Compassionate Death

There can be no such thing as a "right to assisted suicide" because there can be no legal and moral order which tolerates the killing of innocent human life ...

-- Joseph Cardinal Bernadin, November 7, 1996

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Evolution of Meaning

Originally, the term "physician assisted suicide" meant the provision by a physician of the means by which a suffering, terminally ill patient could initiate his or her death. The term "euthanasia" means the killing of a terminally ill person to end his or her suffering. Now, by practice, the term "physician assisted suicide" has been broadened in meaning to include the administration of a lethal substance by a physician to a suffering patient -- a form of euthanasia. Thus, physician assisted suicide can now be defined as any action taken by a physician to provide death to a patient.

Devaluation of Life

For 2000 years of Western Civilization, it was widely accepted by moral philosophers and theologians that the individual human being has infinite intrinsic value, and that the intrinsic value of one human being is equal to that of any other. Such beings have moral rights and obligations that not even they have the moral authority to wave. They are not “owned” by anyone, not even themselves.1 Even so, many times during the history of Western Civilization, groups of humans have been defined arbitrarily as inferior and treated as having less than infinite value. We just need to think of Native Americans and African slaves in America or the Jews and gypsies an areas of Nazi control as examples.

However, since 1960, American society increasingly has embraced the absolute autonomy (“choice”) of the individual. In addition, many moral philosophers and theologians have accepted the relativity of the value of human individuals. They have accepted the premise that some humans are intrinsically superior to others.2 This presumption has rapidly permeated Western Culture.

In particular, the lives of humans with debilitating disease, injury, or other conditions are deemed to be of inferior quality. Also, the lives of children born with certain defects are deemed to be of inferior quality by some. Such devaluation of human life has fueled the campaign for physician assisted suicide.

Utilitarianism

Behind the devaluation of human life is the philosophy of utilitarianism.3 The value of an individual is measured by his or her usefulness to the group in the “strikingly primitive and vulgar form of utilitarianism”4 used to support euthanasia.

We have seen further consequences of this form of utilitarianism. After abortion was legalized, the rush was on to conduct research first on aborted fetuses and now also on human embryos specifically grown for that purpose. As a precursor to the legalization of infanticide, viable organs of defective newborns are being used for transplantation. In the view of this form of utilitarianism, it is morally right to sacrifice “inferior” humans for the benefit of others.

Already, the euthanasia movement has begun to have some success in changing the standards of patient care and in the attempted legalization of assisted suicide.

Redefining Patient Care

The basic level of patient care is that of "comfort care". This includes the provision of pain control, a room with a comfortable temperature, a bed with clean sheets and adequate pillows, proper positioning, food, water, bathing, and other personal care in a supportive environment.

"Therapeutic care" is a higher level of care. This includes the use of medication, surgery, radiation, and other treatments to cure a disease, to remove diseased tissue, to shrink tumors, etc. Therapeutic care can be divided into usual and customary, such as giving an antibiotic, setting a broken bone, and removing a cataract; and "extraordinary care", such as the transplanting of hearts, lungs, etc. Within the medical profession, usual and customary care is almost always mandatory, while extraordinary care is judged by considering many factors.

As an indication of a movement toward euthanasia, court decisions in several states have moved the provision of food and water from “comfort care” into the level of “treatment” -- effectively, "extraordinary care". The family, the physician, or the medical facility can then decide to withhold food and water with the intent of causing death.

Since death by starvation and dehydration is a lengthy process, there is agitation to provide a quicker death through physician assisted suicide.

Suicide; Assisted Suicide

It is very rare that someone with a serious disability commits suicide.5 Rather, as society views seriously disabled and terminally ill individuals as burdens with unacceptable quality of life, these persons may feel an obligation to commit suicide.

Terminally ill patients who wish to commit suicide often have been found to have clinically diagnosable depression.6 Usually, those with clinical depression can be helped with professional counseling and medication.7

With rare exceptions, those who commit suicide suffer from identifiable mental disorders.8 Family and friends need to be on the alert for signs of depression and other mental disorders so that help is obtained.

Immanuel Kant, the philosopher, has given convincing arguments against the rare cases of “rational” suicide in his Lectures on Ethics. To summarize his position: Suicide is strictly incompatible with respect for one’s humanity: treating oneself as only a means to the end of avoiding pain or distress. Suicide is self-contradictory in that the power of free will (the right to choose) is used for its own destruction. Suicide degrades human worth to that of beasts or lower. Suicide is contrary to the highest duty a human being has toward himself or herself: respecting oneself as a person.

For defenders of physician-assisted suicide, there are embarrassing questions. Have those physicians examined the patients’ records to find out if they have been given adequate pain medication or if they have been examined for depression? If patients have made “rational” choices for suicide, are not these physicians assisting them in ethically questionable acts? Finally, do not physicians who assist suicide help to create an atmosphere of distrust between physicians and patients: if the physician cannot cure you, will he care for you or will he kill you? It is reasonable to conclude that physicians who are involved in assisting suicide are doing a disservice both to their patients and to their profession.

Legalizing physician assisted suicide is a giant step toward legalizing euthanasia, in general. Patients who are not terminally ill will demand euthanasia based on equal protection under the law.

