Euthanasia Debated

Care or Killing?

It is difficult for most of us to watch someone suffer because of illness or trauma or age especially if that person is a loved one. Being unable to relieve their suffering can leave us feeling helpless. Empathy can make their pain our pain and we just want it to stop.

There are times also when a person might feel they have lost their quality of life due to illness or trauma or age and just wish to end it all. They may feel guilty about burdening those dear to them. Ending their life may seem to be a logical solution or perhaps even the only solution.

Can euthanasia or assisted suicide ever be acceptable in the modern world?

Euthanasia, sometimes called mercy killing, is defined in the Merriam-Webster dictionary as the act or practice of killing hopelessly sick or injured individuals in a relatively painless way for reasons of mercy (Active Euthanasia); it may also be defined as the act or practice of allowing a hopelessly sick or injured patient to die by taking less than complete medical measures to prolong life. (Passive Euthanasia) Assisted suicide is defined as suicide with help from another person (such as a doctor) to end suffering from severe physical illness.

Those who favor euthanasia may argue that it is a person’s freedom of choice. After all it is their life. They should have this option open to them as a means of ending the suffering now rather than prolonging the agony for weeks or months if there is no hope of recovery. Why burden family and society with unnecessary cost of medical bills if it doesn’t change the outcome?

Those opposed to euthanasia may say that it devalues life. It is morally wrong. It is equivalent to homicide or murder. It can lead to a decline in the quality of medical care because it shifts the focus of doctors and other medical professionals from treating those with chronic illness to ending suffering by means of assisting suicide. What may start out as a means of stopping the suffering of someone with no chance of recovery may very well end in eliminating lives deemed less important, such as the elderly or those with physical disabilities, mental illness. Once euthanasia becomes legal it can bias decisions that need to be made in a life and death situation.

How do we assess the quality of life? At what point does life become “not good enough” to continue? Who gets to determine the standard by which that is measured? Is it a measure of ability to sense pleasure? Would a life that can no longer be enjoyed, bring joy to others, or contribute to the well-being of society meet the measure? Is it measured in degrees of prosperity or status? Is the decline in or loss of physical or mental ability considered a devaluation of life?

Another question that arises is who gets to decide when a life should end? Is it solely the decision of the person who is suffering? What if the person is not capable of making such a decision? Who would be responsible for making the decision on their behalf? Is this a decision society should be making?

In 1984 the Dutch Supreme Court ruled that voluntary euthanasia was acceptable, provided doctors followed strict guidelines. That is, if a patient expressed a wish to die, the physician could euthanize them under the guidelines. In the fall of 2000, the Dutch parliament voted to formally legalize the practice, making the Netherlands the first nation in the world to do so.

The state of Oregon was next. The Oregon Health Plan was established in 1994 and the physician-assisted death law was enacted in 1997. The “Oregon Death With Dignity law” authored in part by the famous Derek Humphry, founder of the Hemlock Society and author of "Final Exit," passed in 1998. Humphry is quoted as saying, “Only about 30 people a year choose an assisted death, which must be approved by two doctors. The Oregon Health Plan's approach to coverage is sound. People cling to life and look for every sort of crazy cure to keep alive and usually they are better off not to have done it."

As of 2014, euthanasia (intentionally causing the death of a person) is now legal in the Netherlands, Belgium, and Luxembourg. Assisted suicide (helping a person kill him or herself) is legal in Switzerland, Germany, Albania, Colombia, and Japan and in the US states of Washington, Oregon, Vermont, New Mexico and Montana. Euthanasia was criminalized in Mexico, Thailand, Estonia, the Australian State of Northern Territory and the US State of California.

Those who oppose euthanasia would ask of those who favor euthanasia, whether there is clarity on why, how and to whom euthanasia would be administered? Some interpret euthanasia as the practice of ending a life in a painless manner for those who are in agony and have a short time to live. So then is the only or primary purpose of euthanasia and assisted suicide to alleviate pain and suffering? Should suffering be understood to include both physical and mental?

Are these practices a compassionate advance in the field of medicine as believed by proponents or a decline in the values of modern society as believed by detractors? In part II of this article we will examine some results of euthanasia or assisted suicide in the countries and states that have legalized these practices.

Euthanasia Examined

In part 1 of this article, Euthanasia Debated, we reviewed some pros and cons of the practice of euthanasia as a means of ending the suffering of someone with terminal illness. We left with the question, “Are these practices a compassionate advance in the field of medicine or a decline in the values of modern society?

The answer may be found if we examine the successes and failures of the countries and states that have legalized euthanasia. Where better to begin than with the Netherlands where it all started?

The Netherlands began accepting euthanasia in 1984 and legalized it in 2000. While experts estimate 60% of assisted suicide cases are not reported, figures show that in 1999, fifteen years after it was accepted, doctors helped 2,216 Dutch patients die. Polls find that an overwhelming majority of the Dutch believe euthanasia should be available to suffering patients who want it. Numbers of reported assisted deaths increased by 13% in 2009, 19% in 2010, 18% in 2011 and 13% in 2012 to a reported 4,188 deaths which is more than 3% of all deaths. The 2012 report also stated that the practice expanded to include 42 people with dementia and 13 people with psychiatric conditions.

