INTRODUCTION

In a war of ideologies, the first casualties are the definitions of the terms used. Euphemisms

abound when people are determined to convince others. The word "euthanasia" comes straight

out of the ancient Greek, "eu" means goodly or well and “thanatos” means death.1 In the 18th-

century, writers in England translated its Greek root which meant, a "good" death, a welcome

way to depart quietly and well from life. In the language of the day, administering a lethal

injection becomes "aid in dying;" the deliberate ending of a person's life to reduce their suffering

becomes “mercy killing”. More commonly used today, however, is the phrase the "right to die."

These are noble sounding words that literally mean that someone can request that a doctor may

kill him. In the terminology battle, the proponents of euthanasia are seeking to redefine the term

euthanasia to gain popularity and acceptance. Notwithstanding the proponents’ effort to

camouflage this moral dilemma with noble sounding words, it remains controversial because it

pits the plight of suffering, dying individuals against religious beliefs, legal tradition, and, in the

case of physician-assisted death, medical ethics.2 In the opposite extreme end of the moral

spectrum, Euthanasia is considered, from a traditional Judeo-Christian point of view, as murder

and a blatant violation of the biblical commandment “Thou shalt not kill.”3 From a secular

perspective, one of the principal purposes of law is to uphold the sanctity of human life. Despite

contrary views, new development shows how values and practices can change over time. Some

practices that were considered barbaric at one time in history have become acceptable in the

twenty-first century.

In April 2002, Netherlands became the first country in the world to legalize euthanasia.

Subsequently, legalization of euthanasia took place in Belgium in September of the same year.4

With the increase acceptance and legalization of euthanasia in other countries, does a staunchly

85% Catholic country embrace the same? The current "debate" on the legitimacy of euthanasia is

a good indicator of the overall moral state of Philippines today. This three-part series addresses

the issues of euthanasia. In part one, it argues on what makes euthanasia legal and illegal. While

1 http://en.wikipedia.org/wiki/Euthanasia#Etymology2 http://www.enotes.com/euthanasia-article3 http://www.inplainsite.org/html/euthanasia.html4 http://ask.yahoo.com/20030710.html

in part two, it argues on what makes euthanasia moral and immoral. Lastly, the conclusion

provides a unanimous stand on the legal and ethical issues surrounding euthanasia.

Historical Background

Date Events

5th Century B.C.-1st

Century B.C.

Ancient Greeks and

Romans Tend to

Support Euthanasia

"In ancient Greece and Rome, before the coming of Christianity,

attitudes toward infanticide, active euthanasia, and suicide had tended

to be tolerant. Many ancient Greeks and Romans had no cogently

defined belief in the inherent value of individual human life, and

pagan physicians likely performed frequent abortions as well as both

voluntary and involuntary mercy killings. Although the Hippocratic

Oath prohibited doctors from giving 'a deadly drug to anybody, not

even if asked for,' or from suggesting such a course of action, few

ancient Greek or Roman physicians followed the oath faithfully.

1st Century A.D.-

Late Middle Ages

During Middle Ages

Christians and Jews

Tend to Oppose

Euthanasia

"There was a remarkable continuity in Church medical ethics

regarding suicide and euthanasia between the dawn of Christianity and

the late Middle Ages. Medieval references to voluntary death were

rare, suggesting that the actual practice of euthanasia had tapered off

dramatically since the fall of Rome. Laws in some parts of Europe

dictated that a suicide's corpse be dragged through the streets or nailed

to a barrel and left to drift downriver. The medieval ethos was

distinctly uncongenial to any kind of self-murder."5

"The ascendancy of Christianity, with its view that human life is a

trust from God, reinforced the views of the Hippocratic school [which

forbid euthanasia]. By the twelfth through fifteenth centuries, it

culminated in the near unanimity of medical opinion in opposing

euthanasia."6

17th Century

Common Law

Tradition Prohibits

Suicide and Assisted

Suicide in the

American Colonies

"For over 700 years, the Anglo American common law tradition has

punished or otherwise disapproved of both suicide and assisting

suicide... For the most part, the early American colonies adopted the

common law approach. For example, the legislators of the Providence

Plantations, which would later become Rhode Island, declared, in

1647, that '[s]elf murder is by all agreed to be the most unnatural, and

it is by this present Assembly declared, to be that, wherein he that doth

it, kills himself out of a premeditated hatred against his own life or

other humor...his goods and chattels are the king's custom." 7

17th-18th Century "No serious discussion of euthanasia was even possible in Christian

5 Ian Dowbiggin, PhD .A Merciful End: The Euthanasia Movement in Modern America, 20036 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 19987 Washington v. Glucksberg (63KB) , 1997

Renaissance and

Reformation Writers

Challenge Church

Opposition to

Euthanasia

Europe until the eighteenth-century Enlightenment. Suddenly, writers

assaulted the church's authoritative teaching on all matters, including

euthanasia and suicide... While writers challenged the authority of the

church with regard to ethical matters, there was no real widespread

interest in the issues of euthanasia or physician-assisted suicide during

that time."8

8 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998

Late 18th Century

American

Evangelical

Christians Reject

Suicide and

Euthanasia

"Enlightenment toleration of suicide proved to be temporary. Under

the leadership of evangelicals...a vigorous religious counterattack

gained momentum as the late eighteenth century drew to a close. The

various waves of religious revivalism, starting with the Great

Awakening of the mid-1700s, prevented secularists and agnostics on

either side of the Atlantic Ocean from generating popular support for

taking one's life. These events dovetailed with the Second Great

Awakening of intense evangelical fervor in the first years of the

nineteenth century and strengthened the condemnation of suicide and

euthanasia that stretched back to the earliest days of colonial America.

The rejection of suicide and euthanasia remained firm, even after

many of the new states decriminalized suicide in the wake of the

Revolutionary War. The majority of Americans rejected suicide's

common-law punishment...but no matter how sympathetic they were

toward the suicide's family, most Americans stopped far short of

condoning self-murder. As late as the antebellum period there existed

in the United States a firm consensus...against suicide and mercy

killing."9

9 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003

1828

The earliest American statute explicitly to outlaw assisting suicide is

enacted in New York. It is the Act of Dec. 10, 1828, ch. 20, §4, 1828

N. Y. Laws 19. "Many of the new States and Territories followed New

York's example… Between 1857 and 1865, a New York commission

led by Dudley Field drafted a criminal code that prohibited 'aiding' a

First US Statute

Outlawing Assisted

Suicide Enacted in

New York

suicide and, specifically, 'furnish[ing] another person with any deadly

weapon or poisonous drug, knowing that such person intends to use

such weapon or drug in taking his own life'… By the time the

Fourteenth Amendment was ratified, it was a crime in most States to

assist a suicide… The Field Penal Code was adopted in the Dakota

Territory in 1877, in New York in 1881, and its language served as a

model for several other western States' statutes in the late 19th and

early 20th centuries… California, for example, codified its assisted

suicide prohibition in 1874, using language similar to the Field

Code's."10

1870s

Samuel Williams

"An important milestone in the euthanasia debate was the isolation of

morphine in the nineteenth century and its widespread use as an

10 Washington v. Glucksberg (63KB) , 1997

Begins to Publically

Advocate Using

Morphine and Other

Drugs for Euthanasia

analgesic [a pain-relieving agent]... When the practice of analgesia had

become reasonably well established, Samuel Williams, a non-

physician, began to advocate the use of these drugs not only to

alleviate terminal pain, but to intentionally end a patient's life... During

the late 1800s, Williams' euthanasia proposal received serious

attention in the medical journals and at scientific meetings. Still, most

physicians held the view that pain medication could be administered to

alleviate pain, but not to hasten death."11

11 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998

1885

American Medical

Association Opposes

Euthanasia

The Journal of the American Medical Association attacks Samuel

Williams' euthanasia proposal as an attempt to make "the physician on

the robes of an executioner."12

1905-1906

Bills to Legalize

Euthanasia Are

Defeated in Ohio

"By the turn of the century, medical science had made great strides. As

physicians who used the modern scientific method and modern

principles of pharmacology consolidated their control over university

and medical school training, the euthanasia debate entered the lay

press and political forums. In 1905-1906, a bill to legalize euthanasia

was defeated in the Ohio legislature by a vote of 79 to 23. In 1906, a

similar initiative that would legalize euthanasia not only for terminal

adults, but also for 'hideously deformed or idiotic children' was

introduced and defeated as well. After 1906, the public interest in

euthanasia receded."13

1915

Dr. Haiselden Allows

Deformed Baby to

"In the early hours of 12 November 1915, at Chicago's German-

American Hospital, Anna Bollinger gave birth to her fourth child, who

is a seven-pound baby boy...the baby was blue and badly deformed.

After conferring with the father, the doctor awakened Harry J.

Haiselden, the hospital's forty-five-year-old chief of staff. Haiselden

diagnosed a litany of physical defects. He predicted that, without

surgery...the child would die shortly. In a decision whose shockwaves

12 Ezekiel Emanuel, MD, PhD .The History of Euthanasia Debates in the United States and Britain," Annals of Internal Medicine, Nov. 15, 1994

13 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998

Die Rather Than

Give It Possibly Life-

saving Surgery

would ripple from coast to coast, and mark a milestone in the history

of euthanasia in America, Haiselden advised against surgery. The

Bollingers tearfully agreed and, on 16 November, Haiselden called a

news conference to announce that, rather than operate, he would

'merely stand by passively' and 'let nature complete its bungled job.'

The child died on 17 November, amid growing controversy.By

declining to operate, Haiselden...almost singlehandedly managed to

accomplish what other defenders of euthanasia before him had not. He

not only got more Americans than ever before talking about

euthanasia, but also won endorsements from numerous prominent

figures. The publicity surrounding his professional conduct, briefly

eclipsing news from World War I, inspired other Americans to speak

out in favor of letting deformed infants die for the good of society...

