Euthanasia is essentially seen as an act in which the life of a person suffering from a terminal illness or impairment is voluntarily ended. The issue is, not unexpectedly, highly controversial, and a great deal of the debate is generated by differing definitions. Then, there is the inescapable element of the act as challenging fundamental ideas as to the sanctity of life, ideas not necessarily related to religious convictions. As euthanasia has long been the subject of intense argument, it is likely to continue as such; in simple terms, euthanasia, and even under the most dire conditions, creates tension and antipathy in all societies. In the following, euthanasia will be examined in regard to its actual nature, as well as in how modern laws and attitudes are addressing the practice.
General Information, Current Law
As noted, just how euthanasia is defined serves as a major element in the debates surrounding it, a fact amplified by the acceptance in the 1990s of the term, “physician-assisted suicide.” The meanings are by no means opposed, for both go to the same idea of euthanasia exercised to end suffering through the ending of life. There are, however, other elements to consider. There is active euthanasia, in which medication is given to cause death, as the passive form usually translates to omitting or ending life-preserving treatment. Further complicating matters are voluntary and involuntary practices. In the former, the patient participates and chooses the euthanasia, while the latter usually occurs when the patient is in a vegetative state and unable to choose (Pappas xviii). As may be expected, then, these variations alone allow for a vast array of ethical arguments, which in turn very much reflect legal rights.
In terms of the history of the subject as being a matter of controversy, that history is lengthy. It is also linked to the rise of Christianity in the Western world, simply because ancient civilizations did not observe faiths in which ending a life was necessarily contrary to divine will. Any suicide, in simple terms, was legal, as the prevailing cultures held to beliefs that human life was valuable only insofar as it was useful to the society and/or felt to be of value to the individual (Dowbiggin 9). The rise and dominance of Christianity would immensely alter these views, and essentially form the basis of Western cultures adamantly opposed to any taking of life beyond the scope of war. Then, as medicine evolved as a science, it could be noted how advances in it facilitated consideration of euthanasia. Not only has medicine replaced theology, to some extent, as an influence in cultural values, the sheer process of medicine’s advances created a platform for euthanasia. For example, cancer deaths in the U.S. more than doubled between 1886 and 1913 and, as the patients were usually cared for in the new hospitals, the medical community took on an immensely important role. Not only was care required, but the enormity of the illnesses added a social and cultural aspect to medical opinion and treatment (Pappas 2). The idea of “care” was extended, and this culminated in the case of Dr. John Bodkin Adams in the 1950s. Charged with ending the lives of elderly patients through medication, Adams was acquitted of one central charge because the British court held that, as his efforts went to relieving pain, the ending of the patient’s life was not criminal (Smith 152). Interestingly, some of the defense strategies employed by Adams would be used by the late Dr. Jack Kevorkian, notorious as the most outspoken proponent of physician-assisted suicide in the 1980s and 1990s.
As Euthanasia became intensely debated in the later 20th century, Kevorkian was himself instrumental in effecting legal change. Kevorkian’s first case of assisting suicide, in fact, led to Oregon’s Death with Dignity Act of 1997 (Schneider). Today, and despite support of euthanasia reaching unprecedented levels, U.S. law is unfavorable to it. 39 states specifically prohibit assisted suicide in any form, and it is deemed either felony murder or manslaughter. Four states have no clear legislation in place regarding it, and three – Oregon, Washington, and Montana – allow it under certain restrictions (Euthanasia). It is important to note, however, that the Washington and Montana laws are only several years old, which points to an ongoing evolution in legislative response. Currently, Connecticut is wrestling with an assisted suicide bill based on Oregon’s “Death with Dignity” statute, and the process is indicative of how public opinion, along with intense interest expressed by various factions, creates a field of uncertainty in regard to legal procedure. For example, as the Connecticut legislation is largely prompted by the success of the Oregon law, opponents of it are citing issues within that perceived success. Opposition holds that the Oregon statute does not adequately address the critical element of the doctor/patient relationship, as there is objection to allowing an individual to take lethal medication with no one present (Stannard).
