should not live anymore that they should have the right to an assisted suicide. Euthanasia has been around since the early 1900’s when in 1906 the first bill was drafted in Ohio. People felt even back then that they should have the right to an assisted suicide. There are four types of Euthanasia and they are Pas
  • Euthanasia13
    Euthanasia13 Many people confronted with a terminal illness are confused about what they can do as a dying person. This is when euthanasia is often discussed. Deciding that this is the only option is a long drawn out process. Being that a large part of American society is of Christian beliefs, it is necessary to look at morality based on religion. The main pro-suicide argument deals completely within the issue of choice. If life is seen as a covenant, or temporary loan from God, the freedom to c
  • Euthanasia2
    euthanasia2 Assisted Suicide It is upsetting and depressing living life in the shadow of death. Many questions appear on this debatable topic, such as should we legalize euthanasia? What is euthanasia? What is assisted suicide? What is the difference between Passive and Active Euthanasia? What is Voluntary, Non-voluntary and Involuntary Euthanasia? What is Mercy Killing? What is "Death with dignity"? But if euthanasia was legalized, wouldn\'t patients then die peacefully rather than using plasti
  • Euthanasia2
    euthanasia2 Assisted Suicide It is upsetting and depressing living life in the shadow of death. Many questions appear on this debatable topic, such as should we legalize euthanasia? What is euthanasia? What is assisted suicide? What is the difference between Passive and Active Euthanasia? What is Voluntary, Non-voluntary and Involuntary Euthanasia? What is Mercy Killing? What is "Death with dignity"? But if euthanasia was legalized, wouldn\'t patients then die peacefully rather than using plasti