EUTHANASIA

Euthanasia is when a physician actively ends a patient's life by directly performing an action, such as giving the patient a lethal injection.

Physician-assisted suicide is when a physician intentionally gives a patient a lethal prescription of medication, such as a prescription for a lethal number of sleeping pills, but it is the patient who takes the overdose of medication.

Natural death is the only morally acceptable form of death. With natural care, one offers the dying patient food and water, and maintains body temperature and cleanliness. Comfort care involves a loving presence, palliation, and prayer. The physician may provide standard medical care such as oxygen, or intravenous fluids, or therapeutic pain medication, for example, to patients dying with lung cancer or end-stage heart or lung disease. The patient and family do have the right to refuse extra-ordinary measures, such as being placed on a mechanical ventilator, for example, when the end is clearly inevitable. Patients may make their wishes known while of sound mind through advance directives, such as a durable power of attorney for health care. The patient dies by natural processes, and the physician's role is to make the patient comfortable in their final hours.

Suffering at the end of life has both objective and subjective components. Objective suffering results from a direct, causal relationship arising from the underlying medical illness. Subjective suffering results from the patient's self-perception and fear of worthlessness, that they may no longer be active in the world or sustain meaningful social relationships. Pain management is indicated only for objective suffering; the restorative art of medicine is appropriate for subjective suffering.


The issue of physician-assisted suicide was thrust into the national spotlight largely because of Dr. Jack Kevorkian, a retired pathologist from Michigan who assisted over 50 people in committing suicide in recent years. He was successively prosecuted for second-degree murder on March 26, 1999 for actively rendering a lethal injection to a patient with Lou Gehrig's disease.

Euthanasia became legal in the Netherlands in 1984; however, this has led to widespread abuse, and in a formal investigation in 1991, the Dutch government discovered 1,000 of 3,300 cases of euthanasia involved incompetent patients who of course could not give consent of their own free will! We are all familiar with the euthanasia practices of the Nazi regime!

Fortunately, the United States Supreme Court on June 26, 1997 supported the sanctity of life and the traditional role of physician as healer and protector of life and unanimously upheld States' rights to ban physician-assisted suicide. In two cases, one from the state of Washington, Washington v. Glucksberg (117 U.S. 2302), and one from the state of New York, Vacco v. Quill (117 U.S. 2293), the Supreme Court upheld the right of the State to protect vulnerable groups such as the poor, the elderly, and the disabled from abuse, neglect, and mistreatment.

The Supreme Court in Washington v. Glucksberg "recognized the real risk of subtle coercion in undue influence in the end of life situations...The risk of harm is greatest for the many individuals in our society whose autonomy and well being are already compromised by poverty, lack of access to good medical care, advanced age, or membership in a stigmatized social group."

The Supreme Court in Vacco v. Quill upheld the right of the states "to prohibit intentional killing and preserving life; preventing suicide; maintaining physicians' role as their patients' healers; protecting vulnerable people from indifference, prejudice, and psychological and financial pressure to end their lives; and avoiding a possible slide towards euthanasia."

The Hemlock Society in Oregon was successful in obtaining passage of a referendum on physician-assisted suicide in the state of Oregon in 1997. While five states - Oregon (1997), Washington (2008), Montana (2010), Vermont (2013), and California (2015) - now allow physician-assisted suicide, it is considered most controversial and rarely practiced in the United States. 41 states outlaw the practice.



REFERENCES

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8 Gates TJ. "Euthanasia and Assisted Suicide." Amer Family Physician 55:2437-2444, 1997.
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11 Rehnquist WH. Supreme Court of the United States, State of Washington v. H. Gluckberg (96-110) on writ of certiorari to US court of appeals for the Ninth Circuit, Argument January 8, 1997, Decision June 26, 1997.
12 Rehnquist WH. Supreme Court of the United States, Vacco, Attorney General, State of New York v. Quill (95-1858), certiorari to the US Court of Appeals for the Second Circuit, Argument January 8, 1997, Decision June 26, 1997.




Principles of Medical Ethics