Should the Government or Doctors Decide the Validity of Euthanasia?

The matter of euthanasia or physician-assisted suicide is often boiled down to a matter of ethics, but simplification does not do justice to this difficult issue. The legality is not the only facet of the debate; there are other factors that must be considered, including the means through which the patient’s life is ended, whether the patient is able to express consent or if it must be given by family, or who should get to decide whether euthanasia is appropriate for a patient. The government’s involvement is inappropriate, and thus should be left alone to panels of doctors to decide on a case-by-case basis.

Euthanasia is not a new topic of debate. It has ties back to ancient Rome, but more importantly, was prohibited by common law in the American colonies (Washington n.p.). Bills to legalize euthanasia and the cases of illegal euthanasia began cropping up more commonly in the 1900s; the Great Depression inspired public outcry in support of voluntary euthanasia (Dowbiggin 33). The support for physician-assisted suicide grew and subsided cyclically until in the 70s, the US Senate held the first meeting on euthanasia, the Society for the Right to Die (a group that sought to legalize active euthanasia) was founded, the first hospice opened up, and eight states signed right-to-die laws into effect (Dowbiggin 242). Despite the popularity (or infamy) of Doctor Kevorkian in the 1990s, the Supreme Court ruled that there was no Constitutional right to die (Washington n.p). Every facet of this debate seems to have been covered.

Euthanasia is abused within the medical community. Nurses have been reported delivering euthanasia to suffering patients “without explicit consent” in 45% of cases (Pereira e39). Doctors are not infallible, nor are they above casting moral judgment on their patients in the same way that family members and politicians do.

There are plenty of reasons to be against euthanasia. Depression is very common in terminally ill patients, prompting many patients to want to end their lives early (Bonin n.p.). Thus, since depression is so common and so easily treatable, euthanasia is unnecessary. Additionally, the decision of an ill patient with depression who asks for assisted suicide cannot be as well-made as if it were coming from someone whose depression was treated. The suffering and low quality of life (or the expectation of the suffering) that lead to depression can be treated very well with modern palliative medicine (Pereira e43). Preventative measures and treatment of depression for end-of-life or terminally ill patients should remove the desire for euthanasia in many cases.

Similarly, euthanasia or “mercy killing” has been used historically as an extension of eugenics. Involuntary euthanasia is euthanasia conducted without the consent of the patient, when another individual, usually a family member, makes the decision for the patient (“Last Rights” n.p.). Even today, however, “mercy killing” exists, and takes the lives of people with disabilities or illnesses. The Netherlands has legalized euthanasia, leaving the decision to conduct euthanasia to a judge, who only needs to decide that the patient’s life is not worth living (Bonin n.p.). American children face the risk of having the worth of their lives decided for them, as well; more than 40 autistic people have been killed by their caregivers in the last five years alone, according to the Autistic Self Advocacy Network (“Day of Mourning” n.p.). Forty may not seem like a very large number, especially spread out over the course of five years, but those forty people were victims of ignorance and bigotry, in part stemming from the idea that autism renders a life worthless or unlivable.

Despite the real concerns, euthanasia’s proponents seek to offer the same right that is given to any other patient: the right to choose. Proponents say that every person has the right to choose how they want to die, just as they choose how they want to live (“Last Rights” n.p.). Though autonomy is often up for debate in legal settings, it is generally accepted that individual adults are able and expected to express autonomy over their lives; the American dream is based on freedom. “We've always said that autonomy and self-determination does trump the infinite value of an individual life, that people have the right to control what is done to their own body. I think that is at risk,” says expert Diane Meier (Stolberg n.p.). Proponents argue that failing to extend the right of individual autonomy, particularly in a medical context, is more unethical than helping a patient to alleviate their suffering early.

If humans are destined to die, proponents argue, it does no good to fight the inevitable, since it leads to prolonged suffering. The existence of good palliative care does not guarantee access to palliative care for all patients; the cost and availability of end-of-life care may not be available to all patients, while a single procedure of euthanasia would end suffering, and perhaps even relieve the financial burden on the patient’s remaining family.

