For many of us, when we think of death, we tend to imagine a serene place, surrounded by our loved ones, content in the fact that our lives have been full and complete, then peacefully slip into slumber. Much of the time, this is not the case and our existence transforms from “person” into “patient.” Days and nights run together. People come and go. Doctors, nurses, and clergy filter in and out. The pain is indescribable and the pleas for relief echo down a hallway. The last coherent words overheard are “terminal cancer.” This is too often a dramatic scene that unfolds daily for many people. Until someone experiences or witnesses the devasting effects this disease has, or any debilitating disease on the mind and body, complete understanding and empathy will elude society. We are in the twenty-first century and still struggle with a moral and ethical decision that has haunted civilization since Grecian times, perhaps longer; is it good and just to submit to the pleas for death emanating from a suffering person? Legal, medical, religious, and individual views have conflicted for centuries, however, it is time to let suffering individuals exercise the 9th and 14th Amendments, which would include mercy death, if they so desire.
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In 1826, Carl Marx, one of the leading German physicians of the mid-nineteenth century asks: “What can be done so the passing from life may be gentle and bearable? Why should not man…find and produce some skillful contrivance for the care of the dying?” (Lavi) Marx believed that the new role of the physician at the bedside was to bring hope to the hopeless and confidence to the despairing in the face of approaching death.
In 1870, a businessman by the name of Samuel D. Williams was the first in the nineteenth century to publicly advocate euthanasia; the medical hastening of death. Williams wrote a piece titled Euthanasia, which proposed a solution to the problem of dying patients suffering from unbearable pain. In it, he touched on many of the same arguments that we anguish on today; the very same arguments that are included in the laws of the few states in the U.S. where mercy death is now legal. He wrote “In all cases of hopeless and painful illness, it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer chloroform…so as to destroy consciousness at once and put the sufferer to a quick and painless death.” (Lavi) He also points out the need for precautions to prevent any possible abuse of this duty, that the need is beyond reasonable doubt, and that this remedy was the expressed wishes of the patient. Although euthanasia is banned in the U.S., assisted suicide is legal in a handful of states. Even so, most physicians denounce either one of these practices because the sacred duty of the medical profession is to prolong life, not shorten it.
On March 6, 1996, in San Francisco, the Ninth Circuit Court of Appeals declared that suicide assisted by a physician is a fundamental liberty right protected by the 14th Amendment. They felt that the decision of how and when to die is a person’s most intimate, personal choice and is central to their dignity and autonomy. In April 1996, the U.S. Circuit Court of Appeals in Manhattan ruled that the state’s manslaughter statute could not be used to prosecute doctors who prescribe lethal drugs to terminally ill patients who ask for them and then use them to commit suicide. (Thiroux and Krasemann) The court questioned what business the state had, and what the state’s interest was in a patient’s right to define their own life.
In an interview with CNN journalist Anderson Cooper, Dr. Jack Kevorkian, who was dubbed “Dr. Death” because of his infamous involvement with over 130 assisted suicides, spoke about the courts and judicial system not caring about the patients and their suffering. And goes on to say that patients have every right, according to the 9th Amendment, to do with their bodies what they choose, whatever it may be, including death. (Kevorkian) Dr. Kevorkian passed away in 2011 and was a key influence in causing great controversy on whether mercy death was a viable alternative to hopeless pain and suffering in patients, particularly terminal patients.
When we think about accountability, who goes to jail when someone commits suicide? Rarely anyone. Would a gun retailer be responsible for a suicide simply because someone purchased their gun from there? Why hold doctors accountable for selling life-ending drugs to individuals who request them, keeping in mind the hopelessness of their situation and the scrutiny their condition was concluded?
Religious leaders, particularly in the Roman Catholic Church, consider mercy death to be worse than suicide since a second person must do the killing. According to them, killing is killing regardless of the motive, and no one has the right to take innocent lives, even at that person’s request. Other, more radical arguments portray a “Hitleresque” future focusing on legal, mercy death as a dismal “cleansing” of the homeless, derelict, deformed, or severely handicapped persons and the eradication of terminal, burdensome family members. In Oregon, where mercy death is legal, one-third of the people who receive life-ending drugs do not ever take them. This is in stark contrast to the objections of the radical religious leaders.
