Euthanasia – Not Only at Patient's Request
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No indeed, euthanasia and assisted suicide would not only be at a patient's request. This false presumption has been disproven time and again by the practical working-out of euthanasia and assisted suicide in locales where it has been legalized. And yes, there are complications, which are not given great media exposure, but which appear in journals devoted to this debate. It is the intention of this essay to correct these false notions - with copious professional documentation.
As one of their major goals, euthanasia proponents seek to have euthanasia and assisted suicide considered "medical treatment." If one accepts the notion that euthanasia or assisted suicide is a good medical treatment, then it would not only be inappropriate, but discriminatory, to deny this good treatment to a person solely because that person is too young or mentally incapacitated to request it.
The way that the judicial process works in the United States is this: A surrogate's decision is often treated, for legal purposes, as if the patient had made it. That means that, if euthanasia is legal, a court challenge could result in a finding that a surrogate could make a request for death on behalf of a child or an adult who doesn't have decision-making capacity. Legally, this is the way the courts would handle it.
In the Netherlands, a 1990 government-sponsored survey found that .8% of all deaths in the Netherlands were euthanasia deaths that occurred without a request from the patient.(Medical) And in a 1995 study, Dutch doctors reported ending the lives of 948 patients without their request.(Hendin)
Suppose, however, that surrogates were not permitted to choose death for another and that doctors did not end patients' lives without their request. The fact still remains that subtle, even unintended, pressure would still be unavoidable. Such was the case with an elderly woman who died under Oregon's assisted suicide law:
Kate Cheney, 85, reportedly had been suffering from early dementia. After she was diagnosed with cancer, her own physician declined to provide a lethal prescription for her. Counseling was sought to determine if she was capable of making health care decisions. A psychiatrist found that Mrs. Cheney was not eligible for assisted suicide since she was not explicitly pushing for it, her daughter seemed to be coaching her to do so, and she couldn't remember important names and details of even a recent hospital stay.
Mrs. Cheney was then taken to a psychologist who said she was competent but possibly under the influence of her daughter who was "somewhat coercive." Finally, a managed care ethicist who was overseeing her case determined that she was qualified for assisted suicide, and the lethal drugs were prescribed.(Barnett) The coercive daughter had her way.
Regrettably, euthanasia or assisted suicide could be used as a means of health care cost containment. Perhaps one of the most important developments in recent years is the increasing emphasis placed on health care providers to contain costs. In such a climate, euthanasia or assisted suicide certainly could become a means of cost containment. These implications were acknowledged during a historic argument before the U.S. Supreme Court. Arguing against assisted suicide, acting solicitor general Walter Dellinger said, "The least costly treatment for any illness is lethal medication."(Transcript)
In the United States alone, millions of people have no medical insurance and studies have shown that the elderly, the poor and minorities are often denied access to needed treatment or pain control.(See) Doctors are being pressured by HMOs to reduce care; "futile care guidelines" are being instituted, enabling health facilities to deny necessary and wanted interventions; and health care providers are often likely to benefit financially from providing less, rather than more, care for their patients.(Smith) Canadians are faced with such long delays getting treatment in the country's overcrowded health care system that the Canadian government has contracted for Canadians to be treated out of the country.(Clinic) Many British doctors and nurses have concluded that the only way to secure the future of the National Health Service (NHS) is to make more treatments available only to those who can pay privately for them.(Rationing) And a survey by the Nuffield Trust and the nurses' magazine, Nursing Times, found that the NHS is failing to care adequately for hundreds of thousands of patients who die each year, many without proper care or pain relief.(Fraser)
Savings to governments could become a consideration. Drugs for assisted suicide cost about $35 to $45, making them far less expensive than providing medical care. This could fill the void from cutbacks for treatment and care with the "treatment" of death.
For example, the Oregon Medicaid program pays for assisted suicide for poor residents as a means of "comfort care."(Barnett April) In addition, spokespersons for non-governmental health insurance plans have said the coverage of assisted suicide is "no different than any other covered prescription." (Postrel) Legalized euthanasia or assisted suicide raises the potential for a profoundly dangerous situation in which the "choice" of assisted suicide or euthanasia is the only affordable option for some people.
