The Right Choice

It is

Good Day

To

Die

(The Euthanasia Solution)

By Greg Stewart
(Bob O’Connor)

To define a meaning of a word means to clarify, to understand, to give definition to, direction or purpose to an item, an object, or an idea. However, the subjective cultural meaning of words tells us what the word means or represents to a society. The following terms are by no means strictly by the book definitions, but meant to capture the spirit of the word.

Definitions:

Euthanasia – is defined as an easy death or means of inducing one whether by oneself or with the aid of another – to die well. It is also the act or practice of painlessly putting to death a persons’ suffering from an incurable condition or condition, and or diseases.

Passive – is defined as not acting [a state of non-action] but acted upon subject to, or produced by an external agency. In terms of this paper, not to hinder the death of a person, by not taking additional or extraordinary measures to prevent it.

Active – is characterized by acting rather than contemplation or through speculation. In other words, active means to assist, to help, to aid in the person’s liberation from life – death.

Value – in its archaic form means to show concern for or appreciation that intrinsically important to others or oneself.

Death – means the ending of all vital physiological functions, the cessation of life without recovery.

Dignity – means the quality or state of one’s worth or lifestyle that brings intrinsic value to one’s self-esteem, character and perception.

Quality – means the degree of excellence, a standard, grade, or caliber to one’s expectation of oneself, friends, and or peers.

Competent – means to be possessed of, or characterized by marked or sufficient aptitude, skill, strength or knowledge.

Introduction (revised)

This past spring the country’s perspective on the dignity of death was heavenly debated. The right to choose when to die, or who has the “authority” and the qualification to make such choice was also highly examined with the neo and the religious right in the control of the Republican Party; bringing a new level of emotion and shrill to the discussion. I originally wrote this paper for school in the spring of 2003, at that time for my English research class, although I did not address the Terry Schiavo directly at the time, my opinion remain the same, that the individual should remain in control of their own body. Furthermore, when unable to make the choice, the direct next of kin, should have the “authority.” In the Terry Schiavo case, that was the husband. Despite of all the recriminations and the demonizing of Michael Schiavo, and the other choices made by different individuals, it was his choice to make, not the state, not the governor’s, and especially not the US Congress’. Our very foundation was coming under the attack of the hysterical majority, which is why this country was established as a republic not majority rule mob mentality. Our founders felt, it was necessary, and pragmatic to protect the minority opinion and dissent. If they had not, this country would not be, what it is today. In fact, this country may have faltered coming out of the gate, we might have ended up like France, or Germany for that matter. So I offer my original opine, unaltered and with original introduction.

Introduction (original)

The undignified death, dying poorly, is the fear of those who have been diagnosed with a terminal illness. The ability to have a good death has become important to the American public because the extraordinary advances in medicine has doubled the life expectancy of the average citizen to nearly 80 years. However, the final days of death can be long and arduous. In fact, those with terminal illnesses experience what they perceive as an undignified death because of the laws and ethics of the medical establishment. Therefore, these establishments and, for the most part, this country have been rooted to the past; death not natural is either suicide or murder. Nonetheless, death in this country is viewed as an ending, not as a celebration of life or a passing to a better place.

Thesis Statement

Simply, that all competent individuals have an inalienable right to chose how they live or die as long as their choice does not do physical harm to another individual. Moreover, every individual should be able to choose how or when they die whether it is done passively or assisted actively by a physician.

Clarification of Freedom – Government Opposition

It is in the “public interest” that the government defines an individual’s freedom when the state deems it necessary to ensure the safety and the trust of its people. Additionally, considered by the government that the whole of the citizenry is greater than the individual’s right and the government has the duty to establish community guidelines when it comes to its citizen’s health and welfare. Therefore, the state may supercede the right of the individual and decides what is best, not the person. One example of this is a person does not have the right to scream fire in a crowded theater, when there is not one – this is the suppression of free speech. Thus, although a person may be in sound mind and spirit it is the duty of state to infringe on the judgement of the person. Therefore, the government can decide what inalienable rights or what rights are endowed, fundamentally, to a person. Namely, an individual can not enlist the assistance of another to aid early termination (suicide) of oneself, although that person may be terminally ill, and harming no other.

