Qualifying euthanasia by calling it active or passive, direct or indirect, voluntary, nonvoluntary, involuntary, or assisted suicide only confuses the picture.
HIPPOCRATES lived before the time of Christ. Prior to his time, the medical practitioner had a dual role. One was to cure. One was to kill.
The great contribution of Hippocrates, which passed into the Christian era and guided the medical profession for the next two millennia, was to separate the curing and killing functions of the physician. Henceforth, a physician would only cure. Down through the centuries in the Hippocratic oath has come the phrase, primum non nocere, “First do no harm.” Now the oath of Hippocrates is no longer sworn by graduating medical students. With abortion, and the onrush of euthanasia, doctors, tragically, have again assumed that dual role.
When you take the giant step of placing a price tag on human life, judging that it has only relative value, then you have made a fatal move, for price tags can be marked down. The Nazis marked them down. Holland marked them down. Abortion demonstrated the same thing. Make no mistake, the slippery slope is a startling reality. Recall William L. Shirer who interviewed a Nazi judge condemned to death at Nuremberg. The judge wept saying, “How could it have come to this?” Mr. Shirer responded, “Herr Judge, it came to this the first time you authorized the killing of an innocent life.”
Tubes and Tubes
Proponents of euthanasia are quick to accuse doctors of not letting a patient die in peace. The typical picture drawn is of an old man strapped in bed, in constant pain, clearly dying. He has tubes in every natural body orifice and in several artificial ones. The doctor is keeping him alive, perhaps to obtain a larger fee, perhaps because the doctor does not want to admit that he has lost the battle for this man’s life.
A common observation in a retirement community is, “I don’t want to be kept alive with all those tubes and painful and expensive treatments.”
Rather Compassionate Care
Years ago, truly life-saving treatments were limited. Only too often, the physician’s role was to comfort and eliminate pain as the patient progressed to an inevitable death. Then, with the advent of antibiotics, better surgery, intensive and coronary care units and new drugs, it became possible to prevent death from occurring. For physicians, there was a learning process, from excesses in keeping dying people alive “too long” to learning how to “let go” and allowing natural death to occur. Today, almost all doctors handle dying patients well. Except in rare cases the caricature of the old man above is no longer valid.
Intensive Care Units
Is the intensive care unit such a frightening, painful place, that people do not want to return to it? A major study sheds light on this.1
Senior patients, previously treated in an intensive care unit, were asked if they would be willing to again undergo treatment in an I.C.U. “if it prolonged your life as perfectly as it could be?” For 10 years? 96% said yes. The percent remained at a very high level when asked for 5, 2 and 1 year each, for 6 months and 3 months. 74% still said yes for just one month.
Patients who are dying, do go on to die. While the proponents of euthanasia constantly speak about such cases, these are not their target at all.
They are, rather those who somebody thinks ought to die, but who won’t….the biologically tenacious. Commonly, such people are not in pain, are not on life support systems, but are, by some judgments, a burden to society. These are people with strokes, multiple sclerosis, Lou Gehrig’s disease, head injuries, quadriplegia, etc.
Pro-euthanasia literature constantly emphasizes pain, constant, intractable, unrelieved, agonizing pain. Physical pain, with rare exceptions, can be controlled. Sound advice, when confronted by a story of a person’s loved one being in constant pain, is “Get another doctor.” If yours can’t control pain, get one who does.
“The claim that serious physical pain is a valid reason to kill a patient does not hold up.”2
The second type of pain which is the main reason why people ask to be killed, is emotional pain, despair, hopelessness, being unloved, anguish, isolation, loss of dignity, weariness with life and not wanting to be dependent on others.
Suicide among those with serious handicaps is almost non-existent. It is the “normals” around them who judge their quality of life to be unacceptable, and who want them dead.3
With rare exceptions, those who commit suicide are clinically depressed. Clinical depression is usually a biochemical dysfunction that can be helped with drug therapy.
Over half of those who commit suicide saw a doctor in the prior month. Their complaints had been insomnia, no appetite, fatigue and other symptoms of depression. Sadly many doctors do not diagnose the underlying depression or treat it.
Patients usually tell others of their wish to die. Whether they continue to feel this way and request or commit suicide is heavily influenced by the response they receive.4
Comfort care consists of TLC, Tender Loving Care. This includes bathing, clean sheets, a warm room, a smile, a bath, proper positioning, pillows, food, water and other personal care.
This entails the use of drugs, surgery, etc. directed toward curing a disease, repairing an injury, removing a tumor, etc. Such therapy can be divided into usual and customary, such as giving antibiotics, splinting a broken bone and removing an appendix; and extraordinary care, such as heart surgery, organ transplants, etc. The care giver has always been seen as negligent if comfort care is not given. Extraordinary treatment has never been mandatory and has been judged in the light of many factors.
