The word euthanasia has its origin millennia ago in Ancient Greece,
where it means literally "the good death". However, in today's society,
there are deeper and more layers of meaning to euthanasia than before.
There are three basic types of euthanasia: voluntary, non-voluntary and
involuntary. Voluntary euthanasia concerns itself with the express wish
of a mentally competent person to die through the assistance of others.
Voluntary euthanasia can further be divided into two categories: passive
voluntary which is the specifically requested withholding of unwanted medical
treatment, and active voluntary which is the deliberate action of killing
the patient at that patient's informed request. Should dying human beings
be made to suffer horribly during their last days in this world before
looking forward to a painful and undignified death when they wish it to
be otherwise? The answer is no. As such, voluntary euthanasia should be
legalized for terminally ill patients.
For many people, euthanasia is a preferable option to dependence and
unbearable suffering. The results of a 1994 Morgan Poll in Australia showed
that 78% of Australians agreed to voluntary euthanasia for patients with
fatal diseases or were injured beyond recovery. A study was conducted on
patients' assessment of states worse than death by Robert Pearlman, a physician
specializing in geriatric care at the Seattle Veterans Health Center. In-depth
interviews were held with 56 adults suffering from cancer, AIDS, or who
had spent time in a coma from heart attacks. The results, published in
the Journal of Clinical Ethics, showed that 96% felt it was worse to be
kept alive under hopeless circumstances with impending death than it would
be to die. 82% felt that total loss of independence would be worse than
death, and 73% were so averse to a life of unremitting pain and suffering
that they would rather be dead. For patients suffering from terminal illness,
the pain they undergo as the disease progresses can sometimes only be relieved
by rendering them unconscious. They would have to spend the last days,
weeks or even months of their life heavily sedated and unaware of their
surroundings. This places stress on their loved ones as well, who have
to stand by and watch as their mind and body degenerate before their eyes.
The measure of life lies not only in quantity but in its quality as well.
The Law Reform Commission of Canada believes that considerations of quality
of life are legitimate factors in decision-making and are valid criteria
in justifying certain acts.
Sue Rodriguez was a 42-year-old mother who suffered from amyotrophic
lateral sclerosis, otherwise known as Lou Gehrig's Disease. Soon she would
lose the ability to speak, swallow, walk and move her body without assistance.
As the disease progressed, she would be unable to breathe without a respirator,
to eat without a gastrotomy and would eventually be confined to bed. She
wished to obtain the assistance of a physician in ending her life by her
own hand when she would be in a condition in which she was unable to enjoy
life. In 1993, Rodriguez appealed to the Supreme Court of Canada, but was
denied the right to doctor-assisted suicide. The Supreme Court found against
her favor five by four, and one of the dissenting judges in the case held
that "state prohibitions that would force a dreadful, painful death on
a rational but incapacitated terminally ill patient is an affront to human
dignity". Rodriguez died in February 1994 assisted by an anonymous doctor.
Although the case of Sue Rodriguez gained national attention in Canada,
she was by no means the only terminally ill patient seeking release from
the agony they are in. In Australia, artist Neil Savage and his wife who
were both terminally ill decided to die together in a suicide pact rather
than be institutionalized for their illnesses. The couple consumed a lethal
cocktail of drugs and alcohol, resulting in the death of Fay Savage, 62,
but not of her husband as the morphine caused him to vomit. Neil Savage
pleaded guilty to the charge that he aided in his wife's suicide and was
sentenced to 200 hours' community service by the presiding judge. They
had witnessed the terrible and lingering death of their parents and they
did not want to go through a similar experience themselves or put their
loved ones through it. It is indeed a sad reflection on the world today
that dying people have to go through exhausting legal proceedings and painful,
often unsuccessful suicide attempts in order to relieve themselves of their
suffering.
Secondly, the negative consequences of not legalizing euthanasia are
very real and cannot be ignored. Some terminally ill patients who are denied
euthanasia attempt to terminate their suffering by ending their lives themselves
and have botched their suicides in the process, bringing further suffering
on themselves and those around them. By denying them their right to euthanasia,
the government satisfies its own moral standards but ignores the outcome
of its action. Some patients cannot bear the excruciating agony that accompanies
terminal illness and when they cannot obtain physician-assisted suicide,
try to kill themselves even though they may not be in a condition to do
so. They may also beg for the help of loved ones not trained in medicine
in their suicide. As a result, the suicide may often be messy, painful
and sometimes unsuccessful. It is unfair on the family and friends of the
patients to have to go through such a nightmare when all they want is to
free their loved ones of pain and torment.