On June 26, 1997, the United States Supreme Court, in a unanimous decision, ruled that states have the right to prohibit physician-assisted suicides. The Court said such bans did not violate either the equal protection or the due process clauses of the U.S. Constitution. However, the ruling does not prohibit states from allowing physician-assisted suicide in narrowly defined cases.

The Holland Example

While it began with a few extraordinary cases, physician assisted suicide and euthanasia have now become routine in the Netherlands, accounting for almost 10% of all deaths there in 1990.9 More than half of the people did not ask to be killed.10

Not only do physicians perform assisted suicide on terminally ill patients, but they also kill newborn infants and hospitalized seniors whose quality of life is judged to be too poor.

There is increasing concern about involuntary euthanasia among Dutch citizens with disabilities. Many of them are joining the Dutch Patients’ Association which issues a wallet-sized card stating that it is “intended to prevent involuntary euthanasia in case of admission of the signer to the hospital.”

Judges have set up guidelines to protect patients. These guidelines are to be honored before a doctor can kill a patient. They include repeated requests by a rational person to die, uncontrollable pain, witnesses, and two doctors who agree the criteria have been met. In practice, few of these guidelines are even considered; the need for repeated voluntary requests has been routinely ignored.11

The lesson of physician assisted suicide in the Netherlands is how quickly the decision moves from a patient’s request to a surrogate’s request to a physician’s personal decision.

The experience of the Netherlands should not serve as a precedent. There are positive alternatives to assisted suicide and euthanasia: pain management and Hospice care.

Can Pain be Controlled?

Contrary to pro-euthanasia propaganda, physical pain, with rare exceptions, can be controlled if the physician knows the appropriate treatment for pain and is not afraid to prescribe a sufficiently high level of medication.12 Unfortunately, it is taking a long time to educate physicians in proper pain management.

Another type of pain that drives people to ask to be killed is emotional pain. The feelings of loneliness, isolation, hopelessness, despair, meaninglessness, loss of dignity, uselessness, weariness with life, and the general fear of being a burden to others can be overwhelming. In these cases, as with any emotional problem, the standard response should be psychological, family, and spiritual counseling.

The Hospice Alternative

Compassionate care is available for terminally ill people with only a few months to live and their families through the Hospice program. Great effort is made to keep patients comfortable during this final period of their life when curative treatment is no longer being sought. Attention is given to the emotional and spiritual needs of patients and their families, as well as to the physical needs of the patients. This care is provided both at home, with visits by nurses, social workers, chaplains, and counselors, and in skilled nursing facilities.

Predictions

Physician assisted suicide was originally aimed at killing terminally ill people in intractable pain. However, the meaning of physician assisted suicide is rapidly being broadened further to include the provision of death to suffering patients who are not terminally ill and then to patients who are judged unfit to live. As in the Netherlands, patients will be subjected to euthanasia to spare family members or caretakers from the burden of their care. At risk will be people with disabilities, mental retardation, mental illness, and frailty due to advanced age.

Many physicians and hospitals will refuse to perform assisted suicide, so for-profit euthanasia centers will be established, much like present abortion centers. People in the group at risk will be pressured into choosing euthanasia, or their surrogates will make the choice for them. Given time and perspective, the families and surrogates may feel guilt for having participated in the decision.

What Can You Do?

Become informed about the advantages, limits, and appropriate use of medical technology. Ask your family physician about his position on pain management. Determine your hospital’s policies on the use of medical technology and the rationing of medical care. Discuss with your family what kind of care you want if your condition prevents you from making decisions for yourself, then put your wishes in writing. Establish a durable power of attorney for health care instead of a “living will,” using great care in your choice of the person to whom you grant that power. Help to educate others about these precautions.

Most importantly, adopt a critical attitude toward the notion of compassionate death and recognize the role of physician assisted suicide in the ongoing devaluation of human life.


1 Robert P. George and William C. Porth, Jr., “Death, Be Not Proud,” National Review, 6/26/95.

2 Joseph Fletcher, Situation Ethics: The New Morality. The Westminster Press, 1966.

3 For example: Peter Singer, Practical Ethics, second edition. Cambridge University Press, 1993.

4 Fr. Richard John Neuhaus, "Don’t Cross This Threshold,” Wall Street Journal, 10/27/94.

5 W. Peacock, Active Voluntary Euthanasia, Issues in Law & Medicine, Winter 1987.

6 Brown, James H, et al, "Is It Normal for Terminally Ill Patients to Desire Death?” American Journal of Psychiatry, Volume 143 (1986).

7 Joseph Richman, Letter to the Editor, “The Case Against Rational Suicide,” Suicide and Life Threatening Behavior, Volume 18(1988).

8 Barraclough, et al. "A Hundred Cases of Suicide: Clinical Aspects,” British Journal of Psychiatry, Volume 125 (1976). E. Robins, The Final Months, 1981.

9 Medical Decisions About the End of Life: Report of the Committee to Investigate Medical Practice Concerning Euthanasia; The Hague (1991). Demographic Year Book, United Nations (1992).

10 Ibid., combined with the Remmetink Report.

11 Carlos Gomez, Regulating Death. Free Press, 1991.

12 Einstein, Albert, "Overview of Cancer Pain Management,” in Pain Management and Care of the Terminal Patient, 1992.

Printed copies of this article can be obtained from:
Dayton Right to Life
Suite 830
211 South Main Street
Dayton, Ohio 45402
(937) 461-3625

Posted 6 Sep 2000.

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