We live in an age of medicine filled with technological wonders – and difficulties. Andre and Velasquez (2010) state that “medical technology has given us the power to sustain the lives (or, some would say, prolong the deaths) of patients whose physical and mental capabilities cannot be restored, whose degenerating conditions cannot be reversed, and whose pain cannot be eliminated.” This poses a medical and ethical dilemma that has pitted us one against the other – should we allow the people in these positions to choose to die, or do we have a moral obligation to preserve life at all costs? This dilemma is alternatively known as euthanasia, dying with dignity, the right to die, murder, or physician-assisted suicide (PAS), depending on whom you ask. We will address it as PAS here.
Before we discuss the controversy surrounding this issue, we must determine what is meant by “death.” In the past, death was pronounced when the heart stopped beating and the person stopped breathing (Hahn, Payne, & Lucas, 2010). Now, however, we can “sustain lives” with artificial respirators, feeding tubes, and medications, even if there is no hope of recovery for the patient. If that is the case, when, then, does death occur? DeSpelder & Strickland (as cited in Hahn, et. al (2010)) inform that The Uniform Determination of Death Act of 1981, which is adhered to by most states in defining death, states, “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” We will use this definition in this article.
At the heart of the controversy surrounding PAS is whether, once born, an individual has a fundamental right to his or her own life – can he choose not only how he wants to live, but also when and how he wants to die? The ACLU (American Civil Liberties Union) (1996) says, "The right of a competent, terminally ill person to avoid excruciating pain and embrace a timely and dignified death bears the sanction of history and is implicit in the concept of ordered liberty.” The Supreme Court, however, in Washington, et al, Petitioners v. Harold Gluckberg et al. (1997), claims, "The history of the law's treatment of assisted suicide in this country has been and continues to be one of the rejection of nearly all efforts to permit it. That being the case, our decisions lead us to conclude that the asserted 'right' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause." The justices thereby left it up to the individual states to decide on legislation allowing or banning physician-assisted suicide. To date, only two states, Washington and Oregon, have laws permitting PAS.
Andre and Velasquez (2010) address the issue of PAS legislation, as well. They say, “Supporters of legislation legalizing assisted suicide claim that all persons have a moral right to choose freely what they will do with their lives as long as they inflict no harm on others. This right of free choice includes the right to end one's life when we choose Furthermore, it is argued, we ourselves have an obligation to relieve the suffering of our fellow human beings and to respect their dignity.” They recognize, though, that others oppose such legislation, and on this they comment that “Those who oppose any measures permitting assisted suicide argue that society has a moral duty to protect and to preserve all life. To allow people to assist others in destroying their lives violates a fundamental duty we have to respect human life. A society committed to preserving and protecting life should not commission people to destroy it.”
Physicians, too, are conflicted about the issue, especially in light of the Hippocratic Oath’s vow to “do no harm.” Dr. Barbara Rockett (2012) claims that PAS is in direct violation of the physician’s oath. Responding to its directive that says, “I will give no deadly medicine to anyone if asked nor suggest any such counsel,” she comments, “Physician-assisted suicide is in direct conflict with this statement which, when followed, has protected the patient, physician, society and the family, and at the same time has committed doctors to compassion and human dignity.” Yet, Dr. Phillip Nitschke (2001) notes that, "Over time the Hippocratic Oath has been modified on a number of occasions as some of its tenets became less and less acceptable Does not doing harm mean that we should prolong a life that the patient sees as a painful burden? Surely, the 'harm' in this instance is done when we prolong the life, and 'doing no harm' means that we should help the patient die. Killing the patient – technically, yes. Is it a good thing – sometimes, yes. Is it consistent with good medical end-of-life care: absolutely yes."
The Los Angeles Times (2005) summed up the dilemma quite well when it said in an opinion post, “ for both patients and their loved ones, real decisions are demanded: When do we stop doing all that we can do? When do we withhold which therapies and allow nature to take its course? When are we, through our own indecision and fears of mortality, allowing wondrous medical methods to perversely prolong the dying rather than the living?” There are no easy answers to any of these questions, and there is much room for continued debate between individuals, physicians, ethicists, politicians, and religious leaders. We must determine not only what death is, but how, and even when, death should occur. Can we, in good conscience, allow friends and family to suffer needlessly while we have the power to grant them peace? Yet, surely, we must impose some limitations on that power to prevent what may become inevitable abuse.
Perhaps the answer lies in living wills, advanced directives that specify an individual’s preferences if he ends up in an incurable medical state and cannot speak for himself. When the wills request that death be permitted, and when that request is upheld, they affirm that we, as individuals, have the right to control our own deaths, just as we have the right to control our own lives. They allow us to die on our terms and with dignity. It is as William Ernest Henley said so eloquently in his 1888 poem, Invictus, when facing his own mortality: “It matters not how strait the gate, how charged with punishments the scroll. I am the master of my fate: I am the captain of my soul.”
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Benatar, D. (2011 October). A legal right to die: responding to slippery slope and abuse arguments. Curr Oncol. 18(5), 206–207. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185895/
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Henley, W.E. (1888). Invictus. PoemHunter.com. Retrieved from http://www.poemhunter.com/poem/invictus/
Nitschke, P. (2001). Euthanasia Sets Sail. National Review Online. Retrieved from http://euthanasia.procon.org/view.source.php?sourceID=000951
Opinion. (2005, 22 March). Planning for Worse Than Taxes. The Los Angeles Times. Retrieved from http://euthanasia.procon.org/view.resource.php?resourceID=000126
Rockett, B. (2012, 31 July). Physician-assisted suicide “in direct conflict” with doctor’s role. [Web log comment]. Retrieved from http://www.boston.com/whitecoatnotes/2012/07/31/barbara-rockett-physician-assisted-suicide-direct-conflict-with-doctor-role/zlbvvbRy4YmSOvcIqHJeIN/story.html
U.S. Supreme Court. (1997). Washington, et al., Petitioners v. Harold Gluckberg et al. 96-110. Retrieved from http://euthanasia.procon.org/sourcefiles/WashingtonvGlucksberg.pdf