Report: Euthansia
Analysis by religioustolerance.org
The
Verbal Battle over Euthanasia
Ethical
aspects of Euthanasia:
Religious
aspects of euthanasia
Development
in the US: Overview
Physician
Assisted Suicide Outside The U.S.
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Euthanasia And Physician
Assisted Suicide (www.religioustolerance.org)
[Comment by Kwing Hung:
Liberal leaning organization]
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Most people in North America die what may be called a bad death. One study found that “More often than not, patients died in pain, their desires concerning treatment neglected, after spending 10 days or more in an intensive care unit.” cited in Ref. 1
The word Euthanasia originated from the Greek language: eu means “good” and thanatos means “death”. One meaning given to the word is “the intentional termination of life by another at the explicit request of the person who dies.” 2 That is, the term euthanasia normally implies that the act must be initiated by the person who wishes to commit suicide. However, some people define euthanasia to include both voluntary and involuntary termination of life. Like so many moral/ethical/religious terms, “euthanasia” has many meanings. The result is mass confusion.
It is important to differentiate among a number of vaguely related terms:
Perhaps the most common form of passive euthanasia is to give a patient large doses of morphine to control pain, in spite of the likelihood that the pain-killer will suppress respiration and cause death earlier than it would otherwise have happened. Such doses of pain killers have a dual effect of relieving pain and hastening death. Administering such medication is regarded as ethical in most political jurisdictions and by most medical societies.
These procedures are performed on terminally ill, suffering persons so that natural death will occur sooner. It is also done on persons in a Persistent Vegetative State - individuals with massive brain damage who are in a coma from which they cannot possibly regain consciousness.
People have many different reasons for wanting to end their life by committing suicide:
Some people who decide that they wish to commit suicide are unable to accomplish the act. They need assistance from their physician. Physician assisted suicide helps them die under conditions and at the time that they wish. PAS is currently legal, under severe restrictions, only in the American state of Oregon and in the Netherlands. In other jurisdictions, they are forced to continue living against their wish, until their body eventually collapses, or until a family member or friend commits a criminal act by helping them commit suicide.
An analysis of the first full year of the availability of assisted suicide in Oregon showed that relatively few people requested help in dying. Some were probably deterred by the resistance of their physician. Only 23 actually obtained medication to induce their death. At least six of the 23 never used the pills, but died a natural death.
Ultimately, there are two approaches to suicide:
(1) Traditional Christian beliefs concerning all forms of suicide were well documented by Thomas Aquinas (circa 1225-1274 CE). He condemned all suicide (whether assisted or not) because:
It violates one’s natural desire to live.
It harms other people.
Life is the gift of God and is thus only to be taken by God. 4
(2) Michel de Montaigne (1533-1592 CE) was the first major dissenter among European writers. He wrote a series of five essays which touched on the subject of suicide. He argued that suicide should be considered a matter of personal choice, a human right. He indicated that it is a rational option under some circumstances. In his “A defense of legal suicide” (1580), he wrote: “Death is a remedy against all evils: It is a most assured haven, never to be feared, and often to be sought: All comes to one period, whether man makes an end of himself, or whether he endure it; whether he run before his day, or whether he expect it: whence soever it come, it is ever his own, where ever the thread be broken, it is all there, it’s the end of the web. The voluntariest death is the fairest. Life dependeth on the will of others, death on ours.”
These two basic positions remain essentially unchanged today. Attempting to commit suicide was once a criminal act. It has been decriminalized for many decades in most jurisdictions in North America. However, assisted suicide remains a criminal act throughout North America, with the exception of the state of Oregon. In that state, it is permitted under tightly controlled conditions.
Many hotly debated social questions revolve around choice:
All are emotionally laden questions. Discussions about euthanasia often get mired in a mountain of emotional accusations, such as charges that the “most vulnerable” of humans are “besieged by euthanasia practitioners” and that families must fight “anti-life assaults on their loved ones” which “threaten the lives of those who are medically vulnerable”.
In reality, the basic question posed by euthanasia/assisted suicide is: should a person:
be given assistance in dying?
Euthanasia is not:
Ultimately, euthanasia is a question of choice: empowering people to have control over their own bodies. As of 1999-MAR, unless a person lives in Colombia, Japan, the Netherlands or the state of Oregon, the only lawful option is to remain alive, sometimes in intractable pain, until their body finally collapses.
The main opposition comes from some:
Groups that promote access to assisted suicide seem publicize cases where people have a terminal illness, are in intractable pain, and want to end their life. Although such cases do exist, they are in small minority. Many dying patients who are in serious pain have adequate access to pain-controlling medication. Most of those who would ask for assistance in dying may well be individuals concerned with quality of life or dignity issues.
Unfortunately, groups on all sides have resorted to scare tactics. They do not tackle the issue directly, but create false scenarios to alarm the public. These methods may work on the short term, but will only serve to eventually alienate the public:
Some considerations:
There are two main arguments offered by Christians, and those of other faiths, that advise against an individual seeking suicide, for whatever reason:
Of course, there is a significant and growing percentage of Agnostics, Atheists, Humanists, secularists, non-Christians and liberal Christians in North America who do not accept these theologically based arguments. They might argue:
An active political question is whether individuals should be allowed to choose suicide, or whether they should be forced to follow the theological beliefs of the dominant religion. This point is similar to that raised in discussions on choice in abortion and compulsory prayer in public schools.
