It has become one of our most common and frightening personal and collective nightmares: To find oneself lying in a hospital bed, hooked up to a number of machines, unable to move or speak or otherwise communicate with anyone. Perhaps in this nightmare we are completely unconscious, in a coma alive only in body and by the cruel grace of modern medical technology %u2015 in other, cruder parlance, a “vegetable”. The right to die has become an issue of increased attention and especially because of one doctor; Dr. J. Kevorkian’s assisted suicides and an increased number of suicides in recent times. In a 1991 poll by the USA Today, an 80% of Americans felt that sometimes there are circumstances where a patient should be left to just die, although only 15% of them felt that doctors and nurses should be left to try their best to save a person’s life. I believe the right to die is not an ethical decision because many people feel that taking a life is morally wrong as well as this may lead to burdened families abusing the right to die by encouraging this option over life.
Many people end up in this terrible situation suddenly and unpredictably - as victims of automobile accidents, for example. But more often, we have some advance notice of the possibility of losing control of our mind and body. For most of us, the specter approaches with the inexorable march of time, through the aging process and a slow deterioration of health. But the risk if not limited to the elderly debilitating diseases such as cancer or AIDS can and does strike at any age. There are thousands of people in beds across the nation with little or no awareness of who or where they are, their hearts kept beating and their lungs pumping by the often mixed blessing of artificial life support. In closing this extremely brief analysis of the problem of euthanasia, as a moral question, the question then is: Have we a right to die?
In the Judaeo-Christian tradition, one quality consistently required of all men is that of mercy. Blessed are the merciful, for they shall obtain mercy. Much of our modern medicine must be classified as good scientific medicine, but is it as well human medicine? Is the physician himself acting like a human being concerned with another human being? Doctors are men, and they should be men with aesthetic interests; they should be men with moral concern; and they should be men who have other qualities besides scientific technique and efficiency.
All that was required was a person’s opinion that respiration and heart beat had stopped. Today it is not so easy. Life, at least physiological life, can be maintained by the most extraordinary means. If kidney function fails, the patient can be hooked to an appropriate apparatus that will do the work of the kidneys for a considerable period. Indeed, patients go in periodically to use such apparatus. If one has a disturbance of the respiratory gas exchange, it is a simple matter to connect him to various types of artificial lungs. If a patient has some difficulty with the proper and efficient heart beat, an electronic device known as a pace-maker can be implanted on the surface of his heart; it will trigger his heart beat quite as effectively as the normal physiological mechanism. But often, one physician reminds us, what we do keeps the patient in a state of suspended animation that might be very difficult to characterize as human life. Unfortunately, if he suffers from serious damage to his central nervous system, doctors can continue this suspended animation not only for days or weeks, but for months and, in some very unfortunate cases, for years%u2015years during which there is absolutely no sign that the person is capable of a single human thought or emotion.
“When is a person dead?” writes Frank J. Ayd, Jr., M.D. This is a question concerning more and more physicians. It also should concern philosophers, theologians, moralists, lawmakers, judges, in fact, everyone. There is no legal definition of death based on twentieth-century medical facts. Practitioners of medicine are painfully aware of the fact that it is homicide in law to hasten the death of a person whose demise through sickness or injury is inevitable anyway. In such situations many physicians prefer not to use extraordinary means to preserve life and most would prefer to stop all artificial means of keeping tissues alive. The physician usually does not follow his preferred course of action because he hesitates to leave himself open to prosecution by legal authorities, censure from colleagues, public criticism, the label of killer or euthanasist, and even possible suit by the patient’s relatives (Ayd, 33).
We need to distinguish as well between “clinical” or “medical” death, at which time normal respiratory and cardiac functions cease, and “biological” death, or permanent extinction of life, which quickly follows unless some extraordinary methods are employed to reanimate the body. At the 1964 meeting of the American Medical Association, Dr. Hannibal Hamlin, of Harvard Medical School, urged physicians to use the EEG to determine when the brain has died, declaring that this means the person is dead. When the EEG becomes flat it is indicative of the ending of brain activity. Dr. Ayd raises the question of the difficulty in deciding how long the EEG should be flat before one turns off the artificial respirator and the pacemaker. To show how unreliable this [the time the EEG silence should be] is as a sole criterion of death, Professor Jean Hamburger, of Hopital Necker, Paris, at the 1966 Ciba Foundation symposium, Ethics in Medical Progress, cited two patients who recovered from barbiturate coma after a “flat EEG for several hours”. Despite this difficulty, the French Academy has ruled that a person shall be declared legally dead when his brain has ceased to function, even though other organs may be kept alive by artificial means (Ayd, 36).