The most popular options today in the face of ethical and legal controversy are the Palliative (however long to live) or Hospice (months to live) care. These caregivers make sure patients are comfortable and tend to their needs whether it be at the patient’s home or a more structured environment. However, toward the end of life, practices include voluntarily stopping eating and drinking, and terminal sedation. According to an article in the Journal of the American Medical Association, these options are availed because they are clinically and ethically complex, and do not require changes in professional standards or the law. They are considered “closer to physician-assisted suicide and voluntary active euthanasia than is ordinarily acknowledged.” (Quill)
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Dr. Marcia Angell, a former executive editor of The New England Journal of Medicine, refers to the medical association’s ethical judgement saying it “focuses too much on the physician, and not enough on the patient.” She goes on to ask, “Why should anyone – the state, the medical profession, or anyone else – presume to tell someone else how much suffering they must endure as their life is ending?” (Haberman)
It is completely ethical today to place a loved one in a Hospice situation where they are heavily sedated and starved to death. Such was the case of my beloved grandmother. She had a progressive, debilitating disease that the doctors could not figure out. After some research, I concluded that she had a disease similar to Progressive Lateral Sclerosis, where her muscles gradually deteriorated, and she went from walker, to wheelchair, to bed rather rapidly. As if that wasn’t bad enough, she developed colon cancer, which spread to her liver, and ultimately, the diagnosis of “terminal” at the age of seventy-six. It was decided that Hospice would be called into her home to make her last days “comfortable.” At first, they seemed like a godsend taking care of her daily needs, but soon the pain became more than she could bear. The nurse suggested that it was time to place her on a morphine I.V. to help ease her pain. Soon, the morphine was culminating at “conscious” levels; any more would put her in a comatose state. Yet, she was still suffering. My grandmother still possessed all her faculties and she was made aware of the next phase. We gathered as a family, one by one, to say our teary goodbyes and the morphine was administered at the highest level allowed. From then on, she was in a comatose state and could consume no food or water. This continued for three weeks until the cancer consumed her body and she finally stopped breathing. Was it the cancer? Personally, I think she starved to death.
How does the medical community accept this type of treatment? How is starving to death more ethical or moral than mercy death? I am sure that many people who have opted for Hospice or Palliative care may have had a completely different experience; one that was a true blessing and a peaceful alternative for their loved one. But I fear all who seek peace do not receive it.
In the United States, most people believe in God and believe they want to do what is right. However, many times that belief system is questioned when innocent lives are in danger or a loved one is in terrible agony. The religious community will still have their objections and the legal system will still intervene. Mercy death, or “right to die,” as it is often called today, is a grave decision that lingers in the ethical, religious, and legal minds that would rather see it all but disappear. But to those that suffer, it is a harsh reality. My grandmother, who died suffering not by her own hands, but by the hands of our legal system, was denied the choice of her right to die.
- Haberman, Clyde. "Stigma Around Physician-Assisted Dying Lingers." Retro Report. The New York Times, 22 Mar 2015. webpage. 18 Jun 2019. .
- Kevorkian, Dr. Jack. "2010: Kevorkian admits helping dozens die" with Anderson Cooper. The Big 360° Interview. CNN. Apr 2010. YouTube video. .
- Lavi, Shai Joshua. The Modern Art of Dying: A History of Euthanasia in the United States. Princeton: Princeton University Press, 2007.
- Quill, Timothy E. "Palliative Options of Last Resort: A Comparison of Voluntarily Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide, and Voluntary Active Euthanasia." Journal of the American Medical Association 278 (1997): 2099.
- Thiroux, Jacques P. and Keith W. Krasemann. Ethics: theory and practice. Boston: Pearson Education, Inc. or its affiliates, 2017. Textbook.
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