| ISSUE SUMMARY |
| Disabilities Ethical History International Medical Psychological Religious |
Euthanasia Examined: Ethical, Clinical and Legal Perspectives Euthanasia: Opposing Viewpoints Language and Reality at the End of Life Suicide and Euthanasia, Are They Ever Right? The Case Against Assisted Suicide: For the Right to End-of-Life Care The Slippery Slope of Assisted Suicide When Killing is Wrong: Physician-Assisted Suicide and the Courts |
The Slippery Slope of Assisted Suicide It has been said that if a fence has been built around something, one should determine why the fence is there before attempting to tear it down. For thousands of years, in virtually every culture, a legal "fence" has prohibited, and treated as homicide, active euthanasia and assisted suicide. The act of assisting death was considered homicide. The reason for this "fence" is extremely valid, for it protects some of the most helpless members of the human family - the frail; older people; those with severe or terminal illness; those with physical or mental disabilities - from having their deaths caused by another. It also prohibits the granting of legal authority for one person to end the life of another.Current trends indicate a willingness to dismantle the fence, picket by picket, fueled by slogans for "patient self-determination," "death with dignity," and "the right to control the time of death." In fact, the first "picket" for which removal is advocated is the one that prevents someone from making a "voluntary" choice to have their life ended. What harm would there be, the argument goes, if the choice is freely made, strictly regulated, and purports to achieve a good end-namely, release from suffering, or choosing one's own time?
1. Why is voluntary euthanasia dangerous? 2. Could we stop at voluntary euthanasia? 3. How would voluntary euthanasia affect us all? One of the most common reasons used to justify active euthanasia or assisted suicide is to relieve the patient from pain. Yet, improvements in pain control are widely recognized by virtually all segments of the medical profession as rendering this argument virtually obsolete. (1) In addition, euthanasia proponents argue that the right of the individual to make medical treatment decisions should include the right to request and receive active euthanasia or to be assisted with suicide. As compelling as this argument appears on the surface, voluntary euthanasia should be rejected for the following reasons:
2. How voluntary is voluntary? In the Netherlands, 65% of family physicians offer the choice of euthanasia without first receiving a request from the patient. (3) Physicians exercise powerful influence over decisions that patients and families make, especially because of their superior base of knowledge. Medical professionals pressure patients; husbands pressure wives; wives pressure husbands; family members pressure relatives. Many physicians admit they kill patients on their own initiative. (4) One must conclude that while a voluntary decision might be legal, it is not necessarily freely chosen. 3. If a patient is killed, who is to substantiate that the choice was freely made? The only witness is dead and society is notoriously reluctant to prosecute physicians. 4. Patients facing a long-term or serious illness vacillate - at times they want to live and at other times, they don't. Who is to determine at what point the patient has reached a final decision? 5. Although euthanasia and assisted suicide are generally perceived as a "solution" in cases of physical illness - either terminal or long term - they would inevitably become accepted for individuals suffering from mental anguish. Who would have the ability to determine that a depression or mental anguish is irreversible before taking such a final action and causing such a final result? 6. Societal endorsement of euthanasia invariably has a "teaching" effect for the weak and frail, leading them to devalue their own existence and feel they have a "duty" to die, and, therefore, to make a request to have their lives ended. The answer is clearly NO - for legal, moral and practical reasons. Legally, we have already moved from recognizing the right of competent patients to refuse medical treatment, to granting that "benefit" to those unable or unwilling to make the decision for themselves. The same legal principles would apply if "voluntary" active euthanasia were allowed. For example, if a person not in pain can request and receive a lethal injection, then how can the injection request be denied to a person with mental retardation perceived to be suffering? The law would not allow such a perceived "inequity" to stand. (5) From a moral standpoint, if killing a person because he or she is suffering is deemed a benefit, is it morally justifiable, then, to withhold that benefit from someone unable to