The Right to Die-NL organization founded in 1973, has been at the forefront of making euthanasia widely available in the Netherlands. This organization has created mobile euthanasia teams to help patients die at home. They also are advocating for legislation to make euthanasia available to anyone over age 70, sick or not. Some think the Right to Die-NL organization may now be going too far. Critics charge that the “right to die” could quickly become "the duty to die" pressuring the terminally ill to take their own lives when they believe they have become a burden. They say the elderly will be afraid to enter hospitals for fear of being euthanized. And in fact it happened that a woman was euthanized because she didn't want to go to a nursing home.

Furthering the expansion of euthanasia to include children began in the mid-1990s. Two court cases regarding euthanasia of infants became the catalyst for the Groningen Protocol, a document providing guidance for both judges and physicians. Of the 200,000 children born in the Netherlands every year, about 1000 die during the first year of life. For approximately 600 of these infants, death is preceded by a medical decision regarding the end of life.

Theo Boer, an ethicist and former nine- year member of one of the five Euthanasia Review Committees in the Netherlands that oversees euthanasia cases, is saying that doctors, politicians and the review committees need to re-evaluate the euthanasia law. Boer has evaluated more than 4 thousand cases of euthanasia and says that it is often given to people who still had some time to live. The latest euthanasia figures for the Netherlands show that nearly one in seven deaths are at the hands of doctors. Despite their reports, the review committees have not have been able to halt these progressions.

The Netherlands is not alone. Having passed the law in September 2012, Belgium is now the third jurisdiction to legalize euthanasia. Doctors are euthanizing an average of five people every day – with a 27% surge in one year. Where euthanasia began as a way of dealing with the "hard cases" it has now expanded to include children, people with dementia, people with psychiatric issues, loneliness, and for those who are just "tired of living."

Germany is presently debating the legalization of euthanasia. It currently permits doctors to cease life-extending treatment or to administer powerful and dangerous sedatives at a dying person‘s request, but assisting a suicide is still a crime at this time.

In the US, Oregon was the first to pass a physician-assisted suicide law in 1997 and claims to have never extended its dispensing beyond those with terminal illness in its 17 years. Since then, a total of 1,173 people have had DWDA prescriptions written but just 752 patients have died from ingesting the prescribed medications.

According to the Oregon government report of January 22, 2014 there were 71 assisted suicide deaths and 122 prescriptions for suicide in 2013; 69% were aged 65 years or older, the median age was 71 years. The prescribing physician was present at the death in 8 of the 71 deaths. Only 2 of the 71 people who died by assisted suicide received a psychiatric evaluation. Is it ethical then to allow people who are in physical or emotional pain to make personal life and death decisions?

Yet according to an Oregon Public Health report, written in September of 2010, Oregon’s suicide rate is 35 percent higher than the national average. This increase does not take into account the number of deaths under assisted suicide act because the state does not recognize it as suicide. Whereas the law sees assisted suicide and euthanasia as an exception, public opinion is shifting towards considering them rights, with corresponding responsibilities on doctors to act. A law that is now in the making obliges doctors who refuse to administer euthanasia to refer their patients to a ‘willing’ colleague. And under Oregon’s law a doctor is not able to protect a depressed patient if they choose assisted suicide.

Jeanette Hall, was terminally ill and wanted to die by assisted suicide in 2000, but her doctor convinced her to try medical treatment. She has been in remission for many years and says she is happy to be alive today.

The Oregon assisted suicide act is not limited to terminally ill people. 2013 saw a significant increase in assisted suicide deaths related to "other illnesses" to include chronic conditions such as diabetes.

The three most frequently mentioned end-of-life concerns were: loss of autonomy (93.0%), decreasing ability to participate in activities that made life enjoyable (88.7%), and loss of dignity (73.2%). Other reasons were: Losing control of bodily functions, inadequate pain control or concern about it, burden on family, friends/caregivers and financial implications of treatment. All but one of these concerns relate to the quality of life and do not address the original purpose for euthanasia which was to alleviate pain and suffering for terminally ill patients with a short time to live.

If quality of life is subjective, how can any law concerning euthanasia be objective? Once you give physicians the right, in law, to cause death, ethical boundaries prohibiting the intentional killing of human beings are forever changed. The result is what we have seen in the Netherlands and Belgium where euthanasia began as a way of dealing with the “hard cases” and has now expanded to include euthanasia for children, people with dementia, people with psychiatric issues, loneliness and for those who are “tired of living”.

If pain and suffering are the primary focus for accepting euthanasia then are there other ways to address these needs? This will be addressed in part III.

Euthanasia Debated

Care or Killing?

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Euthanasia Examined