As noted, there is no single issue rendering euthanasia a controversy. Virtually everything connected to the subject, whether it is physician-assisted or otherwise, touches upon matters of immense ethical, cultural, and legal sensitivity. For example, involuntary euthanasia, or when life-saving or life-giving procedures are ceased, is determined by a “best interests” consideration in medical and legal terms (Smith 156). This inevitably leads to argument as to who may determine best interests when the patient in incapable of response. The most profound issues as to quality of life are then further complicated by society’s efforts to assign responsibility for determining what is essentially a subjective, and consequently individual, matter.
In a sense, the American emphasis on euthanasia, while certainly a subject with some history, came to the forefront with the case of Karen Ann Quinlan in the 1970s. When Quinlan was in a vegetative coma state, her parents petitioned for her being released from life support. The petition was denied, the parents took the matter to the New Jersey courts, and in 1976 Quinlan was removed from artificial life support (Lepore). The nation was essentially galvanized into opposing camps, even as the legislature wrestled with issues ultimately admitting to no definitive course of action. In Quinlan’s case, as in subsequent others, it was believed that a proper verdict could be obtained by ascertaining if the cessation of life support would be, not necessarily in the patient’s best interests, but what the patient would elect if able (Jecker 134). Not unexpectedly, then, opposition to euthanasia responds by noting how others, and even close family members, are not necessarily entitled to make any such supposition, particularly as the incapacitation is a state of being unknown to the patient previously.
Linked to this is a widespread perception that interests other than a patient’s welfare fuel decisions and legislation regarding euthanasia. Recently, it has been noted that conservative political groups have expressed fears that the new health care systems will, in effect, unduly empower medical boards to determine when euthanasia is “ethically” warranted (Lepore). Even when social or political elements are removed, there remains the seemingly insoluble issue of the ethics of active or passive euthanasia. Today, it is widely felt that there is nothing immoral in removing life support from a patient with no hope of consciousness or recovery, yet the same factions tend to strongly resist active euthanasia in any form. However, as doctors and legislators have long noted, active euthanasia is by no means easily discounted as an inappropriate means of ending life. While the doctor’s credo of doing no harm must be maintained, the unfortunate reality is that certain cases blur the ethical distinction, as when a person is in great pain from cancer and certain to die. Withholding pain treatment, or a form of passive euthanasia, translates then to facilitating great suffering (Jecker 60). Then, ending treatment may translate to the patient taking longer to die and consequently suffering more. In such an arena, there can be no single answer to the ethics of euthanasia, and where responsibility begins and ends. That euthanasia remains highly controversial, then, is all the more explicable.
It may well be that the only definitive statement possible in regard to euthanasia is that views regarding it have been both strong and divided since the advent of Christianity. Added to essential belief issues is the reality that, as medical science has advanced, different options exist in both prolonging life and in ending it painlessly, just as these advances generate suspicion regarding actual intent. This is an arena in which science, the law, and ethics are deeply mired, and ironically due to the motives of most parties going to what is actually the most humane and ethical act. Given these enormous and mutable elements, it is probable that cases of euthanasia, in the form of physician-assisted suicide and others, will continue to generate intense debate.
Dowbiggin, I. A Concise History of Euthanasia: Life, Death, God, and Medicine. Lanham: Rowman & Littlefield, 2007. Print.
Euthanasia. State Laws on Physician-Assisted Suicide. 2013. Web.
Jecker, N. Bioethics. Sudbury: Jones & Bartlett Publishers, 2011. Print.
Lepore, J. “The Politics of Dying.” The New Yorker, 2009. Web.
Pappas, D. M. The Euthanasia/Assisted Suicide Debate. Santa Barbara: ABC-CLIO, 2012. Print.
Schneider, K. “Dr. Jack Kevorkian Dies at 83; A Doctor Who Helped End Lives.” The New York Times, 2011. Web.
Smith. G. R. Health Care, Crime and Regulatory Control. Sydney: Hawkins Press, 1998. Print.
Stannard, E. “Connecticut’s Assisted Suicide Bill Has Flaws, Some Experts Say.” New Haven Register, 2013. Web. <http://nhregister.com/articles/2013/03/31/news/doc5158e4a4380ab916806675.txt