Physician-assisted suicide: "slippery slope" or civil right?The issue of physician-assisted suicide Noun 1. physician-assisted suicide - assisted suicide where the assistant is a physician
assisted suicide - suicide of a terminally ill person that involves an assistant who serves to make dying as painless and dignified as possible for the terminally ill Terminally Ill
When a person is not expected to live more than 12 months.
Any gifts given out by the afflicted person at this time may be considered as a dispersion of the estate rather than a gift. has once more landed on the front pages of the nation's newspapers due to four major court rulings earlier this year. Both supporters and opponents of physician-assisted suicide agree that the rulings are likely to have a major impact, although they disagree as to the effects. In the eyes of those who oppose physician-assisted suicide, the proverbial "slippery "slippery slope 'slippery slope' Medical ethics An ethical continuum or 'slope,' the impact of which has been incompletely explored, and which itself raises moral questions that are even more on the ethical 'edge' than the original issue " has become a sheet of glazed ice, slick and dangerous. In the eyes of those who support the death-with-dignity movement, the rulings were a resounding re·sound
v. re·sound·ed, re·sound·ing, re·sounds
1. To be filled with sound; reverberate: The schoolyard resounded with the laughter of children.
2. triumph for civil rights. The language in both cases has been similar to the response that Roe v. Wade Roe v. Wade, case decided in 1973 by the U.S. Supreme Court. Along with Doe v. Bolton, this decision legalized abortion in the first trimester of pregnancy. provoked from abortion opponents and supporters, and for good reason: both issues touch on those most intimate of human concerns--life and death, tradition and innovation, medicine and religion. And considering that state authorities have already promised to appeal two of the rulings to the U.S. Supreme Court, the issue of physician-assisted suicide is likely to remain on the front pages for many years to come.
In many respects, the modern death-with-dignity debate is an extension of the ethical, legal, and medical arguments surrounding the New Jersey Supreme Court's unanimous ruling on March 31, 1976, that allowed Julia and Joseph Quinlan to remove their daughter Karen from life-support equipment. Some medical ethicists warned then that the ruling was the beginning of a trend--the so-called slippery slope--which, followed to its logical conclusion, could lead to decisions to end a person's life being made by third parties not only on the basis of medical condition but also on such considerations as age, economic status, or even ethnicity.
After 20 years, and within the space of several months, four new court rulings have significantly expanded the reasoning behind the Quinlan decision. The most sensational of the four were the March 9 and May 14 acquittals by Michigan juries of Dr. Jack Kevorkian Jack Kevorkian, M.D. (IPA pronunciation: [kɛ.ˈvɔːɹ.ki.ɛn] ) (born May 20, some sources say May 26, 1928) is a controversial American pathologist. , who has attended the suicides of 28 seriously ill A patient is seriously ill when his or her illness is of such severity that there is cause for immediate concern but there is no imminent danger to life. See also very seriously ill. people since 1990, of charges in connection with the deaths of four of them. But while the Kevorkian verdicts were the subject of much popular attention, it was the other two decisions which had the experts opining o·pine
v. o·pined, o·pin·ing, o·pines
To state as an opinion.
To express an opinion: opined on the defendant's testimony. on the nation's op-ed pages and on the more substantive interview shows.
The first of these decisions came on March 6, 1996, when the U.S. Court of Appeals for the Ninth Court in San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden overturned a Washington State law that made assisted suicide assisted suicide: see euthanasia. a felony. The other occurred on April 2, 1996, when the U.S. Appeals Court for the Second Circuit in New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of struck down that state's law making it illegal for doctors to help terminally ill people end their own lives. While acknowledging that "people of good will can and do passionately disagree about the proper result" of assisted suicide, Ninth Circuit Judge Stephen Reinhardt Stephen Roy Reinhardt (born March 27, 1931 in New York, New York) is a circuit judge on the United States Court of Appeals for the Ninth Circuit, with chambers in Los Angeles, California. He was appointed in 1980 by President Jimmy Carter. wrote in the majority opinion:
Like the decision of whether or not to have an abortion, the decision how and when to die is one of "the most intimate and personal choices a person may make in a lifetime," a choice "central to personal dignity and autonomy."
