Euthanasia: A Case of Individual Liberty?

by Jay Johansen

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Pro-euthanasia people typically portray euthanasia as a case of individual liberty. If a person decides that he wants to die, perhaps you or I do not think this is a good decision, but what right do we have to tell him that he cannot do this?

They usually describe a situation like this: A person has some terrible, deadly disease. He is trapped in a hospital bed, with all sorts of medical equipment connected to him, unable to move or do much of anything except exist. He is in terrible pain. He begs to have these machines disconnected, so he can go home and live out whatever life he has left and die in peace. But the doctors refuse, because to turn off the machines would surely result in his death, and they have an ideological bias against doing this.

Doesn't the patient have the right to make that decision for himself?

While that is the public relations speech, that isn't where the debate really is today. It is extremely rare today for a doctor to try to force someone to receive medical care that he doesn't want. Pro-lifers readily agree that anyone should have the right to refuse medical treatment if he believes the side effects -- whether pain or the burden of being tied to some machine or whatever -- are worse than the disease. Even if this means he will live a shorter, but presumably more enjoyable, life.

If someone refused medical treatment because he literally decided that he would rather be dead, assuming that he is not being pressured by others and he is sane and not making this decision rashly in a period of depression ... Well, this certainly stretches the limits of what we mean by personal liberty, but ... maybe that's a difficult, debatable moral issue. But it is not the issue that we face today.

The real issue today is two types of cases:

One: People who, perhaps because of a serious illness or perhaps for reasons unrelated to their illness, are extremely depressed and say they want to die. These people are no different than anyone else who thinks about suicide -- they just have medical problems in addition to their emotional or psychological problems. Some ill people become frustrated that they cannot lead the kind of active lives that they used to before their illness. Some feel guilty about being a burden on their family. But social workers and psychologists have routinely found that when people like this talk about or attempt suicide, the vast majority don't really want to die. What they want is to get the attention of those around them. They want people to say, "No, please don't die, we love you", or "We didn't realize you were so unhappy." They want their suicide attempt to fail. To tell such a person that he has a "right" to commit suicide and that you will help him do it, is to say, "You're right, you are a useless cripple, you're a burden on your family, you're wasting the time of the doctors, and the world would be better off without you."

Even if we accepted the idea that some people might make a reasoned decision to commit suicide, surely we would exclude people who are in moments of depression, or otherwise not fully competent. Wouldn't we? The Iowa Law Review published a "Model Aid-in-Dying Act" (October, 1989) that states might want to adopt. Under this model act, a child over the age of 6 could request "aid in dying" and if his parents refused to go along, an "Aid-in-Dying Board" could overrule them and grant the request. (That's right -- age six!) Jack Kevorkian has written that euthanasia should be available to "the so-called mentally ill whose life circumstances are subjectively intolerable". [letter to Kathy Solari, 28 March 1990]

Two: People who are suffering from illnesses that make them unable to communicate. This includes people who are in a coma, or paralyzed, or simply so sick and weak that they cannot make meaningful sounds or other communication. The pro-euthanasia people say that such patients' "quality of life" is so low that they are better off dead and they should be killed. In the United States, the most frequent way of killing such people is by taking away their food and fluids, so that they starve to death. This must be one of the most agonizing ways to die. They typically give them drugs to prevent their bodies from going into convulsions as they starve, because this would be disturbing to family and friends who come to see the person "die peacefully". This is called "passive euthanasia". "Passive" because they are not directly killing the person: they just define food and fluids as "medical treatment", and then they stop this "medical treatment".

Pro-euthanasia people often say that "of course euthanasia should be limited to people who are terminally ill". They define "terminally ill" as meaning that the person will die within a few months without medical treatment. But if food and fluids are considered "medical treatment", than by this definition who is not "terminally ill"? Surely anyone would die within a few weeks if the "medical treatment" of eating and drinking is taken away from him. (At least in the Netherlands they are more merciful and directly kill the person with a lethal injection rather than slowly starving him to death.)

This is one of the most frightening forms of euthanasia: a person decides that someone else's life is not worth living, and kills him.

But most frightening of all is the argument that someone should be "euthanized" because he has become a burden on society. They will say, for example, that we cannot afford to provide the expensive medical care that this person requires and it will only extend his life by a few months anyway. Isn't it better to spend the money on something more useful? Or they may make the argument a little more abstract, they will say that we must eliminate the "defective" in order to "strengthen the gene pool", or that we should eliminate "surplus" people because the world is "overpopulated". As Jack Kevorkian, the "Doctor of Death" who has been involved in a number of euthanasias in Michigan, put it, "If a rational policy of planned death can be attained, the benefit for society is incalculable". [Transcript from hearing in Michigan v Kevorkian, Oakland Circuit Court, 9 June 1990, Kevorkian's testimony]

First, let's distinguish between extraordinary medical care; and simply providing a warm bed, food and water, and simple medicines. Pro-euthanasia people will try to confuse the issue on this point. I do not say that society should be willing to devote unlimited resources to extending the life of any given person. (While it would be nice if everyone could get all the medical care they need or want for free, in the real world there are only so many doctors, so much medical equipment, etc., and to make more we would have to take away from something else.) I do say that we should never deliberately kill someone because he is "in the way".

A case study, related to me by a friend who is a doctor: He went to visit a patient in a nursing home. The director of the nursing home told him that a couple had recently come to visit their mother at the home, and told him that they wanted him to euthanize her. They frankly told him, "We just can't make it without grandma's inheritance", and they were getting impatient waiting for her to die on her own. The nursing home director threw them out. The next time my doctor friend visited, the director told him that the couple had transferred grandma to another nursing home. Two weeks later, she was dead.

Another case study, related by a Dutch doctor: He diagnosed a woman with cancer. He checked her into the hospital on a Thursday and began treatment. The treatment was quite successful. By Saturday she was showing definite signs of improvement. On Sunday he was quite hopeful she would fully recover. On Monday he came to visit and there was a different patient in her bed. He asked the hospital staff where they had moved her. "Oh", a resident replied, "we needed the bed, so we gave her the injection last night". He meant a lethal injection, of course.

I have heard anecdotal stories that elderly people in the Netherlands are now afraid to check into hospitals, for fear that they will be killed. According to Rita Marker of the International Anti-Euthanasia Task Force, euthanasia now accounts for 15% of the deaths in the Netherlands.

A few years ago Governor Richard Lamm of Colorado said that the "terminally ill elderly have a duty to die and get out of the way". ["Elderlys' Duty to Die", New York Times, 29 March 1984]

Note that we have already made the transition from discussing "a right to die" to "a duty to die".

What does it say about our society, when we say that we will stop caring for a person because he is "unproductive" or "surplus"? I do not believe that the value of a human life can be measured by how many machine parts this person can make or how much he can be expected to pay in taxes. We must engage in economic activities to live, but this is not why we live. The purpose of economics is to sustain human life; the purpose of human life is not to sustain economics. A crippled person, a mentally retarded person, or an old person is no less valuable than a young and healthy person. The fact that they contribute less to the economy (even if true -- some are as productive as you and me) has nothing to do with their value as human beings.

Yes, there are limits to how much we can do for people in need. Sometimes we must make hard decisions, like when there are only two doses of medicine but three patients. The healthy have needs too: we cannot devote all our resources to caring for the sick. But we must constantly strain against these limits, we must cry when we are forced to say sadly that there is no more that we can do, and watch another human being slip away. To do anything else makes us less than human. To say callously that we will allow someone to live only as long as he provides some material benefit to us ... Is that the kind of world we want to build?

Posted 6 Sep 2000.

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Copyright 1995 by Jay Johansen
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