DAY 82 - Euthanasia

Introduction

Euthanasia involves killing people. It is thus a hotly debated topic. It involves issues such as the rights of the individual and the sanctity of life. Three cases of euthanasia demonstrate the complexities related to this issue.

Here's a short Ted Talk by Peter Saul on "Dying in the 21st Century."

1. Case One-Terri Schiavo

In 1990, 26 year old Terri Schiavo collapsed, suffered heart failure, and sustained brain damage. She fell into what is termed a "persistent vegetative state"; she was able to breathe and her heart beat on its own, but she showed little or no sign of awareness. In 1998, her husband, Michael Schiavo, brought action in a Florida court to have his wife disconnected from the feeding tube that sustained her life. He argued that his wife would not have wanted to be kept alive in such a state and that he was acting with her welfare in mind. Her family opposed his efforts, questioning his motives and claiming that Terri did show awareness of her surroundings. A seven-year court battle ensued.

The Schiavo case ignited a firestorm of controversy in the United States over the issue of euthanasia. It pitted those who argued in favour of "dying with dignity" against those committed to the idea of "sanctity of life". The feeding tube was twice removed and twice replaced as litigation continued. In 2003, after a court ordered to have the feeding tube removed, the state of Florida passed a law forcing doctors to continue feeding Terri. This led to a court battle over the legality of the law, which was eventually ruled unconstitutional. In March 2005, Michael Schiavo won the last court appeal and the feeding tube was removed. In a special, emergency session, the United States Congress rushed through a bill calling for another court appeal. This court appeal was dismissed. Terri Schiavo starved to death 13 days after the tube was removed.

To learn more about this case, click on the following two links;

1. CBC News on the Terri Schiavo Case
2. BBC News on the Terri Schiavo Case

2. Case Two-Sue Rodriguez

In 1991, 41-year old Sue Rodriguez was diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease. There is no cure or treatment for this disease. Healthy and active, Rodriguez was told her body would gradually deteriorate, she would lose control of it, and she would likely die within three to five years. She decided that she would choose the time of her death, and took her issue public.

Instead of quietly committing suicide, she petitioned in the courts of British Columbia and Canada for the right to have a doctor assist her in committing suicide. She argued she had a right to die under The Charter of Rights and Freedoms, including the right to have someone assist her if she was unable to do so herself. She claimed that laws against assisted suicide took away this right:

If I cannot give consent to my own death, whose body is this? Who owns my life?

CBC News. "The fight for the right to die". June 11, 2007.

Courts at all levels ruled against her and Parliament refused to change the laws on assisted suicide.

On February 12, 1994, Sue Rodriguez was assisted in her suicide by a doctor whose identity has never been revealed. She was also assisted by Svend Robinson, her Member of Parliament and a strong supporter of her case from the start. While assisting her to die was a criminal act, no charges were laid.

To learn more about this case, click here.  Look to the right side of that web page for links to news video clips on Sue Rodriguez.

3. Case Three-Tracy Latimer

In 1980, Tracy Latimer suffered complications at birth which resulted in a severe form of cerebral palsy. She was severely crippled physically and had an estimated mental age of 4 months. The disease was degenerative. Her condition worsened over time, there was no cure, and she underwent a series of drastic operations designed to prolong her life. In 1993, her father, Robert Latimer, placed Tracy in the cab of his pickup truck and connected a pipe to the exhaust, suffocating his daughter.

Robert Latimer was charged with second-degree murder. In his confession to police, he stated he had killed her to end her suffering:

With the combination of a feeding tube, rods in her back, the leg cut and flopping around and bedsores, how can people say she was a happy little girl?

Anthony Depalma. "Father's Killing of Canadian Girl: Mercy or Murder?" The New York Times On-line. December 1, 1997.

He maintains to this time that he acted rightly.

Robert Latimer was tried and convicted twice. His trials were closely watched by advocates for the disabled. They feared if Latimer were treated leniently, it would be set unsympathetic precedence for the disabled. Latimer's first conviction was overturned for technical reasons. The second conviction resulted in a sentence of two years, one in jail and the other under house arrest, as the judge ruled that Robert had acted out of compassion. This sentence was overturned, as the Criminal Code requires that someone convicted of second-degree murder must receive a sentence of life imprisonment, with a minimum of ten years imprisonment before parole. Robert Latimer began serving his sentence in 2001 and will be eligible for full parole in 2010.

1. To learn more about this case, click here.

Aspects of the Euthanasia Debate

1. What is Euthanasia?

Euthanasia is derived from a Greek word meaning "easy" or "good" death. In modern usage it is associated with terms such as "assisted suicide" and "mercy killing". In the Ancient world, it was considered morally acceptable to end your life if you felt it was not worth living, a view reinforced by Stoic and Epicurean philosophy.

