Who's Death Is It Anyway

Running head: THE PASSAGE INTO DEATH

Whose death is it anyway?

611 Social Welfare Policy

Whose Death is it anyway?

Dying for most Americans has become far more complicated than it once was. A century ago most people died at home of illnesses that medicine could do little to defeat. Now technology has created choices for dying patients and their families, choices that raise basic questions about human dignity and what constitutes a "good death". Who will determine what defines a good death- a translation of the Greek word euthanasia. Who should have the power to decide if a life is worth living or not, the government, the medical establishment, the family or the patient? Many people say they would rather die then suffer in excruciating pain or be trapped in a vegetative state. Should people have the right to decide how and when they want to die? Should others, their family, doctors or government be able to decide for them?

With so much talk about euthanasia these days after the affirming decision of the US Supreme Court (January 2006) in the Oregon physician-assisted suicide case, it would be helpful for mutual understanding to define the principal words being used in the termination of life. Here are some common definitions: Assisted Suicide: Helping a person to end his or her life by request in order to end suffering. (Rarely prosecuted and only lawful in Switzerland where the reasons must be altruistic.) Physician Assisted Suicide: Medical doctor helping patient to die by prescribing a lethal overdose. Patient can choose whether to ingest it. (Lawful only in Oregon, Switzerland, Netherlands and Belgium.) Euthanasia: A broad, generic term meaning help with a good death. Voluntary euthanasia: Death by lethal injection by doctor when requested by patient. (Only lawful in Belgium and the Netherlands for the terminally or hopelessly ill.) Non-voluntary euthanasia: Using powerful drugs, doctor ends life of suffering, dying patient who is comatose. Illegal, but happens all the time, discreetly, in the interest of compassion. Terminal sedation: Upon patient request, doctor puts patient into deep sleep with medications, during which time the patient dies either of the underlying illness or starvation/dehydration. Widely practiced and generally accepted as ethical and lawful. Mercy killing: Taking the life of another person in the belief that this is a compassionate act because the ill person is unable to do so. Mercy killing is unlawful. (Humphry, 2005).

What Euthanasia is not: There is no euthanasia unless the death is intentionally caused by what was done or not done. Thus, some medical actions that are often labeled "passive euthanasia" are no form of euthanasia, since the intention to take life is lacking. These acts include not commencing treatment that would not provide a benefit to the patient, withdrawing treatment that has been shown to be ineffective, too burdensome or is unwanted, and the giving of high doses of pain-killers that may endanger life, when they have been shown to be necessary. All those are part of good medical practice, endorsed by law, when they are properly carried out. (Humphry, 2005)

When Congress grappled with the Terri Schiavo case and a national battle raged over whether laws should allow doctors to help terminally ill patients end their lives, a quieter revolution took place and continues to take place around the country. With or without such laws, many Americans are taking an active role in their own deaths, some with the help of their doctors and others through actions of their own that often blur the definition of suicide. There are no precise figures for how many Americans enlist their doctors' help each year in ending their lives. Surveys suggest that more than half of Americans find physician-assisted suicide morally acceptable. In a 2004 Gallup survey, 65 percent agreed that a doctor should be allowed to assist a suicide "when a person has a disease that cannot be cured and is living in pain," up from 52 percent in 1996. (Robeznieks, 2004). Experts say support for assisted suicide is likely to increase as baby boomers, long accustomed to making the decisions that shape their lives, demand a say over their deaths, as well.

Arguments supporting or opposing assisted suicide are commonly made from several frames of reference. These include ethical, moral, legal and medical arguments, and the arguments regarding safeguards and the slippery slope of legalizing assisted suicide. Ethical and moral arguments in support of assisted suicide include the principle of self-determination to control the time, place, and nature of one's death, placing quality at the end of life above the sanctity of life. Other factors include the desire to preserve dignity and personhood in the dying process and the opposition to prolonging life by using medical technology when it is determined that additional care is futile. Closely related to self-determination is the principle of autonomy. This principle states that persons should have the right to make their own decisions about the course of their own lives whenever they can. By extension, they should also have the right to determine the course of their own dying as much as possible. (Sherwin, 2000)

According to these arguments, even when choices are socially shaped they should be respected as autonomous as long as there is appropriate evaluation of the situation. No person should have to endure terminal suffering that is unremitting, unbearable, or prolonged. When the burdens of life outweigh the benefits because of uncontrollable pain, severe psychological suffering, loss of dignity, or loss of quality of life as judged by the patient, and when the circumstances are not remediable, the dying person should be able to ask for and receive help in assisted suicide. It is further argued that assisted suicide for incurably ill persons experiencing extreme suffering can be distinguished from euthanasia used for the purpose of genocide on the grounds that it is based on principles of dignity, honor, and respect and is chosen and enacted by the dying individuals, rather than being forced on them against their will.

Legal arguments state that it would be in the best interest of dying patients to be able to regulate practices that are currently being used covertly for assisted suicide. Such regulations would also provide safeguards for practitioners who are currently complying illegally with patient requests out of compassion.

Medical arguments contend that competent terminally ill patients wishing to choose assisted