Haiselden demonstrated how support for euthanasia was nurtured by a

cultural climate punctuated by science, naturalism, and humanitarian

reform." 14

1917

The Black Stork Film

Causes Controversy

over Infant

Euthanasia

"The Black Stork, a feature film from 1917, dramatically expresses the

anxieties people had about medicine and disability during this period:

disability was equated with disease, doctors claimed absolute

authority. The film was inspired by the sensational case of Dr. Harry

Haiselden, a Chicago surgeon who convinced the parents of a newborn

with multiple disabilities to let the child die instead of performing

surgery that would save its life. Haiselden's activities brought forth a

storm of public controversy in which all of the currently popular

attitudes toward disability were expressed. Many prominent thinkers,

including Clarence Darrow and Helen Keller, argued that physicians

had the right and the duty to decide whether a life was worth living.

14 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003

Although it was widely accepted that doctors should make these

decisions and act on them in their private practices, it was rare that the

subject was argued in public."15

1930s

Public Support for

Euthanasia Increases

as US Endures Great

Depression

"The dispute over mercy killing, after subsiding in the 1920s, caught

fire again in the 1930s, making these years a pivotal juncture in the

history of euthanasia in America. With the coming of the Depression

and more troubled economic times, Americans began talking again

about suicide and controlled dying... Public opinion polls indicated in

1937 that fully 45 percent of Americans had caught up with Harry

Haiselden's belief that the mercy killing of 'infants born permanently

deformed or mentally handicapped' was permissible."16

1935

Voluntary

Euthanasia

Legislation Society

Founded

The Voluntary Euthanasia Legislation Society (VELS) is founded in

England by C. Killick Millard, a retired public health physician.17

1936

Bill to Legalize

Euthanasia Defeated

"The euthanasia debate was not limited to this side of the Atlantic. A

bill to legalize euthanasia was debated in the British House of Lords in

1936, but was rejected... The defeat of this bill, along with the

outbreak of World War II, the subsequent discovery of the Nazi death

camps, and the recognition of the complicity of German physicians in

15 National Public Radio"The Black Stork: Movie Ads," www.npr.org (accessed May 8, 2009)16 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200317 Ezekiel Emanuel, MD, PhD "The History of Euthanasia Debates in the United States and Britain," Annals of

Internal Medicine, Nov. 15, 1994

in British House of

Lords

the extermination camps quelled but did not eliminate discussion of

the euthanasia question."18

1937

Voluntary

Euthanasia Act

Introduced in US

Senate

Nebraska Senator John Comstock introduces legislation called the

Voluntary Euthanasia Act, which calls for the legalization of active

euthanasia. It is never voted on but demonstrates an emerging interest

in legislating euthanasia.19

1938

National Society for

the Legalization of

Euthanasia Founded

On January 16th, 1938 Charles Francis Potter announces the founding

of the National Society for the Legalization of Euthanasia (NSLE),

which is soon renamed the Euthanasia Society of America (ESA).

According to TIME magazine, "he and a sizable group of other notable

men believe[d] so strongly in the right of an incurably diseased

individual to have his life terminated gently that they... organized a

National Society for the Legalization of Euthanasia... its trustees

included Dr. Clarence Cook Little of the American Society for the

Control of Cancer and of the American Birth Control League, and

Secretary Leon Fradley Whitney of the American Eugenics Society."20

1940s"When the 1940s dawned, many in the euthanasia movement believed

it was only a matter of time before euthanasia became legal in the

18 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 199819 Bryan Hilliard, PhD ."The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-

Physician Relationship," Issues in Integrative Studies, 200020 TIME Magazine "Potter and Euthanasia," www.time.com, Jan. 31, 1938

Nazi Use of

Involuntary

Euthanasia Changes

Public Perception of

Euthanasia in the US

United States...But euthanasia advocates were in for a surprise...

World War II broke out, and as Hitler's war machine Marched

eastward across Europe...news of Nazi atrocities against mental

patients and handicapped children filtered back to America... As word

spread in the late 1940s, the euthanasia movement found itself

increasingly on the defensive, scrambling to deny that the form of

euthanasia it supported was the same as Nazi murder." 21

1946

Committee of 1776

Physicians for

Legalizing Voluntary

Euthanasia Founded

The Committee of 1776 Physicians for Legalizing Voluntary

Euthanasia in New York State comes into existence.22

1950

World Medical

Association

Condemns

Euthanasia; Poll

Shows Declining

Support for

The World Medical Association votes to recommend to all national

medical associations that euthanasia be condemned "under any

circumstances." In the same year, the American Medical Association

issues a statement that the majority of doctors do not believe in

euthanasia. "When an opinion poll in 1950 asked Americans whether

they approved of allowing physicians by law to end incurably ill

patients' lives by painless means if they and their families requested it,

21 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200322 Bryan Hilliard, PhD "The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-

Physician Relationship," Issues in Integrative Studies, 2000

Physician-Assisted

Suicide

only 36 percent answered 'yes,' approximately 10 percent less than in

the late 1930s."23

1952

Groups Petition the

UN to Amend the

Declaration of

Human Rights to

Include Euthanasia

The British and American Euthanasia Societies submit a petition to the

United Nations Commission on Human Rights to amend the UN

Declaration of Human Rights to include "...the right of incurable

sufferers to euthanasia or merciful death... Inasmuch as this right is,

then, not only consonant with the rights and freedoms set forth in the

Declaration of Human Rights but essential to their realization, we

hereby petition the United Nations to proclaim the right of incurable

victims to euthanasia. Eleanor Roosevelt, the Chairperson of the

Commission, did not present the petition to the Commission.24

1962

Pauline Taylor

Becomes President of

the Euthanasia

Society of America

Charles Potter dies and theologian Joseph Fletcher assumes Potter's

unoffical title as the chief philosopher of the euthanasia movement.

"Fletcher fashions a new rationale for euthanasia based primarily on

the notion of patient autonomy." Pauline Taylor becomes president of

the Euthanasia Society of America (ESA). "Taylor...began the ESA's

soul-searching process that led to a major shift in the philosophy for

the entire American euthanasia movement. She believed the ESA in

the past had overemphasized the soundness of an individual's decision

to have his or her life ended if terminally ill and in unbearable pain...

Taylor concluded that the time was ripe to...begin convincing the

public that letting someone die, instead of resorting to extreme

23 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200324 Marjorie Zucker, PhD The Right to Die Debate: A Documentary History, 1999

measures, was both humane and ethically permissible." 25

1965

Donald McKinney

Becomes President of

the Euthanasia

Society of America

Donald McKinney becomes president of the Euthanasia Society of

America (ESA).

"Over the next two decades [McKinney] would help to transform the

euthanasia movement by leading a sizeable faction opposed to active

euthanasia or physician-assisted suicide. In the process he eventually

concluded...that there was a fundamental distinction between passive

and active euthanasia." 26

1967

First Living Will

Written

The first living will is written by attorney Luis Kutner and his

arguments for it appear in the Indiana Law Journal.27

1968

Harvard Medical

School Committee

Defines Irreversible

Coma as a Criterion

for Death

The Ad Hoc Committee of the Harvard Medical School to Examine

the Definition of Brain Death publishes its report in the Journal of the

American Medical Association in August 1968. The committee defines

"irreversible coma" as a new criterion for death. According to the

committee, a new definition of death was needed because of the great

burden that trying to revive irreversibly comatose patients puts on the

patients themselves, their families, hospitals and the community. 28

25 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200326 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200327 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the

Millenium," www.finalexit.org, Feb. 27, 200528 Peter Singer Rethinking Life & Death, 1994

1969

Hastings Center

Founded

The Hastings Center was founded in 1969 by Daniel Callahan to study

ethical problems in medicine and biology and was instrumental in the

development of bioethics as a discipline. The original focus of the

center concerned death and dying, genetics, reproductive biology and

population issues, and behavior control.29

1970

Idea of Patients'

Rights Gains

Acceptance

In the early 1970s, the widely accepted authority of the medical

profession came under concerted attack in the name of patient

autonomy. This challenge has been embodied in the progressive

enumeration of patient rights, especially the right to refuse medical

care, even life-sustaining care. The goals have been to remove

physicians from decision making and to let individual patients weigh

the benefits and burdens of continued life.30

1972

US Senate Holds

First National

Hearings on

Euthanasia

The US Senate Special Commission on Aging (SCA) holds the first

national hearings on death with dignity entitled "Death with Dignity:

An Inquiry into Related Public Issues.”

"The SCA hearings, chaired by Senator Frank Church, proved to be a

superb opportunity for professionals and laypeople to discuss a range

of issues relating to aging and terminal illness, including the evolving

doctor-patient relationship and the difficulties about defining death

itself. Overall, the hearings showed that Americans were becoming

increasingly unhappy about 'the brutal irony of medical miracles,'

which extended the dying process only to diminish patient dignity and

29 Daniel Callahan, PhD "The Hastings Center and the Early Years of Bioethics," Kennedy Institute of Ethics Journal, Mar. 199930 Ezekiel Emanuel, MD, PhD "The History of Euthanasia Debates in the United States and Britain," Annals of Internal Medicine,

Nov. 15, 1994

quality of life. Church insisted that the hearings were not about

euthanasia, but try as he might, he could not keep the subject from

surfacing." 31

1973

American Hospital

Association (AHA)

Adopts Patient's Bill

of Rights

The American Hospital Association adopts a "Patient's Bill of Rights"

which recognizes the right of patients to refuse treatment.32

1974

Society for the Right

to Die Founded; First

US Hospice Opens

"The founding of the Society for the Right to Die [formerly the

Euthanasia Society of America] marked a renewed dedication to

pursuing the legalization of active euthanasia, a reenergized campaign

to seek euthanasia laws through the political process."33

The first American hospice opens in New Haven, Connecticut.34

March 31, 1976

Supreme Court

Rules in Quinlan

Case that Respirator

Can Be Removed

21-year-old Karen Ann Quinlan had fallen into an irreversible coma at

a party in 1974. After doctors declared that she was in a "persistent

vegetative state," her parents went to court to have her respirator

removed. The New Jersey Supreme Court rules in 1976 that Karen

Quinlan can be detached from her respirator. The case becomes a legal

landmark, drawing national and international attention to end-of-life

31 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200332 AHA Patients’ Bill of Rights, 197333 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200334 Bryan Hilliard, PhD "The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-Physician

Relationship," Issues in Integrative Studies, 2003

from Coma Patient issues.35

October 1, 1976

Nation's First Aid in

Dying Statute Signed

into Law in CA

California Governor Edmund G. Brown Jr. signs the California

Natural Death Act into law and California becomes the first state in

the nation to grant terminally ill persons the right to authorize

withdrawal of life-sustaining medical treatment when death is believed

to be imminent.36

1980

World Federation of

Right to Die Societies

Forms; Hemlock

Society Forms

The World Federation of right to Die Societies was founded in 1980.