A number of religious organizations have issued statements on suicide and physician assisted suicide. Conservative faith groups tend to be most vocal in their opposition to suicide. Liberal denominations tend to be more in favor of individual choice:
“2280: Everyone is responsible for his life before God who has given it to him. It is God Who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for His honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.”
Many polls have been taken. However, the results vary according to the precise question asked. Recent results show support for euthanasia choice at:
Ballot measures have been voted upon in three states of the United States. They showed support at:
According to an article by USA Today (1998-JUL-6) physician assisted suicide is:
In Canada, assisted suicide comes under a Federal law and is thus a criminal act everywhere in the country.
1994 - Ballot measure approved:
Citizens in the state of Oregon approved Ballot Measure 16 in the 1994-NOV elections, which would have legalized euthanasia under limited conditions. 1 Under the Death With Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria. The person:
If they meet all of these requirements, then they could receive a prescription of a barbiturate that would be sufficient to cause death. Mercy killings by a family member or friend would not be allowed. Assisted suicides of the type performed by Dr. Jack Kevorkian would not be allowed. Physicians would be prohibited from inducing death by injection or carbon monoxide.
Various informal polls in Oregon had consistently shown that most people are in favor of such a law. Most physicians were as well.2
The National Right to Life Committee, supported by the Roman Catholic church, obtained a court injunction to delay implementation of the measure. The law became stalled in the appeals process. In the meantime, the measure was not enacted. The Oregon Medical Association originally took no stand on the matter but later came out against it because of what it considers legal flaws.
1997 - Second referendum:
Conservatives within the Oregon government forced approval in early 1997-JUN of a second public referendum. It was a mail-in ballot procedure, held from 1997-OCT-15 to NOV-4. The concept of holding a second referendum was supported by about 61% of adults in Oregon.
Both sides in the debate had planned to invest 10 million dollars in advertising prior to the referendum. The Roman Catholic church and other conservative religious groups financed the campaign against access to assisted suicide. They have remained in the background, preferring to funnel their funds through Physicians for Compassionate Care (a group of over 1000 doctors). By early OCT, they had received 3.8 million dollars in contributions. They were able to finance paid co-coordinators, lawn signs, billboards, frequent media ads and pamphlets. Other groups opposed to assisted suicide are: Yes on 51 Committee, Oregon State Council of Senior Citizens, Oregon Catholic Conference, Oregon Citizens Alliance - Families for 51PAC, and Oregon Right to Life Issues PAC. Some groups promoting access to assisted suicide are: Oregon Right to Die, and Oregon Death With Dignity Legal Defense and Education Center. Most doctors and most psychiatrists in Oregon favor the law.
One concern in Oregon relates to the suicide method that the measure would allow. Death by injection would not be permitted. Medication intended to cause death can only be given orally. This is considered by many to be a fatal flaw in the bill. Oral medication is sometimes not effective because some patients vomit up the pills before they can take full effect. Others are unable to swallow pills because of their physical condition. The result may be a coma or a lingering death. At the same time, many physicians find it difficult to abandon the use of pills and directly inject a poisonous substance. Derek Humphry, co-founder of the Hemlock Society wrote that the Oregon law “could be disastrous” because it did not permit lethal injections. He referred to a study in the Netherlands that showed that pills often failed. “The only two 100% ways of accelerated dying are the lethal injection of barbiturates and curare or donning a plastic bag.” 3
An unidentified lawyer said: “It’s becoming the abortion issue of the next century and just as nasty...Yet it is even more important because how we die concerns absolutely everyone.” There is a strong element of truth in this statement. Even though a minuscule percentage of people would ever request assistance in dying, many (perhaps most) people will be comforted by knowing that assistance is available if one asks for it.
The groups promoting access to assisted suicide had received contributions of only $800,000 and were about $300,000 in debt at the time of the referendum. Their campaign was run by volunteers. Both sides accused each other of “lying, distorting research, misrepresenting information and running campaigns based on fear and deception...Some advertisements have been so outlandish that media outlets have refused to run them.” 2 The vote was about 60% in favor of access to physician assisted suicide.
Response was predictable:
In a surprising development, an employee of the state attorney general’s office said on 1997-NOV-4 that the law had cleared all of the court appeals on OCT. 27, and was actually in force.
Within 24 hours of the announcement of the results, state officials started to prepare forms for physicians to record instances of assisted suicide. These were later distributed to physicians in the state. The “Request for Medication to End my Life in a Humane and Dignified Manner” form will require two doctors to record:
Rules and regulations were already available; they had been drafted a few years ago, when the law was originally approved. Professional organizations of physicians, pharmacists and psychiatrists also prepared procedures to govern their members.
