Module 5 Euthanasia, Physician Assisted Suicide and The Right to Die

Movement

Key Terms • Hippocratic Oath – an ancient, optional code of ethical

principles • Euthanasia – intentional shortening of the life of a person

or animal to spare further suffering

• Active Euthanasia – taking some action to cause death

• Passive Euthanasia – withholding treatment that might prolong life (generally tolerated by society)

• Key question: Should actions be introduced, continued, done, or discontinued?

Key Terms • Terminal Sedation – relieving dying patients’ distress by

keeping them in a deep sedation or coma until death • An alternative to active euthanasia • Called “slow euthanasia”

• Liberty Principle – individuals can make their own decisions

• Informed Consent – patients must be fully informed before proceeding with treatments

• Competence – the mental ability to understand the information and make a rational decision

Key Terms • Nazi “euthanasia” – the false name given to the murder

of innocent people and associated genocide • Black Stork – The movement in the U.S. in the early

1900s to allow “defective” infants to die • Eugenics – The movement aimed at sterilizing people

with “defective genes” • Led to other ideas, such as letting “defective” infants die and

ending the lives of “incurable” patients

• Slippery Slope Argument – Opposing any instance of assisted death because it could contribute to widespread abuse in other instances

Assisted Suicide and Euthanasia

• In both, at least two individuals are involved. • In Assisted Suicide, permission and

cooperation is obtained from individual wishing to end life. Not always the case in euthanasia.

Euthanasia and Religion Various Religions have commented on Euthanasia

and other forms of assisted Suicide: Judaism: God created a person and therefore

owns the body, a person is just the caretaker Duty to preserve life – Orthodox & Conservative

Jews find euthanasia morally unacceptable Active Euthanasia is condemned by all Jewish

groups

Euthanasia in Christianity & Islam

Christianity: suffering is part of God’s plan for all humans

Typically oppose any intentional killing of oneself or others

Islam: Suicide, Euthanasia and Physician Assisted Suicide is generally disapproved of

“Do not destroy yourselves”

Euthanasia Hinduism & Buddhism Hinduism: assisted suicide and euthanasia may

interfere with karmic processes and is undesirable, but is not forbidden

Extending human life through medical interventions may also interfere with karma

Ahimsa: avoidance of causing pain or killing any life Gandhi: “Should my child be attacked with rabies and

there was no helpful remedy to relieve his agony, I should consider ot my duty to end his life”

Buddhism: intentionally ending a life is unacceptable Easing suffering is inappropriate

Right-To-Die Cases • Estimated that 10,000 to 35,000 Americans exist in

persistent vegetative states

• Estimated that another 150,000 have minimal consciousness syndrome

• In the news: Karen Ann Quinlan, Debbie, Nancy Cruzan, Terri Schiavo

• Not in the news: People in similar situations who are not young, white, attractive females

Right-To-Die Cases: Karen Ann Quinlan • Suffered severe, irreversible brain damage as a result of

oxygen deprivation (April 14, 1975) • Spent months on a ventilator, dropped to 60-pounds,

curled into a fetal position, in a “persistent vegetative state”

• Parents asked physicians to turn off ventilator; they refused

• Parents took their request to court; it was denied • New Jersey Supreme Court ruled that a ventilator could

be turned off if physicians agreed that the patient had no reasonable chance of regaining consciousness

• The ventilator was removed (in 1976) • She remained alive until she had pneumonia in 1985

Copyright © Allyn & Bacon 2007

Right-To-Die Cases: Debbie • Story published in the Journal of the American

Medical Association in 1988 by “Anonymous” • Debbie, 20 years old, dying of ovarian cancer,

emaciated, hadn’t eaten or slept in two days, hadn’t responded to chemotherapy, breathing with great difficulty

• Her only words to the doctor were “Let’s get this over with.”

• The doctor gave her a lethal injection

Right-To-Die Cases: Nancy Cruzan • 26 y.o., auto accident, brain trauma, oxygen deprivation • Maintained with feeding tube; no communication • Parents decided to stop tube feeding; hospital refused

without court order • U.S. Supreme Court ruling: a competent person had the

right to refuse medical treatment, and if the person wasn’t competent the State could decide what constituted clear evidence of the person’s wishes

• Nancy’s physician withdrew his opposition after 6 years • Nancy died after the tubes were removed

Copyright © Allyn & Bacon 2007

Right-To-Die Cases: Terri Schiavo • Suffered a heart attack (2-25-90) • On life support; showed only reflexive movements,

random eye opening, and no communication ability • Terri’s husband and parents had intense conflict • 1994 Terri developed a urinary tract infection; husband

and physician agreed not to treat it; also DNR posted • 1997 husband petitions to discontinue life support; many

court battles between husband and parents • Much rested on testimony that Terri said she wouldn’t

want life support

Right-To-Die Cases: Terri Schiavo • On several occasions courts ruled in favor of removing

life support, but each time it was blocked • Media got involved; Florida Governor Jeb Bush passed

“Terri’s Law” to return feeding tube; the U.S. House and Senate agreed to a federal bill to return feeding tube

• Terri died (3-31-05) of dehydration • Autopsy showed that her brain had shrunk to half its

size; she had severe and irreversible damage

Objections of the Medical Community to Assisted Death • Taking a life is inconsistent with the responsibilities and

values of a physician • Religious convictions forbid taking a person’s life under

any circumstances, with the possible exception of self- defense

• The life might be mis-taken • Serious legal consequences might be expected to befall

any physician who engaged in assisted death • The dying person accuses the physician of being a

failure (actually the physician’s self-accusations)

Assisted Suicide

• Assistance can include: means used to cause death such as drugs or a gun, place, emotional support.

• Physician-assisted suicide: assistance ending one’s life with the help of a physician.

• Usually sought out by the terminally ill or chronically ill.

Evaluating Dr. Kevorkian’s Approach: Summary of 93 Cases • Most of the people were not terminally ill • Gender bias – encouraged and increased suicidality

among women • Clients fit the profile of suicide attempters rather than

terminally ill • He functioned without adequate medical information and

consultation • Death is much too extreme a solution for the relief of

suffering • Despite his disclaimers, it appears that he has rushed

people into assisted death without adequate safeguards and consideration

• He uses “silencing” techniques to defend his actions

Assisted Death in The Netherlands • Requirements for a physician to assist in ending

a patient’s life: • The patient is terminally ill • The patient has made an explicit request for life-

termination • The physician informs the coroner of his actions and

provides a detailed check list regarding the patient’s situation and the physician’s own actions

• First nation to make it legal • Belgium now has similar laws • Australia had such a law, but later overturned

Current Status of Assisted Death in the U.S. • Merging of The Hemlock Society and Compassion in

Dying in 2005 to form Compassion and Choices • Has many requirements and safeguards • Will help clients arrange for assisted death

• Oregon Death with Dignity Act • Has many requirements and safeguards • Physicians write prescriptions for lethal doses of

medication after an adequate waiting period • Patient must be 18 or older with an incurable,

irreversible terminal illness and life expectancy of less than 6 months

Copyright © Allyn & Bacon 2007