Assisted Suicide and Euthanasia for the Terminally Ill

Abstract

Assisted suicide and euthanasia are morally charged topics surrounding the issue of what constitutes the grounds upon which a terminally ill person or caregiver of a terminally ill person can seek assistance or make a decision on ending the terminal person’s life. There are no clear guidelines on the topic. The issue of ending a life via assisted suicide or euthanasia encompasses laws, statutes, ethics, faith systems, personal beliefs, and extremely intense emotions. The following report examines some of the relevant contributing factors in the right to die discourse, holding that the ultimate foundation for deciding whether assisted suicide or euthanasia are good courses of action and the laws that provide for one to end their life through prescriptions medications.

Assisted Suicide and Euthanasia for the Terminally Ill

Introduction

Assisted suicide and euthanasia involve the wilful termination of a human life using external intervention either in the form of pharmaceuticals or through withholding essential medical care. In some cases it is a chemically-induced death that is desired in response to some terminal and painful illness, where the act requires some deliberation by both the person wishing to end their life and the person to whom the terminal patient has asked for help in doing so. In other cases it involves making a decision to end a terminal patient’s life when they cannot make the decision themselves. Typically, the terminology associated with the name of the act is revealing of the mindset of those perpetuating the discourse about it. The term ‘assisted suicide’ connotes an immorality or bad action of some sort, while the term ‘euthanasia’ generally has an implicit dignity surrounding the act. This paper will examine the discourse surrounding the act of terminating one’s life using medical intervention, whether through withholding care or through administering drugs to hasten death. This paper also examines the current policies in the United States regarding this subject. Two frameworks are offered to expand the discussion on assisted suicide/euthanasia. The first schema deals with ethical behavior, and whether or not assisted suicide can be considered ethical. The second rubric deals solely with the concept of terminating one’s life via assisted suicide through the Christian perspective and the guidelines for the laws allowing one to end their own life when terminally ill. The thesis of this paper is that assisted suicide/euthanasia is ultimately a morally correct act. Relevant supporting issues are inserted into the discussion, including two real-life case studies. A conclusion is offered to highlight the main points of the topic and synthesize the salient issues.

Assisted Suicide and Euthanasia: Ethical Behavior or Bad Act?

Ethical behavior is essentially relates to how people utilize and employ their morality. There are generally three broad topic areas of ethics. Meta-ethics asks where ethics derive from. Normative ethics look at how we arrive at determining what is right behavior, and what is wrong behavior. Applied ethics is more detailed, delving into the morality of discrete subjects such as assisted suicide (Blackburn). Sometimes, the issue over whether something is ‘ethical’ (meaning a right, moral act) depends upon whether it is considered ‘legal’. However, what is legal is not always considered moral, and what is moral is not always considered legal. Such conundrums face people daily as they attempt to navigate the rocky path of moral behavior in response to some issue.

Moral dilemmas are not something that the typical person must examine in their personal lives, at least not on a constant basis. However, moral dilemmas do indeed face the average citizen of humanity from time to time, and how that person chooses to deal with their own dilemma may call into question the foundations upon which their ethics are built. For some, religion is the moral arbiter; for others, logic determines their ethical stance. Indeed, it may be noted that that state of desperation can also be a determiner of ethical behavior, as it applies to the person in relation to their particular social mores (Singer). Specifically, if a person is suffering some terminal and horribly painful disease, such as end-stage kidney disease, and they essentially have little quality of life left, is it morally right for them to end their life if they choose to do so? If the person in question cannot speak for themselves, the issue becomes more complicated.

Assisted suicide and euthanasia are often thought of in terms of a ‘mercy killing’. It is considered by those in favor of the act to be merciful to allow the person with the painful terminal illness to die a death of dignity and peace, rather than end their life in pain and suffering. The issues surrounding the ‘morality’ of assisted suicide/euthanasia are manifest. First, to consider the ethical implications of this event, the perspective of the terminal patient or those making decisions for the terminal patient needs to be examined.