However, in modern usage, euthanasia is not suicide, which is when you end your own life. In a medical situation, when you refuse treatment or stop eating, it is not euthanasia, as it is an act done by you to hasten your own death-suicide. Until 1972, suicide was illegal in Canada, though enforcement of penalties was always an issue. Euthanasia involves someone else ending your life, either with or without your consent. In the Western tradition, Christianity views suicide as a sin. Many other religions hold similar views, regarding life as sacred. They prohibit any form of euthanasia. Euthanasia remains illegal in Canada and in most countries: It is considered murder.

However, widespread discussion involving the morality of the practice emerged in the 19th century, with greater medical understanding and an interest in the rights of the individual, including the right to life and the right to die. In recent years, a debate has emerged over whether euthanasia should be permitted, and, if so, how it should be regulated. Several countries have laws permitting and regulating euthanasia, and there is a franchise chain of euthanasia clinics operating in Europe.

Learn more about Dignitas, the Swiss-based group promoting assisted suicide.

2. Types of Euthanasia

Euthanasia can be divided into two main types: active and passive. Active euthanasia involves intervening to end life, such as giving a lethal injection. Passive euthanasia involves withholding treatment and 'allowing nature to take its course', as occurred in the Schiavo case. Crudely, this is sometimes referred to as 'pulling the plug' - removing life support.

Some ethicists argue there is no difference between passive and active euthanasia. In the Schiavo case, for instance, it was the removal of the feeding tube that caused Terri's death; this removal was an intentional act on the part of the doctors-they actively hastened her death.

Consent

The issue of consent is crucial to the euthanasia debate. Voluntary euthanasia occurs when someone asks to have his/her life ended with the assistance of someone else. This generally takes place when someone is dying of a painful illness with no hope of recovery and they ask to have their suffering shortened. This practice is often referred to as "assisted suicide", since the person is aware of what they are doing, but may not be capable of committing suicide without help. The Sue Rodriguez case was voluntary euthanasia.

Non-voluntary euthanasia is more controversial and the ethical issues are less clear than in cases where consent is obtained. Non-voluntary euthanasia involves ending a life without the consent of the person who will die. Someone else makes the decision on the stricken individual's behalf. This would occur when the person is not competent enough to make such a decision (e.g., someone with a severe mental handicap) or are prevented from doing so (e.g., are in a coma). The wishes of the person who will die are usually considered, if they are known or can be guessed, as is the person's best interests.

Non-voluntary euthanasia is sometimes referred to as "mercy killing". Typically, it occurs in cases where someone is suffering; the person who ends their life without their consent is motivated by a desire to end the pain or to preserve their dignity. Both the Terri Schiavo and Tracy Latimer cases were non-voluntary euthanasia.

As people become more concerned with the issue of "dying with dignity", many are preparing what are known as living wills. These are advance directives, instructions for how they would like to be treated if they are incapacitated with little or no hope of recovery. The legal status of these living wills varies by jurisdiction.

Infanticide

This is an especially controversial aspect of the euthanasia debate. Infanticide is the killing of infants. It is an ancient practice described in the Twelve Tables of Rome, from the 5th century BCE. It continues in many places to this day to control overpopulation when resources are scarce, end the lives of physically malformed infants, or unwanted infants. Some consider the modern practice of abortion to be similar. The case of the "100 million missing women" of Asia is often used to provide evidence that infanticide of baby girls is a common practice in China.

In modern Western nations, the infanticide debate centres on preserving the lives of severely handicapped babies who have little likelihood of having a reasonable quality of life. The ethicist Peter Singer is a major advocate of the practice, using utilitarian arguments to support his stand.

Infanticide by its nature is non-voluntary, as infants cannot give any competent consent. Sometimes passive, it is often active euthanasia. There is growing evidence that, while technically illegal, it is occurring in places such as Canada, particularly in the case of severely disabled infants.

Arguments against Euthanasia

There are several lines of argument against euthanasia:

Religious

Life is God's gift to man, and is subject to His power. Hence whoever takes his own life, sins against God ... For it belongs to God alone to pronounce sentence of death and life.....

St. Thomas Aquinas, Summa Theologica, (1267)11-11, Q.64, Art 5.

Most religions are opposed to euthanasia, which is seen as contrary to the natural order or Divine Will, in the same way as murder. Ending a life prematurely can be seen as opposing God's will and running contrary to a Divine Command. In religions that value suffering or believe in an afterlife, such as Christianity, easing suffering may be depriving the dying of a valuable experience necessary for their soul's journey in the afterlife.