In addition, doctors are afraid to openly discuss end-of-life decisions
with patients due to illegalities. This prevents an open and honest relationship
between doctor and patient in which the doctor can discover the patient's
wishes regarding his/her own life and death. According to Associate Professor
Helga Kuhse, director of Monash University's Centre for Human Bioethics,
"Doctors are reticent with the patients because once you raise the issue...
it looks as a case of the intentional termination of life". Often, doctors
are left to make their own decisions which concern the survival of the
patients. It is ironic that while euthanasia is deemed illegal, there are
many cases of doctors who do not obtain patient consent when they withdraw
or withhold treatment, or administer potentially life-shortening palliative
care. It is much better to have the decision of voluntary euthanasia made
after open discussion with some sort of "institutional safeguards" than
leaving it to the judgment and conscience of individual doctors. Medical
practitioners need to know where they stand on this issue, instead of making
decisions themselves while being in fear of being prosecuted or torn between
socially accepted norms and compassion.
Currently there are cases of misuse of euthanasia, for example in cases
where the patient is pressured by family members to give consent to the
ending of their lives. The legalization of voluntary euthanasia provides
an opportunity for safeguards against just such a situation, and other
instances of coercion and fraud. The legalizing of voluntary euthanasia
would provide a set of guidelines and regulations for the parties involved
to follow, such as psychological counseling and psychiatric evaluation
(which will ensure that the patient's choice is one given freely without
coercion), signed legal agreements and a cooling-off period, as outlined
in the Rights of the Terminally Ill Act of Australia's Northern Territory,
and the regulation that only doctors can perform euthanasia. An example
of misuse of euthanasia is the case of Dr Jack Kevorkian, who has caused
fear and repugnance by his unethical methods of offering euthanasia to
all and sundry who request it. Some of his patients are not terminally
ill and could have committed suicide without assistance if they wanted
to, as in the case of Marjorie Wantz and Sherry Miller. Dr Kevorkian has
also offered his patient's organs for transplant without following proper
medical regulations and procedures, thus inciting further widespread fear
of euthanasia.
Thirdly, every terminally ill patient has the basic fundamental right
to voluntary euthanasia. The law must recognize the principle of personal
autonomy and self-determination which is the right of every human being
to make decisions regarding his own body and have these decisions respected.
Patients suffering from a fatal disease who wish to end their life but
are incapable of doing so themselves have the right to a physician-assisted
suicide. However, doctors are in no way obligated to perform euthanasia
if they do not want to. No medical staff who is opposed to euthanasia shall
be required to administer it. Thus, legalizing euthanasia not only ensures
that the right of the patient is respected, but the right of the physician
as well. It has been found in a survey by the University of New South Wales
that a majority of doctors (59% out of 2000) agreed with the principle
of euthanasia but they fail to implement it because they fear the legal
consequences. For those who oppose euthanasia for religious or personal
reasons, euthanasia is not forced upon them and likewise, they should not
impose their own moral standards on those who agree to euthanasia. Those
who object to euthanasia on moral grounds can face death in accordance
with their personal beliefs and will still have this freedom when voluntary
euthanasia is decriminalized. Nobody forces them to change their moral
outlook and they should not expect everyone else to live according to their
own set of tenets.
Furthermore, in a society where people are letting technology take over
their lives and allowing other parties to make decisions for them, they
need to know that they at least have some manner of control over their
own dying. Even if most people do not want euthanasia, it reassures them
that they would have the freedom to make their own choice if and when such
a situation arises. The existence of a public policy gives them peace of
mind and assures them that they live in a society that is not only free
and democratic, but also compassionate, in which personal autonomy is respected.
As the disease progresses in terminally ill patients and they slowly lose
their freedom of movement and hold over their own bodily functions, they
need to know that they still have control over their life. If even that
is taken away from them, then they are subjected to an undignified and
bitter death. Just as everyone has the right to live with dignity, they
also have the right to die with dignity.
A terminally ill man, Bob Dent, 66, became the first person to commit
suicide under new voluntary euthanasia legislation in Australia's Northern
Territory in 1996 before it was overturned a year later. Diagnosed with
prostate cancer in 1991, Dent obtained the three signatures required from
his own doctor, a cancer specialist and a psychiatrist, observed the nine-day
cooling off period, and was then free to choose the time and place of his
own dying. He committed suicide with help from his doctor by intravenous
feeding of drugs into his cancer-ridden body. He was asleep within a few
seconds, and a few minutes later he was dead. His doctor, Peter Nitschke,
said that Dent saw his death as an end to suffering. Dent's case is an
example of personal autonomy being respected by law and of a dying man
who made a voluntary and informed decision to end his own existence. He
was lucid and in full control of his faculties and his own life when he
died. Despite strong public support for voluntary euthanasia (70% of Australians
were in favor according to a Morgan Poll) the law was overturned by the
Federal Parliament in 1997. By its action, the government did not seem
to take into account its citizens' rights and wishes, and instead impose
its own moral code upon them, expecting the people to follow its definition
of right and wrong and what is "good" for them.
Everyone may be searching for a "good death", but terminally ill patients
merely wish to have a painless, merciful death at the time of their own
choosing. Surely that is not asking much. It is easy for society, the government,
and people to deny them this one act of mercy by spouting "moral", "ethical"
and religious tenets by the dozen. They have not traveled in their shoes,
and they do not know what dying is. In the end, all that these patients
want is to die, peacefully, with dignity, and no pain.
Copyright 1999 Amis Lee