One is that medicine as a science seems to be pursuing a policy of prolonging life without taking into consideration the meaning or value behind such prolongation. There are many people who believe that human physical life in absolute terms is sacred. The doctor is obligated by tradition to do everything he possibly can to preserve human life as long as possible. Many of us are concerned about this. Our decisions at any moment as to how far we are morally obligated to go in medicine in using various procedures to prolong life must be based on our best judgment; we need to discuss the matter as intelligently as possible to reach a proper and moral decision. My second concern is that I sincerely believe a person has the right to die with dignity. Some of the heroic efforts one witnesses to prolong life, whether for minutes or years, make me question whether or not as a profession we are paying due regard to this human right to die with dignity.
We are all aware that euthanasia in some form or other and in all kinds of varying degrees is or has been practiced by all medical personnel. Yet no state in our union has any laws permitting its use in any form; in fact, euthanasia is defined by law as either murder or homicide. At a mid-western medical meeting some years ago, the presiding physician asked for anyone in the assembly who had never practiced euthanasia to raise his hand. Not one hand was raised.
First are those who favor voluntary euthanasia (a personalistic ethical position). Second, those who favor involuntary euthanasia for monstrosities at birth and mental defectives (partly personalistic and partly eugenic ethics).Third, those who favor involuntary euthanasia for all who are a burden upon the community (a purely eugenic position). The third might well be stretched to cover Hitlerian genocide. However, it should be perfectly obvious that we do not have to endorse the third just because we favor the first or second or both.
Magnusson in his book, Angels of Death, distinguished between direct and indirect euthanasia. Direct, which he now terms simple euthanasia, is the practice of directly inducing death in order to end demoralizing and incurable suffering. Indirect euthanasia he now terms anti-dysthanasia, i.e., refusal to prolong an ugly or painful state. The “goal, motive, and foreseeable consequences in both forms, the direct and the indirect voluntary courses of action, are the same: i.e., the death of the patient”. He mentions three subforms under the indirect form: 1) administering a death-dealing pain-killer; 2) stopping treatment altogether, not doing anything to prolong the patient’s dying; and 3) withholding treatment altogether, simply not doing anything first or last to keep the patient alive? (Magnusson, 105).
One of the best proposals in favor of euthanasia to my knowledge was a bill prepared and signed by 1,776 New York physicians and presented to the General Assembly in 1947. It was backed by the Euthanasia Society of America and by thousands of other doctors. It contained three provisions: 1) any sane person over twenty-one years of age suffering from an incurably painful and fatal disease may petition a court of record for euthanasia, in a signed and attested document, with an affidavit from the attending physician saying that in his opinion the disease is incurable; 2) the court shall appoint a commission of three, of whom at least two shall be physicians, to investigate all aspects of the ease and to report back to the court whether the patient understands the purpose of his petition and comes under the provision of the act; and 3) upon a favorable report by the commission the court shall grant the petition, and if it is still wanted by the patient, euthanasia may be administered by a physician or any other person chosen by the patient or by the commission. This model bill is permissive, but not mandatory. Neither the patient nor the physician is compelled to act. The patient may change his mind at any time. The bill, of course, did not pass.
I would like to discuss briefly some of the arguments raised against euthanasia. Most of my information comes from Neil M. Gorsuch (2009) book, The Future of Assisted Suicide and Euthanasia.
Three related objections can be grouped together:
What constitutes suicide is difficult to define. The most common ruling among Roman Catholic moralists is that “it is never permitted to kill oneself intentionally, without explicit divine inspiration to do so”. Humility requires us to assume that divine inspiration cannot reasonably be expected to occur either often or explicitly enough to meet the requirements of medical euthanasia. Whether suicide in any form is ever allowable raises a great problem about the war hero, the Christian martyr, any person who gives his life to save another.
As to the charge of murder, the legal definition of such an act implies premeditation with malice. While murder and euthanasia embody the same act%u2015taking a life%u2015they are justifiably different. The injunction “thou shalt not kill” raises the problem that those who justify war and capital punishment, and most Christians do in some way or other, cannot condemn euthanasia on this ground. Furthermore, the commandment is more properly translated “thou shak do no murder”, as it is in our Episcopal Book of Common Prayer. The ancient Jews allowed both warfare and capital punishment. Further, Lev. 24:17 lays down the law, “He who kills a man shall be put to death”, showing that lawful forms of killing may be used to punish the unlawful. The many Hebrew and Greek words used for unlawful killing clearly mean killing treacherously, for private vendetta or gain, or simply murder.