1997 - Opposition from the Federal Government:
Immediately after the law was affirmed, Thomas Constantine, the administrator of the federal Drug Enforcement Administration (DEA) wrote a policy statement. 4 He stated that prescribing drugs to help their terminally ill patients kill themselves would be in violation of the Controlled Substances Act. It “was not a legitimate medical use under the federal drug laws... [He] warned that the government would impose severe sanctions on any doctor who writes a prescription for lethal doses of medicine for a patient.” Their prescription-writing authority could be canceled. This statement was written at the request of Republican Senator Orrin Hatch (R) and Representative Henry Hyde (R). It is ironic that conservative Republicans such as Hatch and Hyde are normally in favor of states’ rights and against federal interference in local affairs. But their moral concerns at allowing people to ask for help in committing suicide outweighed their political philosophy. Dr. Charles Hofmann, president of the Oregon Medical Association stated: “The only official word we have is that physicians who prescribe barbiturates for assisted suicide could face sanctions. Our recommendation would be to not become involved until this is settled.” Oregon Senator Ron Wyden, himself an opponent of assisted suicide, and Oregon Governor John Kitzhaber attempted to convince the Justice Department that any such sanctions against physicians would be a misreading of the control substances law. Robert Applegate, a spokesperson for the governor said: “We think that what happened is that the DEA was pushed out on a limb by a couple of powerful conservatives.”
1998 --First usage of the law; Reno reversed ban:
On 1998-MAR-26, a woman in her mid 80’s died from a lethal dose of barbiturates which had been prescribed by her doctor under this law. She was the first person to publicly do so. She had been fighting breast cancer for 20 years and recently had been told by her doctor that she had less than two months to live. She had been experiencing increased difficulty breathing. She made a tape recording in which she said that “I’m looking forward to it. I will be relieved of all the stress I have.” Her personal doctor would not help her end her life, so she turned to an advocacy group “Compassion in Dying;” they found a doctor that would assist her. She fell into a deep sleep about 5 minutes after taking the lethal dose of pills; she died peaceably about 25 minutes later.
Bob Castagna, a spokesperson for the Oregon Catholic Conference said: “This is a tragic and sad day for Oregon and the United States. Assisted suicide has begin in the state of Oregon to our profound regret and sorrow. May God have mercy on all of us.” Gale Atteberry, spokesperson of Oregon Right to Life said: “It makes my heart break that we have stooped so low in society that we allow the terminally ill to kill themselves instead of reaching out with true compassion that would be being with them to the end.”
By mid-1988, Attorney General Janet Reno reversed Constantine’s earlier ruling. She stated “that doctors who use the law to prescribe lethal drugs to terminally-ill patients will not be prosecuted ... there was no evidence that Congress meant for the DEA to have the novel role of resolving the profound moral and ethical questions involved in the [physician-assisted suicide] issue ...the drug laws were intended to block illegal trafficking in drugs and did not cover situations like the Oregon suicide law.”
1998 -- analysis of the law’s effects:
By the end of 1998, one prediction of the anti-choice forces had not materialized. There has been no rush of people to Oregon to seek an easy end to their life. Since the law was passed, only about one Oregonian per month has elected to commit physician assisted suicide.
Dr. Arthur Chin of the Center for Disease Control and Prevention was the lead researcher in a study of the physician assisted suicide law in Oregon. The study found that during the calendar year 1998: 5
2000 -- analysis of the law’s effects:
During the year 2000, 27 Oregonians ended their lives with the help of the assisted suicide law. Over the first three years that the law has been in place the number of patients choosing legal PAS has remained at six to nine per 10,000 deaths. “...the proportions of PAS patients married, widowed, divorced or never married resemble those seen among other Oregonians dying from similar diseases.” 6 College-educated patients were much more likely to choose PAS than those with less than a high school degree, by a factor of 12 or more.
2001 -- Opposition from the Federal Government:
In early 2001, Oregon state senator Ron Wyden wrote Attorney General John Ashcroft asking that the Bush administration not mount an attack on the state law permitting assistance in suicide. There were indications that some political conservative would try again to undo the law.
On 2001-NOV-5, Attorney General John Ashcroft wrote a letter to Asa Hutchinson, chief of the Drug Enforcement Administration. He declared that assisting a terminally ill patient to commit suicide is not a “legitimate medical purpose” for federally controlled drugs. He said that any physicians who use drugs to help patients die face suspension or revocation of their licenses to prescribe federally controlled drugs. This reverses an earlier order in 1998-JUN by his predecessor, Janet Reno. Responses were as expected:
The Attorney General of Oregon, Hardy Myers, quickly initiated a lawsuit to have the Ashcroft’s directive declared unconstitutional. A doctor, pharmacist, and three people who may want to kill themselves with a doctor’s help have become plaintiffs. The federal district court in Oregon quickly issued a temporary injunction which prevents the federal government from enforcing Ashcroft’s interpretation of the Controlled Substances Act (CSA). This debate is a difficult one for social conservatives. Most are opposed to granting terminally ill people the right to request assistance in dying from physicians. But conservatives also generally disapprove of the Federal government interfering with states’ rights under the Commerce Clause and the 10th Amendment. 8
Ashcroft’s case was rejected by the court.