To aid in a suicide, in the view of the government, is considered manslaughter not murder, because the intent of the death was free from malice. According to Eric Sanders, in his article Kevin Sampson versus State of Alaska, the Alaskan Supreme Court concluded that “the prohibition against physician-assisted suicide does not violate the liberty, privacy, or the equal protection” clause of their Constitution. In other words, the state has the right to decide about the health and care of its citizenry.
Furthermore, it is the view of the government that the issue regarding self-termination can not be separated from the person. Therefore, the person’s emotions to make a rational decision are erratic at best. Moreover, the government has opined the pitfalls of allowing physician to assist in dispensing death. Again, according to Eric Sanders article detailed some of the government’s concerns for the community:

• Undiagnosed or untreated mental illness;
• Improperly managed physical symptoms;
• Insufficient attention to the suffering and fears of the dying;
• Vulnerability of socially marginalized groups;
• Devaluation of the lives of the disabled;
• Sense of obligation;
• Patient deference to physician recommendations;
• Increasing financial incentives to limit care;
• Arbitrariness of proposed limits; and
• Impossibility of developing effective regulation.

Additionally, the governing body policy of the Code of Medical Ethics states that “physician assisted suicide is ‘fundamentally incompatible’ with the [doctor] role as healer (Sanders).” In whole, it is the government observation that the controversy regarding physician-assisted suicide should at the least be “studied” so that the proper regulation can be properly tempered for those individuals that are terminally ill. Furthermore, the government believes that the “state” should determine, at the least, the how, who, and if possible, the when to die, for the terminally ill. Indeed, to allow the public to initiate or to control their destiny regarding euthanasia would be too chaotic and diverse for the state to ensure the public’s safety.

Ethical Opposition

The slippery slope of active euthanasia as stated says that once sanctity of life has been devalued by allowing active euthanasia then other active "involuntary", much more heinous and unacceptable forms become plausible. The ethical philosophers believe that to allow euthanasia in any form, passive or active would bring the foundation of our culture to an early termination. In other words, to allow euthanasia is in fact, allowing disarray to a system that, for the most part, is working when treating terminally ill patients. That aiding the consequentialists, the proponents, in active euthanasia is creating slippery-slope of events that will and can turn dark, if not for our elderly, but certainly for the indigent and mentally handicapped. Simply, with the indigent inability to pay; elderly seen as a drain on resources; and, the mentally challenged as incapable of contributing effectively and competently to society the physician may preempt by passively or actively pulling the plug on these patients (Clark).

Furthermore, the safeguards currently in placed to protect patients are insufficient. Therefore, the alternatives that might assist terminally ill patient comfort-level may not be developed, because the patients may feel overly pressured by their family and friends to save themselves from the indignity of the fight. Alternatively, patients may decide for assisted suicide option because of “the feeling of the lack of worth, or manifest a protest against inadequate care.” Consequently, such care may be due to inexperienced young doctors, and “the effect of pain and narcotics on ability to give informed consent (Clark).” Therefore, the moral imperative of ethical oppositionist of active euthanasia is to dissuade the terminally ill in considering suicide because all life is considered valuable and sanctified. Moreover, euthanasia in any form whether assisted or not is considered “terrible medicine” that seems to be in the view of psychiatrist Herbert Hendin, the executive director of American Foundation for Suicide Prevention in New York City (Branegan).

Psychiatrist Herbert Hendin is the author of Seduced by Death, and he berates the policy of the Netherlands toleration of euthanasia and point to its failure of physicians reporting the cases of euthanasia to the public prosecutor as required (Branegan). Thus, the built in policies to ensure that the publics trust are not abused are primarily going unchecked. These guidelines according to Jay Branegan, and Barbara Smit, in their Time Magazine article, “I Want to Draw My Line Myself” were:
• Patient must be suffering pain unbearably from an incurable disease.
• The doctor must know the patient very well to ensure the request is voluntary.
• In addition, doctor must consult with another physician.

Admittedly, the Dutch primary care physician is the family doctor, in most cases, and with the socialize medicine the nursing care for the chronically ill is thriving. However, the abuse of non-reporting by physicians should bring concern to authorities of why the secrecy. One could conclude that the emotional stress of dealing with morality of assisted suicide is intrinsically wrong. Thus, the Dutch doctors are conflicted with their ethics of assisting their patients to die because the Dutch physician's values the sanctity of life (Branegan).

Physician Opposition

The doctor oath is primary, “to do no harm”, and this is continues to be the view of most doctors. In a study of the American Medical Association House of Delegates, 61.6 percent opposed the legalization of physician-assisted suicide. The beliefs by the delegates are rooted in the long held belief that suicide is wrong. It also their belief that physician-assisted suicide is “morally wrong and is poor public policy” (Whitney et al).