But whereas the Ninth Circuit decision was based on the Fourteenth Amendment Fourteenth Amendment, addition to the U.S. Constitution, adopted 1868. The amendment comprises five sections. Section 1
Section 1 of the amendment declares that all persons born or naturalized in the United States are American citizens and citizens and privacy issues, the Second Circuit ruling in April invoked an "equal protection" argument that people suffering terminal illnesses should have the same right as those, such as Quinlan, who are in a coma and have the law on their side in the decision to halt life-sustaining nourishment or treatment. "Physicians do not fulfill the role of `killer' by prescribing drugs to hasten death," wrote Second Circuit Judge Roger J. Miner, "any more than they do by disconnecting life-support systems."
After the federal appeals court decisions came down, I contacted Alan Meisel, professor of law and director of the University of Pittsburgh's Center for Medical Ethics medical ethics The moral construct focused on the medical issues of individual Pts and medical practitioners. See Baby Doe, Brouphy, Conran, Jefferson, Kevorkian, Quinlan, Roe v Wade, Webster decision. . Meisel picked up on the Ninth Circuit Court's abortion language and its expansion of termination of life support to the right to assisted suicide, which he calls physician aid in dying. "This is an issue that is going to get thoroughly aired over the next decade or two in the way that abortion has in the past two decades," Meisel predicted and went on to add:
It's an issue about which people have very strong opinions and on which there is no clear consensus. We have accepted as a society for 20 years allowing physicians to terminate life support for terminally ill patients. That goes back to the Karen Quinlan case. We have in effect recognized, most certainly in the case of competent patients ... that people have a right not to be made to suffer if it is their competent choice that death is preferable. So, if we're going to talk about physician-assisted suicide, the only thing we're talking about is a different means of accomplishing the same end. I don't think it's my personal opinion alone; I think that Judge Reinhardt shares the same view.
I think the difference between withholding treatment and actually intervening to help people end their lives is a fictitious difference. There is no real difference between the two, because even when we terminate treatment, we act to end their lives. When we remove, for instance, the feeding tube feeding tube
A flexible tube that is inserted through the pharynx and into the esophagus and stomach and through which liquid food is passed. , that brings about someone's death. Whatever difference there might be is too inconsequential to result in any legal or moral difference.
But Lois Snyder, J.D., a faculty associate at the University of Pennsylvania (body, education) University of Pennsylvania - The home of ENIAC and Machiavelli.
Address: Philadelphia, PA, USA. Center for Bioethics bioethics, in philosophy, a branch of ethics concerned with issues surrounding health care and the biological sciences. These issues include the morality of abortion, euthanasia, in vitro fertilization, and organ transplants (see transplantation, medical). , disagrees with Meisel's assessment. During a telephone interview, she said:
It's important for us as a society to say that we do care how people die. It's not just a matter of their control to go off and kill themselves. I strongly support the patient's right to stop treatment, including life-support treatment. The difference is about your right to be left alone in one case, to allow nature to take its course. On the other side, in physician-assisted suicide, you're talking about actively bringing about death, and you're asking for something to be done as opposed to nature just taking its course and refusing additional treatment. Snyder thinks the "slippery slope" argument is important:
But that's not the whole argument against physician-assisted suicide. It's sort of the more practical argument. I just don't think it's a good idea for society to put its seal of approval on assisted suicide. It sends the wrong message, and it's doubly bad to give the role of assisted suicide to physicians, who are by training and tradition supposed to be healers and comforters and not agents of death.
This is a very important turning point for the nation. I'm not convinced that what people want so much is a right to physician-assisted suicide as more care, comfort, and compassion at the end of life. A lot of what has been going on has been an indictment of our ability to give people the kind of care they need at the time of death.
Alexander Capron, a professor of law and medicine at the University of Southern California The U.S. News & World Report ranked USC 27th among all universities in the United States in its 2008 ranking of "America's Best Colleges", also designating it as one of the "most selective universities" for admitting 8,634 of the almost 34,000 who applied for freshman admission , raised a similar theme in his response to the Ninth Circuit ruling. "Whatever the legal issues," he told the New York Times, "this clearly stands as a reminder to the medical profession that the public regards it as having failed it abysmally, with the high-tech prolonging of life, in terms of assuring that a patient's wishes will be respected."
