Throughout the ages, religious tradition and instinctual human self preservation have motivated mankind to preserve and protect life at all costs. Enormous effort has been invested in inventing and perfecting the means of prolonging and improving human life. However, as early as the 1950s, if the discussion is limited to contemporary times, arguments have arisen which are calling into question the necessity of maintaining terminal patients on life-support systems for indefinite periods. More recently, even patients who have not been admitted to intensive-care units or cancer-wards are also being considered candidates for euthanasia or, informally, mercy-killing.
A tentative definition of "euthanasia" can be phrased, according to the Random House Unabridged Dictionary, as "The act of putting to death painlessly or allowing to die, as by withholding extreme medical measures, a person or animal suffering from an incurable, especially a painful disease or condition." (Random House, 1993). However, if more recent and broad-based works are consulted on this delicate matter, it is discovered, for example, that Derek Humphry has cast a more sensitive and compassionate light on this practice which is being discussed more and more frequently in upper-echelons of our society.
Yet, the question inevitably arises: Who determines whether euthanasia will be permitted and who decides when and under what circumstances? The present analysis will address these issues and intends to discuss several related dilemmas and moral decisions. There is no doubt that euthanasia is both "topical" and "critical" to the way we organize and prioritize our society, according to all sources consulted.
Contemporary literature readily available on the subject of euthanasia ranges from Elizabeth Kubler-Ross in the 1960s to the news releases of famous trials and legal battles of the 1990s. Moreover, the American Medical Association, the American Hospital Association and the nation's Bar Associations have also begun to "sensitize" the populace to the ethical concerns relating to euthanasia. Widely acclaimed publications have emerged in the last three decades on this subject among which are those of Baird, May and Kluge (1989, 1980, 1975). As this paper progresses, discussion will be offered within the context of their substantive contributions, in addition to the contributions of others, to the right-to-die movement, assisted suicide and euthanasia, all expressions which denote similar concepts.
It must be acknowledged that medical practice has evolved gradually to the point where human suffering can be alleviated as the patient lapses into the initial stages of death. Physicians are now able to predict with an uncanny degree of accuracy how much longer the human organism can survive when threatened by any number or variety of diseases. Using this knowledge, many decisions can be made by the patient, him or herself, by family-members or by a medical team of experts.
Yet, from an ethical standpoint, not to mention the legal aspects which are infinitely complex, the actual timing and circumstances of death still fall into a shady area of uncertainty and controversy. Only last month a noted Michigan physician, who had actively participated in the mercy-killing of more than 130 patients, was finally found guilty of unlawfully terminating the life of a Lou Gehrig patient in the final painful stages of the disease. Indeed, Dr. Kevorkian was found guilty of second-degree murder, a verdict which shocked a good percentage of the professional health care field (Time, 1999).
While there may well be cases such as Dr. Kevorkian's brought to the attention of the public through the mass-media, it is estimated that medical personnel across the nation are, intentionally but well within the framework of law, withdrawing life-support technology from tens of thousands of patients annually, some of whom are not in extremis. When doing so, hospitals, nursing homes and elderly hospices refer to, and abide by, procedural guidelines by which they operate in all 50 states (Kurtz, 1965). Euthanasia, therefore, in the broad sense of the term, is being practiced virtually everywhere.
Yet, what about the patients who are not in the final stages of an illness or those who could linger in semi-vegetative states for decades? Increasingly, families are making the often emotional and heart-breaking decisions which financial considerations are forcing upon them. AIDS victims, cancer patients, those with chronic or progressively degenerative diseases, such as cystic fibrosis, multiple sclerosis, debilitating osteoporosis or Lou Gehrig's disease fall into this unfortunate category. With monthly treatments reaching upward into the area of tens of thousands of dollars for private nursing, medication and respiratory or circulatory support devices, the options for even middle-class families are dwindling (Spector, 1991).
As early as the 1950s, euthanasia under these circumstances was practiced in the United States, although it did not assume precisely that label. According to the personal recollections of a colleague's dying grandmother, families in the Post-War years gathered at the bedside of the dying relative -- priest standing to one side of the patient, and family physician with a potentially lethal morphine injection in hand, on the other (Desrosiers, 1999).
In another interview, one recorded by Drs. Daniel Redwood and Kubler-Ross, both noted authorities on death and dying, it was mentioned that patients often prefer to return home and die with family and friends, coffee and cigarette in hand. (Kubler-Ross, Redwood, 1998) Indeed, given the structure of health-care costs and the growing inability of a large segment of the US population to provide a suitable standard of living even for their healthy family-members, a case is being made -- on a broader scale than ever before in this country and on the basis of purely socio-economic reasoning -- for adoption of euthanasia as a standard solution. This seems unfortunate since key reasoning should be based on ethical considerations, not on economic constraints imposed by bankers, financiers and politicians.