2001 -- analysis of the law’s effects:
During 2001, physicians in Oregon gave fatal prescriptions to 44 terminally ill individuals. Twenty-one of the recipients used them to commit suicide. The total number of physician assisted suicide cases is 91 since the Death With Dignity law came into effect in 1997. 9
2002 - Further developments:
The government of Oregon has initiated a lawsuit in federal court to block the federal Justice Department from taking legal action against Oregon doctors who prescribe medication to assist their patients commit suicide. A federal judge ruled in favor of the state state law in 2002-APR. 10 It was probably to be a simple decision, because the U.S. Supreme Court has already ruled that states can permit doctors to assist in the suicide of their terminally ill patients.
In 2002-SEP, the Justice Department is appealing the decision to the 9th U.S. Circuit Court of Appeals. Their argument is that federal law prohibits doctors from prescribing controlled substances to assist in a suicide. The State of Oregon is arguing that they have the right to permit doctors to assist their patients to commit suicide. Kevin Neely, spokesperson for the Oregon Department of Justice said that: “The fact of the matter is that the issue in front of us right now isn’t a question of the ethics. It’s a question, really, of whether or not the government has the ability at the federal level to interfere with the local governments...Obviously, in terms of ... ethics this is a serious issue. But that discussion has already occurred twice in Oregon ... and consistently Oregonians have felt overwhelmingly, at least recently, that we have the right to do this.” Mike Howden, spokesperson for Stronger Families for Oregon, a conservative agency, criticized the state government. He said: “There’s a continuing effort to disassociate any moral consideration for the patient. Yet those same folks will tell you that it’s immoral for us to not relieve their pain.”
A ruling from the court is not expected until mid-2003. Both sides have stated that they will appeal the decision if they lose. 10
2002 -- analysis of the law’s effects:
During 2002, physicians in Oregon gave fatal prescriptions to about 75 terminally ill individuals. Thirty-eight of the recipients used them to commit suicide. The total number of physician assisted suicide cases is 129 since the Death With Dignity law came into effect in 1997. 11
According to EWTN for 2000-JUL-11, former judge Robert Sanderson, 81, applied to a county court to allow him to establish a power of attorney for his wife. It would authorize his death in the event that two doctors agreed that his medical condition was hopeless. He claimed that a state law which criminalized assisted suicide violated the 1st, 4th, 5th, 6th 9th and 14th Amendments to the U.S. Constitution. In 1998, the court agreed that the law was unconstitutional because it conflicted the 1st Amendment. The case was appealed to the Colorado Court of Appeals. In his submission, Sanderson maintained that free will granted by God or nature allowed him to choose to kill himself with the help of another person. The court rejected the case, saying that “an individual’s religious beliefs do not excuse the individual from compliance with an otherwise valid law prohibiting conduct the State is free to regulate.”
Section 782.08 of the Florida Statutes prohibits assisted suicide. Charles E. Hall had acquired HIV from a blood transfusion, and wanted to ask his doctor, Cecil McIver, M.D., to assist in his suicide at some date in the future when the infection developed into AIDS and his medical condition degraded to the point where he no longer wanted to live. He asked the Florida court to place an injunction against the State Attorney from prosecuting Dr. McIver in the event that he helped Mr. Hall commit suicide. The court found that Mr. Hall was mentally competent, suffering from deteriorating health and was terminally ill. The court granted the injunction; it based its decision on Florida’s privacy provision and the federal Equal Protection Clause. The privacy law states in part: “[e]very natural person has the right to be let alone and free from governmental intrusion into his private life.” The court required that “the lethal medication must be self administered only after consultation and determination by both physician and patient that Mr. Hall is (1) competent, (2) imminently dying, and (3) prepared to die.”
The State Attorney appealed the ruling of the Trial Court. On 1997-JUL-17, the Supreme Court overturned the earlier decision . Their reasoning was that Florida’s privacy provision did not extend to this case, that the state has an interest in preventing suicide, that the integrity of the medical profession must be preserved. They stated that:
“We do not hold that a carefully crafted statute authorizing assisted suicide would be unconstitutional. Nor do we discount the sincerity and strength of the respondents’ convictions. However, we have concluded that this case should not be decided on the basis of this Court’s own assessment of the weight of the competing moral arguments. By broadly construing the privacy amendment to include the right to assisted suicide, we would run the risk of arrogating to ourselves those powers to make social policy that as a constitutional matter belong only to the legislature. 1
The “Death with Dignity Act,” HB 2487, was passed by a House committee in late 2002-FEB. It would allow “a terminally ill, competent adult to obtain a prescription for medication to end his or her life in a humane and dignified manner through a self-administered oral lethal dose. [The bill] Prohibits mercy killings, lethal injections, and active euthanasia.”
There were two similar Senate bills:
The “Death with Dignity Act,” HB 2487, passed the Hawaii House of Representatives on 2002-MAR-7 by a vote of 30 to 20. The bill then went to the Senate. Senator David Matsuura the chairperson of the Senate Health Committee, personally disagreed with the bill, and refused to allow it to be voted upon by his committee. 4,5 In a surprise move, the Senate overruled Matsuura by voting to pull the bill out of the Health Committee. HB 2487 was debated on 2002-MAY-2:
On MAY-2, the Senators voted 13 to 12 to hold a final vote on the bill on MAY-3. If it had passed, then the bill will go to Governor Ben Cayetano, who had already stated that he supports such a bill and would be expected to sign it. Focus on the Family posted a list of Senators who were considered “swing votes.”