Dr. Charles W. Plows, chair of the American Medical Association's Council on Ethical and Judicial Affairs, previously addressed the failure of the medical community to adequately deal with death in a letter to the editors of the New York Times on September 17, 1995. Responding to an article about physician-assisted euthanasia, Plows wrote: "Physicians must do better at discussing end-of-life treatment decisions with patients and at providing optimal comfort care and emotional support in the final stages of disease. `Unacceptable suffering' cannot serve as a ground for euthanasia because in almost all cases severe pain can be relieved."
Another letter in the same issue of the Times, written by Edward J. Halloran, a North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures
Area, 52,586 sq mi (136,198 sq km). Pop. registered nurse, expressed a like sentiment:
Assisted suicide is neither necessary nor desirable when hospice services are initiated. Maintaining hope, independence, and comfort is a far better choice than suicide or an agonizing death.
What is required for the dying is to have access to hospice counseling early in the process. I cannot help believe that the benefit of extended hospice services would accrue to both the dying and those who pay for the extensive hospital services used at the end of many American lives.
The role and duty of healer and of the medical profession have been debated at least since the ancient Greeks This an alphabetical list of ancient Greeks. These include ethnic Greeks and Greek language speakers from Greece and the Mediterranean world up to about 200 AD.
: Top - 0–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Related articles
A , when Hippocrates tried to codify codify to arrange and label a system of laws. the physician's job and responsibilities in the oath that bears his name.
Snyder and her colleague, Dr. Arthur Caplan Arthur L. Caplan PhD, is Emanuel and Robert Hart Professor of Bioethics and director of the Center for Bioethics at the University of Pennsylvania. Prior to coming to Penn in 1994, Caplan taught at the University of Minnesota, the University of Pittsburgh, and Columbia University. , director of the University of Pennsylvania Center for Bioethics, cited the oath in a summer 1995 article they cowrote for the Philadelphia Lawyer Philadelphia lawyer
clever at finding fine points and technicalities. [Am. Usage: Misc.]
See : Cunning . Calling the oath "a fundamental tenet of medicine that physicians be, and be seen as, healers and comforters, not agents of death," they asserted that doctors have taken the oath for thousands of years, vowing
to do no harm and "give no deadly medicine to anyone if asked, or suggest any such counsel." Doing otherwise would compromise the physician-patient relationship physician-patient relationship Medical malpractice A formal or inferred relationship between a physician and a Pt, which is established once the physician assumes or undertakes the medical care or treatment of a Pt; the establishment of a PPR is 'automatic' in and the trust that is necessary to sustain it. It would also undermine the integrity of the profession. Slippery slopes are invoked about the possibilities for misuse and abuse of power and about cracks in our moral infrastructure that could lead to crumbling.
But the oath can be interpreted different ways, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Barbara Daly, codirector of the Clinical Ethics Program at University Hospitals of Cleveland University Hospitals is a major not-for-profit medical center in Cleveland, Ohio, United States. With 150 locations throughout northeast Ohio, it encompasses a network of hospitals, outpatient centers and primary care physicians. . During a telephone interview, she said:
The easy answer to this is that the oath specifies the physician's primary duty above all is to do no harm. But that leaves quite open the question of what constitutes harm. Death is not the worst outcome in some cases; sometimes the greater harm is living a life that is devoid of meaning. If you accept that premise, then the prohibition against doing harm translates into a prohibition against doing things to people that continues that life or withholding your ability to help a patient to end his life.
William H.A. Carr, president of the Hemlock hemlock, any tree of the genus Tsuga, coniferous evergreens of the family Pinaceae (pine family) native to North America and Asia. The common hemlock of E North America is T. Society of Indiana, pointed out in the September/October 1995 issue of the Saturday Evening Post that, not only can the proscription against doing harm be read in at least two ways, the oath contains other elements which have become time-worn and irrelevant, rendering it meaningless in the assisted-suicide debate. "Those who invoke the Hippocratic oath Hippocratic oath
ethical code of medicine. [Western Culture: EB, 11: 827]
See : Medicine inevitably find themselves defending a document that, for many years, has been more honored in the breach than in the observance," Carr wrote. He cited the oath's beginning, in which the new physician swears by Apollo, Aesculapius, Hygieia, Panacea, and all the other Greek gods and goddesses. He asked:
Are we to assume that every physician who takes the oath thereby forswears Christianity, Judaism, or any other modern religion in favor of the old pagan gods and goddesses?
Realistically, the Hippocratic oath should be viewed as a quaint and admirable relic of the distant past, part of the truly glorious history of medicine--but not as a restriction on physicians who want to provide their patients with the best possible care.
