, Research Paper
WHY I BELIEVE IN VOLUNTARY EUTHANASIA There are at least two forms of suicide. One is ‘emotional suicide’, or irrational self-murder in all of it complexities and sadness. Let me emphasis at once that my view of this tragic form of self-destruction is the same as that of the suicide intervention movement and the rest of society, which is to prevent it wherever possible. I do not support any form of suicide for mental health or emotional reasons. But I do say that there is a second form of suicide — justifiable suicide, that is, rational and planned self-deliverance from a painful and hopeless disease which will shortly end in death. I don’t think the word ’suicide’ sits well in this context but we are stuck with it. Many have tried to popularize the term ’self-deliverance’ but it is an uphill battle because the news media is in love with the words ‘assisted suicide’. Also, we have to face the fact that the law calls all forms of self-destruction ’suicide.’Let me point out here for those who might not know it that suicide is no longer a crime anywhere in the English-speaking world. (It used to be, and was punishable by giving all the dead person’s money and goods to the government.) Attempted suicide is no longer a crime, although under health laws a person can in most states be forcibly placed in a psychiatric hospital for three days for evaluation. But giving assistance in suicide remains a crime, except in the Netherlands in recent times under certain conditions, and it has never been a crime in Switzerland, Germany, Norway and Uruguay. The rest of the world punishes assistance in suicide for both the mentally ill and the terminally ill, although the American state of Oregon recently (Nov. l994) passed by ballot Measure 16 a limited physician-assisted suicide law. At present (Feb. l995) this is held up in the law courts. Even if a hopelessly ill person is requesting assistance in dying for the most compassionate reasons, and the helper is acting from the most noble of motives, it remains a crime in the Anglo-American world. Punishments range from fines to fourteen years in prison. It is this catch-all prohibition which I and others wish to change. In a caring society, under the rule of law, we claim that there must be exceptions. ORIGIN OF THE WORDThe word ‘euthanasia’ comes from the Greek — eu, “good”, and thanatos, “death”. Literally, “good death”. But the word ‘euthanasia’ has acquired a more complex meaning in modern times. It is generally taken nowadays to mean doing something about achieving a good death. Suicide, self-deliverance, auto-euthanasia, aid-in-dying, assisted suicide — call it what you like — can be justified by the average supporter of the so-called ‘right to die’ movement for the following reasons:Advanced terminal illness that is causing unbearable suffering to the individual. This is the most common reason to seek an early end. Grave physical handicap which is so restricting that the individual cannot, even after due consideration, counseling and re-training, tolerate such a limited existence. This is a fairly rare reason for suicide — most impaired people cope remarkably well with their affliction — but there are some who would, at a certain point, rather die. What are the ethical parameters for euthanasia?The person is a mature adult. This is essential. The exact age will depend on the individual but the person should not be a minor who come under quite different laws. The person has clearly made a considered decision. An individual has the ability nowadays to indicate this with a “Living Will” (which applies only to disconnection of life supports) and can also, in today’s more open and tolerant climate about such actions, freely discuss the option of euthanasia with health professionals, family, lawyers, etc. The euthanasia has not been carried out at the first knowledge of a life-threatening illness, and reasonable medical help has been sought to cure or at least slow down the terminal disease. I do not believe in giving up life the minute a person is informed that he or she has a terminal illness. (This is a common misconception spread by our critics.) Life is precious, you only pass this way once, and is worth a fight. It is when the fight is clearly hopeless and the agony, physical and mental, is unbearable that a final exit is an option. DOCTOR AS FRIENDThe treating physician has been informed, asked to be involved, and his or her response been taken into account. What the physician’s response will be depends on the circumstances, of course, but we advise people that as rational suicide is not a crime, there is nothing a doctor can do about it. But it is best to inform the doctor and hear his or her response. For example, the patient might be mistaken — perhaps the diagnosis has been misheard or misunderstood. It used to be that patients raising this subject were met with a discreet silence, or meaningless remarks, but in today’s more accepting climate most physicians will discuss potential end of life actions. The person has made a Will disposing of his or her worldly effects and money. This shows evidence of a tidy mind, an orderly life, and forethought — all something which is paramount to an acceptance of rational suicide. The person has made plans to exit that do not involve others in criminal liability or leave them with guilt feelings. As I have mentioned earlier, assistance in suicide is a crime in most places, although the laws are gradually changing, and very few cases ever came before the courts. But care must still be taken and discretion is the watchword.
