Euthanasia: Should Death be a Choice?
David Goodall was 104 years old when he decided to travel to Switzerland, not for a vacation or to visit loved ones, but instead to exercise his right to “exit this world on his own terms.” The Australian scientist and right-to-die activist was not suffering from a disease; instead he choose physician-assisted suicide in a country in which it was legal because at age 104 he simply no longer desired to continue living. This only renewed the controversy over who, and under what circumstances, has the right to end a life.
In the United States, life expectancy rose to an average of 78.6 years in 2016, compared to 68.2 years in 1950, and a mere 47.3 years in 1900. War and disease certainly played a role in depressing life expectancy in earlier times; today, improvements in technology, medicine and elder care have contributed significantly to our overall health and life expectancy. Although this is a great achievement, it has led to a number of societal disruptions brought on by the increase in the population among those 65 and older, including a blow to the solvency of the U.S. Social Security system, and strain due to lack of financial preparation for retirement (partially due to the decline in employer-sponsored pension plans). The population growth among those 65+ has also increased demand not only for health care services, but for increasingly complex healthcare supports among the aging. Furthermore, social changes such as smaller family sizes and hence fewer children to rely on in old age, and also the diminished likelihood that families will live in close proximity can impact the quality of life among the aging. All of these pressures have served to bring the various models of euthanasia to the forefront of discourse as Americans evaluate end of life choices, given a culture that may allow them to live longer, but at a cost in multiple respects.
The concept of euthanasia has always been an extremely sensitive and polarizing subject with some considering it immoral. Our society is grappling with this question: should a person have the right to spare their own suffering by choosing death? Furthermore, should someone be able to enlist a physician to end their life, even in situations where the person is not facing a terminal disease or unbearable pain? Under what conditions might one exercise the right to die? Think about how you might answer this question as it applies to your own life. What if it were your child, or a parent or other loved one? It is truly a conundrum and has no simple solution.
To begin, it is important to understand what is meant by the term ‘euthanasia’; it originates from the Greek word ‘εὐθανασία’, which means ‘good death.’ (From Greek: εὐθανασία; “good death”: εὖ, eu; “well” or “good” — θάνατος, thanatos; “death”). In the Oxford Dictionary, euthanasia is defined as “The painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma.” Based on a strict interpretation of this definition, the practice of euthanasia would only apply to people under the condition that they are choosing to die voluntarily to rid themselves of any further suffering from their catastrophic disease; in addition, there is an expectation that the practice would be carried out in a gentle, compassionate manner.
It is important to note that there are two types of euthanasia- active and passive. Active euthanasia consists of an action that is taken that will end the patient’s life (for example, administering a fatal drug after sedating the patient). Passive euthanasia occurs when no action is taken, thus allowing the patient to die by either withholding treatment (commonly implemented through a Do Not Resuscitate [DNR] order) or by withdrawing treatment (such as turning off life support). PAS (Physician-assisted suicide) is often erroneously lumped together with active euthanasia. The difference between the two is that in PAS, the patient (not the doctor) is in complete control of the process that leads to their death; the patient performs the fatal act, while the physician merely provides the patient with the means to do so.
Across the world, societies have grappled with the ‘right to die’ question in a variety of ways. In Germany, euthanasia and assisted suicide are particularly loaded terms, because of the relationship to the Nazi regime and the Holocaust. Some of the world’s most powerful countries (i.e., the United Kingdom, France, and India) have legalized the most basic form, passive euthanasia, thereby allowing someone to die by restricting the medical interventions that might save them. Further along the continuum of involvement is active euthanasia (legal in highly developed first world countries such as Canada, Japan, Luxembourg and Belgium). The controversial physician-assisted suicide is only legal in the democratic nations of Switzerland, Germany, the Netherlands, and in a few more progressive states in America (Washington, Oregon, Colorado, Hawaii, Vermont, Montana, Washington, D.C., and California).
Notably, the majority of Americans actually support some form of euthanasia. One Gallup poll taken in 2018 found that 72% of Americans support legalizing euthanasia for those who have an incurable disease, and 67% think that euthanasia of said individuals is ethical. Virtually of the countries (with the exception of the United States) that permit euthanasia in some form also have universal healthcare, further corroborating how these governments recognize their citizens basic human rights.
There are many complex factors that must be considered in order to determine the need for access to euthanasia. Some people cite religious reasons to explain their stance against euthanasia. Many religious groups are against euthanasia in any form, as they believe that life is a gift from God, and therefore all processes that are naturally part of life and death are controlled by God. Accordingly, people should not interfere with “God’s Plan.” Practically all religions with a supreme God have a command from God in their scriptures or texts that states “you shall not murder” (i.e., the 6th commandment in the Bible) that could be interpreted to include euthanasia, or taking one’s own life. In fact, according to the 2018 Gallup poll about euthanasia, only 37% of those who attended church at least once a week supported euthanasia; this was the only demographic in the poll that had an approval rating below 50%, with the next lowest approval rating (54%) being from those who had a conservative ideology.