make such a request? From a practical standpoint, one only has to view what happened in Nazi Germany and now the Netherlands and Oregon as proof that allowing only voluntary euthanasia to be legal is unworkable. How would voluntary euthanasia affect us all? It is naive to believe that someone else's voluntary "choice" would not affect or impact us all. In the December 1989 issue of the American College of Surgeons Bulletin, Dr. T. Douglas Kinsella and others stated: "Medicine's professional integrity will be lost if it does not reject the legalization of active euthanasia. The tradition of medicine is to resist death and illness on behalf of those who have not the knowledge or skills to resist; active euthanasia seeks death on behalf of those who have not the desire to resist. The latter formulation of death as a goal cannot be reconciled with the teaching or practice of medicine as a healing art." (6) If healing and killing both become equally valid goals of the medical profession, and if death becomes a legal "right," then physicians will feel obligated to offer death as an "option" to patients or to families on behalf of patients. Given the powerful influence of physicians, would one be able to trust information given if the physician believed that a patient's death was a "benefit?" Legalized euthanasia would quickly lead to abandonment of the patient, whether the person wishes to choose death or not. In the face of pressure from medical professionals, family or friends to choose death, the patient ć who by definition is weak, helpless and vulnerable ć will feel an obligation to choose death. The increased isolation felt by the patient when the necessary caring support collapses will fuel the decision. If the logical path which has governed the withdrawal of treatment to date is followed, or the course of real events occurring in the Netherlands and Oregon spreads in the United States, others could choose death for any of us, even against our wills. Insurance or government coverage for health care could dwindle, based on the age or condition of the patient, leaving no realistic option but death, even for those who do not wish to die. Those at risk of being killed without consent or against their own wishes, would become fearful of seeking a physician, being hospitalized, or entering a nursing home. (7) One would view one's family with fear and suspicion, fearing that they would choose lethal injection without your consent or against your wishes. Finally, what would legitimization of assisted suicide and lethal injections teach our young? The notion of calculated, premeditated death as a noble action, mixed with the immaturity of the adolescent, would indeed become a lethal potion promoting teen suicide. Conclusion In the words of Professor Hadley Arkes and others, in an essay entitled "Always To Care, Never To Kill" in the November 27, 1991 issue of The Wall Street Journal, "If life is a thing that can be renounced or taken at will, the moral structure of the human community, understood as a community of persons, is shattered. The result is a brave new world in which killing is defined as caring, life is viewed as the enemy, and death is counted as a benefit to be bestowed." (8) We must limit human "choices" when those choices victimize ourselves, others, and society as a whole. We must minister compassionately to those who suffer and those who fear death. We must maintain the healing tradition of medicine. To splinter the fence which protects the vulnerable among us is to relegate countless victims, and eventually ourselves, to death at the hands of another. Reference Notes: 1. "Deciding to Forego Life-Sustaining Treatment: Ethical, Medical and Legal Issues in Treatment Decisions," President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, March 1983, pp. 19-20, 73, 277-286. 2. Tad Bartimus, "Promises to Keep," Milwaukee Journal, August 18, 1991, pp. 1ff. 3. "Medische Beslissingen Rond het Levenseinde, II: Het Onderzoek voor de Commissie Onderzoek Medische Praktijk inzake Euthanasie" (Medical Decisions About the End of Life, II: The Study Ordered by the Committee to Investigate Medical Practice Concerning Euthanasia). The Hague, v. 2, 1991, p. 83. 4. Ibid. 5. Attorney Thomas Marzen, General Counsel, National Legal Center for the Medically Dependent and Disabled, Inc. Remarks, Bioethics Conference, "The Slide Toward Euthanasia: There Are Alternatives," Milwaukee, Wisconsin, November 22, 1991. 6. T. Douglas Kinsella, MD, et. al., "Legalized Euthanasia: An Aesculapian Tragedy," American College of Surgeons Bulletin, 74, December 1989, p. 8. 7. Richard Fenigsen, MD, "Euthanasia in the Netherlands," Issues in Law & Medicine, Vol. 6, No. 3, 1990, p. 243. 8. Hadley Arkes, et. al., "Always to Care, Never to Kill," Wall Street Journal, November 27, 1991. Posted on June 26, 2004. |