If we understand the need for euthanizing pets who suffer, we should understand the need for offering the option to suffering humans, as well; a pet is not comparable to a human in terms of intelligence or consciousness, but that only means that a human is all the more aware of their own suffering and able to give consent to euthanasia or assisted suicide. Anti-euthanasia groups bring morals into the equation by questioning the ethics of helping someone to end their life, but it seems equally as immoral to deny someone the end to their suffering, particularly when it would be the cause of their death because of illness or age, for selfish reasons, like not wanting to let go, or imposing values on a suffering patient.

Patients only want to die with dignity. The case of Terri Schiavo is an extreme example of what can go wrong when the patient is denied active euthanasia—that is, being administered drugs to end the patient’s life, rather than passive euthanasia, which includes discontinuation of treatment, or removing the patient from life support—but the publicity of her case showed her nationwide in a comatose state. If she were aware, like some of her family claimed, it does not seem more moral or ethical to have broadcast her vegetative state than it would have been to allow her to be euthanized by her physicians (Stolberg n.p.). For individual patients whose cases are not so high profile, not wanting to be trapped within a failing body, seen by loved ones and strangers alike, is an understandable request.

Even though the Supreme Court ruled that there is no Constitutional right to euthanasia, laws ensuring individuals are able to maintain their bodily autonomy in a medical setting are crucial. If there are worries about a slippery slope allowing non-terminal patients to be euthanized, as Pereira reports, then the argument can be made for a slippery slope that will eliminate medical autonomy and consent by continuing to disallow euthanasia for willing patients (e40). There is a difference between involuntary euthanasia, in which medical staff takes it upon themselves to put a patient out of their misery, and voluntary euthanasia that a terminal patient requests.

The government is too large to appropriately preside over individual cases of euthanasia. Its rulings on the legality of euthanasia and the ethics of physician involvement have fluctuated, based largely, it seems, on public opinion. It is bloated and slow, and the drawn-out hearings and proceedings, as evidenced in the Shiavo case, show that the government cannot handle the delicate subject of a patient’s suffering.

Individual medical professionals cannot necessarily be trusted to handle a patient’s requests, either. Therefore, the government should do its part to legalize physician-assisted or administered euthanasia for terminal patients only, but leave a case-by-case analysis of the individual patient’s request for euthanasia to a large panel of expert physicians. This panel would determine the quality of life, available treatment options, cost, and burden on the remaining family to accept or deny a patient’s request for euthanasia. Patients who are determined to be depressed, or who would benefit from palliative care, would be treated this way, rather than going straight to euthanasia, but patients would be free to resubmit requests if the initial treatments did not fulfill the patient’s needs as expected.

Families would be able to submit their approval or objection to the euthanasia for the panel’s consideration, but would not create a stalemate as there was in the Shiavo case. This way, families would not feel as though a panel of strangers would hold the future of an ill loved one in their hands alone. This procedure should only be used seriously when the patient does not have a living will—something that became more popular than ever, thanks to Shiavo’s case (Stolberg n.p.)—since personal autonomy is of the greatest importance, the wishes of the patient should override any familial wishes.

There is no reliable way to assign responsibility for euthanasia to the government or doctors alone. There must be legislation to regulate for whom euthanasia should be available, and by whom it can be administered. The panel allows accountability. It is difficult enough to have a loved one go through terminal illnesses, without having to worry about their prolonged suffering.

Works Cited

Bonin, Angela. "Human Euthanasia, The Debate: The Arguments for Both Sides." Examiner.com. N.p., 20 Feb. 2012. Web. 5 Mar. 2014.

"Day of Mourning." Autistic Self Advocacy Network. N.p., 24 Feb. 2010. Web. 7 Mar. 2014.

Dowbiggin, Ian Robert. A Merciful End: The Euthanasia Movement in Modern America. Oxford England: Oxford University Press, 2003. Print.

"Last rights." The Economist. The Economist Newspaper, 19 June 1997. Web. 8 Mar. 2014.

Pereira, J. "Legalizing Euthanasia or Assisted Suicide: The Illusion of Safeguards and Controls." Current Oncology 18.2 (2011): e38-e45. Print.

Stolberg, Sheryl. "Schiavo's Case May Reshape American Law." The New York Times. The New York Times, 31 Mar. 2005. Web. 9 Mar. 2014.

Washington, Et Al., Petitioners v. Harold Glucksberg Et Al. U.S Supreme Court. ProCon.org. N.p., 1997. Web. 8 Mar. 2014.