Kelly Rosati, executive director of the Hawaii Family Forum in Honolulu, HI complained that “Many of the senators did not even know that this was planned.” 6
“Pro-life groups and other assisted suicide opponents — including the Honolulu-based Hawaii Family Forum, Focus on the Family and the Family Research Council — activated their grassroots networks on Wednesday, [MAY-1] asking constituents to pray for the bill’s defeat and to call, fax and e-mail the senators.” 7 As a result, Senate offices were flooded with calls and faxes from individuals who were opposed to allowing people access to physician assisted suicide. There was no similar level of calls from those who favored access. Three senators changed their vote, and the measure was defeated 14 to 11. Rod Tam (D) was one of the three. He is quoted as saying: “Upon reviewing the bill, the e-mails, faxes and phone calls, it is my decision that such an important and emotional issue involving life-and-death decisions should not be decided in the short time span we have left in this session.” Kelly Rosati, executive director of the Hawaii Family Forum, attributed the defeat of the bill mainly to prayer. Since the legislative session ended the next day, the bill is dead.
Focus on the Family wrote: “Everyone agrees the assisted suicide issue will be back next year. In fact, some of those who voted against the bill did so only because they saw technical problems in the legislation that couldn’t be resolved before the session ended.” 7 Rosati noted: “The irony of all of this is that if you look at all of the senators on the floor yesterday, a majority of them do support physician-assisted suicide. Even with that, we were able to prevail.”
There is strong organized opposition to the bill from conservative Christians. Kelly Rosati, has said in the past: “There will not only be a subtle, or not-so-subtle, duty upon elderly patients to feel that they need to check out early, but we will also move quickly into the situation where we don’t just have physician-assisted suicide, we actually will have physician-assisted death. The lives of the vulnerable are at risk with the passage of this proposal.” The bill, of course, only authorizes physician assisted suicide after a terminally ill person requests it. Physician assisted death would remain murder.
Starting in 1991, a physician assisted suicide bill has been repeatedly considered and rejected by the Maine legislature. These failures motivated Mainer’s for Death With Dignity to bypass the legislature and attempt to obtain a law via a public referendum. They obtained in excess of 40,000 signatures in support of a ballot initiative. It received top billing on the Main November election ballot. It will ask: “Should a terminally ill adult, who is of sound mind, be allowed to ask for and receive a doctor’s help to die.”
Opposed to assisted suicide are the “Roman Catholic Diocese of Maine, the Maine Medical Association, the Maine Hospice Council, medical educators, as well as others with a pro-life orientation.” Opponents have organized three PACs.
Edith Smith, of the Maine Citizens Against the Dangers of Physician-Assisted Suicide said “We’re the underdogs in this. The State of Maine should not ever have physician assisted suicide. It’s not necessary and it’s definitely dangerous.” She feels that the brief published in support of the measure is “fatally flawed. Among other things, it does not encourage family involvement. The definition of who is a next of kin does not require that person to be a blood relative.” She estimates that the “anti” side will have to raise between $500,000 and 1 million dollars to defeat the measure. 2
The International Anti-Euthanasia Task Force listed a number of concerns about the proposed “Death with Dignity” act:
Voters narrowly defeated the measure on 2000-NOV-7 by a margin of 51 to 49%.
Merian’s Friends is a group which promotes physician-assisted suicide. It is named after Merian Fredericks, who committed suicide with the help of Dr. Jack Kevorkian. They were able to accumulate 379,000 signatures on a petition to legalize assisted suicide. Almost 250,000 were needed to place a proposed bill on the 1998-NOV-3 ballot. Michigan voters turned down the proposition by a vote of about 71 to 29%. Some opponents said that the voters rejected the proposed law, not the concept of assisted suicide. Dr. Jack Kevorkian was opposed to the law; he saw it as excessively restrictive. Dr. John Finn, executive director of Hospice of Michigan, commented: “It may have been a different outcome if they had a very open-ended piece of legislation that would be accessible to all suffering patients, not just the terminally ill.” There was strong initial support for the bill. This faded when opponents stressed that the proposal was excessively complicated and improperly shielded from government oversight. Citizens for Compassionate Care wound up spending close to $6 million to defeat the proposition. Merian’s Friends only had $1 million to spend, and it cost $900,000 to place the initiative on the ballot.
On 1996-APR-3, the 2nd US Circuit Court of Appeals declared unconstitutional a State of New York law that criminalized physician assisted suicide for terminally ill patients. A panel of 3 judges found that the law violates the equal protection guaranteed by the 14 Amendment to the US constitution. This ruling only affected 3 states: Connecticut, New York and Vermont. On 1996-APR-18, the Attorney General of the state of New York asked that the ruling be suspended for a short time, while the State appealed the decision to the US Supreme Court. The decision of the court was overturned by the U.S. Supreme Court.
On 1996-MAR-7, The 9th US Circuit Court of Appeals declared unconstitutional a state of Washington law that criminalized physician assisted suicide for terminally ill patients. The court ruled by an 8 to 3 majority that the law violates the equal protection clause guaranteed by the 14 Amendment to the US constitution.
