For many people, the issue of doctor assisted suicide is very disturbing.
As ethicist Carolyn Schmidt puts it, "The whole concept of doctor assisted
suicide is a sad commentary on where we are societally. My personal viewpoint
is that the whole concept is a total distortion of the basic commitment
of the physician to support and help life. I cannot see how a physician
can legitamize bringing about death."
Nevertheless, this is not a universal consensus. More than one person has
suggested that Dr. Kervorkian -- a Michigan physician whose "suicide
machine" has been used by three patients -- has brought attention to
an important problem, even though he is "the wrong spokesman for the
right issue."
David Mayo, Ph.D. and professor of philosophy at UMD and member of The Hemlock
Society, put it this way. "I'm sympathetic to what Kervorkian is doing,
but I'm unsympathetic to his modus operandi. I think he's a bit of
a loose cannon, to be perfectly honest. A loose cannon who loves publicity."
Dr. Mayo stated that he prefers Derek Humphry as the spokesman for this
issue.
Derek Humphry and other proponents of doctor assisted suicide usually build
their case around two main arguments. Those two arguments, according to
Dr. Mayo, are the mercy argument -- the notion of sparing someone unnecessary
suffering -- and the self-determination argument, the right to determine
one's own fate or level of care while dying.
"Against that," Dr. Mayo adds, "the primary argument is the
'very slippery slope' argument. What will this lead to?"
Dr. William Portilla, a physician active on both state and local ethics
committees, expressed this same concern. "Is this all scary? Yes. You
talk to people who are well versed in Nazi Germany. Euthanasia was a very
early step in all of that. So it is scary territory," Dr. Portilla
said, "and those words, 'euthanasia' and 'suicide,' scare people, too."
A recent column in Newsweek shows that such fears are not unfounded. In
a My Turn essay called "A Gentle Way to Die", March 2, writer
Katie Letcher Lyle relates how she put her 16 year old cat to sleep, then
goes on to advocate a similar solution for the troubles of a severely retarded
40 year old man named Henry who exhibits violent behavior patterns. This
"gentle death" for Henry -- that is, a lethal injection -- is
labeled humane. "Is a gentle death for human beings always the worst
answer?" writes Ms. Lyle. "...I find it disgraceful, as well as
ironic, that we cannot bring ourselves to treat our fellow humans as humanely
as we treat our pets."
Interestingly enough, one of the most emphatic letters to Newsweek in opposition
to this editorial came from Derek Humphry of the Hemlock Society. "We
at the Hemlock Society," Humphry wrote, "were appalled to see
that an advocate on behalf of the handicapped was hinting that a mentally
disturbed man should be euthanized. Euthanasia should be lawfully available
for the terminally ill adult who requests death because of unbearable
suffering. To kill Henry, even out of mercy, would be murder in the worst
degree."
WHERE DO WE DRAW THE LINE?
What is evident, then, is the problem of where to draw the lines. There
is a wide range of opinions as to what is acceptable and unacceptable here.
Many of the doctors interviewed by The Senior Reporter seemed to place that
line between passive and active euthanasia. Do Not Resuscitate Orders might
be considered a form of passive euthanasia.
Several doctors refered to the concept of "futile treatment",
wherein a doctor is not obligated to use extraordinary intervention when
its ultimate effect is obviously going to be futile. Carolyn Schmidt, who
opposes both doctor assisted suicide and active euthanasia, strongly supports
the non-use or withdrawal of extraordinary means of treatment such as respirators.
"I don't feel morally we are required to use these," she said.
"But there is a big difference between withdrawing or not using a technology
and developing a technology of killing."
