What's Wrong With Involuntary Euthanasia?
by David N. O'Steen, Ph.D., and Burke J. Balch, J.D.
A massive push is now underway to ensure that many people
with a supposed poor "quality of life" --
not only people with disabilities that are congenital, but also with
disabilities caused by illness or
injury -- are "allowed" to die against their will.
This campaign for involuntary euthanasia demonstrates that pro-lifers were
correct when we said that euthanasia proponents would never stop at "voluntary"
For many years euthanasia advocates, for public consumption at least, have
marched under the banner
of "autonomy" and "respect for family decisions." They pushed for living will
laws, and later for durable
power of attorney laws, that would enable people to say they didn't want
life-saving treatment or to authorize others to refuse it if the authors should
become incompetent. Any opposition to these measures
was dismissed as an effort to "impose morality" on the free choice of patients
to decide for themselves.
At the same time, euthanasia advocates masked their true intentions by
appealing to the sanctity of the family. If a patient had left no word about
whether she wanted her life preserved, they argued, the decision
should be made exclusively by her nearest and dearest -- her family. They
inveighed against any governmental "interference" through the courts or even
those agencies established to protect the rights of vulnerable people.
Now, having "succeeded" in achieving widespread legalization and acceptance of
both of these positions, euthanasia proponents are dramatically changing their
As the pro-life movement has warned all along, the true motive of
many leaders of the euthanasia movement is to eliminate those with a poor
"quality of life." Individual rights, autonomy, and deference to
farnilies were all convenient slogans with which they successfully assaulted
what twenty-five years ago was the prevailing ethic of respect for all life.
Today, however, the culture has changed, so that the quality of life ethic
arguably has become predominant. And in this context, euthanasia advocates are
now discarding the principles of individual and
family autonomy they once so extolled. For them, there is no room for respect
for the autonomy of those who want to live.
We used to hear denounciations of the "paternalism" of doctors who, citing the
Hippocratic Oath, expressed reluctance to starve their patients at their
family's request. Now, some of those who used to be
most vociferous in attacking physician paternalism argue that patients and
families have no right to obtain
lifesaving treatment whenever doctors believe the life it will preserve lacks
We in the pro-life movement must now educate ourselves to take part in a great
debate about whether people who want to live should be allowed to live. What
are the facts and the arguments?
||What Is the Evidence That Doctors Are
Really Denying Treatment So People Die Against Their Will?
||Even a cursory look at the medical literature
reveals that a rising number of health care
providers are insisting that when they believe
a patient's life is not worth living because of
the person's disabilities or poor "quality of
life," this means they should be able to deny
lifesaving treatment, even if the patient and
patient's family disagree:|
- A nursing home study reported in the March 1991 New England Journal of
Medicine found that 25 percent of the time advance directives were not
followed by the nursing home and medical staff. (An "advance directive," such
as a Will
to Live, contains instructions about medical treatment left by patients to
guide health care decisions in which they are no longer able to
participate.) The popular myth is that patients are "overtreated." But this
study found that in 18 percent of the cases the
patients were denied treatment they had requested, compared to only 7 percent
of cases in which treatment they had rejected was provided.
- In September 1990, the Journal of the American Medical Association
published an article arguing that when family members
who direct that their relative bc resuscitated have "views about suffering and
quality of life [that] differ substantially from those of
most reasonable people ... then physicians should not be forced ... to adhere
to family preference."
- In December l990, the Society of Critical Care Medicine issued a "consensus
report" asserting that health care providers have the right to refuse therapy
requested by a patient if they think it "burdensome." This
includes treatment for which they think "loss of function [is] ...
disproportionate to benefit" -- even though the patient whom
they are sentencing to death thinks the "benefit" of continued life is worth
the "loss of function."
- In January l99l a Minnesota hospital went to court to try to cut off
medical treatment for Helga Wanglie, an 87-year-old
patient with brain damage. Prior to her incapacity, she had many times made it
clear that she would want lifesaving medical treatment,
food, and fluids if she became disabled. Her family unanimously supported her.
The hospital eventually lost the court battle. But numerous doctors and
ethicists writing about the case made clear it was only a pioneering first
attempt to establish the principle that doctors can deny treatment
against the paticnt's wishes when they consider the patient's quality of life
to be too poor. Indeed, similar cases have reached the
courts of Georgia, Massachusetts, and New Jersey.
- Dr. Donald Murphy of George Washington University Medical Center
believes "lucid individuals probably cannot anticipate what aggressive measures
they would want for themselves should they become demented." Therefore, he
argued in the October 1988 Journal of the American
Medical Association, we "should allow the health care team to make a
unilateral decision to withhold CPR [cardio-pulmonary resuscitation] from
severely demented patients. " The reason? Their "poor quality of life."
||How Can You Force a Doctor to a Give Treatment He or She Thinks
Is Medically Inappropnate?
||There is a world of difference between a legitimate medical judgment
about whether a treatment can save a life and a non-medical
value judgment that a life should not be saved.|
The proper role of a physician includes diagnosis, making judgments about the
probable effect of providing alternative medical treatments, and administering
medical treatment It does not include judging that a life that can be preserved
is not worth preserving, overriding the opinion of the person whose life it
||What About Doctors Who Believe It Is Unethical to Treat Patients With a
Poor Quality of Life? Should They Be Forced to Treat Against Their
||Most living will and durable power of attorney laws currently allow
doctors unwilling to abide by patient directives to transfer
care to another doctor. This was the solution euthanasia advocates successfully
argued should apply to doctors who, for example, feel morally obliged to give
food and fluids a patient or surrogate rejects.|
Why shouldn't the same approach be followed when the situation is the other way
around? All a doctor whose "ethics" forbid preserving the life of a person with
a disability has to do is preserve the status quo by maintaining lifesaving
treatment until the transfer is completed.
Any doctor who enters into a physician-patient relationship assumes certain
duties, which are enforced by medical malpractice suits. Among them is a duty
to give adequate medical care, and not to abandon the
patient. Providing treatment or food and fluids until the transfer is completed
seems a small imposition when the patient's very life is at stake.
Posted 6 Sep 2000.
Copyright 1995 by David O'Steen and Burke Balch
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