One may say: "Certainly people wouldn't be forced into euthanasia or assisted suicide, would they?" Well, Oregon's assisted suicide law does not allow anyone to "coerce" or use "undue influence" to obtain a request for assisted suicide.(Oregon) However, there is absolutely nothing in the Oregon law to prevent HMOs, managed care companies, doctors or anyone else from suggesting, encouraging, offering, or bringing up assisted suicide with a patient who has not asked about it. Emotional, financial and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia or assisted suicide is considered as good as a decision to receive care, some people will feel guilty for not choosing death. The concern about "being a burden" could serve as a powerful force that could influence the decision. The third annual report on deaths under the Oregon assisted suicide law illustrates this. In 63% of the deaths reported, fear of being a burden was expressed as a reason for requesting assisted suicide.(Oregon 3)
Even the smallest gesture could create a gentle nudge into the grave. Such was evidenced in greeting cards sold at a national conference of the Hemlock Society. According to the conference program, the cards were designed to be given to those who are terminally ill. One card in particular exemplified the core of the movement that would remove the last shred of hope remaining to a person faced with a life-threatening illness. It carried the message, "I learned you'll be leaving us soon."(Greeting)
Wouldn't legalized euthanasia and assisted suicide make certain that patients can die peacefully, surrounded by their families and doctors, instead of being suffocated by plastic bags or gassed to death with carbon monoxide? No. Legalizing euthanasia and assisted suicide only legitimizes the use of plastic bags and carbon monoxide to kill vulnerable people. For example, immediately following the passage of Oregon's assisted suicide law, some who favor euthanasia and assisted suicide said the new law would permit the types of activities carried out by Jack Kevorkian.(Oregon 1994) Others said pills could lead to complications and only a lethal injection or suffocation with a plastic bag could ensure death.(Humphry)
Official reports in Oregon have not provided information on problems and complications associated with assisted suicide deaths. If it were not for occasional news reports and inadvertent disclosures, assisted suicide in Oregon would seem problem-free. However, two particularly troubling accounts have shattered that image:
After Patrick Matheny received his lethal dose of drugs from the Oregon Health Sciences University via Federal Express, he delayed taking them for four months. On the day of his death, he experienced difficulty. His brother-in-law, Joe Hayes, said he had to "help" Matheny die. According to Hayes, "It doesn't go smoothly for everyone. For Pat, it was a huge problem. It would not have worked without help."(Barnett March11)
Another assisted suicide that went awry was disclosed by attorney Cynthia Barrett, an assisted suicide supporter, in December 1999 during a class at Portland Community College titled, "Physician Assisted Suicide: Counseling Patients/Clients." According to Barrett, "The man was at home. There was no doctor there," she said. "After he took it [the drug overdose], he began to have some physical symptoms. The symptoms were hard for his wife to handle. Well, she [the wife] called 911. The guy ended up being taken by 911 to a local Portland hospital. Revived. In the middle of it. And taken to a local nursing facility. I don't know if he went back home. He died shortly -- some period of time after that time."(Hamilton)
During the campaign to legalize euthanasia in Australia's Northern Territory, supporters painted pictures of a calm, peaceful death with the patient surrounded by loved ones. The Australian law(Rights) (which was later overturned(Middleton)) legalized both euthanasia and assisted suicide. Draft guidelines for its implementation recommended that family members should be warned that they may wish to leave the room when the patient is being killed since the death may be very unpleasant to observe. (Lethal injections often cause violent convulsions and muscle spasms.(Rights March96))
Although euthanasia and assisted suicide remained technically illegal in the Netherlands until 2001, for many years the Royal Dutch Association of Pharmacy has provided prescribing guidelines to prevent problems and to increase the efficiency of euthanasia and assisted suicide. Yet there are still a number of complications and problems reported with such deaths.(Groenewoud) Even Dutch euthanasia activists acknowledge these difficulties, stating in their own euthanasia society publication that, in one out of five cases of euthanasia or medically-assisted suicide, there are problems or complications.(Beatrijs)
Barnett,Erin "A family struggle: Is Mom capable of choosing to die?" Oregonian, October 17, 1999. See additional information on Kate Cheney.
Barnett,Erin "Suicide coverage passes review," Oregonian, April 26, 1999.
Barnett,Erin "Dilemma of Assisted Suicide: When?" Oregonian, January 17, 1999 and Erin Barnett, "Man with ALS makes up his mind to die," Oregonian, March 11, 1999.
Beatrijs Trip, "Summary of Interview with former professor of pharmacology and hospital doctor, Dr. Jan Glerum," from "Relevant," Volume 26, Number 3, July 2000, posted on World Federation of Right to Die Societies web site (http://www.worldrtd.org/dutch/pharm.html). Accessed May 22, 2001. Dr. Glerum is described in the summary as a pharmacist and hospital doctor who "was often involved with euthanasia and in the attempts of people to kill themselves."
"Clinic gets contract to treat Canadian patients," Associated Press, January 23, 2000.