Identifying and clarifying these terms and developing rational standards
for making difficult decisions has been a major role of the hospitals' medical
ethics committees. [see Sidebar on Definitions]
The Hemlock Society proposes that the patient must be terminally ill and
expected to die within six months. But others, it appears, wish to push
the line back still further. None of the patients whom Michigan's Dr. Jack
Kervorkian helped put to death by means of his suicide machine fell into
the Hemlock Society's criteria for what is acceptable. Although all three
requested and produced their own deaths with the aid of his machine, none
would have been dead within six months. (Dr. Kervorkian's cause has not
been helped by remarks such as, "To hell with the ethicists. I'm a
real doctor.")
Historically, the accepted code of ethical conduct for doctors has been
the Hippocratic Oath. Hippocrates was a Greek physician in the fourth century
B.C. who taught that diseases have natural causes and can therefore be studied
and often cured. As a result of his writings and teaching, he is called
by many "the father of medicine." The most famous document attributed
to Hippocrates is called the Hippocratic Oath. The Hippocratic Oath has
served as a model of professional conduct and for the ethical practice of
medicine. One portion of the oath reads: "I will neither give a deadly
drug to anybody if asked for it, nor will I make a suggestion to this effect."
Dr. Camenga, a neurologist with the Duluth Clinic, affirmed the role this
set of guidelines has tradionally played for physicians who are addressing
end of life issues. "Certainly we are all having to think these things
through a little more, but I have some fairly firm opinions. They come from
such sources as the Hippocratic Oath and the notion that doctors should
do no harm. That one should not be involved in suicide is very much a part
of the ethic of medicine as I understand it." Dr. Camenga went on to
say, "I am far more comfortable with using technical means to prolong
life than I am with using technical means to abbreviate life."
An October 6,1989 article in the Journal of the American Medical Association
by Ethics and Health Policy Counsel David Orentlicher, MD, JD, argues that
allowing phsycians to assist in the suicide of hopelessly ill patients will
violate the nature of the patient-physician relationship. "Indeed,
from the time of Hippocrates, the principles of medical ethics have instructed
physicians to refuse their patients' requests for death-causing treatments."
It is apparent from recent surveys that this Hippocratic tradition is eroding,
even among doctors. Dr. Orentlicher concludes, "Suicide by the hopelessly
ill may someday be sanctioned. However, much more thought needs to be given
before involving physicians in the process and compromising their essential
role as healers."
IF NOT HIPPOCRATES, WHAT THEN?
At bottom in all these matters is the question, How do we go about determining
what is right and wrong in a given situation? What are the components of
an ethical decision? How can physicians, patients and their families --
or courts -- decide?
Ethics has to do with decisions that involve making a distinction between
right and wrong. In its simplest form, an ethical determination is an assessment
of a moral act based on (1) what we do, (2) how we do it, (3) when we do
it, and (4) our motivation for doing it, or why we do it.
But behind these criteria are also underlying assumptions about the meaning
and value of life. Is human life inherently sacred? Or is value determined
by one's current contributions to society as a whole? This latter utilitarian
view comes dangerously close to resembling the social engineering of physicians
and geneticists under Hitler's Germany of the thirties.
In the Twin Ports, much work is being done to address the dilemmas raised
by prolonged suffering among the terminally ill. Advocacy for the right-to-die
in the local health care community appears minimal. However, because a growing
number of states -- more than a half dozen at this time -- is currently
discussing legislation that pertains to this issue, it is not unlikely that
the debate will eventually reach Minnesota lawmakers as well.
The issues are immensely complex and there is much at stake. On the state
and national levels, it is hoped that proposed legal and ethical changes
in health care policies will receive a thorough examination before such
policies are revised. Ideas which have immediate surface appeal often have
unseen consequences.
Any information in this article pertaining to legal or medical matters
is not to be construed as professional advice. Copyrights remain the property
of the authors.
Original versions of these articles originally appeared in The Senior Reporter
in the spring of 1992.
Part One: Issues and Their Implications
Part Two: Ethics Committees
Part Three: Local Perpsectives on the Right-to-Die
Debate
Part Four: Patients Have Rights, But Doctors Have Rights,
Too
Part Five: The Pros and Cons of Physician Assisted
Suicide
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