Its membership included dozens of organizations from countries

around the world that were concerned with euthanasia and the the right

to die.37

May 5, 1980

Pope John Paul II

Issues Declaration

Opposing Mercy

Killing

Pope John Paull II issues the Declaration on Euthanasia, opposing

mercy killing but permitting increased use of painkillers and a patient's

refusal of extraordinary means for sustaining life.38

Dec. 1984The American Medical Association publishes two reports,

35 In Re Quinlan , 197636 New York Times "California Grants Terminally Ill Right to Put an End to Treatment," Oct. 2, 197637 World Federation of Right to Die Societies "Ensuring Choices for a Dignified Death, www.woldtd.net (accessed

May 9, 2009)38 Marjorie Zucker, PhD The Right to Die Debate: A Documentary History, 1999

American Medical

Association Supports

Withholding or

Withdrawing Life-

Prolonging Medical

Treatment in Certain

Circumstances

"Withholding or Withdrawing Life-Prolonging Medical Treatment,

and "Withholding or Withdrawing Life-Prolonging Medical Treatment

-- Patients' Preferences."

The reports detail the American Medical Association's formal position

that with informed consent, a physician can withhold or withdraw

treatment from a patient who is close to death, and may also

discontinue life support of a patient in a permanent coma.39

1987

California State Bar

Becomes First Public

Body to Support

Physician Aid in

Dying

The California State Bar Conference passes Resolution #3-4-87 to

become the first public body to approve of physician aid in dying.40

1988

Unitarian

Universalist

Association Passes

Resolution in

Support of Aid in

Dying

The Unitarian Universalist Association of Congregations passes a

national resolution titled "The Right to Die With Dignity." The

resolution favors aid in dying for the terminally ill, thus the Unitarian

Universalist Association of Congregations becomes the first religious

body to affirm a right to die.41

Jan. 8, 1988The Journal of the American Medical Association publishes an

39 American Medical Association "Opinion 2.20: Withholding or Withdrawing Life-Sustaining Medical Treatment," www.ama-assn.org, (accessed May 12, 2009)

40 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the Millenium," www.finalexit.org, Feb. 27, 2005

41 "The Right to Die With Dignity" , 1988

Journal of the

American Medical

Association Publishes

Article By Hospital

Worker Who

Euthanized a Patient

anonymous article entitled "It's Over Debbie."

The article describes how a gynecology resident in a large private

hospital had injected a patient suffering from painful ovarian cancer

with an overdose of morphine. The article stirs controversy and

debate, and many condemn the resident for what he had done.42

1990s

Public Opinion

Surveys Show More

Than Half of

Americans Support

Physician-Assisted

Death

By the early 1990s, the growing interest in the right-to-die movement

became apparent in public opinion surveys. These showed that more

than half of the American public was now in favor of physician-

assisted death and membership of the Hemlock Society rose

dramatically to reach 50,000... With increased public interest, the

stage was set for an explosive swell of activity: in the courts, in

professional medical journals and institutions, and, most significantly,

in the homes of the American people.43

June 4, 1990

Jack Kevorkian

Participates in His

First Assisted Suicide

Jack Kevorkian, MD, assists Janet Adkins, a Hemlock Society

member, in committing suicide in Michigan. Adkins' death is the first

of many suicides in which Dr. Kevorkian assists.44

Cruzan v. Director, Missouri Department of Health comes before the

United States Supreme Court. The case receives national attention, as

42 Jonathan Moreno, PhD Arguing Euthanasia: The Controversy Over Mercy Killing, Assisted Suicide, and the "Right to Die," 1995

43 Sue Woodman Last Rights: The Struggle over the Right to Die, 200044 Wesley Smith, JD The Slippery Slope From Assisted Suicide to Legalized Murder, 1997

June 25, 1990

Supreme Court

Rules in Cruzan

Case that a Person

Has the Right to

Refuse Life Saving

Medical Service

it is the first right-to-die case that the court has agreed to hear. In

1983, a car accident had left Nancy Cruzan permanently unconscious

(by most accounts). Her parents requested to withdraw her feeding

tube, but the Missouri Supreme Court refused. The United States

Supreme Court ruled that a competent person has a constitutionally

protected right to refuse any medical treatment, but upholds Missouri's

right to insist on clear and convincing evidence as to the wishes of

patients who do not have decision-making capacity. In light of the

ruling, the Cruzans' lawyer goes back to court with new evidence as to

Nancy's prior wishes, and Nancy's feeding tube is removed. She dies

on December 26th, 1990.45

November 5, 1990

US Congress Passes

Patient Self-

Determination Act

Congress passes the Patient Self-Determination Act, requiring

hospitals that receive federal funds to tell patients that they have a

right to demand or refuse treatment. It takes effect the next year.46

1991

Choice in Dying

Formed

Choice in Dying is formed by the merger of two aids in dying

organizations, Concern for Dying and Society for the Right to Die.

The new organization becomes known for defending patients' rights

and promoting living wills, and grows in five years to 150,000

members.47

45 Wesley Smith, JD The Slippery Slope From Assisted Suicide to Legalized Murder, 199746 Patient Self Determination Act, Nov. 5, 199047 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the

Millenium," www.finalexit.org, Feb. 27, 2005

November 1991

Washington Voters

Defeat Physician-

Aid-in-Dying

Initiative

Washington State introduces ballot Initiative 119 to legalize

"physician-aid-in-dying." The initiative is defeated.48

November 3, 1992

California Death

with Dignity Act Is

Defeated

California voters defeat Proposition 161, the California Death with

Dignity Act, which would have allowed physicians to hasten death by

actively administering or prescribing medications for self

administration by suffering, terminally ill patients. The vote is 54-46

percent.49

April 1993

Compassion in Dying

Formed

Compassion in Dying is founded in Washington state to counsel the

terminally ill and provide information about how to die without

suffering and 'with personal assistance, if necessary, to intentionally

hasten death.' The group sponsors suits challenging state laws against

assisted suicide.50

May 1994

48 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 200149 Wesley J. Smith, JD Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder, 199050 Compassion & Choices "Aid-In-Dying Timeline," www.compassionandchoices.org (accessed May 12, 2009)

New York Task

Force Publishes

Report Against

Physician-Assisted

Suicide

The New York State Task Force on Life and the Law publishes When

Death Is Sought, a report that argues against the legalization of

physician-assisted suicide.51

November 1994

Oregon Death With

Dignity Act Passed

The Oregon Death With Dignity Act is passed, becoming the first law

in American history permitting physician-assisted suicide.52

April 30, 1997

President Clinton

Prohibits Using

Federal Funds for

Assisted Suicide

President Clinton signs the Assisted Suicide Funding Restriction Act

of 1997, which prohibits the use of federal funds to cause a patient's

death.53

June 26, 1997

US Supreme Court

Rules There Is No

Right to Die

The Supreme Court rules in Washington v. Glucksberg and Vacco v.

Quill that there is not a constitutional right to die.54

51 New York State Task Force on Life and the Law , May 199452 Oregon Death With Dignity Act , 199453 Assisted Suicide Funding Restriction Act of 1997, 199754 Washington v. Glucksberg and Vacco v. Quill, 1997

November 1997

Oregon Voters Keep

Death With Dignity

Act

Oregonians vote 60 to 40 percent in favor of keeping the Death With

Dignity Act.55

November 1998

Jack Kevorkian

Assists a Suicide on

National Television

Jack Kevorkian, MD, is a guest on 60 Minutes, during which he shows

a videotape of him administering a lethal injection to Thomas Youk, a

man suffering from Lou Gehrig's disease.56

November 1998

Michigan Defeats

Physician-Assisted

Suicide Proposal

Michigan introduces Proposal B to legalize physician-assisted suicide.

The proposal fails by a vote of 29% to 71%.57

1999

Jack Kevorkian

Convicted of Murder

A Michigan court convicts Jack Kevorkian, MD, for the murder of

55 Oregon Department of Human Services "Death With Dignity Act History," www.oregon.gov, Mar. 200656 People v. Kevorkian , 200157 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 2001

Thomas Youk and sentences him to 10-25 years in prison.58

2000

Maine Death with

Dignity Act Is

Defeated

Maine introduces a ballot initiative, the Maine Death with Dignity

Act, which reads "Should a terminally ill adult, who is of sound mind,

be allowed to ask for and receive a doctor's help to die?" The initiative

is defeated by a margin of 51% to 49%.59

2001

Netherlands

Legalizes Euthanasia

The Netherlands officially legalizes euthanasia.60

2003

Attorney-General

Aschroft Challenges

the Oregon Death

with Dignity Act

US Attorney-General John Ashcroft asks the 9th Circuit Court of

Appeals to reverse the finding of a lower court judge that the Oregon

Death With Dignity Act of 1994 does not contravene federal powers.61

2005The Terri Schiavo case garners national media attention. Terri Schiavo

had been brain damaged since 1990 when, aged 26, her heart stopped

58 People v. Kevorkian, 200159 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 200160 International Task Force on Euthanasia and Assisted Suicide "Frequently Asked Questions,"

www.internationaltaskforce.org, 200661 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the

Millenium," www.finalexit.org, Feb. 27, 2005

Terri Schiavo Has

Her Feeding Tube

Removed after Long

Court Battle

beating temporarily and oxygen was cut off to her brain. In 1998, her

husband Michael Schiavo filed a petition to have her feeding tube

removed. Seven years of legal battles ensued between Michael

Schiavo and Terri's parents, the Schindlers. After a Florida Circuit

Judge ruled that Terri Schiavo's feeding tube be removed and the

Florida Supreme Court overturned "Terri's Law," a law intended to

reinsert the feeding tube, the United States Supreme Court refuses for

the sixth time to intervene in the case. Terri Schiavo dies on Mar. 31,

2005, 13 days after her feeding tube is removed.62

January 17, 2006

US Supreme Court

Upholds Oregon's

Death With Dignity

Act in Gonzales v.