Furthermore, the delegates believe that legalizing physician–assisted suicide “might cause more harm to the profession and to the nation” (Whitney et al). Namely, the possible abuses from the legal profession in second guessing the physician could, the financially paralyze the medical industry. Malpractice insurance my stop carrying doctors in the fear of wrongful death lawsuits. Thereby, limiting the number of doctors who can treat patients, and in turn could clog up the patient care, restricting access to healthcare. Thus, this view is understandable considering the current state of the American culture wanting to place blame and responsibility on “someone” on a perceived wrong. Especially in sight of the evidence of Dutch physician’s lack of reporting euthanasia cases (Sanders).
Moreover, the current perceived health care crisis regarding health maintenance organizations (HMO’s) would place the indigent, elderly, and mentally handicapped, and the poor at greater risk. Again, the inability to pay for an adequate healthcare by the indigent, and the drain on resources by elderly and mentally challenged will likely encouraged physicians to “opt out” these groups quality of care. This concern addressed in the case of the Kevin Sampson versus State of Alaska, “vulnerability of socially marginalized group” would be subject to “arbitrariness” (Sanders). Thus, the ethics of the patient’s right to die, and the issue of physician-assisted suicide has put the quagmire between the delegates and the rank-and-file of the organization. However, they both agree that it is better that the status quo remains, so that the patients need could addressed individually. Therefore, it is the concern of the individual patient that is important to the physician not association or governmental policies (Whitney et al.).

The Freedom of Choice – Support

A good death can not be measured or defined nor can it be judged by some innocuous, esoteric set of rules, because each individual person or culture or ethnic group sees death differently. How an individual’s views death corresponds to, how the individual feels about euthanasia, and physician-assisted suicide. However, this is not necessarily an absolute, but a factor in how death is viewed. According to June Mui Hing Mak and Michael Clinton, “In western culture, a good death [is] … defined [as] one in which the patients’ wants and needs are met.” The key words here are the “patients wants and needs” not what a governing body wants. The Chinese have a saying “‘a good birth is not as good as a good death’” (Mak et al.). Meaning that how one takes on death is just as important in how one takes on life. For instance, an individual may look at this opportunity as a social event, and have family; friends visit until the day the person dies. To many, this would be viewed as a good death, but to others, it is the intangibles that make up a good death for the individual satisfying. Some of the elements of the “intangibles” are:

• Comfort or relief of pain and suffering,
• Openness and being aware of dying,
• Completion or accepting the timing of one’s death,
• Optimism or keeping hope alive,
• Readiness or preparing for departure,
• Location or living with one’s choice about where to die;
• And, most importantly, control or acceptance of autonomy (Mak et al.).

The ability to accept one’s death is most assuredly one of the essential factors in the patients’ competency to make the decisions about how they want to die. Once the person has come to terms about their death, then, this is where the important decisions are to be made if the person has not already made out a living will. "The decision” can come only from a place of informed, rational, competent state of mind including the awareness of surroundings thereby eliminating any doubt about one’s intention. Therefore, it is at this point when choices can be made by the individual, the doctor(s), the family, and friends becoming empowering for those involved. Moreover, depending on how much time a person has left the quality and the quantity of care can be assessed. It is every individual right to be able to state how one precedes death and the intangibles are a rational person measure to defining a good death. How one faces death can only be measured by oneself and their god.

Religious Acceptance

According to Courtney S Campbell, “Death is a defining characteristic of the human experience. Yet … remains elusively beyond human control…” Meaning that, with all the technologies available to medicine and life extending technologies everyone dies sooner or later. Ordinarily, the obvious answer to whether or not religion supports euthanasia, and physician-assisted would be no. However, although the primary three monotheistic religions: Judaism, Christianity, and Islam belief that preservation of life is paramount some are willing to concede that the “dignity” and the “integrity” of self must be given its due weight (Campbell).
For instance, all three of these religions – Judaism, Christianity, and Islam – “ address the end of life from a common value of perspective … sovereignty, stewardship, and the self.” Sovereignty defined “denotes the lives and bodies of persons created by, and ultimately return to, God… Through the value of stewardship, [one is] considered the “agents of God” called to carry out the work of divine intent on earth…[and] the dignity of persons, linked to the notion ‘self’…” (Campbell)

In other words, through sovereignty God has “graciously” brought mankind into existence, and by “bestowing” humanity with uniqueness He has adorn man the ability of free will. This ability of free will, however, does not allow man to play God with life and death. However, with stewardship, the ability of free will or “decision-making” gives mankind the responsibility for one’s action as well as entrustment of one’s body.