And Alan Meisel concurs in declaring the oath moot: "Physicians are not legally bound to follow the Hippocratic oath. It is a historical doctrine, subscribed to by a group of physicians in ancient Greece The term ancient Greece refers to the periods of Greek history in Classical Antiquity, lasting ca. 750 BC (the archaic period) to 146 BC (the Roman conquest). It is generally considered to be the seminal culture which provided the foundation of Western Civilization. . Other physicians rejected it. The Supreme Court has rejected that it has any relevance to modern-day law."
As for modern-day medicine, the American Medical Association American Medical Association (AMA), professional physicians' organization (founded 1847). Its goals are to protect the interests of American physicians, advance public health, and support the growth of medical science. has stood firmly against physician-assisted suicide. AMA (Automatic Message Accounting) The recording and reporting of telephone calls within a telephone system. It includes the calling and called parties and start and stop times of the call. President Dr. Nancy Dickey articulated the association's stance in her response to the Second Circuit Court's ruling. Doctors recognize a clear line between using medical technology to keep a dying person alive and using it to end a life, she told the Los Angeles Times Los Angeles Times
Morning daily newspaper. Established in 1881, it was purchased and incorporated in 1884 by Harrison Gray Otis (1837–1917) under The Times-Mirror Co. (the hyphen was later dropped from the name). . "Stepping over that line [to assist a suicide] is not in the best interest of patients or society."
But fissures have appeared even among doctors. Late last year, a group of eight physicians, calling themselves Physicians for Mercy, announced that they were endorsing the use of the term patholysis for physician-assisted suicide; the term was invented by Dr. Jack Kevorkian and defined by him as meaning "to relieve suffering." This explanation was the core of the argument Kevorkian's lawyer Geoffrey Fieger Geoffrey Fieger is an American attorney. Based in Southfield, Michigan, he represented Dr. Jack Kevorkian in his doctor-assisted suicide trial, and later ran unsuccessfully as the Democratic nominee for governor of Michigan in 1998. used in his successful defense of the doctor this year.
Physicians for Mercy also proposed 10 guidelines for physician-assisted suicide that its members said they hoped would help win acceptance of the practice. Those guidelines, similar to proposals by Kevorkian and to guidelines contained in the Oregon law legalizing physician-assisted suicide, include a review by doctors of any such request by a competent adult; consultation with a qualified obitiatrist (a doctor who specializes in helping people die); consultation with a physician and also a specialist dealing with the patient's specific disease; and consultation with a specialist in pain management.
Guidelines in the Oregon law, which was approved by that state's voters on November 8, 1994, include requirements that the patient be referred to a specialist for counseling "if appropriate," that the next of kin The blood relatives entitled by law to inherit the property of a person who dies without leaving a valid will, although the term is sometimes interpreted to include a relationship existing by reason of marriage. Cross-references
Descent and Distribution. be notified by the patient, that the patient have the right to rescind the death request at any time, that there be verification "immediately prior to writing the prescription that the patient is making an informed decision," and that all of these procedures be documented.
Alan Meisel believes such safeguards will help prevent the doomsday predictions that economically and socially disadvantaged people could be forced or pressured into ending their own lives:
I think that there are risks that people will be pressured to seek physician aid-in-dying. And I think there are risks that this will occur more with certain vulnerable sectors of the population. However, there is the same risk that that will occur with terminating treatment. And there is no greater danger that people will seek physician aid-in-dying than they will in seeking termination of life support. The way to deal with these risks is not to prohibit this practice but to regulate it, and that's exactly what the [Ninth Circuit] judge has said in this case--that the state of Washington can't prohibit it but can regulate it.
But the federal appeals court rulings are not the final word on this issue, as suggested by Alexander Capron in his New York Times interview: the ruling "seems so inconsistent with what the Supreme Court has said in the past that it almost forces its hand in reviewing the case. Legally it doesn't make sense. The right to refuse treatment is clear. It applies across the board. But who has the right to assisted suicide?"