Oregon

The Supreme Court, in a 6-3 opinion in Gonzales v. Oregon, holds that

the Controlled Substances Act does not authorize the Attorney General

to ban the use of controlled substances for physician-assisted suicide.

Oregon's Death With Dignity Law is upheld.63

June 1, 2007

Jack Kevorkian Released on Parole

Jack Kevorkian, MD, the pathologist sentenced on Apr. 13, 1999 to

10-25 years in prison for his role in the euthanasia of Thomas Youk is

paroled after serving 8 years.64

62 BBC "Timeline: Terri Schiavo Case," Mar. 31, 200563 Gonzales v. Oregon, Jan. 17, 200664 New York Times "Kevorkian Is Released from Prison," June 1, 2007

February 19, 2008

Luxembourg

Legalizes Physican-

Assisted Suicide and

Euthanasia

The Luxembourg parliament adopts a law legalizing physician-

assisted suicide and euthanasia.65

November 4, 2008

Washington Death

with Dignity Act Is

Passed

Washington voters approve the Washington Death with Dignity Act

(Initiative 1000) making Washington the second US state to legalize

physician-assisted suicide.66

December 5, 2008

State of Montana

Legalizes Physician-

Assisted Suicide

Montana district judge Dorothy McCarter rules in the case of Baxter v.

State of Montana that Montana residents have the legal right to

physician assisted suicide, thus making it the third US state to legalize

physican aid in dying.67

December 31, 2009

State of Montana

Affirms Physician-

The Montana Supreme Court affirmed 4-3 in the case of Baxter v.

State of Montana that physician-assisted suicide is not "against public

policy" in Montana. The Court further ruled that state law protects

doctors in Montana from prosecution for helping terminally ill patients

65 Reuters , "Luxembourg Parliament Adopts Euthanasia Law," www.reuters.com, Feb. 20, 200866 Washington Death with Dignity Act , Nov. 4, 200867 Baxter v. State of Montana , Dec. 5, 2008

Assisted Suicide Not

Against Public Policy

die. The court declined to rule on the larger question of whether

physician-assisted suicide is a right guaranteed under Montana's

Constitution.68

68 Opinion/Order of the Montana Supreme Court on Baxter v. State of Montana, Dec. 31, 2009

Definition of Terms:

1. Euthanasia - The act of a physician or other third party ending a patient's life in response

to severe pain and suffering69.

2. Voluntary Euthanasia - refers to the action taken by the physician and the patient, who

both agree (with informed consent) to end the patient's life70.

3. Involuntary Euthanasia - refers to a third party taking a patient's life without the

informed consent of the patient. This is commonly practiced in veterinary medicine when

animals are "put down" or "put to sleep." In modern medicine, it could conceivably be

applied to the act of taking a terminally ill, suffering patient's life, which has lost all

mental capacity to make his/her own decisions71.

4. Active Euthanasia - In active euthanasia a person directly and deliberately causes the

patient's death72.

5. Passive Euthanasia - In passive euthanasia death is brought about by an omission - i.e.

by withdrawing or withholding treatment in order to let the person die73.

6. Competence - A competent patient is one who understands his or her medical condition,

what the likely future course of the disease is, and the risks and benefits associated with

the treatment of the condition; and who can communicate their wishes74.

7. Palliative Care - Medical, emotional, psychosocial, or spiritual care given to a person

who is terminally ill and which is aimed at reducing suffering rather than curing75.

69 http://en.wikipedia.org/wiki/Euthanasia70 Ibid71 Ibid72 http://en.wikipedia.org/wiki/Euthanasia73 Ibid74 http://www.bbc.co.uk/ethics/euthanasia/overview/keywords.shtml75 http://www.bbc.co.uk/ethics/euthanasia/overview/keywords.shtml

8. Terminally Ill - is a medical term popularized in the 20th century to describe a disease

that cannot be cured or adequately treated and that is reasonably expected to result in the

death of the patient within a relatively short period of time76.

76 http://en.wikipedia.org/wiki/Terminal_illness

PART I

Arguments on legality of Euthanasia

1. Futility of living a poor quality life

The right to life entails a right to a good quality life, one wherein an individual can fully enjoy

the essence of his existence – to feel happiness, or sadness, or excitement -- one that is not bereft

of consciousness or emotions.

In a landmark case in Western Australia, the Supreme Court confirmed the right of a

quadriplegic to refuse tube feeding. Being quadriplegic and losing the vigor of his existence, the

petitioner, Mr. Rossiter, told his caregivers to stop giving him food down his feeding tube. The

nurses reported that they have given him food and care but what Rossiter only wanted was his

mobility. Being paralyzed is not the kind of life that Rossiter wanted.77

Nancy Cruzan lost control of her car one day in January 1983 in Missouri. When the paramedics

arrived, they were able to restore her breathing and heartbeat and she was transported,

unconscious, to hospital. She continued to be fed through a surgically- implanted gastrostomy

tube. After several years, a court found that, although her respiration and circulation continued

unaided, she was oblivious to her surroundings except for reflexive responses to sound and

perhaps painful stimuli; her brain had degenerated, irreversibly; she was a spastic quadriplegic;

she suffered contraction of her four extremities, with irreversible muscle and tendon damage; and

had no cognitive or reflex ability to swallow food or water or to maintain her essential daily

needs nor would she ever recover such an ability. She lay in persistent vegetative state.78

In the cases mentioned, the patients are diagnosed as being in a vegetative state. These are the

situations when only the respirators, gastrostomy, and other machines keep the patients alive. As

in Cruzan, her responsive reflexes only respond to painful stimuli. This is not the kind of life that

is worth living. This is artificial life sustained by machines. Biological death is very imminent.

Without these machines, the patient dies, but then at least she dies to rest from a poor quality life.

77 http://edition.cnn.com/2009/WORLD/asiapcf/09/21/australia.right.to.die/index.html78 http://www.law.umkc.edu/faculty/projects/ftrials/conlaw/cruzan.html

2. Compassionate killing over invasive medical treatments

Medical treatments and procedures can be invasive such as those employed to cancer patients,

especially those who are already in the terminal stage. Physicians usually assume that what

patients and families want in a crisis is resuscitating life at all costs. However, surveys show that

public opinion is on the side of withdrawing all "invasive" and "extraordinary" treatment in such

cases.79

Gayle Stelter writes, "For almost seven years I have been living with cancer, mostly joyously and

gratefully, but gradually seeing the disease encroaching relentlessly on my once healthy body.

Throughout these years, I have thought long and hard about death and I've discovered that it's not

the prospect of death itself that is so frightening, but the process of dying…”

The court case of Karen Ann Quinlan tells of a poignant example of medical technology’s ability

to prolong life. It was in 1975 when Quinlan collapsed into an irreversible coma that left her in a

vegetative state, unable to breathe without a respirator, or eat without a feeding tube. After

seeing Karen like this for several months, her family finally came to the conclusion that she was

beyond hope, and decided to remove her from the ventilator. The New Jersey Supreme Court

case that followed was the first to bring the issue of euthanasia into the public eye. Although

Quinlan was removed from mechanical ventilation during 1976, she lived on in a persistent

vegetative state for nine years until her death from pneumonia in 1985. The case set a precedent

for a right to refuse unwanted medical treatment.80

Quinlan case presented one form of “passive euthanasia” wherein the immediate family of the

terminally ill patients decides to pull the plug. Out of compassion, the parents of Quinlan chose

to let her die peacefully than to continue suffering the invasive treatments for a comatose patient

such as the respirator and feeding tube.

3. Medical Care Costs More Than the Family Can Afford

79 Ethanasia: What is Good Death?80 http://en.wikipedia.org/wiki/Karen_Ann_Quinlan

Patients with terminal illness do not want to diminish their assets by incurring large medical

costs as their death approaches. As an act of generosity, they would rather die sooner, and pass

on their assets to their beneficiaries. Some, due to poverty or lack of health-care coverage cannot

afford pain killers as medications.

In China 80% are poor peasants, who cannot afford expensive medical technology use by a

hospital. A reported case tells of woman who is diagnosed of cervical cancer. Due to

medications, she has been suffering a lot. Yet there was still no assurance as that she will be

cured. Because of financial constraints, she chose to surrender and refuses to get further

medication.81

4. Euthanasia presents a new take on medical practitioners.

Euthanasia comes from a Greek word which means ‘good death’. Many observers note that good

death can hardly be achieved due to the advances of medicine which have increased people’s

health and life span. But then these advances have also greatly affected the dying process. For

example, in the early twentieth century the majority of Americans died at home, usually victims

of pneumonia or influenza. Today most people die in the hospital, often from degenerative

diseases like cancer that may cause a painful, lingering death.82 Many countries have raised the

flag for legalizing euthanasia. Among them are The Netherlands, Belgium, and Luxembourg.

The first country to legalize euthanasia is The Netherlands. Euthanasia in The Netherlands is

regulated by the “Termination of Life on Request and Assisted Suicide (Review Procedures)

Act" which took effect on April 2002. It states that euthanasia and physician-assisted suicide are

not punishable if the attending physician acts in accordance with criteria of due care. The patient

must be informed of the presence of reasonable alternatives and the applied method of ending

life. He must have consultation of another physician. The Act also requires physicians to report

euthanasia to a review committee to demonstrate their compliance.83

81 www.eubios.info/EJ63/EJ63D.htm82 http://www.enotes.com/euthanasia-article83 Buiting H, van Delden J, Onwuteaka-Philpsen B, et al. (2009) "Reporting of euthanasia and physician-assisted

suicide in the Netherlands: descriptive study". BMC Med Ethics 10: 18.

