Andrea, an attractive thirty-nine-year-old woman, has been dealing with cancer for five years. She has gone through chemotherapy and radiation, procedures with severe side effects that debilitated her for months and seemed to have aged her by ten years. She has, nevertheless, recuperated enough to return to her job as director of her city’s planning commission. However, Andrea’s latest medical exam revealed that the cancer had spread to her bones and brain. Her oncologist has recommended further radiation treatments and chemotherapy, as well as a bone marrow transplant. Andrea is now facing even more torturous treatments as well as a very poor survival rate. After agonizing deliberation, Andrea confides in her physician that she is tired and sick of fighting, and that she wants his help to end her life. She has no living relatives to help her except a brother with whom she has no communication. Because she fears the loss of control that will inevitably come as the cancer spreads in her brain, she is asking her physician, Dr. Stanley, whom she has chosen for his caring and compassionate disposition, that when the proper time comes, he prescribe a lethal dose of medication for her. If she is not able to selfadminister the drugs, she is asking that he do it for her. Andrea is looking ahead and planning what she hopes will be a peaceful and calm death. Because she is still fully functioning at work and making competent decisions, she does not feel that her request is being clouded by depression; instead, she feels that she is being realistic and hoping for a good death.
Dr. Stanley has discontinued life support at other patients’ requests as well as withheld useless treatment for patients, also at their request. Both of these practices are called passive voluntary euthanasia and are legal. However, Andrea’s request is something new for him. Prescribing a lethal medication for Andrea to self-administer would be physician-assisted suicide. If Dr. Stanley administered the lethal dose himself, it would be active voluntary euthanasia. Both of these practices are illegal in every state except Oregon. Dr. Stanley has a dilemma on his hands: He believes that no human should directly and intentionally take the life of another; he also wishes to relieve Andrea’s suffering.
The above fictional scenario gets to the crux of the euthanasia controversy. The issue is debated by people who have radically different perspectives on the essential value of human life. As clinical psychologist and researcher from The Rehabilitation Centre in Ottawa, Canada, Keith G. Wilson points out, “People who are against legalization are motivated primarily by religious or secular moral concerns, which place the sanctity of human life above other considerations. Those who are in favor of legalization are more concerned about the relief of incontrollable pain and suffering, as well as with the rights of the individual to exercise choice and control.”
Supporters of euthanasia hold autonomy, individuality, and self-determination as their highest values. They believe it is the individual’s right as an autonomous being to choose when and how to die. They contend that respect for an individual’s rights to autonomy and selfdetermination is fundamental to human dignity. Some euthanasia supporters propose that the right to die is guaranteed under the law and the constitutional “right to privacy,” which forbids the state from interfering in private decisions, including when to die.
In requesting assistance in dying, Andrea is exercising self-determination, individuality, and autonomy. She is also expressing another value dear to euthanasia supporters, which is the right to have a planned and peaceful death. In the face of debilitating disease, Andrea values the quality of her life more than life itself; she feels her life, so greatly compromised by her illness, will one day not be worth living. Andrea may be able to face death more calmly knowing that she has the option to end her life when she chooses, enabling her to enjoy the time she has left. As expressed by Faye Girsh, executive director of the Hemlock Society, a pro-euthanasia organization, “The reason that polls in this country, and in Canada, Australia, Great Britain, and other parts of Europe, show 60 to 80 percent support for legalization of assisted suicide is that people want to know they will have a way out if their suffering becomes too great. They dread losing control not only of their bodies but of what will happen to them in the medical system.” In requesting assistance from her physician, Andrea is calling on Dr. Stanley’s compassion and mercy. She, like many others in her position, is asking him to alleviate and eventually end her suffering.
Euthanasia opponents, on the other hand, believe that the sanctity of life is of supreme value. They believe that it is wrong to kill another human being through euthanasia and that suicide and physician-assisted suicide are intrinsically evil. Furthermore, in their view, euthanasia is a threat to the moral fabric of society. As expressed by professor of medicine and law Margaret Somerville, “Euthanasia presents an overt threat to maintaining the important societal value of the sanctity of life.” She adds, “To legalize such killing, especially to institutionalize it in the medical profession, is to set destructive values for our society.” Opponents fear that by practicing euthanasia society will become desensitized toward death resulting in the devaluation of human life.
Dr. Stanley agrees with these opponents that the sanctity of life is of supreme importance. He is also influenced by the medical profession’s Hippocratic oath, which says that a physician should “give no deadly medicine to any one.” For a physician to kill or assist in killing might ultimately lead to the destruction of patient-doctor trust and tarnish the image of the physician. Dr. Stanley believes that the role of the compassionate physician, acting on behalf of his patient’s welfare, is to protect his patient from death. Dr. Stanley has no obligation to comply with Andrea’s wishes, but he must let her know his feelings in time for her to find another physician who might help her.
As this scenario illustrates, there are strongly divergent values underlying the euthanasia controversy. Modern technology and medicine have brought these issues to the foreground. Diseases that historically would have killed people are now successfully treated. In addition, death no longer occurs mainly in the home among family but in hospitals; at least 75 percent of deaths occur in institutional settings, either nursing homes or hospitals. Usually a variety of treatments had been undertaken to forestall these deaths, resulting in increased medical decision-making near the end of the patient’s life. Many people feel, as Andrea has anticipated, a profound lack of control in these new end-of-life situations. Indeed, surveys show that a large majority of people in the United States would like to be allowed to end their lives before incurable and painful diseases debilitate them and submit them to unbearable suffering. Whether they will be allowed to make this choice will depend in part on the course taken by the euthanasia debate.
The euthanasia debate will continue to be an emotional and complex one. This anthology, At Issue: The Ethics of Euthanasia, presents personal, medical, and religious perspectives on this hotly debated topic. How policy makers eventually address the ethical challenges surrounding euthanasia has enormous personal consequences for people like Andrea and Dr. Stanley.