Case Study #1: Baby Isaiah and Euthanasia

In Canada in October of 2009, Baby Isaiah was born with the umbilical cord around his neck following a 40 hour protracted labor. Severely oxygen deprived and suffering resultant brain damage, the little baby boy had to be placed on ventilator to support his life. The baby was declared ‘brain dead’ by the neonatologist in charge of the case. In January of 2010, still in the neonatal intensive unit and on a ventilator, hospital doctors informed the parents that all medical options had been exhausted and they were going to discontinue life support. The mother and father sought legal action to stop the hospital from taking their baby off life support. It was the position of the parents that the baby was improving every day, opening his eyes, moving a little more every day, and growing. The parents felt that Isaiah was improving. The doctors felt otherwise (Craine, 2010).

After a legal battle to stop the hospital from ending their son’s life, the family eventually came to their own conclusion that little Isaiah would not recover from his birth injury. The ventilator and other life support were removed, and the child died (from a lack of medical intervention) in his parents arms on March 11, 2010. Subsequent criticism of the hospital revealed that they did not give the baby the same care they do for others diagnosed with traumatic brain injury, and that the hospital only gives a diagnosis of ‘brain dead’ when there is the intent to harvest organs (Craine, 2010).

In this case, there is an intense ethical dilemma. This is clearly euthanasia, not assisted suicide, since the baby was just too young to make his own decisions. However, the decision to end the child’s life was first placed in the hands of the medical staff, not the parents. Also, the parents did not wish their son to be pulled off of life support, instead asking for more time for the child to develop and perhaps recover from his birth injuries.

Baby Isaiah may have been kept on life support, and may have recovered. Or, he may not have recovered, and required a life of care living on a ventilator and essentially being ‘brain dead’. The ethical dilemma is in the fact that the future could not be known for Baby Isaiah, and the decision to end his life was based on hypothetical unknowns. Whether or not the child died a merciful death is ultimately unknown, yet if the child had been kept alive yet required 24-hour hospital care for the rest of his life into old age, then perhaps the most dignified thing to do was allow the child to die. That is the argument that determined the morality of this case example. In the case of Baby Isaiah, the ethical lines are not so clearly drawn; the human life in question was a newborn infant with no way to speak for himself; in other cases the issue of euthanasia/assisted suicide is more clear-cut.

Case #2: Jane, 69 years old, Terminal Cancer

Jane (pseudonym), a retired pediatrician experiencing end-stage cancer that had metastasized throughout her skeleton, battled cancer for 8 years and underwent numerous treatments and therapies. Her cancer had progressed to the terminal stage, and she was given hospice care with an outlook of 6 months left to live. Jane experiences sharp and severe pain whenever she moves, which most of her time is spent bedridden. She experiences swollen extremities, bed sores that do not heal, incontinent bowels, vomiting, poor vision, and weakness. Jane is only given medication to help with pain, which does not adequately manage her pain (Compassion in Dying v. State of Washington, 1996).

Jane wished to end her life by taking prescription drugs. She requested assistance in ending her life from the Compassion in Dying organization. The organization would provide counseling and support, and other as-needed services during the time she takes the drugs to end her life. The organization was blocked by court order in assisting Jane, to which the organization, 4 physicians, and 3 patient plaintiffs filed a lawsuit in the state of Washington; the two other patient-plaintiffs were in similar situations, they too were requesting assistance with ending their lives (Compassion in Dying v. State of Washington, 1996).

Since the case had gone to court, the court had to address whether the plaintiffs had a constitutionally protected right to end their lives in the manner they wished. At the time of the court case, assisted suicide was illegal. All three patients died after the case had gone to court. It is unclear whether the patients received assistance in ending their lives, or died of natural causes. The ultimate outcome was that the Washington statute against physician assisted suicide using prescriptions for terminally ill adults who were mentally competent and seeking death, was invalid and a violation of the patients 14th Amendment rights (Compassion in Dying v. State of Washington, 1996).