Fraser,Lorraine "NHS patients 'die without proper care or pain relief," Electronic Telegraph (London), May 27, 2001. Accessed at http://www.telegraph.co.uk:8...tmo=rrrrrrrq&pg=/et/01/5/27/npain27.html on May 27, 2001.
Greeting card was from "Grief Songs" Greeting Cards. It was described on the program and purchased at "Reforming the Law: The 5th National Conference on Voluntary Euthanasia," sponsored by the National Hemlock Society and the Metro Denver Hemlock Society, November 15 and 16, 1991 in Denver, Colorado. Card on file at International Task Force office.
Groenewoud,Johanna H. et al., "Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands," 342 New England Journal of Medicine (February 24, 2000), pp. 553-555.
Hamilton,Catherine "The Oregon Report: What's Hiding behind the Numbers?" Brainstorm, March 2000. Accessed at http://www.brainstorm.com. Hamilton was present at the class which she audiotaped. the revelations made at the class were also discussed on Portland's KXL Radio and in the Oregonian. [David Reinhard, "The pills don't kill: The case, First of two parts, Oregonian, March 23, 2000 and David Reinhard, "The pills don't kill: The case, Second of two parts, Oregonian, March 26, 2000.]
For more information on 911 call case, see third case.
Hendin,Herbert "Physician-Assisted Suicide and Euthanasia in the Netherlands: Lessons from the Dutch," 277 Journal of the American Medical Association, (June 4, 1997), p. 1720-1722
Humphry,Derek (co-founder of the Hemlock Society and author of the suicide manual, Final Exit), Letter to the Editor, New York Times, December 3, 1994 and Mark O'Keefe, "Dutch researcher warns of lingering deaths," The Sunday Oregonian, December 4, 1994.
Medical Decisions About the End of Life, I. Report of the Committee to Study the Medical Practice Concerning Euthanasia. (Volume 1 of 2), (The Hague, September 19, 1991) p. 15. (Also known as the "Remmelink Report.")
Postrel,Dan "State could cover assisted suicide," Statesman-Journal (Salem, OR), December 1, 1994.
Middleton,Karen "Right-to-die law overruled," The Age (Australia), March 25, 1997.
"Oregon's Assisted Suicide Law," ABC News Nightline, December 7, 1994. Geoffrey Fieger (Jack Kevorkian's attorney) and Dr. Peter Goodwin (medical director for Compassion in Dying, advisory board member of Hemlock, professor at Oregon Health Sciences University, and a principal proponent of Oregon's assisted suicide law) both agreed that the Oregon law would permit use of an assisted suicide device such as that developed by Jack Kevorkian. Kevorkian's device, used in most of the known deaths in which he participated, resulted in the victim's death by carbon monoxide poisoning.
Oregon "Death with Dignity Act" [ORS 127.890 §4.02 (2)].
Oregon Death with Dignity Act: Three Years of Legalized Physician-Assisted Suicide, Oregon Health Division (February 21, 2001), Table 3.
"Rationing 'only option' for NHS," BBC New Online, February 7, 2001. Accessed at http://www.bbc.co.uk/low/english/health/newsid_1156000/1156665.stm on February 7, 2001.
"Rights of the Terminally Ill Act," Northern Territory of Australia (1996).
"Rights of the Terminally Ill Regulations," Northern Territory of Australia (1996); Maria Ceresa, "Euthanasia may be agonising to watch: guidelines," Australian, March 22, 1996; Gail Alcorn, "Spasms warning on mercy killings," Sydney Morning Herald, March 22, 1996; Geoffrey Lee Martin, "'22 steps' to legalised euthanasia," Electronic Telegraph, May 27, 1996.
See: "Ethnicity and Analgesic Practice," 34 Annals of Emergency Medicine (January 2000), pp. 11-16; Sheryl Stolberg, "Study Finds Pain of Oldest Is Ignored in Nursing Homes," New York Times, June 17, 1998; "Management of Pain in Elderly Patients with Cancer," 279 Journal of the American Medical Association, (1998), pp. 1877-1882; Charles Cleeland et al., "Pain and Treatment of Pain in Minority Patients with Cancer," 127 Annals of Internal Medicine (1997), pp. 813-816; and American College of Physicians & American Society of Internal Medicine, "Report: No Health insurance? It's Enough to Make You Sick - Scientific Research Linking the Lack of Health Coverage to Poor Health," (November 30, 1990) accessed at http://www.acponline.orguninsuredlack-exec.htm
Smith,Wesley J. Culture of Death: The Assault on Medical Ethics in America, (Encounter Books 2000).
Transcript of Oral Arguments before the U.S. Supreme Court in Washington v. Glucksberg, (No. 96-110), 143 Chicago Daily Law Bulletin (January 10, 1997), p. 2.