Some argue that “God reserves for Himself the right to decide at what moment a life shall cease” (Magnusson, 65). If such a monopoly theory is valid, it is just as immoral for one to try to prolong life, as in many of the extraordinary medical means undertaken, as it is to shorten a life for incurable and painful diseases. The whole issue seems to be whether we can draw the line between prolonging a patient's life and prolonging his dying. The notion that physical life is absolutely sacred is Hindu or Buddhist, not Christian. The Christian does not have to believe that physiological life is sacrosanct. He is called upon to be ready to give his life gladly for his faith, as for a noble cause.
It is further pointed out that patients pronounced incurable may recover after all, for doctors can and do make mistakes, as do all human beings. Alongside this is the thought that if we hang on, something new may turn up; or that through experimentation with an incurable patient, medicine may learn more. In fact, the move to freeze bodies at the time of death in the hope that they can be revived at some future time when a now incurable disease can be treated falls in the same category. These may be valid arguments for medical advancement, but I question how much mercy is shown for the person who is dying, for example, of metastatic cancer.
Some argue that suffering is a part of the divine plan for the good of man’s soul and must therefore be accepted. Neil M. Gorsuch writes: “The advocates of euthanasia, moreover, disregard the supernatural destiny of man and the role which suffering can play in the achievement of sanctity. They do not realize the ability of man, aided by God’s grace, to bear suffering patiently. They do not know how resignation to pain can serve as penance and temporal punishment for personal moral failings. Lacking a true belief in the supernatural, they have no respect for the power of faith and prayer to produce miracles in even the most hopeless cases. Neither do they understand how the Communion of Saints makes possible vicarious suffering, that is, the ability of man to endure pain for the spiritual good of fellow man. The proponents of “mercy killing”, steeped as they are in a materialistic philosophy of life, cannot grasp the significance of these profound vital truths of Christianity” (Gorsuch, 228).
Anesthesia in surgery would thus be immoral, as would sedatives and analgesics. When we make suffering in general a matter of one’s soul’s good, we overlook the divine suffering on the cross, the atonement, the saving power of the cross, as a singular event. The Sermon on the Mount says: “Blessed are those who are persecuted for righteousness’ sake, for theirs is the kingdom of heaven. Blessed are you when men revile you and persecute you and utter all kinds of evil against you falsely on my account. Rejoice and be glad, for your reward is great in heaven” (Mt 6:10-12). By no stretch of the imagination can I make this cover the suffering of people in sickness and approaching death. The same portion of Scripture says that blessed are the merciful, for they shall obtain mercy.
Furthermore, Gorsuch quotes from an article entitled Counting End of Life Decisions by Clive Seale, in The British Medical Journal of September 19, 2009: “I feel as Dr. Woodward did when he said, “I have no sympathy with the man who would shorten the death agony of a dog but prolong that of a human being”. Dr. Woodward had himself advised a class of medical students, “I hold it to be your duty to smooth as much as possible the pathway to the grave even if life is somewhat shortened” (Seale, 649).
Alex Paton writes: “The ending of our life would not threaten us if we had not falsely made ourselves the center of life’s meaning” (Paton, 1259).
John Hardwig states it thus: “Death itself is not unpleasant. I have seen a good many people die. To a few, death comes as a friend, as a release from pain, from intolerable loneliness or loss, or from disappointment. To even fewer it comes as a horror. To most it hardly comes at all, so gradual is its approach, so long have the senses been benumbed, so little do they realize what is taking place”(Hardwig, 41).
I would like to end this paper as Neil M. Gorsuch ends his chapter in The Future of Assisted Suicide and Euthanasia that medicine contributes too much to the moral stature of men to persist indefinitely in denying the ultimate claims of its own supreme virtue and ethical inspiration, mercy. So, we may be sure that there will come a day when Science will protest its errors and will shorten our sufferings. Many of us do things with the best of intents, more often than not the consequences are dire and that is because we do not know what is right or wrong. All that we care is whether something is popular or not. And it is from here that conformists and non-conformists are derived. It is very rare to see a person untainted by the public opinion make a judgment on the wrong or right, based on an objective truth. At this juncture, objectivity is usually out of reach for many people as they try to understand life and living and on so without an understanding, it is quiet hard to decide whether life should or should not continue.
As for that person who wants to die, they may be sited in one place closer than hereafter than other people, and although I hold my opinion on suicide, I also have my own opinion of free will in this instance.