Erwin Chemerinsky Erwin Chemerinsky (born 1953) is a well-known professor of Constitutional law and federal civil procedure, has recently accepted a position at the University of California, Irvine, in the new Donald Bren School of Law, beginning in 2009. , a professor of constitutional law quoted in the same article, noted that, "in the last 10 years, the Years, The
the seven decades of Eleanor Pargiter’s life. [Br. Lit.: Benét, 1109]
See : Time Ninth Circuit has probably been reversed by the Supreme Court more than any other." Yet the Second Circuit, which came down on the same side as the Ninth, is seen as a more conservative court. Judge Miner, who wrote the majority opinion, was appointed as a district judge by President Reagan in 1981. The Second Circuit's decision cites an additional reason for the unconstitutionality of banning physician-assisted suicides: discrimination. "This [equal protection] provides a more modest and narrow path," Harvard law professor Laurence H. Tribe told the Los Angeles Times. "There is something utterly arbitrary and unintentionally cruel in condemning some competent terminally ill patients to continue their suffering because they have not been put on respirators."
Ethicists disagree on whether the U.S. Supreme Court should review this issue just yet. Snyder, who believes the Supreme Court would not support the lower federal court rulings, wants the High Court to rule. "I don't know Don't know (DK, DKed)
"Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. that it's a national political issue," she said. "It's getting a lot of attention in the media, as it should, and it will probably become a big issue for the states, depending on whether the Supreme Court takes one of these cases and on what they say. I think the Supreme Court should definitely hear one of the cases."
Daly and Meisel disagree. "At this very moment, I see no need for them to hear a case," Daly said. "The states seem to be handling it well. As a country, we're going more in the direction of states controlling medical issues anyway."
"I would like to see the Supreme Court stay out of it until lower federal and state supreme courts have had more of an opportunity to debate the issue," Meisel said. "I believe that, if the Supreme Court does take a position on this issue, it is not likely to provide support for it."
The tone of the nation's assisted-suicide debate is similar to the hyperbole and passion of the abortion debate The abortion debate refers to discussion and controversy surrounding the moral and legal status of abortion. The two main groups involved in the abortion debate are the pro-choice movement, which generally supports access to abortion and regards it as morally permissible, and the . Kevorkian has been called Dr. Death Dr. Death is a moniker that has been adopted by, or an epithet that has been applied to, multiple people:
tr.v. chas·tised, chas·tis·ing, chas·tis·es
1. To punish, as by beating. See Synonyms at punish.
2. To criticize severely; rebuke.
3. Archaic To purify. for his courtroom demeanor during the two recent trials that ended in acquittals. He has been lauded for standing up to national criticism and for coming down on the side of principle.
In the June 12, 1995, issue of the conservative National Review, retired professor and psychoanalyst Ernest van den Haag Ernest van den Haag (September 15 1914, The Hague – March 21 2002, Mendham, New Jersy) was a Dutch-American sociologist, social critic, and John M. Olin Professor of Jurisprudence and Public Policy at Fordham University. called Kevorkian "a rare and courageous exception" to the doctors who know how to help patients end their lives but refuse "because of moral obligations or in fear of legal liabilities [and who] impose their own socially supported moral beliefs on patients who do not share them but cannot act unaided."
Peter J. Bernardi, a Catholic priest, invoked the abortion analogy against assisted suicide in an article he wrote for the April 30, 1994, issue of America magazine. According to Bernardi:
Once the privacy principle was so legally enshrined in Roe as to allow the taking of innocent human life, it has become increasingly difficult, if not impossible, to brake the descent. A momentum has been established whereby the former presumption in favor of human life has given way to myriad forms of rationalizing and excusing the taking of life. Just as most abortions now are no longer "hard case" but "convenience" abortions, so will the circle of candidates for assisted suicide inevitably increase.
But van den Haag dismissed the abortion analogy in his National Review piece, arguing that the comparison is invalid because the fetus has no choice in the matter, while a competent adult is able to make an informed decision. He wrote:
Conceivably the fetus could have an interest in survival. If allowed to develop, the fetus may be expected to desire and enjoy life. In contrast, assisted suicide shortens the life of a patient who has decided himself that prolongation does not serve his interests. Surely, the normal fetus could not be assumed to have an interest in self-destruction. The suicidal patient suicidal patient Psychiatry A Pt at ↑ risk of committing suicide in the near future Risk factors–♂: ≥ age 60, widowed, divorced, white, Native American, living alone, unemployed or having financial difficulties, substance abuse Risk does.