The legal debate concerning euthanasia took off with the "Postma case" in 1973. The case

concerned a physician who had facilitated the death of her mother following repeated explicit

requests for euthanasia. The physician was convicted but then the case had opened the court's

judgment to set out the criteria when a doctor would not be required to keep a patient alive

contrary to their will. A course of a number of court cases during the 1980s had formalized such

criteria.84

Second to The Netherlands, Belgium has also legalized Voluntary Euthanasia in September

2002. The law requires that the patient requesting voluntary euthanasia must be in the terminal

stage of their illness lest, a third medical opinion needs to be sought. Belgium provides all the

patients with access to free painkilling medication so as to ensure that no patient shall resort to

euthanasia as a result of poverty or because of their pain. Its law also necessitates that the patient

must be over eighteen (18) years of age. 85

Luxemburg also followed suit. On February 2008, the bill legalizing euthanasia has been

approved. It bears stressing that the decision making when a patient plea for euthanasia to end

his suffering calls for the discretion of the doctor. This burden is unique from the regular

transaction between the doctor and the individual patient who has come for help. Many

physicians have been looking back to the Hippocratic Oath when faced with the situation.

However, it must be noted that with the burden presented, physicians need to come out of their

refuge from ancient aphorisms. Situations faced by the patients and physicians centuries ago are

different from today. Taken from the oath are the words, “I will apply dietic measures for the

benefit of the sick according to my ability and judgment; I will keep them from harm and

injustice.” 86When the patient has been subjected to too much pain and suffering because of his

terminal illness, and he asked to be released from the oppression of his disease, what else are the

other forms of harm could he possibly fear? What injustice could be given to the person who

asked to be release from the injustice of his pain?

84 Rietjens JA, van der Maas PJ, Onwuteaka-Philipsen BD, van Delden JJ, van der Heide A (September 2009). "Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?"

85 http://www.euthanasia.net/page/Belgium86 http://euthanasia.procon.org/view.answers.php?questionID=000198

5. Terminally Ill patients have the right to a dignified death.

"In ancient Greece and Rome, before the coming of Christianity, attitudes toward euthanasia

tended to be tolerant. Many ancient Greeks and Romans had no cogently defined belief in the

inherent value of individual human life, and pagan physicians likely performed frequent

abortions as well as both voluntary and involuntary mercy killings. Although the Hippocratic

Oath prohibited doctors from giving 'a deadly drug to anybody, not even if asked for,' or from

suggesting such a course of action, few ancient Greek or Roman physicians followed the oath

faithfully. However, throughout classical antiquity, there was widespread support for voluntary

death as opposed to prolonged agony, and physicians complied by often giving their patients the

poisons they requested The ancients stressed the voluntary nature of the dying, provided that it

was done for the right reasons; for example, to end the suffering of a terminal illness." 87 During

the recent years, there have been cases of patients suffering terminal illness who asked for help

to end their suffering. There is no reason to deviate from the past practice when the patient is

suffering from a degenerative disease which leads to the deterioration of his body.

The wife of Derek Humphry was dying of bone cancer. Thrombosis had set in, her bones were

cracking and she was losing control of her bowels. One day, after a very close brush with death,

she sat up in her hospital bed and said to her husband, "Will you help me die?"88 There is also a

70 year old patient of Dr. Cox. Mrs. Boyes was persistent in request for voluntary active

euthanasia. She was so ill that she "screamed like a dog" if anyone touched her and conventional

medicine did not relieve her agony. In her last days, she repeatedly requested to die. 89 The

testimonies of Humphry and Dr. Cox are of the many instances when the emotional, mental, and

physical being of a person is giving up. These situations show the circumstance when death lies

beside a terminally ill person. As what the people believed during the classical antiquity, the time

of the blossoming of the Hippocratic Oath, it is a voluntary nature of man to die. The body of a

terminally ill person becomes a poison to his emotional health. These persons have the right to a

dignified death. To prolong their agony is to deprive them of their right of choice. Law must also

recognize, as it now does implicitly, the principle of personal autonomy and self-determination,

87 http://euthanasia.procon.org/view.resource.php?resourceID=13088 http://www.scu.edu/ethics/publications/iie/v4n2/euthanasia.html89 http://www.euthanasia.cc/cases.html

the right of every human being to have his [her] wishes respected in decisions involving his [her]

own body. It is essential to recognize that every human being is, in principle, master of his own

destiny. He may, of course, for moral or religious reasons, impose restrictions or limits on his

own right of self-determination.

Arguments on Illegality of Euthanasia

1. Alternative treatment exist for the ends of euthanasia

Euthanasia is not the only solution for relieving the pains and sufferings of the terminally ill. The

same purpose is sought to be achieved by providing palliative care.

The World Health Organization defines palliative care as the active total care of patients whose

disease is not responsive to curative treatment. Control of pain, of other symptoms, and of

psychological, social, and spiritual problems, is paramount. The goal of palliative care is the

achievement of the best quality of life for patients and their families.90 It seeks to provide relief

from pain and uncomfortable symptoms while integrating psychological and spiritual features of

patient care. 91

The legalization of euthanasia negates the purpose of practitioners in providing palliative care.

In the results of a 2010 study in The New England Journal of Medicine showed that lung cancer

patients receiving early palliative care experienced less depression, increased quality of life and

survived 2.7 months longer than those receiving standard oncologic care.92 Palliative care may

not totally abrogate the pains and sufferings of which euthanasia can provide by ending the life

of the terminally ill. However, legalizing euthanasia limits the possibility that meticulous

research in palliative care may provide a more prolonged pain free life of the terminally ill.

Moreover, it is noteworthy to consider that in palliative care, terminally ill patients are not only

provided pain relief but also psychological and spiritual care to maximize their remaining life.

The goal is not to cure, but to provide comfort and maintain the highest possible quality of life

for as long as life remains.

90 Bill Muehlenberg’s commentary on palliative versus euthanasia91 Christian Nordqvist , Medical News Today92 Temel, J.S., et al, Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer, N Engl J Med

2010; 363:733-742, August 19, 2010

Well-rounded palliative care programs also address mental health and spiritual needs. The focus

is not on death, but on compassionate specialized care for the living. Palliative care is well-suited

to an interdisciplinary team model that provides support for the whole person and those who are

sharing the person's journey in love.93

In the Philippines,, the growth of the hospice and palliative care movement in the country now

makes it possible for the terminally ill and those suffering from life-threatening ailments to stay

at home where their physical and spiritual needs could be met. Hospice care does not seek to

cure. It seeks to provide a “better” quality of life during the remaining days of the patient.

Formally introduced in the Philippines in 1993, the hospice movement now counts 23 institutions

and 520 service providers as members. These organizations, which are generally supported by

private individuals and groups, have formed the National Hospice and Palliative Care Council of

the Philippines Inc. (Hospice Philippines) to promote palliative care across the country.94

In this light, the necessity of legalizing euthanasia is not as apparent as it seems for there are

palliative care which caters not only to the same end but also to those ends which euthanasia

cannot provide such as maintaining the highest quality of life considering the patient’s condition.

2. Euthanasia undermines medical research

One of the major driving forces behind the exceptional medical advances made this century has

been the desire to develop treatments for previously fatal illnesses, and the eagerness to alleviate

hitherto unmanageable symptoms. Medical research is essential if medicine is to advance further.

When the focus changes from curing the condition to killing the individual with the condition,

this whole process is threatened. The increasing acceptance of prenatal diagnosis and abortion

for conditions like spina bifida, Down's syndrome and cystic fibrosis is threatening the very

dramatic progress made in the management of these conditions, especially over the last two

93 James Hallenbeck, MD. Pallative care perspective94 Inquirer, 9/16/2007, Hospices offer compassionate care

decades. Rather than being employed to care and console, funds are being diverted to fuel the

strategy of 'search and destroy'.95

The purpose of medical research is to find cure for what is, at the present, considered to be

incurable illnesses. If the rest of countries in the world legalize euthanasia, it will weaken and

undermine the improvement of medical research. Any physicians or doctors related and have

potential to make advanced in scientific and health care knowledge will not get enough

motivation that some people who are terminally ill will simply ended by euthanasia. They will

not feel encouraged and urged to make the improvement.

3. Euthanasia violates physician’s code of conduct

Traditional medical ethical codes have never sanctioned euthanasia, even on request for

compassionate motives. The Hippocratic Oath states 'I will give no deadly medicine to anyone if

asked, nor suggest such counsel....' The International Code of Medical Ethics as originally

adopted by the World Medical Association in 1949, in response to the Nazi holocaust, declares 'a

doctor must always bear in mind the obligation of preserving human life from the time of

conception until death'. In its 1992 Statement of Marbella, the World Medical Association

confirmed that assisted suicide, like euthanasia, is unethical and must be condemned by the

medical profession. When a doctor intentionally and deliberately enables an individual to end his

life, his actuation is unethical. 96 Legalizing euthanasia would render physician’s duty and

obligation to cure patients nugatory since in euthanasia the physician is assisting to an easy way

out that is to kill the person whom he is obliged to cure.

4. Euthanasia is driven by a cynical desire to cut health care costs

Remember, for H.M.O.s (health-maintenance organizations), profits come not through providing

services but from limiting costs, meaning reducing services in some cases. Imagine the money

95 Peter Saunders, Twelve Reasons Why Euthanasia Should Not Be Legalized96 International Code of Medical Ethics adopted by 3rd World Medical Assembly, London, England, October

1949

that could be saved--and thus profits earned--by H.M.O.s by not treating cancer patients because

they 'choose' instead to be killed; in not treating AIDS patients because they choose instead to be

killed; in not treating M.S. patients because they 'choose' instead to be killed; in not treating

quadriplegic patients because they 'choose' instead to be killed.97 This disturbing paradigm is one

reason why managed care is now called 'managed death' by those who worry about legalized

euthanasia in a health-care system dominated by H.M.O.s.

The same is true with government funded health care program. With euthanasia as a means of

saving expenses and making budget cuts, government will inevitably abuse this scheme.

Although this may seem favorable to the government in cutting down costs, it would be

contradicting to the purpose of euthanasia. The government, instead of providing sufficient

health care budget, would cut down the same by rationalizing that there is a way out of

unnecessary medical care to terminally ill patients that is to kill them. This insufficient budget

would then mean that proper health care of those who are not supposed to be terminally ill

(especially the poor) will be inadequate. The inadequacy of medical care may be, in turn, the

reason for patient’s condition to worsen.