Over 40 states have specific laws which specifically criminalize assisted suicide. This ruling only affected Western states and territories: Alaska, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, N. Mariana Islands, Oregon and Washington.
The court said “when patients are no longer able to pursue liberty or happiness and do not wish to pursue life, the state’s interest in forcing them to remain alive is less compelling....A mentally competent, terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced to a child-like state of helplessness, diapered, sedated, incompetent “. The decision was condemned by the American Medical Association, the Roman Catholic Church and many groups within the pro-life lobby. It was greeted with enthusiasm by many AIDS activists. The ruling was later overturned by the U.S. Supreme Court.
The Supreme Court rendered its decision on the New York and Washington cases, on 1997-JUN-26. They found that the average American has no constitutional right to a physician assisted suicide. The vote was 9 to 0, an unusual, unanimous decision. Thus, the New York and Washington laws which ban such suicides are constitutional. On the other hand, the court implied that there is no constitutional bar that would prevent a state from passing a law permitting physician assisted suicide. Oregon has done exactly this. So, the battle must be fought on a state by state basis. Chief Justice Rehnquist wrote:
“Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in an democratic society”
This is a disadvantage to the “pro-life” camp who are working to make certain that freedom to choose assisted suicide remains unavailable to all Americans. The ruling means that they will have to prevent all 50 states from passing permissive laws. If even one state passes such a law, then at least wealthy patients will be able to relocate to that state, satisfy the resident requirements, and obtain help in dying.
The Supreme Court decision was very narrow in scope. It only ruled on whether the public had a general right to assisted suicide. The case was originally brought by six terminally ill individuals in intractable pain who wanted access to assisted suicide. But by the time that the court heard legal arguments, all six had died. Thus, the court was unable to rule on whether terminally ill individuals should have a right to assisted suicide. Instead, they made a decision on whether citizens generally had that right.
Many of the justices indicated that certain groups within society might have a constitutional right to access to suicide (e.g., individuals who are terminally ill and in intractable pain). If a case were brought by such a person, then the court might find in their favor. The trick will be to find a person who can survive a terminal illness long enough for their case to wander through the judicial system and reach the Supreme Court. If even one of the original six patients had been able to survive, the court’s decision might have been very different. They might have ruled that people generally had no legal right to obtain assistance in dying, but that terminally ill patients in pain did have.
Some justices discussed the dual effect theory. This is a situation in which a physician prescribes an adequate level of morphine or other drugs to control pain, even while knowing that it will shorten the patient’s life. They found that this was acceptable behavior. Some of the justices expressed concern about any laws which permitted assisted suicide; they were worried that such laws might be abused, and that they might be the first of a series of laws which might generate a “slippery slope” towards a society that has wide-open assisted suicide, without effective controls.
The main purpose of this bill is to block access to physician assisted suicide in the state of Oregon. Although the title of the bill implies that it is intended to promote pain relief,” it would probably have the opposite effect. Many doctors would likely be concerned about a DEA agent reviewing prescriptions. They would feel pressured to under-prescribe pain medication, leaving their patients in agony, to avoid prosecutions.
Ben Mitchell, professor of bioethics and contemporary culture at Trinity Evangelical Divinity School in Deerfield, IL commented that physician assisted suicide “is a barbaric answer to pain...When you think about it, it just makes sense. There’s not a single drug approved by the Food and Drug Administration for use in killing a human being. Drugs are designed to treat illness, not kill patients. The bill introduces a little bit of sanity into the culture of death. This will not stop the euthanasia and assisted-suicide movement in this country, but it will slow it down a bit.” Pro-choice individuals and groups who support an person’s right to choose assisted suicide believe that forcing a person to remain alive when their continued life has become unbearable, is itself barbaric.
The bill is clearly unconstitutional. The U.S. Supreme Court decision of 1997 implied that states can pass laws which permit physician assisted suicide, and that individuals have a right to take advantage of these laws if they wish. The Federal Government can hardly pass a law to prevent such access.
If passed, the law would place physicians in a dreadful situation. The law stipulates that a doctor can prescribe a narcotic for the relief of pain, even if it has the undesirable side effect of shortening a patient’s life. But if they misjudge the dose, give the patient too much medication, and cause that patient’s quick death then the physician may be charged under the act, and end up with a 20 year jail sentence. Each physician who prescribes a narcotic for pain relief will worry about a DEA investigator looking over their shoulder, evaluating the dose and trying to guess the doctor’s intent. The trick would be to prescribe insufficient medication to accelerate the patient’s death too much, and catch the attention of the federal officials. Physicians are liable to err on the side of their own safety and prescribe inadequate medication to control the pain. A lot of patients will be in severe, continuous agony if this bill becomes law.
On the other hand, the law does recognize that doctors would be able to prescribe narcotics even if they have the side effect of shortening a patient’s life somewhat. Such dosages are common place throughout North America. However, they are on legally shaky ground in many jurisdictions. Passage of the law would legalize this very common method of pain control. Some physicians currently leave their patients in agony out of fear of being charged with murder because they shortened the patient’s life by even a small amount. Doctor’s will now be able to prescribe some level of medication, and reduce their patient’s agony, without endangering themselves.