'Sanctity of Life'

This is an argument used by both religious and non-religious opponents of euthanasia. It is sometimes referred to as right to life and is also a prominent argument in the abortion debate. Many anti-abortionists are also leaders in the anti-euthanasia movement.

The sanctity of life argument maintains that all life is valuable and should be honoured, not treated like a commodity. It is morally right to value life and not intervene to speed up death. Some philosophers argue that life itself is a good, and any act that takes it away must be wrong. This especially applies to deontological ethical normative systems, such as Kant's.

This particularly applies in cases of non-voluntary euthanasia, such as infanticide or euthanasia of the severely disabled. Many advocates for the disabled argued that able-bodied people are prejudiced, underestimating the quality of life that a disabled person enjoys. Often, able-bodied people who become disabled are surprised that their life is still worth living. In the Latimer case, for example, it was argued that Tracy had happiness in her life and that we should not (because we can not) judge how much someone else values his/her own life.

If we do so, we are making decisions over what kind of human life is more valuable and should be allowed to continue, and of what type of life is less valuable and should be discontinued. For example, can we decide that older people don't have lives as valuable as younger people? That one race of people don't have lives as valuable as another race of people? Can we maintain that disabled people don't really enjoy their lives as much as the able-bodied people? Can we argue that less attractive people don't have lives as valuable as those who are deemed to be beautiful? Rich and poor?

The legacy of the 20th century's humanitarian outrages plays a part in this debate. Until the 1940's, the notion of mercy killing was widely accepted, and in many cases treated leniently. However, before and during the Second World War, the Nazis practiced euthanasia on hundreds of thousands of disabled people they deemed less fit to live. This history is usually brought out in the euthanasia debate and linking euthanasia supporters to the Nazis makes for a strong emotional argument against the practice. Dr. Pieter V. Admiraal, Dutch aneastheologist and euthanasiast said, "The very word euthanasia is never used because of the madman Hitler."

Who is to say whose life is more valuable?

Slippery Slope

In the same way that telling one lie makes it easier to tell the next, it is argued that allowing some euthanasia would inevitably lead to a lot more, regardless of the restrictions initially put in place. We would slide down the "slippery slope". If we permit euthanasia in some cases, where do we draw the lines? Would allowing euthanasia in some cases not lead us to expand its use? Soon, it could be imagined, euthanasia would be applied in an ever-widening range of cases. The criteria for consideration of euthanasia would widen, as in some of the examples given above.

To avoid the slippery slope problem, it is argued that we should stay off the hill.

Abuse

Allowing euthanasia opens up the possibility of abuse for criminal purposes. Older people might be pressured by their children to commit suicide to speed up the inheritance process; if they refused, they could be helped along. The question of motive arose in both the Schiavo and Latimer cases. Terri Schiavo's treatment had incurred considerably large medical costs; Terri's death would relieve her husband Michael of the burden of paying for her treatment and he could get on with enjoying the new family he had started while she was in her persistent vegetative state. Robert Latimer was accused of trying to make his life easier by ending Tracy's life. There are already cases where children have their parents declared incompetent in order to seize family assets. It's argued that widespread euthanasia would make this even easier.

Doctors could abuse their power over life and death, in contradiction to their professional code of ethics. In emergency triage situations, doctors often have to make decisions about who to treat first and who not to treat. If restrictions on euthanasia were eased, they might stop bothering to ask people for permission to terminate their lives simply do it, ignoring a patient's right to consent or refuse. Each year, many thousands of patients are misdiagnosed; if euthanasia was widely acceptable, these could be fatal mistakes. Doctors might prescribe euthanasia for patients with a terminal illness, even though this patient might live for months. Some studies indicate this is already occurring, as doctors decide to speed up the dying of terminal patients to save money on their care and free up a hospital bed.

Murderers could cover up their crimes, making it look like euthanasia. The "Dr. Death" case in Britain involved a doctor who murdered at least 200 patients, mostly elderly. He forged documents and defrauded their estates. He was convicted of 15 counts of murder, later killing himself in jail. If euthanasia had been legal in Britain, might he have simply claimed that he was following requests?

The argument here is that when certain aspects of killing are legalized, it opens a Pandora's Box of possibilities.

Arguments in Favour of Euthanasia

Portable death: a euthanasia machine used
in Australia from 1995 to 1997.

There are many arguments in favour of allowing euthanasia in some form and to some degree. These include:

Right to die

The idea that the individual has rights is integral to Western society. In Canada, the Charter of Rights and Freedoms upholds your right to 'life, liberty, and the security of the person." You have the right to choose how you wish to live your life, within reasonable limits. You decide such things as where you will live and what job you will have. Shouldn't you have the right to choose the timing and manner of your own death? "Is my life not my own to do with as I please?" This was the argument made by Sue Rodriguez.