Issues of Liberty and Compassion

The two cases presented here illustrate the amorphous ethical dilemma surrounding the legal question of whether one has a right to die. In the case of Baby Isaiah, the issue was not one of whether the child had a right to die, but if he had a right to life. Based on the best medical evidence available at the time as given to his parents, the child would not have had nor would he experience anything that could qualify as a quality life, and would simply exist as a brain dead being for as long as he was kept on life support; the implication was that the pain and suffering would be the burden of the family, and that was not a blissful outcome for them, or if making Isaiah live a life lacking quality or dignity in any typical conception. There came a point where the parents had to decided whether or not they could put aside what they wanted to be, from what was actually happening. This is a difficult situation however in the end the parents compassion for their child, baby Isaiah, to have a peaceful life and death is what ultimately helped them to make the decision to allow their child to die.

In the case of Jane and the Compassion in Dying organization, Jane and the other patients who wished for assisted death were denied their legal right to do so, on the grounds that indeed they had no legal right to seek assisted death. Washington state statutes supported that position at the time of the court case that Jane and others filed. However, the outcome was that the patients “Due Process”, as written in the 14th Amendment of the United States Constitution, was violated by not allowing them the liberty to seek assistance in ending their lives. The statute in question was regarding the actions of physicians in assisting the patients in ending their lives, yet the court decision had to overturn the statute since it violated the 14th Amendment rights of the patients.

Additionally, the case study of Jane demonstrates that it was not compassionate to force her to experience such a deteriorated state of life, when she was clearly in end stage cancer and would ultimately die a painful death even though taking medication for pain management. Jane did not wish to continue her life such as it was, and asked for a dignified and compassionate death through assistance and support in ending her life as she chose to through the use of prescription medications. It stands to reason, that Jane and others in her situation would wish to not exist in a minute by minute pain-filled existence for the remainder of their lives. Therefore, it may be compassionate to allow them to seek the supports they need to end their lives (Meisel & Cerminara, 2004).

Christian Views: Finding Moral Ground

The ethical and moral argument regarding end of life and right to die issues is fraught with mixed emotions and legal debates. For the Christian perspective, dealing with the issue may seem rather practical: the Bible teaches followers that suicide is always wrong. Taking a child’s life is murder. There appear to be no gray areas, only the moral argument that abnormally terminating a life is quite simply, wrong.

Christian teachings are the foundation of deciding how Christians should conduct themselves, from minor problems to great controversies. The Holy Scripture imparts to believers that man is the creation of God, and in so being, bearing the Divine mark of grace. Indeed, the Sixth Commandment tells us “thou shalt not kill”, and this proscriptive statement follows even into the medical field with the Hippocratic Oath “first do no harm.” Christian underpinnings of medical ethics calls into question those procedures that involve a health professional that indeed, do harm, and after all, do kill. Assisted suicide is immoral, and goes against living a sanctified life. The sanctity of life is profound in the holy teachings; God is creation, all of creation is God (Cohen, 1996).

However, there are those Christians who believe that allowing a person to die a peaceful and dignified death that is free of pain is not only compassionate and merciful; it is moral and the right to do so on those grounds. Christian proponents of assisted suicide state that the dignity of man is violated by having to live in pain and fear due to intolerable circumstances, such as that which would accompany end-stage cancer. The person is in obvious misery, and cannot find peace or grace in living. To live in this state is to deny the grace of God; therefore it is acceptable to end one’s life at that point. Additionally, the concept of Christian Brotherhood is upheld by the caregiver in supporting their ailing fellow through achieving a dignified and painless death through euthanasia (RS Revision: Religious Studies Online 2008).

Indeed, it might be argued that it is within the scope of compassion of the Christian worldview that it is acceptable to allow one seek a painless death when their death is inevitable due to a terminal illness, and that continuation of that death would amount to cruelty. If the quality of life is so deteriorated that the only experiential events the person with terminal illness can face is one of intolerable pain and suffering, then it may serve to show them the act of Christian love and assist in fulfilling their wish to end their life in a state of grace, and not a state of cruel pain (Jordan 2003).

