Other people's lives: reflections on medicine, ethics, and euthanasia.

AuthorFenigsen, Richard

Part Two: Medicine Versus Euthanasia

Chapter XXI. The Philosophy Of Euthanasia

"Use logic to overcome the scruple." (245) Francois Mauriac

The advocates of physician-assisted suicide, or voluntary euthanasia, present the following argument:

* Hopelessly ill people who in the end will have to die in unbearable pain, wish to be freed from a life that has become a burden to them. They should not be compelled against their will to endure their meaningless suffering. Medical progress can now extend the lives of the gravely ill; in doing so, the doctors are guided by technical considerations, without regard for the human aspect of such interventions. As a result, people are condemned to an unbearable life and to a death unworthy of human beings.

* Another important factor is the aging of the population, the prevalence of disabling infirmities inherent in old age, and the proliferation of nursing homes and institutions for chronically ill residents, who are cut off from their families, isolated from the rest of society, and who have lost faith in the meaning of their lives.

* And let's not forget the terrible scourge of Alzheimer's disease. "Do any of us want to end out lives with the paralyzing fear and anxiety and the complete loss of one's mental faculties? Do any of us want our spouse to spend ten long, lonely years after losing all real contact with a lifetime partner?" asks a proponent of death by own choice. (246)

* Like every important social problem, this one can and should be solved by society. We have achieved freedom of belief and expression. All problems can now be discussed, all taboos can be shaken and outdated dogmas doubted. The old taboo on killing is at odds with compassion and a truly humane attitude. Suffering people desire to put an end to their lives. The rational autonomous beings' right to make such a decision should be recognized as a fundamental human right.

* However, the extremely painful problem of unnecessary human suffering cannot always be solved by the victims' conscious and voluntary decision. By rigidly adhering to the voluntary principle we deprive infants who are severely disabled and people who are demented or comatose of the chance for a painless death. (247) A number of comatose persons are being kept alive by artificial means, at great effort and expense, and to the despair of their families. Caregivers do not dare to make a decision and cut short these lives. But to keep a comatose person alive is also a decision and the one who makes such decision should be obliged to justify it. (248)

* Steps should be taken to avoid errors and abuses. The patient's families should be involved in the decision. The carrying out of euthanasia and assisting patients in suicides must be entrusted to doctors. The conclusion that the patient's condition is hopeless should be confirmed by a committee or at least another doctor. Physicians who carry out euthanasia or assist their patients in committing suicide should proceed with due care.

While appealing to noble emotions, the argument of the proponents of euthanasia also makes a logical, cogent impression. But assertions that entail irreversible consequences for human life must be supported by irrefutable proof. Thus, all elements in the narrative and all assumptions in the reasoning of the advocates of euthanasia, or assisted suicide, ought to be meticulously examined.

The Abolition of All Taboos. The overthrowing of taboos occurs selectively. Perhaps it is worth reflecting on the fact that society offered little resistance in defending the inviolability of human life while still defending with great force the taboo on private property. Not only have we maintained certain old taboos, but we also have created new ones, like the inviolate right of growing and grown children to live their own lives without the restraining intervention of parents and without concern for them. When Dr. P killed her mother at her request in a home for the chronically ill (the Leeuwaarden trial, 1973), she was reproached in a letter to the editor of Time Magazine: "probably taking the mother home would have solved the problem, but this did not occur to Mrs. P." Indeed it did not. Killing her mother was an acceptable solution, but disturbing her own well-ordered life was not. In Dr. P's eyes, the taboo on killing had already been abolished, but the taboo on privacy was binding. The issue of abolition of taboos would not seem to require further commentary.

