By Jamie York
Dr. Jack Kevorkian's murder conviction in March 1999 brings to mind some interesting questions regarding euthanasia. Is there a distinction between life and quality of life? If individual doctors can go too far in assisting suicide, can they also go too far by ordering continuous tests and procedures for terminally ill patients? At what point does the preservation of life become cruelty? Do family members really understand the technological implications when they tell doctors to "do all you can do" to save their loved one?
Each person on this planet is unique. We have our own personalities, our own tastes, our own ideas and interests. But just as we all live differently, we also die differently. No two people die in exactly the same way, whether we die from natural causes, suicide, or from accidents. The only certain thing is that we all will die in one way or another.
In Western society, the quality of human life is often measured in terms of longetivity. In the United States today -- thanks to public health measures, medicines and medical technology -- the human life expectancy is now about 80 years. The notion that "living longer is better" seems imbedded in the public consciousness.
Most people want to live long, healthy lives, but what happens when the body succumbs to an incurable disease? What happens when the body and brain deteriorate through aging or injury and no longer function like they used to? What happens when a child is born with severe birth defects? Does it still hold that living longer is better?
According to euthanasia opponent Stephen G. Potts, the acceptance of euthanasia could delay the discovery of treatments for diseases that are now terminal, eliminate hope as a factor in recovery, put pressure on families to request euthanasia for dying relatives to relieve themselves of the financial burden of continued care, conflict with the aims of medicine by turning the killing over to doctors, and violate the sixth commandment -- "Thou shalt not kill."
"There are thousands of comatose or demented patients sustained by little more than good nursing care," Potts writes. "They are an enormous financial and social burden. How soon will the advocates of euthanasia be arguing that we should 'assist them in dying?'"
The key term in Potts' argument is "sustained." How many of these thousands of comatose or demented patients would already have died of natural causes if modern technology had not "sustained" them? These people, once healthy and active individuals, are medically alive, but there is no longer a quality of life and there never will be. The humane motive of euthanasia is to keep people as free of pain and suffering as possible so they can die a natural death with dignity, but opponents argue that letting a patient die naturally by discontinuing life support measures is no different than administering a lethal injection. They argue that both active and passive euthanasia are murder.
The circumstances under which people are fed, hydrated and oxygenated to keep them alive vary widely, so the moral question of euthanasia -- whether active or passive -- concerns only people who are considered terminal by medical professionals. An exception to this might be the unborn fetus of a brain-dead woman. Although the woman may be considered terminal in that she could not survive without artificial life support, should she be kept alive through postmortem maternal ventilation (PMV) if there is a reasonable chance she could deliver a healthy baby? Julien Murphy argues that a woman must be alive to be pregnant and that the pregnant woman must be a person. She thus refers to the "pregnant cadaver." Murphy writes:
"PMV perpetuates the desire to control life and deny death. PMV, like modern medicine in general, is based on an assumption of metaphysical dualism: that the body can be perceived and managed by seeing it as separate from human consciousness. Higher human activities such as consciousness, cognition, and imagination are devalued. We cannot diminish the value of human pregnancy without diminishing the value of being human....Postmortem maternal ventilation, by requiring pregnancy of women after their brain deaths, fails to envision what the capacity for maternal consciousness in pregnancy should mean to a human community."
Murphy's comments here, especially regarding the devaluation of human consciousness, have relevance for the entire discussion of euthanasia. Supporters of euthanasia say that it is a humane practice that relieves pain and suffering and allows people to die with dignity. Why bother to keep people alive artificially if their condition has reduced them to nothing but a shell of what they once were? Why not let them die natural deaths by simply not using modern medical technology to keep them alive, or, in some rare cases, help them to die without suffering by administering a lethal injection? According to James Rachels, "the bare difference between killing and letting die does not, in itself, make a moral difference. If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons....active euthanasia is not any worse than passive euthanasia." Dr. Kevorkian's murder conviction in Michigan should send a chill throughout the medical community and, indeed, throughout human society.
As one who has worked as a nursing assistant in an emergency room, an intensive care unit, a recovery room, a cancer care unit, an orthopedic unit, a newborn nursery, and in a nursing home, I have seen the normal labored breathing, clammy skin and glassy eyes of those near death. But I have also seen the intense suffering of elderly patients subjected to constant medical testing and surgical procedures and I have often doubted that such tests and procedures were always in the best interest of the patient. Could doctors, perhaps out of fear of lawsuits, be treating the family of the patient rather than the patient? Certainly, we do not want to lose our loved ones, but we must also understand that death is inevitable no matter how many tubes are inserted into the body to keep one's vital organs functioning. There is a point where medical testing goes beyond the notion of "doing all we can do" and actually becomes cruel.
I am a proponent of euthanasia. I believe that food and water and medical intervention do not always express care and compassion and that euthanasia should not be a legal issue at all, but should be a humane option for patients and their families. I also believe that euthanasia should depend upon the following medical criteria, as outlined by Joanne Lynn and James Childress:
(1) the procedures that would be required are so unlikely to achieve improved nutritional and fluid levels that they could correctly be considered futile
(2) the improvement in nutritional and fluid balance, though achievable, could be of no benefit to the patient
(3) the burdens of receiving treatment outweigh the benefits
The practice of euthanasia, whether active or passive, should be based upon these medical criteria, but no physician should be asked to make such desisions alone. Euthanasia should be the result of a round table conference involving the patient (if possible), the family, a doctor, nursing staff and other caregivers, a patient advocate such as a social worker or minister, as well as interested friends of the patient. This team approach will empower doctors to abide by the decision of the group and give their patient death with dignity. It will also protect the patient from the practice of euthanasia when the medical criteria have not been met. A living will, too, is a good idea, but hospital patients should have a copy made and posted on the wall above their bed so there is no confusion about what measures to take. I remember several cases of all-out resuscitation of patients who had living wills in their chart specifying no resuscitation.
While Dr. Kevorkian has long been a supporter and activist for individual rights regarding active euthanasia, his opponents have portrayed him as "eccentric" and as a "cheap purveyor of easy death." Perhaps the use of the round table conference will help alleviate such concerns. In any case, Dr. Kevorkian's murder conviction must be overturned or all terminal patients may be forced to die with feeding tubes in place, months or years after they would have died naturally.
Acknowledgments
Gold, Steven Jay. Moral Controversies: Race, Class and Gender in Applied Ethics. (Belmont, California: Wadsworth, 1992).
Lynn, Joanne, and James Childress. "Must Patients Always Be Given Food and Water." Gold, p. 149,153.
Murphy, Julien. "Should Pregnancies Be Sustained in Brain-Dead Women? A Philosophical Discussion of Postmortem Pregnancy." Gold, p. 173.
Potts, Stephen G. "Objections to the Institutionalization of Euthanasia." Gold, p. 156.
Rachels, James. "Active and Passive Euthanasia." Gold, p. 145.
Postscript
Besides having worked in health care for 13 years, there is another reason for my interest in euthanasia. I have been diagnosed as having Hepatitis C, a disease that gradually destroys the liver. While some 25 percent of patients treated with the drug Interferon have showed some improvement, I have chosen not to use Interferon because I believe the side effects would be worse for me than the potential benefit. This was and is my choice to make. I have also chosen to use vitamins and herbs and to exercise regularly.
One thing is certain: If I have an ounce of strength to prevent it, I will not die in a hospital hooked up to some machine. If the Hepatitis kills me, whether it is in one year or in 20 years, I want to die with dignity. In the meantime, I'm going to keep writing, playing music, traveling, hiking, biking, and enjoying life as much as I can.
-- JY