Dr. Diane Meier of Mount Sinai School of Medicine in New York, NY led a survey of 1,902 doctors on the topic of physician assisted suicide. 2,3 They polled doctors who specialized in aging, infectious diseases, cancer and diseases which affected kidneys, nerves and lungs. These were the areas of medicine where they felt that requests for assisted suicide might commonly surface. They found that:
It would appear that laws which restrict physician assisted suicide to cases involving terminal illness with intractable pain will only handle the wishes of a minority of those persons who seek assisted death.
Recent developments:
Some countries that have addressed this issue are:
A survey conducted by Newspoll in 1995-JUL found 81% of Australian adults support voluntary euthanasia. This is an increase over an earlier result of 79% in 1994-JUL. A poll by the Roy Morgan Research Centre in 1995-JUN showed similar results: 78% in favor. This is an increase from 66% in 1986. A separate poll showed that 60% of doctors and 78% of nurses in Victoria favored voluntary euthanasia. An additional poll was taken among 6500 Christian congregations, representing 19 denominations. They found that 40% agreed with assisted suicide for terminally ill persons; 30% opposed; 30% uncertain. Among older church attendees, support was higher (50% among those 60 and older).
Bob Dent, 66, was the first person to take advantage of the new law. He had moved to the Northern Territory as a Church of England (Episcopal, Anglican) missionary. He became disillusioned with politics within the church and left his calling to become a building estimator. He was diagnosed with cancer in 1991, and converted to Buddhism shortly afterwards. He wrote a letter saying “If you disagree with voluntary euthanasia, then don’t use it, but please do not deny the right to me.” He said that no religious group should “demand that I behave according to their rules and endure unnecessary intractable pain until some doctor in his omniscience decides that I have had enough and increases the morphine until I die.” In the presence of his wife and doctor, he initiated the process that gave him a lethal drug injection.
The Most Reverend Harry Goodhew, Anglican Archbishop of Sidney denounced the case on 1996-OCT-7; he said: “The moral shape of our nation is under threat with the first legally sanctioned euthanasia death in the Northern Territory, and so is the relationship between doctors and their patients. It has now been shown to us what this means [sic] doctors are no longer those who save lives. Under the Northern Territory law they are also those who kill...We must feel the deep grief of the wife of the one who died, and also understand the human pain which brought about this ending of a man’s life. But these facts cannot be allowed to persuade us that this action was right. It is morally wrong. I cannot approve it from any point of view.”
A second terminally ill person obtained physician assistance in dying on 1997-JAN-7. She was Janet Mills, age 52, who suffered from a rare form of skin cancer that causes the skin to disintegrate. The Anglican Dean of Sydney, Boak Jobbins, said the latest death was another day of shame for Australia. He said, “Quite clearly we are a nation that has come to the end of its resources...We no longer have anything to offer the terminally ill, the aged or the disabled but a quick exit at the end of a needle.”
On 1997-MAR-25, the Australian Senate disallowed the Northern Province’s law. The vote was 38 to 33. This passed the bill into law, since it had already been approved by the lower house. This action is directly opposed to public opinion. In addition to the polling results cited above, a nation-wide poll of nurses showed that 70% were in favor.
The first machine built to legally kill patients, was developed by Dr. Philip Nitschke in the Northern Territory. It was scheduled to be displayed in the London Museum of Sciences, London, England starting 2000-JUL. It involved a computer that asked the patient three times whether he/she really wanted to die. If the patient agreed each time, then 100 ml of liquid Nembutal was pumped through a fine needle into the patient’s arm. She/he fell asleep and died within five minutes. 9
A Saskatchewan farmer, Robert Latimer, was tried for the mercy killing of his severely disabled daughter in 1997-OCT. He was found guilty of second degree murder which, under Canadian law, requires a 10 year minimum jail sentence. The jury recommended that he be eligible for parole after one year. The sentence has been appealed through various courts.
Justice Minister Anne McLellan said on 1997-NOV-6 that the federal government might change the law to allow reduced sentences for people found guilty of second degree murder, but has no intention of legalizing either euthanasia or assisted suicide. She indicated that she has reneged on a promise by her predecessor to hold a free vote in the House of Commons on physician assisted suicide. A Senate committee recommended in 1995 that a new category of “compassionate homicide” be created under the Criminal Code to cover cases of non-voluntary euthanasia. This suggestion might receive renewed attention in the near future.
The Canadian House of Commons rejected by a vote of 169 to 66 a motion by Svend Robinson (NDP - Burnaby-Douglas) on 1998-MAR-25. The motion would have stuck a committee of Members of Parliament to study doctor-assisted suicide. Justice Minister Anne McLellan has said that there is no need for such a study; the Senate conducted a study only three years previously. Robinson intends to introduce a similar private member’s bill early in 2001.It will call on the House of Commons o “look at the recent developments in the Netherlands and also to look in depth at the whole issue of euthanasia and physician-assisted suicide and make recommendations to Canadian law....In my view, the existing provisions of the criminal law are profoundly unjust and, in some cases, cruel.” 10
An anti-euthanasia bill was defeated in Parliament in 2000-APR. Dr. Liam Fox, spokesperson for the Conservative Party has expressed alarm at the status of passive euthanasia in England. The party is concerned that orders have been issued that at least 50 patients be allowed to die and not be resuscitated when their breathing or heart stops. The party is calling for clear guidelines to medical personnel.
