"Dying is not a crime." - Dr. Jack Kevorkian.
I recently learned that human euthanasia is legal in some areas of the world. I wanted to find out more about what is permitted and what isn't. I began this article believing it would be a short review. As it turns out the concept of human euthanasia is extremely complex and varies greatly in motivation, support, and practice. What follows is what I found.
Passive Euthanasia vs Active Euthanasia vs Murder
The phrase "assisted suicide" is associated most famously with two doctors. Dr. Philip Nitschke is an Australian physician who legally practiced assisted euthanasia in Northern Australia in the early 1990s. When it was later criminalized, he created EXIT International, a nonprofit organization advocating the right to death, regardless of illness or health.
Dr. Jack Kevorkian is an American physician who performed many assisted suicides before it was widely criminalized in the early 1990s. He advocated for the rights of terminally ill patients to be given the means to end their own lives. He was convicted in Michigan of second degree murder when, instead of allowing the patient to administer their own lethal injection, he administered it to a patient himself.
These are both instances of "active euthanasia," ending a patient's life with a deliberate administration of a lethal dosage or substance.
Passive euthanasia is a far more common and accepted practice. Passive euthanasia is the removal of life supporting medical devices in order to end a patient's life. The most famous patient recently was Terri Shaivo. Terri remained in a permanent vegetative state after a 1990 cardiac arrest. In 1998, Terri's husband applied to have her feeding tube removed. Her parents blocked him in court for seven years. In 2005, after courts repeatedly upheld her husband's application, her feeding tube was removed and Terri passed away.
Active Assisted Suicide
In the United States active assisted suicide is permissible in three states: Oregon (1994), Washington (2008), and Montana. In these states it is only legal under the circumstance of terminal illness. Internationally, Luxembourg permits self administered suicide for terminally ill patients. Other countries have more open laws. Assisted suicide regardless of illness is permissible in Belgium, the Netherlands, and Switzerland.
In the US states that permit assisted suicide the following minimum criteria must be met: patient is 18 years old and a resident of the state, death is expected within six months, the patient has voluntarily submitted a written request to end their life, and the lethal dosage of medication is self administered. It requires the written consent of multiple physicians and there are repeated reaffirmations and waiting periods allowing the patient to change their mind.
Advocacy Groups
- Dr. Nitscke's EXIT International advocates across the world, but mostly in Australia for the right of any person to end their life on their own.
- Dignitas is a Swiss organization that provides the legal and medical backing to any person choosing to end their own life, including psychiatric evaluation, medical evaluation, and legal counsel. Dignitas supports suicide for any person.
- Dignity in Dying is a UK organization that supports the right of terminally ill patients to end their own lives. Assisted suicide remains illegal in Australia and the UK.
United States Assisted Suicide Law Timeline
Oregon State Ballot Measure 16: Allows Terminally Ill Adults To Obtain Prescription for Lethal Drugs (Death With Dignity Act)
Nov. 8, 1994
"An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner.”
Nov. 8, 1994
"An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner.”
March 26th 1999, Dr. Jack Kevorkian is convicted of Second Degree Murder in Michigan.
Washington State Ballot Initiative 1000: Death With Dignity Act
Nov. 4, 2008
"An adult who is competent, is a resident of Washington state, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication that the patient may self-administer to end his or her life in a humane and dignified manner...
Montana State: Assisted suicide upheld in court, but no legal statute permitting or criminalizing the act.
The Ethics
There seem to be two versions of active assisted suicide in the world. There are those who advocate for the right of any person, regardless or motivation, to end their own life. Then there are those, like Dr. Kevorkian, who advocate for what is often called "death with dignity," allowing a terminally ill patient to end their life prematurely.
Ethically this is a very complex situation. Dr. Kevorkian's patients gave consent to their suicide and were only given the means to do so. They were often bedridden and while held the mental capacity and emotional desire to end their lives, the physically were unable to. It was not until he administered death to a patient who was not physically able to themselves, was he convicted of murder.
A 2011 Gallup Poll found 48% of Americans morally opposed assisted suicide while 45% called it "right".
A 2011 Gallup Poll found 48% of Americans morally opposed assisted suicide while 45% called it "right".
In the US there is also the concept of the right to refuse treatment. No matter how life threatening any competent individual has the right to refuse necessary treatment. Is that not committing suicide? And is that any worse that choosing to end your life with the use of medical treatment?
How about the plain right to end your life? Is it ethical for a clinician to assist a healthy individual in ending their life? Do individuals have that right?
How about the plain right to end your life? Is it ethical for a clinician to assist a healthy individual in ending their life? Do individuals have that right?
EXIT International (2012) About Us. exitinternational.net Accessed Oct 9, 2012. http://www.exitinternational.net/page/AboutUs
Lydia Saad (2011) Doctor-Assisted Suicide Is Moral Issue Dividing Americans Most. Gallup Politics. gallup.com.
http://www.gallup.com/poll/147842/doctor-assisted-suicide-moral-issue-dividing-americans.aspx
Lydia Saad (2011) Doctor-Assisted Suicide Is Moral Issue Dividing Americans Most. Gallup Politics. gallup.com.
http://www.gallup.com/poll/147842/doctor-assisted-suicide-moral-issue-dividing-americans.aspx
Kate Pickert (2009). A Brief History of: Assisted Suicide. Time. Retreived from http://www.time.com/time/nation/article/0,8599,1882684,00.html
I think there is a very fine line when addressing the problem of whether patients have the right to refuse treatment that would potentially lengthen their life. I believe if a patient is competent, then they have every right to decide what treatment options to pursue. But this adds a new aspect to the problem, because who is to say one patient is competent while another may not be. I read an interesting article where a quadriplegic woman suffering from cerebral palsy decided to have her feeding tube taken out. She was in an immense amount of pain and wanted it to end. A court ruled that deciding to stop treatment and let nature take its course is not the same as committing suicide. Granted this case was years ago, I still agree with its ruling.
ReplyDeleteKleinman, I. (1991). The right to refuse treatment: ethical considerations for the competent patient. Canadian Medical Association Journal, 144(10)