Bernardi also defended the religious view, arguing that life and death decisions belong in the realm of God: "Ultimately the religious conviction that life is a gift from God that we are not free to end on our own terms Our Own Terms was the first full-length by Subterfuge and it was released on Pride Recordz. After its release on January 28, 2001, this CD helped propel Subterfuge to the top of the LIHC scene. Tracks
2. The Way It's Always Been
3. Til The End
4. is the most effective motive for remaining opposed to doctor-assisted self-killing. But what effect would that argument have on someone who is not religious or who does not believe in God?"
Van den Haag's answer:
Only in our time has it come to be believed that individuals collectively own society, rather than vice versa VICE VERSA. On the contrary; on opposite sides. . They also are thought to own themselves. Without God (or slavery) no one else really could. Owners can dispose of what they own as they see fit. We thus each become entitled to control our life, including its duration, to the extent nature permits, provided that this control does not harm others in ways proscribed PROSCRIBED, civil law. Among the Romans, a man was said to be proscribed when a reward was offered for his head; but the term was more usually applied to those who were sentenced to some punishment which carried with it the consequences of civil death. Code, 9; 49. by law.
Robert P. George
Robert P. George is McCormick Professor of Jurisprudence at Princeton University, where he teaches courses on constitutional interpretation, civil liberties and philosophy of law. , a lawyer who teaches legal and political theory at Princeton, and William C. Porth, Jr., also a lawyer, dismissed van den Haag's "ownership" theory in a response published in the June 26, 1995, National Review. They argued that people are not "owned" by God or by anybody else (including themselves), but that their value exists simply in their humanity:
As subjects of moral rights and obligations, people are not chattels CHATTELS, property. A term which includes all hinds of property, except the freehold or things which are parcel of it. It is a more extensive term than goods or effects. Debtors taken in execution, captives, apprentices, are accounted chattels. Godol. Orph. Leg. part 3, chap. 6, Sec. 1. to be owned, traded, or disposed of as they or anyone else "sees fit." As persons, not merely things, human beings have intrinsic, not merely instrumental, value. Hence people possess a dignity to which rights attach that not even they have the moral authority to waive, i.e. inalienable rights The term inalienable rights (or unalienable rights) refers to a theoretical set of human rights that are fundamental, are not awarded by human power, and cannot be surrendered. They are by definition, rights retained by the people. .
In defending a right to commit suicide Verb 1. commit suicide - kill oneself; "the terminally ill patient committed suicide"
kill - cause to die; put to death, usually intentionally or knowingly; "This man killed several people when he tried to rob a bank"; "The farmer killed a pig for the holidays" , Van den Haag makes an implicit appeal to J. S. Mill's principle that people ought to be free to do as they please so long as they do not directly harm others. Mill himself, however, saw that his "harm principle" could not rationally be stretched to authorize people to "dispose of themselves as they see fit." For example, he famously denied that people have a moral right to sell themselves into slavery. Whatever is ultimately to be said for and against his philosophy of liberty, Mill stands with Jefferson, not Van den Haag, on the question of inalienable rights.
Snyder also stands with Mill:
I'm not personally a religious person, though I guess some of these arguments would have a lot in common [with religious arguments]. I'm concerned that we've gone too far in arguing about the sanctity of the right to autonomy as a legal right and as an ethical matter. I think that just as you shouldn't have the right to give up your freedom by selling yourself into slavery, you shouldn't have the right to give up your self-determination [through assisted suicide].
The law sets the minimum standards by which we function as a society, and I would like it to reflect what I think is the right thing ethically. There are people who will say it doesn't matter what laws get passed, any individual physician doesn't have to participate. But I think that misses the point about what we as a society stand for, and I also think that it's not a good idea to pass laws which people then can't actually get implemented. Abortion would be an example of that; we have a right to abortion under certain circumstances, but there aren't that many obgyns out there who perform abortions. It poses a hardship to the right to abortion to not really be able to have full access; so in physician-assisted suicide, if we're going to have laws that say not only is it okay but it's your right, then we're going to need to have doctors participate in it.
Precisely the point, argues Meisel:
One of the most important things to remember is that no one is being forced either to aid patients in ending their life or to end their life against their will. This assumes the voluntary participation of a willing patient and a willing physician. Different religious groups will have their view on it, but I don't think that one can properly characterize it as exclusively a religious, ethical, or legal issue. It partakes of all of those things.
And what of that "slippery slope"?