This is similar to the situation feared in New Zealand. Most of the beds are occupied by the

elderly, but in the coming years there will be huge increase in younger patients with diabetes

needing expensive dialysis treatment. Treatment is expected to be rationed, with those not

making the list potentially facing palliative care in the later stages or assisted suicide. It is feared

that physicians and other health care providers, will pressure patients to request assisted suicide. 98

5. Legal euthanasia is prone to abuse

In Netherlands where euthanasia is legal, a recent Dutch government investigation of euthanasia

has come up with some disturbing findings. In 1990, 1,030 Dutch patients were killed

WITHOUT THEIR CONSENT. And of 22,500 deaths due to withdrawal of life support, 63%

(14,175 patients) were denied medical treatment WITHOUT THEIR CONSENT. Twelve per-

97 Wesley Smith, Consultant to the International Anti-Euthanasia Task Force. Forced Exit. 199798 www.internationaltaskforce.org/ascc.htm

cent (1,701 patients) were mentally competent but were NOT CONSULTED.99 The primary

philosophical support for euthanasia is represented by a demand for radical personal autonomy.

Personal autonomy is a difficult concept to develop safeguards around for vulnerable persons

who often have a diminished ability or opportunity to make decisions concerning self-

determination. Many vulnerable people have other people who are responsible for making

decisions for them.100

In the Terri Schiavo case, it was a legal battle between the husband and the parents of Teresa

Marie "Terri" Schiavo that lasted from 1998 to 2005. At issue was whether the equipment that

had been used to sustain her life since 1990 – specifically a feeding tube – should be

disconnected, thereby allowing her to die. Terri Schiavo collapsed in her St. Petersburg, Florida

home in full cardiac arrest on February 25, 1990. She suffered massive brain damage due to lack

of oxygen and, after two and a half months in a coma, her diagnosis was elevated to vegetative

state. 1998 Schiavo's husband, Michael, petitioned the Sixth Circuit Court of Florida (Pinellas

County), to remove her feeding tube pursuant to Florida Statutes Section 765.401(3). He was

opposed by Terri's parents, Robert and Mary Schindler, who argued that she was conscious. The

court determined that she would not wish to continue life-prolonging measures and on April 24,

2001 Terri's feeding tube was removed for the first time, only to be reinserted several days later.

On February 25, 2005, a Pinellas County judge ordered the removal of Terri Schiavo's feeding

tube. After all attempts at appeals through the federal court system were unsuccessful, Schiavo's

feeding tube was disconnected on March 18, 2005. She died at a Pinellas Park hospice on March

31.

In all, the Schiavo case involved 14 appeals and numerous motions, petitions, and hearings in

the Florida courts; five suits in federal district court; Florida legislation struck down by the

Supreme Court of Florida; a subpoena by a congressional committee to qualify Schiavo for

witness protection federal legislation; and four denials of certiorari from the Supreme Court of

the United States.

99 http://www.euthanasia.com, Shreyansh Mardia on July 14, 2008, Euthanasia- Mercy Killing- An Unconstitutional Act

100 Alex Schadenberg, The Interim: Can euthanasia safeguards protect interests of vulnerable persons?

In the above case, medical practitioners are in debate of whether or not Terri was terminally ill

or that her case could be cured and whether her consent and wishes are represented by her

husband’s affirmation. The determination of when to qualify a patient as euthanasia candidate is

subjective to the doctors’ recommendations. Doctors, like any other professionals, are not

infalliable. As such, there can never be an absolute assurance that a patient who is terminally ill

today will never be cured. This scenario is often the reason why legal euthanasia is abused.

In countries where there are laws regarding the conduct of euthanasia, its implementation is still

abused for personal reasons. Mercy killing has become a leeway for people to justify killing

either for personal or economic reasons such as their own interests in the disposition of estate

through wills of the terminally ill patients.

PART II

Arguments on the Morality of Euthanasia

1. Principle of Well-Being

Patients’ well-being ought to be promoted (if not for its own sake, then because of the derivative

importance of well-being). There have been several high-profile legal battles over the right to die

in the UK. Perhaps most famously is the case of Dianne Pretty, a woman in the terminal phase of

motor neurone disease who wanted assurance that her husband would not be prosecuted if he

helped her commit suicide.

Dianne and her husband fought an unsuccessful legal battle which ended on April 29th 2002

when the European Court of Human Rights dismissed her claim that the British courts were

breaching her human rights by refusing to allow her husband to help her commit suicide. Dianne,

who was paralysed from the neck down, had to be fed through a tube and used a computer

attached to her wheelchair to communicate, died after suffering breathing difficulties three days

after the ruling – the frightening death she wanted to avoid. 101

The idea of intentionally ending life due to quality of life assessment is not a feature unique to

utilitarian though. Ronald Dworkin (The New York Review of Books, Ronald Dworkin, an

American philosopher, and scholar of constitutional law, advocate of moral reading of the United

States Constitution and an interpretivist approach to law and morality) claims that there is a

sense in which most people think that life is “sacred”. When they say life is sacred, they mean

that personal life, able to sustain critical interests, is inherently valuable. It is this sense of life

that is sacred, not mere biological life that is no longer capable of sustaining personal creativity.

A valuable life therefore, requires more than natural investment. A valuable life requires creative

personal investment. Our lives are judged valuable as long as we are able to maintain and

appreciate the value of this creative investment. There is no intrinsic value to be had in bodily

life, only in the conscious control of life which individuals shape their lives. When the condition

101 Clare Dyer, The Guardian, Diane Pretty makes final “death with dignity” plea

of the body no longer acts in the service of this creative life of authorship, it is reasonable to

intentionally seek to end life. 102

For Dworkin, then, the quality of a person’s life is crucial to forming a judgment about whether

or not a life is worth preserving. That decision, at least for competent patients will be determined

by the judgment of individual patients. People should have the right to choose a painless and

dignified end, either at the time or beforehand, perhaps in a "living will". The right

circumstances might include: extreme pain and suffering; helplessness and loss of personal

dignity; permanent loss of those things which have made life worth living for this individual. To

postpone the inevitable with no intervening benefit is not a moral act. 103

Each individual has a right to make the “most intimate and personal choices central to personal

dignity and autonomy.” That right encompasses the right to exercise some control over the time

and manner of one’s death. The patient-plaintiffs in these cases were all mentally competent

individuals in the final phase of terminal illness and died within months of filing their claims.

Jane Doe described how her advanced cancer made even the most basic bodily functions such as

swallowing, coughing, and yawning extremely painful and that it was “not possible for [her] to

reduce [her] pain to an acceptable level of comfort and to retain an alert state.” Faced with such

circumstances, she sought to be able to “discuss freely with [her] treating physician [her]

intention of hastening [her] death through the consumption of drugs prescribed for that

purpose.”104

Clearly, it is contrary to the right to a well being to prevent persons who have clearly no other

option but to await such undignified and excruciating circumstances. Moreover, it is in

contradiction to a person’s conscience to allow a patient to suffer instead of allowing him the

right to choose to avoid such suffering.

102 Craig Paterson , A Natural Ethics Approach, Asisted Suicide and Euthanasia , 2008103 A humanist discussion of …EUTHANASIA, BHA submission to the Committee considering the Assisted Dying

Bill (2004)104 Quill v. Vacco, 80 F.2d 716, 720 (2d Cir. 1996) (quoting declaration of Jane Doe).

2. Right of Ownership

A claim in favor of a right to self determination is based on the concept of ownership. If one has

a right of dominion over his property, including the disposal and destruction, the right of

dominion can be extended to cover body parts and ultimately life itself. Self ownership is a

concept invoked to justify freedom of the individual from the dominion of others. In a free

society, you own your life, and your only obligation is to respect the legitimate rights of others.

Everyone is entitled to be treated as the sole owner of his or her own life.

However such concept is limited only if such exercise would infringe the right of others. In

euthanasia, however, no other right except of the patient’s right is encroached.

3. Equal Concern and Respect

Ronald Dworkin has championed the claim that a right to make a momentous personal decision,

free from coercive interference, is derived from the notion of equality of persons. In failing to

respect another person’s conception of what constitutes the good life, we devalue that person as a

true equal.

As Dworkin states in Taking Right Seriously, “Government must not only treat people with

concern and respect, but with equal concern and respect. It must not constrain liberty on the

ground that one citizen’s conception of a good life is nobler or superior to another’s.” 105

To say that other person’s idea of what is a good life, that is free from pains and sufferings, is not

the true “idea of life” is to say that the person saying the same has a superior notion of a good

life. This paradigm is, according to Dworkin, disrespect for the other person.

4. Principle of autonomy

Patients’ autonomy ought to be respected (if not for its own sake, then because of the derivative

importance of autonomy, i.e. the fact that promoting and respecting someone’s autonomy

generally speaking enhances this person’s well-being).

105 Ronald Dworkin, “A Special Supplement: Taking Rights Seriously, The New York Review of Books”

Joel Feinberg has advanced one of the most comprehensive accounts of the personal autonomous

self. He lists the qualities that inhere in an autonomous life; qualities such as authenticity,

integrity and distinct self-identity. These qualities provide a kind of overview of the self in whom

these qualities in here. The autonomous self, for Feinberg, strives to maintain self-direction in a

world where external factors impinge on personal deliberations.106

In terms of the characteristics that distinguish autonomous persons, most highlight forms of self-

directedness that distinguish autonomous persons from the condition of being subject to the

controlling influence of others. The truly autonomous person forges his or her own tastes,

opinions and values.

In order to genuinely respect persons as autonomous persons, we must recognize that they are

able to direct their own lives and actions in accordance with their own plans, projects and

personal commitments. For Feinberg, an autonomous person can reach a choice consonant with

self to be free from the burdens of life providing that the choice is genuinely an expression of the

self and not the result of other factors that can radically impinge upon and distort considered

judgment. Hence, to compel or order a person not to have the choice to express his freedom from

life’s uncertainties is congruent to infringing his right to autonomy.