The person leaves a note saying exactly why he or she is taking their life. This statement in writing obviates the chance of subsequent misunderstandings or blame. It also demonstrates that the departing person is taking full responsibility for the action. NOT ALWAYS NOTICEDA great many cases of self-deliverance or assisted suicide, using drugs and/or a plastic bag, go undetected by doctors, especially now that autopsies are the exception rather than the rule (only 10 percent, and only when there is a mystery about the cause of death). Also, if a doctor asked for a death certificate knows that the patient was in advanced terminal illness then he is not going to be too concerned about the precise cause of death. It hardly matters. I find that police, paramedics and coroners put a very low priority of investigation of suicide when evidence comes before them that the person was dying anyway, and there is a note from the deceased. Detectives and coroners’ officers will walk away from the scene once they are satisfied that the person who committed suicide was terminally ill. But, having considered the logic in favor of auto-euthanasia, the person should also contemplate the arguments against it. First, should the person go instead into a hospice program and receive not only first-class pain management but comfort care and personal attention? Put bluntly, hospices make the best of a bad job, and they do so with great skill and love. The right-to-die movement supports their work. But not everyone wants a lingering death, not everyone wants that form of care. Today many terminally ill people take the marvellous benefits of home hospice programs and still accelerate the end when suffering becomes too much. A few hospice leaders claim that their care is so perfect that there is absolutely no need for anyone to consider euthanasia. While I have no wish to criticize them, they are wrong to claim perfection. Most, but not all, terminal pain can today be controlled with the sophisticated use of drugs, but the point these leaders miss is that personal quality of life is vital to some people. If one’s body has been so destroyed by disease that it is not worth living, that is an intensely individual decision which should not be thwarted. In some cases of the final days in hospice care, when the pain is very serious, the patient is drugged into unconsciousness. If that way is acceptable to the patient, fine. But some people do not wish their final hours to be in that fashion. There should be no conflict between hospice and euthanasia — both are valid options in a caring society. Both are appropriate to different people with differing values. RELIGIONThe other consideration is theological: does suffering ennoble? Is suffering, and relating to Jesus Christ’s suffering on the cross, a part of preparation for meeting God? Are you merely a steward of your life, which is a gift from God, which only He may take away. My response is this: if your answers to these questions is yes, then you should not be involved in any form of euthanasia.But remember that there are millions of atheists and agnostics, as well as people of varieties of religions, degrees of spiritual beliefs, and they all have rights, too. Many Christians who believe in euthanasia justify it by reasoning that the God whom they worship is loving and tolerant, and would not wish to see them in agony. They do not see their God as being so vengeful as refusing them the Kingdom of Heaven if they accelerated the end of their life to avoid prolonged, unbearable suffering. Another consideration must be that, by checking out before the Grim Reaper calls, is one is depriving oneself of a valuable period of good life? Is that last period of love and companionship with family and friends worth hanging on for? The argument that this is so is heavily used by our critics. But after my in depth research, and being aware of many hundreds of self-deliverances, I can attest that even the most determined supporters of euthanasia hang on until the last minute — sometimes too long, and lose control. They, too, gather with their families and friends to say goodbyes. There are important reunions and often farewell parties. Euthanasia supporters enjoy life and love living, and their respect for the sanctity of life is as strong as anybody’s. Yet they are willing, if their dying is distressing to them, to forego a few weeks or a few days at the very end and leave under their own control. KNOWLEDGE IS COMFORTWhat many people do not realize is that, for many people, just knowing how to kill themselves is in itself of great comfort. It gives them the assurance to fight harder and therefore often extends lives just a bit longer. Many people belive that the book, Final Exit, is “the best insurance policy they’ve ever taken out.” Once such people know how to make a certain and dignified self-deliverance, they will often renegotiate the timing of their death. Now that we have the knowledge and the drugs, with control and choice in grasp, we can negotiate new terms with life concerning our fate. Surely, for those who want it this way, this is commendable and is in fact an extension rather than a curtailment of life. What is needed now are careful laws permitting physician-assisted suicide — voluntary on everybody’s part. The new Oregon Death With Dignity Act is a beginning.
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