Snyder and Caplan, in the Philadelphia Lawyer essay, cited a report from the Netherlands, where euthanasia is illegal but the law is not strictly enforced. According to Snyder and Caplan, the report said that the Dutch physicians "sometimes act without patient requests in performing euthanasia and that there was a sense among some patients that they had a duty to die."
Suggesting with some sarcasm that perhaps the Dutch need better checks and balances, Snyder and Caplan wrote that, while regulation and safeguards might ease some concerns about possible abuse, the safeguards are a "lawyer's dream" and a "physician's nightmare," and such a bureaucratic process would demoralize de·mor·al·ize
tr.v. de·mor·al·ized, de·mor·al·iz·ing, de·mor·al·iz·es
1. To undermine the confidence or morale of; dishearten: an inconsistent policy that demoralized the staff. patients wishing to end their lives with "dignity."
George and Parth also cited the Dutch experience in their response to van den Haag, and they offered an accounting of current practice and future possibility:
We are well into our slide. Consider the widespread approval . . . of depriving comatose co·ma·tose
1. Of, relating to, or affected with coma.
2. Marked by lethargy; torpid.
comatose (kō´m patients of food and water. Consider recent proposals from the highest ranks of the American medical profession to allow harvesting of organs from anencephalic an·en·ceph·a·ly
n. pl. an·en·ceph·a·lies
Congenital absence of most of the brain and spinal cord.
an infants before death. Consider the even more "advanced" state of affairs in the Netherlands, where non-consensual euthanasia is common. Does all this appear to be anything but a perfectly logical progression? It is but a short step from judging that a person who is old, infirm INFIRM. Weak, feeble.
2. When a witness is infirm to an extent likely to destroy his life, or to prevent his attendance at the trial, his testimony de bene esge may be taken at any age. 1 P. Will. 117; see Aged witness.; Going witness. , and in pain can rationally "choose death" to concluding that it is irrational for such a person to refuse to make that choice. As our population ages, government will face increased burdens in caring for the elderly. It is not unrealistic to fear that government may assume what began as a private prerogative, and move from making life-and-death decisions for the comatose, to making them for the insane, for the retarded, for those of less-than-average intelligence, and finally for those who are entirely rational and intelligent but whose desire to cling to life brands them as obstinate ob·sti·nate
1. Stubbornly adhering to an attitude, opinion, or course of action.
2. Difficult to alleviate or cure. , uncooperative, and just plain unreasonable. Are we then to rely on nothing but the heroism of individual doctors to restrain the abuses of government? If so, let us hope there are some "rare and courageous exceptions" among physicians of a rather different stripe from Dr. Jack Kevorkian.
One final ethical argument arises in the defense raised by Kevorkian's lawyer, Geoffrey Fieger, to obtain his latest acquittals. The defense cannot necessarily be faulted for building its case on a legal loophole--Michigan law contains a clause that exempts doctors from legal culpability culpability (See: culpable) for a patient's death if the patient dies as a result of treatment which is intended to relieve pain and suffering. But what this case was really about, for both the public and the medical community, was a physician making it easier for people to take their own lives. As Caplan argued in a column for King Features Syndicate King Features Syndicate, a print syndication company owned by The Hearst Corporation, distributes about 150 comic strips, newspaper columns, editorial cartoons, puzzles and games to nearly 5000 newspapers around the world. King Features Syndicate is a unit of Hearst Holdings, Inc. after Kevorkian's March acquittal.
[Fieger] took aim at the "intent" loophole and steered Kevorkian toward it. The attorney said Kevorkian did not provide carbon monoxide carbon monoxide, chemical compound, CO, a colorless, odorless, tasteless, extremely poisonous gas that is less dense than air under ordinary conditions. It is very slightly soluble in water and burns in air with a characteristic blue flame, producing carbon dioxide; and gas masks to people with the intent of causing their death. he argued that he had always merely intended to relieve suffering. Oh, please. What utter nonsense.
Whatever else you believe about physician-assisted suicide, lugging carbon monoxide and gas masks with you on house calls is not the road to pain relief. . . .
That lack of moral conviction is precisely why his place in the right-to-die debate should be as the John Brown of the movement--a loony fanatic who stirred a nation to confront an important issue, but no one that anyone could take seriously.
I believe Caplan's right on that. A principled stand, lacking the principle, has no legs. Ethicists on both sides of the issue agree that it deserves serious public debate. Sadly, Kevorkian cheated us of that in these trials