In Harm to Self, Feinberg rejects the paternalistic idea that the state or other individuals can

legitimately interfere with the mainly self-regarding interest of autonomous persons. Self-

determination is characterized by the significant capacity persons have for personal autonomy.

The moral freedom of people to shape their lives for themselves, without being subject to undue

external control, is held central to the idea of respect of persons. In order to genuinely respect

persons, we need to recognize an extensive autonomy derived right to choose how to live and

die.107

In the case of In re Quinlan I, a 21-year-old Karen Ann Quinlan was admitted to the hospital in a

coma, and was later declared by doctors to be in a "persistent vegetative state." After five months

106 Joel Feinberg, Voluntary Euthanasia and the Inalienable right to life, April 1, 1977, University of Michigan

107 Craig Paterson , A Natural Ethics Approach, Assisted Suicide and Euthanasia , 2008

on a ventilator, her parents requested that the ventilator be removed and that Ms. Quinlan be

allowed to die. After doctors refused, her parents brought the matter to court. The New Jersey

Superior Court denied her parents' request, but the New Jersey Supreme Court reversed and ruled

that Quinlan's "right to privacy" included her right to be removed from the ventilator. It further

held that the termination of treatment pursuant to the right of privacy is, within the limitations of

this case, ipso facto lawful. Thus, a death resulting from such an act would not come within the

scope of the homicide statutes proscribing only the unlawful killing of another. There is a real

and in this case determinative distinction between the unlawful taking of the life of another and

the ending of artificial life-support systems as a matter of self-determination." 108

In the subsequent case of Cruzan, US Court held that State is not required to accept the

'substituted judgment' of close family members in the absence of substantial proof that their

views reflect the patient's. 109In another case, US Court held that the assumption of a right to

refuse treatment was grounded not, as the Court of Appeals supposed, on the proposition that

patients have a general and abstract 'right to hasten death'... but on well established, traditional

rights to bodily integrity and freedom from unwanted touching." 110 In the above cases, it is worth

to note that the principle of autonomy is greatly considered.

108 In re Quinlan, 70 N.J. 10 Mar. 31, 1976109 Cruzan v. Director, Missouri Dept. of Health 497 U.S. 261June 25, 1990110 Vacco v.Quill 526 U.S. 793 June 26, 1997

Arguments on the Immorality of Euthanasia

1. Disrespect for human life and human dignity

To the argument that euthanasia promotes dying with dignity by ending terminally ill patients’

lives, is it disrespect to human dignity in taking a life which based on the above discussion is still

dignified? When physicians choose to end a person’s life, is he not saying also that the person

has no more human dignity? And if so, are they in a position to suggest when dignity can be

breached? And in cases where the patient chooses to die due to incapacities, does he attribute his

dignity to mere intellectual capacity to choose?

Essentially, Keown111 and Gormally112 write from the unacknowledged perspective of neo-

naturalism. The fundamental assertion of these authors is “the recognition that every human

being, however… mentally, impaired, possesses a fundamental worth and dignity which are not

lost as he or she is alive. For Kewon and Gornmally, this concept is absolute. Kneown and

Gormally suggest that attaching any diminished worth to brain-dead individuals makes “the

possession of human worth depend on an arbitrary discrimination between individuals.113

It is necessary to begin with the recognition that every human being, however immature or

mentally impaired, possesses a fundamental worth and dignity which are not lost as long as he or

she is alive. Contrary to the view of some, human worth and dignity do not depend on acquiring

and retaining some particular level of intellectual ability or capacity for choice or for

communication. On that view of human worth and dignity, it turns out that the relevant level of

intellectual ability or whatever other characteristic is asserted to be morally decisive always

require to be determined in an arbitrary fashion. In making the possession of human worth and

dignity depend on an arbitrary discrimination between individuals; this view destroys the

indispensable foundation of justice in society. For basic human rights belong to human beings

precisely because of their worth and dignity, and if the possession of the latter is to be

determined arbitrarily ( as between those who are terminally ill or those who lack intellectual

ability such as brain dead and other incompetents ( persons in vegetative state) so will be the

111 http://en.wikipedia.org/wiki, Damien Keown is a prominent bioethicist and authority on Buddhist bioethics.112 http://ajgoddard.webnode, Luke Gormally is a leading Roman Catholic bio-ethicist who is Senior Research

Fellow and former Executive Director of the Linacre Centre for Healthcare Ethics in London 113 Ian Harriss, Ethics and euthanasia: Natural law philosophy and latent utilitarianism

possession of the former ,but there cannot be a framework conducive to just relationships in a

society if who are to count as the subjects of justice is determined in an arbitrary fashion. For

this reason, the recognition of the fundamental worth and dignity of every human being is the

indispensable foundation of justice in society. In other words, human rights are enjoyed in virtue

of common humanity, not the possession of some arbitrarily stipulated human ability at some

arbitrarily stipulated level.114 Further, this arbitrary fashion is exhibited in the view that those

who have suffered severe brain damage, resulting in permanent loss of consciousness or of

cognitive abilities, no longer possess worthwhile lives. But this view of certain gravely impaired

human beings is incompatible with recognition of their basic worth and dignity. It is the view

which underlies the claim that it is reasonable to aim, at least by omitting treatment and care, to

end the lives of these persons when they are patients. This judgment may also be arrived at on

the basis of the assertion that such persons, being unaware, no longer have any `interests'115, so

that, there being no positive good of theirs at which one could aim, one may rather aim at ending

their lives. But none of us has to be conscious of all prospective benefits or interests to be the

recipient of the same. And if we can be the recipients of benefits, we can have an interest in

being benefited without that interest being a conscious interest. All of us, indeed, have an interest

in not being treated in ways which are inconsistent with recognition of our dignity as human

beings, whether or not we are aware of that interest.116

Another way in which the fault of denying worth to certain human lives is exhibited is in the

judgment that the value of a life depends wholly on the value and importance a person gives to

his or her life through his choices. If that were so, then loss of the capacity to choose would bring

about a state of affairs in which the only value one's continued existence would have would

depend on the value one had chosen to attach to it when competent or when still intellectually

conscious. This is the understanding of the value of a life behind the view that, in respect of a

person's own life, his or her choices made prior to loss of competence should be allowed to

114 (John Keown MA (Cantab) DPhil (Oxon), Human Dignity, Autonomy and Mentally Incapacitated Patients: A Critique of Who Decides?

115 A view entertained by Who Decides? at 5.24, following LawCom231: 6.17, following Lord Mustill in Bland116 http://www.linacre.org/whodec.html citing John’s Keown: Human Dignity, Autonomy and Mentally

Incapacitated Patients: A Critique of Who Decides?

determine when his or her life is to be ended, in cases, when that may be purposefully achieved

by omission of treatment or care.

2. Euthanasia is against human nature

Every human being has a natural inclination to continue living. “Our reflexes and responses fit us

to fight attackers, flee wild animals, and dodge out of the way of trucks. Our bodies are similarly

structured for survival right down to the molecular level. When we are cut, our capillaries seal

shut, our blood clots, and fibrogen is produced to start the process of healing the wound. When

we are invaded by bacteria, antibodies are produced to fight against alien organisms, and their

remains are swept out of the body by special cells designed for clean-up work”117.

To allow pre-emption of death violates this natural goal of survival. It contradicts this nature

because all processes are bent towards the end of bodily survival. By human beings bodily

composition alone indicates that our natural inclination is survival. Allowing human beings to

artificially interfere with the natural process of death violates human nature and in so doing, it

violates dignity. Dignity comes from seeking human being’s ends. When one of the goals is

survival, and actions are taken that eliminate the goal, then the natural dignity suffers. Unlike

animals, human beings are conscious through reason of their nature and their ends. Euthanasia

involves acting as if this dual nature, the inclination towards survival and awareness of this as an

end, did not exist. Thus, euthanasia denies our basic human character and requires that human

beings regard themselves or others as something less fully human.

3. Euthanasia is against self interest

Because death is final and irreversible, euthanasia contains within it the possibility that human

beings will work against their own interests if they practice it or allow it to be practiced on them.

Although contemporary medicine has high standards of excellence and a proven record of

accomplishment, it does not possess perfect and complete knowledge. A mistaken diagnosis is

possible, and so is mistaken prognosis. Consequently, belief of dying may be made in error.

They may believe that there is no hope when, as a matter of fact, the chances are good. Also,

117 J. Gay-Williams, The Wrongfulness of Euthanasia, 1992 In Ronald Munson, ed., Intervention and Reflection: Basic Issues in Medical Ethics, Belmonth, CA: Wadsworth

there is always the possibility that an experimental procedure or a hitherto untried technique will

pull as through.

It is viewing the body as a target to be dominated and killed that differentiates an act of

euthanasia from the morally acceptable practice of withdrawing futile medical treatments.

Letting a dying person die without prolonging his or her death allows us to give up useless and

burdensome interventions. In a naturally inevitable death, a whole person as an embodied self

dies from an irremediable medical condition.

4. Policy of slippery slope

Many people worry that if voluntary euthanasia were to become legal, it would not be long

before involuntary euthanasia would start to happen.118

A person apparently hopelessly ill may be allowed to take his own life. Then he may be

permitted to deputize others to do it for him should he no longer be able to act. The judgment of

others then becomes the ruling factor. Already at this point euthanasia is not personal and

voluntary, for others are acting “on behalf of” the patient as they see fit. This may well incline

them to act on behalf of other patients who have not authorized them to exercise their judgment.

It is only a short step, then from voluntary euthanasia, to directed euthanasia administered to a

patient who has given no authorization, to involuntary euthanasia conducted as part of social

policy. Moreover, when euthanasia becomes involuntary, the right to autonomy and self

determination becomes nugatory as the person who wants to die are not the entirely and solely

the one taking his life.119

Holland has euthanasia. They started out killing the terminally ill, but have veered markedly

from this approach. Some estimate that over 50% of those euthanized in Holland are killed

118 Lord Walton, Chairman, House of Lords Select Committee on Medical Ethics looking into euthanasia, 1993 “We concluded that it was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law in the United Kingdom could not be abused.

We were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death.”