One hot-button issue in the euthanasia debate is the mandate for doctors to adhere to the Hippocratic Oath, which being written over 2500 years ago was perhaps a time when it was impossible to foresee the tremendous advances made in medicine. The Hippocratic Oath states that:
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
Also,
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.
Some people interpret the Hippocratic Oath to also include the statement “First do no harm” (such as by giving patients the means to commit suicide), although this does not appear in the literal translation of the original Oath. On the other hand, some interpret the Hippocratic Oath to mean that by relieving patients of any further suffering, doctors are in fact upholding their oath by preventing suffering.
Doctor Marcia Angell, a Senior Lecturer in Social Medicine at Harvard Medical School interprets the Hippocratic Oath as a philosophy that supports the case for euthanasia:
When healing is no longer possible, when death is imminent and patients find their suffering unbearable, then the physician’s role should shift from healing to relieving suffering in accord with the patient’s wishes. Still, no physician should have to comply with a request to assist a terminally ill patient to die, just as no patient should be coerced into making such a request. It must be a choice for both patient and physician.
Some believe that legalizing euthanasia would create a ‘duty-to-die’ culture, as explained by Helena Berger, the President and CEO of the American Association of People with Disabilities:
In this profit-driven economic climate, is it realistic to expect that insurers are going to do the right thing, or the cheap thing? If insurers deny, or even delay, approval of costlier life-saving alternatives, then money saving but fatal measures become the deadly default.
Is it possible that people with disabilities would be made to feel that they are a burden to society and consider euthanasia when they would not otherwise do so? Clearly, people should not be coerced into euthanasia for economic reasons, or in order to avoid being ‘a burden’ on others.
As of now, there is no evidence of the ‘slippery slope’ that Ms. Berger warns about emerging in places when euthanasia is legal. As times change, “People may realize that the next step and then the next are also acceptable, even if they cannot see it now,” argues David Benatar. In his article in the research journal Current Oncology, in which he points out the flaws in logic present in the ‘slippery slope’ and abuse arguments:
There is no reason to withhold from some people a legal right to reasonable activity merely because other people will abuse that right. The appropriate response is regulation, imperfect though that may be.
Society will have to evaluate whether laws should be constructed to protect citizens from this danger. Given that abuse may be present regardless of its legality, the choice is whether the government should regulate the process, as people will still seek euthanasia even if it is illegal.
The state of Oregon requires the safeguard of two verbal requests and one written request from the patient to be euthanized, with the time between the first and last request being at least fifteen days apart. Furthermore, the patient must be terminally ill with a life expectancy of less than six months, and this prognosis must be confirmed by a second physician. Both doctors must determine that the patient is capable of independently making the decision and confirm that the patient does not have a medical condition that impairs their judgement. Perhaps a law such as this could be evaluated for implementation on the Federal level.
The truth is that arguments that are either 100% ‘for’ or ‘against’ euthanasia in every situation are flawed. It is an exceedingly complex issue, and an agonizing choice, which simply cannot be reduced to a black-or-white stance. So perhaps there is a middle ground in this debate. We are a nation founded on the principles of democracy including the first amendment freedoms of speech and religion, and the 14th amendment protection against being deprived of life and liberty without due process. Shouldn’t the same protected freedoms available throughout our lives also be available at the end of life?
Some people insist that if we allow the various forms of euthanasia to be legal, it will supplant the course of normal treatment because insurance providers will essentially force people to be euthanized against their wishes by denying them essential medical treatment in a timely manner. This argument can be addressed with the implementation of proper legal restrictions and protections.
Legal regulations would be necessary to ensure that doctors act in accordance with their patients’ wishes. In Oregon, rules such as these have already been implemented; there, the patient must self-administer the lethal dose, which ensures that the patient is confident in their decision and there is no room for misinterpretation of their intent. A doctor’s right to choose to decline their participation must also be respected. Additional regulations could be implemented, so people with mental illnesses who can demonstrate they are capable of making the decision regarding euthanasia, are allowed to do so. In addition, euthanasia should not be considered as a replacement for palliative care, which is focused on relief from the symptoms and stress of a serious illness; instead, it should only be an alternative for extreme situations. The aim is to help people live as long as they possibly can without pain (or with minimized pain), and according to their wishes.
In order to ensure that the process is implemented in an ethical manner, the patient should first have no doubt about their decision, and should complete a living will to support the affected people around them, clarifying why they have chosen to be euthanized, and accepting full ownership of their death. As the English poet John Donne wrote, “No Man is an Island,” and family, friends and the health care staff caring for the patient will all be impacted by this person’s death.
I do not know what I would do if I experienced long-lasting and untreatable pain or disease, but I would take comfort in knowing that the option of euthanasia would be available to me. What’s more, by placing the responsibility for this decision in the hands of the individual patient, it relieves others of the gut-wrenching burden of having to interpret a loved ones wishes. Today and every day, there are individuals, families and medical professionals grappling with these issues; we can continue the debate, but preferably our society will arrive at a thoughtful and reasonable compromise to support these populations. Shouldn’t we all be afforded the dignity which was allowed to 104-year-old David Goodall as our final chapter comes to a close?