According to Campbell, “we … are stewards of our bodies … therefore entrusted with capacities (competence) and responsibility to make appropriate decisions.” Therefore, being “agents of god” one can determine the morality of what lifesaving measures to take to save oneself or that of a loved one. Moreover, the “dignity of the person” with the three religions (Judaism, Christianity, Islam) believe that “preserving life is not an absolute good in and of itself”, but “is a good that opens the way to achieving higher goods that constitute the religious self” (Campbell). Simply, “the spiritual goal of liberation [or compassion] can be seen as an ethical reason for seeking or hastening death.” (Campbell)

A Reasonable Government

A government must follow the will of the people or it will find revolution knocking on its door wanting to chop off the leadership’s head. Since, the 1970’s the Netherlands has tolerated some form of euthanasia. In fact, the Netherlands has already passed the law formerly. The guidelines (regulations) that have been hammered out over the pass 20 years have come into effect. The guidelines require a formal declaration that state,
• “The patient makes a voluntary and informed request,
• That he or she is suffering from irremediable and unbearable pain,
• And that all medical options have been exhausted,
• A second, independent doctor must be consulted; and,
• The euthanasia must be carried out carefully, and reported to an inspection panel made up of a lawyer, a physician, and an ethics expert.” (Janssen)
According to Roel Janssen, “a study conducted showed that 92 percent of the Dutch population supported euthanasia. Furthermore, that 200,000 people out of 16 million carried a paper declaring their wish to be helped to die in case there is no more prospects for a normal, healthy life.” A normal life, pain free, and healthy is the elements the proponents have used to persuade the Dutch government to allow euthanasia. In fact, there is strong movement afoot in favor of voluntary death in the Netherlands despite the pro-life lobby (Janssen). The Netherlands is one government that understood the will of the people must take precedence over the state when the individual end of life has been determined. Meaning, how a person dies is uniquely their own and must be respected as long the individual has made an informed, voluntary and competent decision.

The freedom of choice is paramount, and to be able to choose how one greets death comforts the spiritual nature not only to the families, but also to society as whole. An example of this would be, in a case of Bouvia v. Superior Court, Judge Lynn Compton stated, “Self-determination is the most basic of freedoms. Each of us has the absolute right to our own goals and values, as long as they do not infringe upon the rights of others. These rights include our right to die at life’s end at the time and place of our choice, whether by active or passive means. The law must so provide.” (Risely)

Again, the government has restated once more, that the individual has the right to choose one’s final end game.

Conclusion

In the late 1990’s, a sci-fi television show, known as Star Trek: Next Generation, had a race of beings called the Klingons – a fierce warrior race. One of, the Klingons, rallying cries was “It is a good day to die!” when going into battle. This cry was not heroic fodder to pump up their ego or to show their courage, but a way of showing that life has been good and whatever the outcome of the day, that they were ready to face death. Their families understood that they might not come back, because they faced the challenges head on with dignity, honor, and courage. They accepted the choice of being a warrior. In turn, when a person chooses to die through passive or active means – it does not intend to show cowardice. On the contrary, it displays composure by facing down the reality and moving forward.

Works Cited

Branegan, Jay, Smit, Barbara, “I Want To Draw the Line Myself” Time 149:11 (3/17/97): EBSCO HOST Research Database. 8 April 2003. http://web15.epnet.com/citation
Campbell, Courtney S., “Euthanasia and Religion” UNESCO Courier 53:1 (1/2000): EBSCO HOST Research Database. 8 April 2003. http://web15.epnet.com/citation
Clark, Michael “Euthanasia and the Slippery Slope” Journal of Applied Philosophy 15 (1998): EBSCO HOST Research Database. 8 April 2003. http://web15.epnet.com/citation
Janssen, Roels “Government Suports Euthanasia” Issue 390 (Oct99): EBSCO HOST Research Database. 8 April 2003. http://web15.epnet.com/citation
Mak, June Mui Hing, Clinton, Michael, “Promoting a Good Death: An agenda for Outcomes Research – A Review of the Literature” Nursing Ethics (1999): EBSCO HOST Research Database. 8 April 2003. http://web15.epnet.com/citation
Riseley, Robert L., “Voluntary Active Euthanasia: The Next Frontier” Issues in Law & Medicine 8:3 (Winter92): EBSCO HOST Research Database. 2 April 2003. http://web15.epnet.com/citation
Sanders, Eric T., “Kevin Sampson V. State of Alaska” Issues in Law & Medicine 15:2 (fall99): EBSCO HOST Research Database. 8 April 2003. http://web15.epnet.com/citation
Whitney, Simon N. MD, JD, Brown, Byron W., Jr., PhD, Brody, Howard, MD, PhD. Alcser, Kirsten H., PhD., Bachman, Jerald G., PhD., Greeley, Henry T., JD “Views of the United States Physician and Members of the American Medical Association House of Delegates on Physician-assisted Suicide Department of Family and Community Medicine 16:5 (2001): EBSCO HOST Research Database. 8 April 2003. http://web15.epnet.com/citation

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