All Problems Are Solvable and Every Important Problem Should Be Solved by Society. This is the basic idea and point of departure for the proeuthanasia movement. It is an expression of the triumphant self-confidence of Western industrialized society which has succeeded in solving so many problems. We produce great wealth, we have created a government of law and order and a pluralistic, tolerant community; we are approaching the ideal of peaceful and free life for all citizens. If there are problems, they can always be solved providing there is a genuine will to solve them. If some minority is being discriminated against, we will enforce the appropriate laws and launch an educational campaign. We will set up special classes for children having difficulties with learning. When ice damages the highways, we will repair them. There are no unsolvable problems, only problems awaiting a solution, for example, that people must suffer and then die. The time has come to solve this problem, and it can be done.

But it cannot be done. The notion that all problems are solvable is quite obviously at variance with the truth. It denies the sad reality and man's inevitable tragedy. It is man's fate on this earth to be born, to strive, to struggle, to hope, and in the end, to be disappointed in all he sought, to suffer defeat in every battle, to lose those he loved, to be conscious of the inevitability of death, to suffer and to die; this is a tragic fate and one without a solution. We can solve many problems, but not the ultimate ones.

The "solution" proposed by the pro-euthanasia movement is obviously a sham. We can blow up a ship that is taking on water, but we cannot assert that thereby we have solved the problem of leakage. No problem is solved by destroying the thing involved.

Institutions for the Elderly and the Chronically III. These institutions have been created due to a great demand, are maintained at high financial cost, and perform a very useful function. On the other hand, the negative aspects of these institutions are also evident. Some people, isolated in an institution, lapse into depression and may even think of hastening their own death. But to use this argument to justify euthanasia is logically (not to mention morally) inadmissable. Institutions for the ill and aged are not natural disasters to which, with all their consequences, we must resign ourselves. These institutions are the result of our own deliberate actions. They were created as places where the elderly can live. Had our efforts produced only the opposite result, leading to people asking for death, then the logical conclusion would have been to close the institutions, not to kill the residents.

But, of course, in reality this is not necessary. Married couples manage well in institutions and many single persons adapt quite reasonably. And we should encourage other solutions for those who fare poorly: first of all, quality care for the elderly who stay with their families or alone in their own apartments. It is less expensive than maintaining the institutions.

The assertion that "we have done so much to improve the lives of the elderly that now we must kill them" is obviously absurd.

Keeping the Sick Artificially Alive with Modern Technology. The allegation that it is modern technology that produces the demand for voluntary euthanasia can hardly be substantiated. In Holland, in the majority of cases, euthanasia is performed by family physicians, at patients' homes, on patients treated without any special techniques. Hospital patients who are conscious and tired of treatment and all the machines, have the right to refuse treatment, and have always had this right and exerted it. If the patient is unconscious there in no question of "voluntary" euthanasia.

The theorists of euthanasia do not take into account that the hated "modern technology" can actually encourage patients' will to live. Patients in respiratory failure, admitted to intensive respiratory care units, after a few days of assisted ventilation, clearing the airways, antibiotics, and steroids, leave the hospital in improved condition and an optimistic frame of mind.

And let's note that the allegations of senseless prolonging life through use of modern technology were already made in 19th century: In 1875, Ernst Haeckel wrote about "improved modern medicine" which supposedly was not permitting "those unworthy of life" to die, (249) and in 1899, Baldwin accused "subcutaneous injections, transfusions and intravenous infusions" of allowing medicine "to keep us from the grave in a state of constant struggle for life." (250) And yet at that time the ability of medicine to prolong human life was almost nil. Thus, to use the "modern technology" argument it is not necessary for somebody's life to be prolonged, or even for any such technology to exist.

Death Unworthy of a Human Being. The fate of people who die after long suffering is decried as "unworthy of a human being." A value judgment, of course, but one worth reflecting on. Death, after a short, long, or very protracted illness and suffering, is not an invention of modern medicine, it was always the sad fate of many people. Victims of plague pneumonia died in few days, but patients in congestive heart failure dragged on for a couple of years, breathless and on swollen legs, and soldiers with abdominal wounds sometimes took months to die. To believe the advocates of euthanasia, the majority of our predecessors on this planet, hundreds of...

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