Euthanasia: a concept whose time has come?

• Author: Dickey, Nancy W.

The issue to be discussed is euthanasia--its advantages and disadvantages, the reasons supporting its use, and the reasons opposing its use. As Joubert said in the eighteenth century, it is better to debate a question without settling it than it is to settle a question without debating it. The goal is to debate the subject though probably not settle it. The issues of euthanasia have been around for centuries. The restrictions against physician participation date back to Hippocrates and perhaps beyond. Yet the points of view regarding the advantages and disadvantages punctuate discussions intermittently through time and appear to be reaching a crescendo in the United States over the last decade. With the California attempt at a referendum,(1) Washington State's Initiative 119,(2) and the legislative proposals of several states regarding euthanasia or physician-assisted suicide,(3) the United States may be the first jurisdiction to legalize euthanasia since the Romans many centuries ago.

Margaret Pabst Battin has succinctly set forth the diverse philosophic and ethical questions that must be addressed: "Because it arouses questions about the morality of killing, the effectiveness of consent, the duties of physicians, and equity in the distribution of resources, the problem of euthanasia is one of the most acute and uncomfortable contemporory problems in medical ethics."(4) In the extensive debates regarding euthanasia many of these issues have been touched on. Despite this complexity, however, euthanasia has received what appears to be increasing support. Perhaps because of medicine's new technologies and abilities to support life, the problem is, or is perceived to be, more pressing than in the past. There is clearly, in our society, an interest in euthanasia or assisted suicide as an answer to the suffering of the last days before death occurs, particularly for those individuals who have severe pain.

Certainly, the issues and arguments involved are not easily resolved; were there simple answers, we would not have been mired in the discussions for many years. However, understanding the issues enhances the individual's ability to consider the alternatives. I shall present a number of arguments in opposition to euthanasia--reasons why our society should not permit it. There are many concerns about the approval of euthanasia and the problems that might ensue. Some of the concerns might be adequately addressed by vigorous regulation, while others would be difficult to address because they are attitudinal and philosophic. Insofar as the discussion moves the public debate and social decisionmaking forward, we shall have contributed to an important process.

It is imperative in such a difficult area of policy-making that there is deeper understanding of the issues than that which is acquired in the thirty-second sound bite of modern news reporting. Many public discussions appear to be based more upon misstatements and exaggerations than upon facts. The outcome of this discussion is too vital to the future of our society to allow the debate to be based upon half-truths and misrepresentations. For example, in the recently touted New York best-seller, Final Exit, Derek Humphry states that "technology can now prolong life past its natural span. And once those 'miracle machines' are turned on, it is also illegal, most of the time, to turn them off."(5) This statement is simply not true; using living will and durable power of attorney laws, there is widespread ability to discontinue, at a patient's request, treatment that is futile or even treatment that is useful. Humphry's statement is intended to send shivers of fear into the public for the purpose of molding public opinion.

A demand for integrity in the discussion is particularly poignant in that the debate should not be--in fact, is no longer--merely an interesting ethical question. It has become a public debate and probably will be a public decision. As stated by Susan Wolf of the Hastings Center, "The policy question of whether euthanasia and assisted suicide should be legalized, or if not legalized then tolerated under certain circumstances, has long since gone to the public. If bioethicists speak merely to each other, or indeed only to health care personnel, they ignore the full reach of their relevant audience."(6) Since the debate has gone to the public and to the polling place, the public must be given reasonable information, factual and adequate information. To trivialize the issue of dying to salable sloganism demeans all involved. . . not the least, our loved ones who may be suffering.

Professionalism

Certainly, as a physician, I find that one of the most compelling reasons to oppose euthanasia is concern about the usual dependence upon the medical profession to end a person's life. Obviously one does not practice medicine for any period of time without seeing patients die; there are even times that death is welcomed as a better alternative for the individual than the continuance of painful existence. However, physicians virtually never entice death willingly into their presence, and most physicians feel they have taken an oath to do all they can to preserve life and relieve suffering. It is not uncommon to refer to the ancient Hippocratic Oath by which physicians sore: "I will follow that system for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel." Fewer physicians actually recite this oath today, but many continue to espouse the concepts contained therein.

A somewhat more modern ethical prohibition exists in the American Medical Association's Current Opinions of the Council on Ethical and Judical Affairs of the American Medical Association. In Opinion 2.17, "Quality of Life," the Council states: "Life should be cherished despite disabilities and handicaps, except when the prolongation would be inhumane and unconscionable. Under these circumstances, withholding or removing life...