About 3% of all deaths in the country are reported as involving physician assistance. The actual number is believed to be higher. Public opinion is heavily in favor of continuing the present system. In a public poll, 92% of Dutch adults supported physician assisted suicide in a 1998 poll.
Physicians have complained that the present guidelines left them in a legal limbo. On 1999-JUL-12, the Dutch government announced the introduction of a bill to decriminalize physician assisted suicide. Wijnand Stevens, a spokesperson for the justice ministry said: “It was agreed that to decriminalize euthanasia is the logical [next] step of the policy we have had so far.” 6 Assistance in dying would only be permitted only if:
The Voluntary Euthanasia Society (NVVE) and Royal Dutch Medical Association (KNMG) have welcomed the bill. All three parties of the ruling coalition backed the bill during debate on 2000-NOV-23. Political opposition came from the Christian Democrats and some small Calvinist religious parties. A spokesperson for the conservative Protestant State Reformed Party commented that the Dutch government is “mopping up the last remaining scraps of Christian morals from the law books.” They control two seats in parliament. Bert Dorenbos, spokesperson for the pro-life group Cry for Life, said: “You’ll never know if doctors are coming to cure you or kill you.” (He was apparently unaware of the act’s provisions that the patient must first make repeated requests for assistance).
The bill was passed 104 to 40 in the lower chamber of parliament. Approval by the upper house is expected early in 2001. 10 Derek Humphry, founder of the Hemlock Society said that the absence of an enabling law in the U.S. has driven the practice of assisted suicide underground. “It’s going on underground extensively, but we would rather see it above ground and open and supervised by a team of people...Every day, there are dozens of cases in North America.” Rev. Joaquin Navarro-Valls, a Vatican spokesperson said that the Dutch bill “violates the dignity of human beings... and goes against the natural law of individual conscience.”10
In 2002-DEC, the highest court in the Netherlands ruled on a case involving a physician, Philip Sutorius, who had helped former senator, Edward Brongersma, to commit suicide in 1998. Brongersma had suffered from incontinence, dizziness and immobility. He said he was tired of life. The court ruled that Brongersma’s condition was not sufficiently critical to justify a mercy killing: “The question in this case was whether euthanasia is justified also in circumstances where a patient is tired of life.” They concluded that the euthanasia law had not been intended for situations like this one.
1. the patient is suffering in unbearable physical pain
2. death is inevitable and imminent
3. all possible measures have been taken to eliminate the pain with no other treatment left open
4. the patient has clearly expressed his or her will to approve the shortening of his or her life.
Judge Matsuura said “Dr.Tokunaga’s action did not meet all these conditions, arguing that the patient had made no clear expressions about his physical pain nor about his will to approve euthanasia. The doctor’s action cannot be viewed as euthanasia and represents illegal termination of the patient’s life.”
Recent developments include:
References
1. The text of the Northern Territory of Australia law is at: http://www.nt.gov.au/lant/rotti/amend.html
2. The Right-To-Die Society in Canada has a web page at: http://www.rights.org/~deathnet/open.html
3. ERGO, the Euthanasia Research & Guidance Organization promotes voluntary assisted suicide for terminally and irreversibly ill with unbearable suffering. They include a list of “right-to-die” agencies from around the world, movies which have dealt with the topic, a list of books on euthanasia, etc. See: http://www.efn.org/~ergo/
4. VESS, the Voluntary Euthanasia Society of Scotland maintains a WWW site with an A-Z interactive glossary, information on Living Wills, case histories, mailing lists, and a Values History Centre. See: http://www.netlink.co.uk/users/vess/fastaccs.html
5. Brad Knickerbocker, “Sanctioned euthanasia: lessons from abroad,” The Christian Science Monitor, 1998-DEC-3 at:http://www.csmonitor.com/durable/1998/12/03/fp1s2-csm.shtml
6. “Dutch to legalize mercy killing.” Associated Press, 1999-JUL-12.
7. South African Law Commission, “Euthanasia and the artificial preservation of life.” Text is at: http://www.law.wits.ac.za/salc/discussn/dp71.html
8. Maranatha Christian Journal is a religious online news source at: http://www.mcjonline.com Their article on euthanasia is at: http://www.mcjonline.com/news/news3699.htm
9. “London museum exhibits euthanasia machine,” EWTN News at: http://www.ewtn.com/vnews/getstory.asp?number=3685
10. “Netherlands legalizes euthanasia,” Globe and Male, Toronto ON, 2000-NOV-29, Page A17.
Recent developments:
References:
1. Jim Rudd, “National Right to Life’s Deception,” at: http://covenantnews.com/rudd020701.htm
2. “78% favour abortion rights: Poll shows support touching its all-time high,” National Post, Toronto, ON, Canada, 2002-NOV-27, Page A1 and A8.
3. “Guilty verdict upheld in Dutch euthanasia case,” Reuters, 2002-DEC-24, at: http://www.alertnet.org/thenews/
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