Using this scenario, however, as a backdrop for what seems to be transpiring locally in New Mexico, certain pertinent observations can be validly formulated. The Director of Casa de Oro Nursing Home, located in Las Cruces, has routinely interfaced with Memorial Medical Center and with local HMOs to provide counseling and advice to families confronting the serious decision of whether or not to sustain the life of a loved one. Virtually daily, the interaction of these health professionals with families occurs at Casa de Oro and other area nursing homes (Desrosiers, 1999). Elderly patients, in pain and misery, are evaluated; progress notes on their conditions are kept, and, when medical records indicate a downward trend, a decision to withhold life-support, entailing in a sense the actual 'committing' of euthanasia, is made, jointly and solemnly. Occasionally, when the patient is unconscious or judged incompetent, the decision at nursing homes is made by the spouse, often against the wishes of siblings, offspring or medical practioners. In these cases, the spouse's wishes are usually honored, unless there are compelling medical reasons to believe that the patient is likely to improve. Of course, euthanasia can also become a "solution" when the patient him or herself decides, in advance, in conjunction with the spouse. However, because this decision is made in advance, as in the case of Jackie Kennedy, for example, who decided several weeks before her death that she wanted no heroic measures to be taken, it is sometimes subject to change later on for emotional or medical reasons, according to Kubler-Ross in both her general writings, and in her famous work entitled On Death and Dying (1970).
In addition to the material produced by the authors referred to earlier, namely Baird, May and Kluge, the Hemlock Society, founded by Derek Humphry, distinguished author of Freedom to Die and Final Exit, has published extensively in the field of justifiable homicide, or euthanasia. Indeed, while this topic has become better known in recent years, it has its origins actually in the era of Socrates, when "suicide", assisted or unassisted, for principled motives may have set in motion much of the pro-euthanasia thinking for millennia to come (Humphry, 1996).
Putting all of this into proper perspective, however, it can be seen that the spectrum of pro-euthanasia reasoning advanced by Kubler-Ross, by elements within the AMA, by various American educational associations, as well as by the popular press and throughout a large swath of academia, has created ripples in public thinking and in legal circles. In my estimation, basing my feelings both on my reading in this area and on my own grandmother's impending death, there can be no doubt that, when medical hope evaporates, and the patient is undeniably suffering either physically or emotionally, euthanasia (whether assisted suicide, withdrawal of life-support in a passive sense or medically induced) seems justified, particularly with the consent of spouse and medical officials.
The human entity is far too dignified, and far too beloved by kith and kin, to linger in pain and misery for months or years in the name of sustaining an essentially inviable life. People, even in extreme situations, according to Dr. Kubler-Ross, can face death with dignity and equanimity, as did the children at Treblinka who, although they had witnessed some of the most horrific acts of which man is capable, left behind drawings of butterflies on their concentration camp walls, often mere hours before their deaths.
REFERENCES
Baird, R.M. and Rosenbaum. S.E. Euthanasia: The Moral Issues , Prometheus Books, Buffalo, 1989.
Desrosiers, L. Personal Interview, El Paso, Texas, April 1999.
Hemlock Society Inter Net Site, http://www.finalexit.org/USA.dir.html#hemlock
Humphry, D. Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, Dell Trade Paperbacks, New York, 1996.
Humphry, D. and Clement, M. Freedom to Die : Politics and the Right-to-Die Movement, St. Martin's Press, New York, 1998.
Hyde, J. "Dr. Kevorkian -AP Release", Albuquerque Journal, March 26, 1996
Kluge, E. W. The Practice of Death, Yale University Press, New Haven, 1975
Kubler-Ross, E. On Death and Dying, Macmillan, New York, 1970.
Kubler-Ross and Redwood, (Interview) http://www.doubleclickd.com/Articles/kubler.html, 1998.
Kurtz, R.H. Manual for Homes for the Aged, compiled and published by Federation of Protestant Welfare Agencies, New York, 1965.
May, W. and R. Westley The Right to Die, Thomas More, Chicago, 1980.
Orentlicher, D. "The Alleged Distinction Between Euthanasia and the Withdrawal of LifeSustaining Treatment: Conceptually Incoherent and Impossible to Maintain.", University of Illinois Law Review, Urbana-Champaign, 3:98, 837.
Spector, R.E. Cultural Diversity in Health and Illness, Appleton & Lange, Stamford, Ct., 1996.
Thompson, B. APA Citation Style Model: Educational Information Resources Center
http://www.ed.gov/databases/ERIC_Digests/ed391990.html
................. "Dr. Kevorkian Found Guilty", Time Magazine, April 6, 1999
................. "Nursing Home Evictions", Albuquerque Journal, March 26, 1999,
................. Random House Unabridged Dictionary, Random House, New York, N.Y.,1993.