The right to die applies in particular to cases when a person is dying with no hope of recovery and suffering greatly. The idea of right to die is about having the right to choose as a free individual. Libertarian philosophers and advocates of extreme rational egoism insist on this right, although other philosophers are more cautious, pointing out that your rights do not override your moral obligations. You are not freed from your responsibilities in life, such as dependent children or parents, debts, or philosophy assignments, which all need to be considered. Suicide has serious moral implications.

The crime of suicide lies in its disregard for the feelings of those whom we leave behind.

E. M. Forster, Howard's End, (1910), Penguin Books

Quality of life

Related to right to die is the idea of the value that you give to your life. If I feel my life is no longer worth living, I can end it by committing suicide. But if I am unable to do so myself, why shouldn't someone else be allowed to help me? The medical system intervenes to help me stay alive; why not to help me end my life? This was another part of the argument made by Sue Rodriguez. When her quality of life dropped below what she considered acceptable, she consented to her own death to end her suffering. The quality of life argument has interesting connections to the sanctity of life argument against euthanasia. Both value life, but the quality of life argument holds that some life is not worth living, for example, that of extreme suffering.

Of course, to be acting morally, you must be able to make such a decision rationally, and not just because you are having a bad day: euthanasia is not a reversible procedure. While some people hold that suffering is valuable, others hold that it is undignified and unnecessary, if it can be prevented.

The common medical practice of DNR (Do Not Resuscitate) orders fall into the category of respecting quality of life. They acknowledge that in some cases, heroic measures to preserve someone's life may be successful, but will lead to greater suffering. For example, in the case of someone near death from a disease which is incurable, who suffers heart failure, performing CPR (cardio-pulmonary resuscitation) may prolong their life, but the violence of the procedure can lead to severe injuries, such as cracked or broken ribs, causing greater suffering. You will live longer, but in great pain, and your underlying condition is still there. You may wish you had died. DNR orders are not considered euthanasia, however.

This quality of life argument can be applied in both cases of voluntary and non-voluntary euthanasia, with decisions about the value of life being made without consent. It applied in all three of the cases in the Introduction to this activity.

Learn more about Do Not Resuscitate Orders and view a brochure.

The "Good Death"

To die proudly when it is no longer possible to live proudly. Death of one's own free choice, death at the proper time, with a clear head and with joyfulness, consummated in the midst of children and witnesses: so that an actual leave taking is possible while he who is leaving is still there, likewise an actual evaluation of what has been desired and what achieved in life, an adding-up of life - all of this in contrast to the pitiable and horrible comedy Christianity has made of the hour of death.

F. Nietzsche, section 36 of 'Expeditions of an Untimely Man' in Twilight of the Idols (1889)

Closely related to the quality of life argument is that of the "good death". Death is the natural end of life, something that will come to us all, eventually. The idea of dying well after living well and being in control of your death is seen as a more dignified exit than one in which you simply suffer to the bitter end, with life slowly ebbing away. It is argued that our modern society views life as a commodity, and that, in line with consumerism, more must be better. 

Death can be feared and seen as "bad". Medical technology has advanced to the point where we can now delay death and continuing to possess our life, regardless of its quality, is seen as proper. While medical technology is now claiming that soon we will be able to live to 140 years old, many argue they would not want to do so if 60 or 70 of those years consisted of suffering. These individuals might argue that simply being alive is not living.

Historically, dying was more a part of life than it is now. People accepted the inevitability of death and prepared for it. Those with terminal illnesses prepared to die with dignity, and in peace. Many in the modern euthanasia movement reflect this view. The Swiss-based euthanasia group is named Dignitas, Latin for dignity.

Medical resources

The argument has been made that our medical systems are under strain. On average, it is estimated that half the medical care resources you use in your life will be used during your last three months of life fighting death. If you have a terminal illness with little hope of cure, why put yourself through the suffering that usually accompanies this kind of treatment and force the medical system to foot the enormous bill?

This utilitarian argument for euthanasia argues that it would be better for our health care systems as a whole to spend resources on people who can be saved and cured, rather than on hopeless heroic measures to preserve lives that are naturally ending. This model focuses on palliative care to ease the suffering of the dying, rather than on prolonging life at any cost (financial, physical, and emotional). It benefits everyone, including the patient, who does not have to undergo painful medical procedures with little chance of success. This argument can also be applied in cases of infanticide, where the child is severely crippled and suffering. The counter-argument here has already been made—if this approach were taken, what would prevent doctors from killing their patients to save the system money?