Death with Dignity Act

In October of 1997 the state of Oregon passed the “Death with Dignity Act” allowing patients to end their life if terminally ill. “An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner in accordance with ORS 127.800 to 127.897.”(Oregon State, 2007). This was the first law ever passed in the U.S. like this, since this law other states have followed. There are very clear well written out guideline as to how and whom qualifies to make a request to end his or her own life. First and foremost The Right to Die Organization stand behind Oregon and the “Death with Dignity Act”, it is strict for good reason but does allow for those who want to die a merciful and painless death to do so. A summary of the guidelines provided by Oregon.gov are to follow. The person must be 18 years old, a resident of Oregon, determined by a consulting physician and attending physician to be terminally ill and have expressed their wish for death. There must be a witness present; that is not relative to the patients by blood, marriage, adoption, in the patients will, an owner or employee of the health facility where the patients receives treatment or the patients attending physician at the time of the request. This witness is to sign the request for the medications for the patient to end his or her own life. The physician must determine that the patients is capable of making this decision, is dying of a terminal illness, make the patients aware of hospice type care, and refer the patient to another physician for medical conformation of the illness. The attending physician is also responsible for recommending that the patient notifies his or her family of their decision to end their life. No more than fifteen days can pass between the first request (the initial oral request/expression or wish to end their own life) to end his or her own life and the second, the patient always has the right to rescind their request. No less than 48 hours can pass between the patient’s written request and the writing of the prescription drug. The laws are strict and very well structured, for good reason as for once the drugs are taken there is no going back on ones decision. This law is the first of many to come Washington State also has a “Death with Dignity” law. “Actions taken in accordance with ORS 127.800 to 127.897 shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law. [1995 c.3 s.3.14]” (Oregon State, 2007). This part of the law address the ethics behind humanity, most people believe something is unethical if it is illegal. However, this law makes it legal to write a prescription for someone to knowingly end their own life; therefore many people will find that it is ethical to end one’s life through prescriptions. The grounds of these laws all allow the patient to make the decision while the physicians must provide the patients with all of the other options and have an extensive amount of evidence that their diagnosis is correct and the patients only has six months to live. In many cases the last six month of life are nothing but sheer misery, filled with nothing but pain, embarrassment and suffering. In the United States it is left up to each state to determine whether or one can legally end their own life, without legal consequences for the physicians or whomever may choose to help the patient in ending their life.

Conclusion

The ‘right to die’ issue whether addressed as assisted suicide or as euthanasia finds its most compelling moral arguments in the act of kindness in allowing a person to die a dignified death that is experiencing an otherwise intolerable state of living. This is a difficult moral and legal issue. Moreover, religious ethics come into play and even in what seems to be clear cut religious stances, there exists ground for interpretation to allow for a merciful death. The ethics that a person chooses to apply to the issue is dependent upon their upbringing, their beliefs, their cultural values and social norms, and their religious and political views. With so much area for interpretation over such an intensely emotional issue, it is no small wonder that the issue of assisted suicide and euthanasia encounters such heated debate. The case example of Baby Isaiah presented the ethical dilemma of ending an infant’s life. While it may be argued that it was ultimately for the best interest of the child and of the family to do so, it is nevertheless a very difficult issue to examine. In the second case regarding Jane and the legal issue, it may be easier to arrive at a conclusion over whether allowing Jane to end her life with assistance was moral, compassionate, merciful, and legal, due in no small part to her obvious prolonged suffering and competent mental state in desiring to end her life. The Christian perspective shows how even in such a rubric as religion protecting the sanctity of life, there exists room for interpretation to support the notion that compassion should be the basis of ethical understanding in right to die issues. The laws in Oregon and Washington make it possible for patients to have a choice without legal consequences for their doctors or themselves. The ultimate outcome will continue to be debated and likely based on the weight of individual case merits.