Mixed Up Priorities
Some have now moved food and water from “comfort care” into “treatment.” If then, a decision is made to withhold further “treatment,” food and water can be removed. If the doctor removes therapy, the patient sometimes dies. If the doctor removes food and water, the patient always dies, and painfully. Removing food and water isn’t “letting him die,” it’s “making him die.”
Legal in Holland
Holland legalized euthanasia. What began as a few extraordinary cases, has now become routine. 130,000 people die each year in Holland, and up to 20,000 are either killed or helped to die by doctors. As many as half did not ask to be killed.
These now include newborns judged to have a poor quality of life, a depressed adult who was physically well,5 and also depressed teenagers.
Hospitalized seniors are routinely visited by an organization that offers to oversee their case to prevent their doctor from killing them. The Dutch Patients’ Association placed a warning in the press that, in many hospitals, patients are being killed without their will or knowledge, or the knowledge of their families, and advised the patients and their families to carefully inquire on every step in the treatment, and when in doubt, to consult a reliable expert outside the hospital.6, 7, 8
Judges originally set up qualifications that were suppose to be honored before a doctor could kill a patient. In 2002 these were confirmed in statute law. These include repeated voluntary requests to die, uncontrollable pain, “Force Majeure” (doctor has no other choice), witnesses and two doctors who agree. But few of these are even considered, and the requirement for a voluntary request, by a rational person, repeatedly made, has been routinely ignored.
Changed My Mind
What the senior citizen says at the church social, or even in a doctor’s office, is not necessarily what that same patient will say when actually confronted with the possibility of dying. Life, however limited, is a good that most cling to. If you do honor their request, be sure it’s the most recent one, not one casually uttered years earlier.
Other Reasons to Oppose Euthanasia
- Doctors are frequently wrong in judging that a patient will die.
- When the only living witnesses are those who wanted her dead and the doctor, who is to confirm that she really did ask to die?
- If society approves euthanasia, how many elders will ask for it so as to no longer burden their loved ones?
- How voluntary is “voluntary”? Doctors and family can pressure a vulnerable patient into requesting death.
- In Holland progress in providing palliative care has largely disappeared (there are only a few small hospices there). Whereas in nearby Britain where, euthanasia is forbidden, there are over 300.
- Given the costs and increasing numbers of older people in the US, good palliative care will rapidly become unavailable if euthanasia is a legal option.
Need for Education
The more people know about the care of the terminally ill, and the pros and cons of legal euthanasia, the less they support it.9 Among doctors, support for euthanasia is strongest among those who know the least about it.10
A Plea to Lawmakers
If you do legalize euthanasia, please do not have a doctor do it. Rather hire a professional executioner. For over 2000 years people have trusted their doctor to “do no harm.” This trust has been seriously undermined by legal abortion. Please do not complete the destruction of this trust and confidence.
The American, Australian and the Canadian Med. Associations have all condemned euthanasia.
Euthanasia advocates appeal to the fearful in the name of ideals of compassion and autonomy. But they promote policies which, despite their best intentions, can only result in coercion and cruelty. If successful, such activity will dehumanize older people as much or more than any indiscriminate overuse of medical technology.11
The tragedy that will befall depressed, suicidal patients will be matched by what will happen to terminally ill people, particularly the old and the poor. Assisted suicide and euthanasia will become routine ways of dealing with serious and terminal illnesses, just as in the Netherlands. And, palliative care will be undercut for everyone.12
“When patients suffering from terminal illness are given proper palliative and supportive care, the desire for assisted suicide generally disappears.”13
1. Patient…Preference for Med. I.C.U., Danis et. al., JAMA 8-12-88, Vol. 260, No. 6, pg. 797-802.
2. Amicus Brief, AMA Glucksberg case, at 1&2, US Supreme Court Jan. 1997.
3. W. Peacock in Shewman, Active Voluntary Euthanasia, Issues In Law & Medicine, Winter 1987, pg 234.
4. H. Hendrin, Seduced by Death, W. W. Norton, 1996, Pg. 218.
5. Acquittal After Assisted Suicide, Br. Med. J. 2/7/94.
6. R. Fenigsen, Involuntary Euthanasia in Holland, Wall Street Journal, Sept. 30, 1987.
7. J. Willke, How Doctors Kill Patients in Holland, National Right to Life News, May 23, 1989.
8. J. Bopp et al., Euthanasia in Holland, Issues in Law & Medicine, vol. 4, no. 4, Spring Õ89, pp. 455-487.
9. Survey of Voter Attitudes in U.S.; the Terrance Group, Houston, TX, Sept. 1994.
10. R.K. Portenoy et al; Determinants of Willingness to endorse Assisted Suicide: 1995.
11. ibid (Portenoy), Pg. 222.
12. ibid (Portenoy), Pg. 218.
13. Amicus Brief, Nat. Hospice Org. Quill & Glucksberg cases, US Supreme Court, Jan. 1997.