119 J. Gay-Williams, The Wrongfulness of Euthanasia, 1992 In Ronald Munson, ed., Intervention and Reflection: Basic Issues in Medical Ethics, Belmonth, CA: Wadsworth

without consent. Some of the elderly are afraid to go to the doctor, for fear they will receive

involuntary euthanasia.120

5. Argument on individualistic decisions

Whence would come such an individualistic moral right or assumption of absolute dominant

power? After all, each person’s self-consciousness like each individual’s body, has been created

and received from the person’s parents and forebears, and nourished by the community and

culture in which the person’s life is organically embedded. A human life and identity is a gift

from evolutionary biology, natural ecological conditions, parental procreative child rearing, and

collective cultural socialization- all transcending the individual power of self-determining will

claiming unilateral life or death powers121.

Feminists understand that individuals cannot be treated or treat others as though they are alienate

monads cut off from all bonds with one another. Having received the gift of life and social

identity, one has a moral obligation to preserve and respect each human life and refrain from

suppressing, killing or destroying self or others. Which one is permitted to do to one’s self and

which others are permitted to do to one – these cannot be morally or psychologically

separated122.

When a person seeks or assists an act of euthanasia, he acts to end all human relationships. No

more comfort can be given or received; no more befriending or watching and waiting with

another will take place. Interpersonal bonds will be decisively cut off, all human dependence and

interdependence rejected.

Exercises of autonomy, of the capacity for self-determining choice are not the fundamental

source of worth and value in a person's life. Human beings possess an ineradicable value prior

and subsequent to the possibility of exercising autonomy. Autonomy itself as a capacity is to be

valued precisely in so far as its exercise makes for the well-being and flourishing of the human

beings who possess it. But it is plain that many exercises of the capacity, that is, many self-

determining choices, are destructive of human well-being -- both in the life of the chooser and in 120 R. Tom Tolomeo, "Big Brother, M.D.," All About Issues, July-August 1993

121 Sydney Callahan, A feminist case against euthanasia, Women should be especially wary of arguments for “the freedom to die”.

122 Ibid.,

the lives of others affected by his or her choices. The mere fact that someone has elected to act or

to be treated in a certain way establishes no title to moral respect for what has been chosen. The

character of the choice must satisfy certain criteria in order to warrant our respect. The most

basic criterion is that a choice should be consistent with respect for the fundamental dignity both

of the chooser and of others. Since justice in society rests on belief in the ineradicable value of

every human life, whatever its condition, a just legal system cannot look favorably on choices to

kill a person based on the judgment that his or her life is no longer worthwhile123.

123 (John Keown MA (Cantab) DPhil (Oxon), Human Dignity, Autonomy and Mentally Incapacitated Patients: A Critique of Who Decides?

Part III

Proponents Position

Considering the present circumstances involving euthanasia, the proponents believe that

euthanasia should not be legalized. Before dealing with the “morality” of euthanasia,

considerations of its potential impact on society should be dealt with.

First, it will affect medical research. One of the major driving forces behind the exceptional

medical advances made available in this century has been the desire to develop treatments for

previously fatal illnesses, and the eagerness to alleviate hitherto unmanageable symptoms. At

present, medical research is being funded to provide cure for those illnesses which are proven to

be fatal and incurable. The research for AIDS pandemic, for example, has greatly been advanced

at present in that a person infected can survive up to 50 years with proper treatment. This was not

the case 20 years ago. What made this and all other kind of researches to advance such

considerable extent is the inevitable possibility that even the most fit and healthy people may

fatally suffer from these illnesses. If our way to counter the pain and suffering of terminally ill

patients is to kill them or allow them to die without medical treatment, then the efforts of

scientists and physicians to advance in scientific discovery and research will become futile.

Second, it will impact health care cost. It may seem that legalizing euthanasia may shorten

hospital confinement and potentially save cost for both private individuals and the government

through health care system following the “save the money by killing the sick” argument. It is still

a shaky ground where public confidence must rest upon. In Oregon, for example, where

euthanasia is legal, there had been instances where the Oregon Medicare denied chemotherapy,

and offered to pay for killing the patients instead124. Moreover, it would become contrary to

public policy when people, instead of being given medical assistance, are provided with a less

costly solution of ending their lives. Although this is more likely speculative, the fact that it

happened in places where euthanasia is legal does not preclude the probability that the same may

also happen.

124 Wesley J. Smith, June 20, 2009, Save Money by Killing the Sick: Euthanasia as Health Care Cost Containment Not Such a Parody as the Author May Think

Third, it will require further legislation for its procedure for checks and balances. In

countries where euthanasia is legal, there are certain legislations, such as Australia’s Terminally

Ill Act of 1995, that were enacted to prescribe the procedures for the administration of

euthanasia. In these legislations, a heavier burden is given to physicians in ascertaining if the

patient’s condition is terminal. There are also requirements imposed upon the medical

practitioners like the consensus of a third opinion is necessary to ascertain the condition of the

candidate of euthanasia. Although there are procedures to ensure propriety of the execution,

these legislations still did not prevent cases like the Schiavo case where medical practitioners are

in debate of whether or not Terri was terminally ill, or that her case could be cured; and, whether

her consent and wishes are represented by her husband’s affirmation. The determination of when

to qualify a patient as a qualified euthanasia candidate is subjective to the doctors’

recommendations. This is definitely a scenario that can potentially be terrifying, considering that

misdiagnosis often times occur in the medical field. People may be killed in the premise that

their conditions are incurable when in fact the same can be treated.

Fourth, it will negate palliative care. One of euthanasia’s goals is to end the patient’s

unbearable pain. Palliative care, on the other hand, seeks to provide relief from pain and

uncomfortable symptoms while integrating psychological and spiritual features of patient care.

Although Palliative care may not totally abrogate the pain and suffering of the patient, it still

seeks to minimize such. Not only does it provide physical relief, but also it addresses the

psychological and spiritual needs of patients through varied programs. Formally introduced in

the Philippines in 1993, the hospice movement now counts 23 institutions and 520 service

providers as members.

Lastly, it will afford religious scrutiny at least to Christian countries like the Philippines.

There are cases where euthanasia is impliedly and indirectly practice in hospitals as when

comatose patients, by family members’ request or financial incapacity, opt to put off life support

machine and allow such patient to breathe naturally, which is not sufficient to sustain his or her

life, hence, eventually die. To legalize euthanasia is to put affront such practice and make it more

evident. Recognizing the scrutiny which the Reproductive Health Bill is receiving by the

religious sectors, there is no reason to believe that the same will not receive such scrutiny.

Moreover, considering the moral norms and beliefs system of the country, it is evident that life is

valued greatly regardless of the incapacities of the human person. This will only be a subject to

political and religious intervention that will bring about pickets and potentially boycotts of

hospitals.

As to its morality or immorality, the proponents believe that euthanasia should not be

countenanced.

The debate over the morality of euthanasia lies essentially between the sanctity of life, on

one hand and the quality of life on the other. If a person who is terminally ill has only a month

to live, pro-euthanasia argues that if the person wants to die to avoid having to suffer a month of

agonizing and tremendous pain, he should be allowed to do so. On the other hand, anti-

euthanasia would argue that ending one’s life would be disrespecting the sanctity of life.

Essentially the proponents find that the arguments rest on the question: When do we consider the

sacredness of life? Is it a life without personal creativity or personal competency? Or is the

respect absolute in as long as life remains?

It is in this position that the proponents believe that “dignity” of human life should not be

arbitrarily determined. The proponents believe that human dignity is fundamental in every

human being and that it is not lost by the absence of some degree of personal creativity or

intellectual ability. Moreover, the determination of the candidacy for euthanasia, as observed in

other countries where it is legal, rests upon the recommendations and opinions of medical

practitioners. Hence, when a person is terminally ill and is recommended by the doctor to be put

to death to avoid either useless costs or insurmountable suffering, is the doctor saying that his

life has no more worth and that he be better off dead? It is in this note that the proponents find

euthanasia, in a way, disrespectful of the intrinsic value of human dignity. The proponents

believe that no human reason can entirely and succinctly grasp the determination of human

dignity for only the Supreme Being according to the divine law has monopoly of it. Thus, no one

should be allowed to determine when a human being is undignified. Worthy to note also is that

human beings possess an ineradicable value prior and subsequent to the possibility of exercising

autonomy. A baby who cannot decide on his own does not have autonomy or personal creativity

yet but it is of common conviction that he or she possesses dignity. The same should also hold

true of terminally ill patient who is bereft of such autonomy.

As to the principle of autonomy and principle of self determination, the group finds the

same contradicting to the nature of man. Proponents of euthanasia argue that in order to

genuinely respect persons as autonomous beings, we must recognize that they are able to direct

their own lives and actions in accordance with their own plans, projects and personal

commitments. The proponents believe, as J. Gay Williams posits that human beings have the

natural inclination to continue surviving. Bodily human self-healing mechanism provides that

inclination of continued survival. To allow people to decide to kill themselves based on respect

for personal autonomy and self determination would be in contradiction to the nature of human

beings to fight for survival rather than succumb to extinction.

Moreover, the proponents believe that pro-euthanasia is at fault by denying worth to

certain human lives exhibited by the judgment that the value of a life depends wholly on

the value and importance a person (or his family member) gives to his or her life through

his choices. It is in this position that the proponents adhere to the feminist view that human life

and identity is a gift from evolutionary biology, natural ecological conditions, parental

procreative child rearing, and collective cultural socialization- all transcending the individual

power of self-determining will claiming unilateral life or death powers. Self determination and

autonomy should be actualized in the context of communal responsibility and not only of

personal determination. When a person decides to die, that such person not only chooses to be

dead but also to be cut off from all interpersonal relationships, he chooses to be cut off from the

bonds that he has to his family, as well as to the community.

Lastly, as to the battle between pain versus relief, the proponents find that though a patient

in pain may be better off dead to save him from the insurmountable pain, the weight

accorded to value for human life and dignity outweighs emotional feelings from such

circumstance. Further, the group also believes that such predicament can also be an opportunity

to provide care and compassion to loved ones, thus strengthening the interpersonal bond while

awaiting the natural and eventual death.

http://www.euthanasia.com/

http://www.linacre.org/whodec.html