Ethics and Euthanasia
The first step towards moving society to accept that which is abnormal is to inundate society with the abnormal as a norm, until society begins to accept it as a norm. We see this happening in various ways in American society today, but none with the vigor of the movement to legalize and make moral medical euthanasia. At present, the move to make euthanasia legal and medically ethical appears to be attempting to gain public support with compromise (Huxtable 2007). Advocates of medical euthanasia are inundating the public with "what if" scenarios that are aimed at gaining public sympathy and support for the "right to die (Jones 2007)." Once individual cases for the right to die win public attention and support, then the right to die becomes legally acceptable, regardless of whether or not the majority of Americans support medical euthanasia. Once medical euthanasia becomes legal, of course it would follow that it would be medically ethical because it would not be against the law. It begs the question of whether or not making medical euthanasia legal, makes it medically ethical?
The answer to this question is no, making medical euthanasia legal does not make it medically moral -- and there are certainly medical physicians, nurses, and members of the public who would beg to differ with the position taken here; but they are wrong. The goal of medicine in America has long been to maintain and improve the quality of life. Medical euthanasia does neither. What it does do, of course, is create profits for insurance companies that would be exempted from paying for costly care and treatment of catastrophic illnesses should the patient "elect" life termination.
The Right to Die
The liberal backed effort to establish legal medically assisted suicide contends that there is no quality of life in debilitating illnesses for which the medical outcome is eventual death. Supported of the right to die refer to it as "physician-assisted suicide (PAS) (Jones 1)," and hold that the prognosis of death, although the exact date of death defies prediction and, with successful treatment, could delay death for years. In support of physician-assisted suicide, some liberal sociologists and cultural anthropologists have worked to put physician-assisted suicide in a philosophical context (11-12). Cultural anthropologist Mary Douglas and sociologists Robert N. Bellah and Steven M. Tipton created theoretical models of PAS (12). Their model provides two things:
1. "A lens for understanding the influence of social location and culture on requests for and opinions about PAS.
2. A social framework for a revision of American liberalism in an egalitarian direction (11-12)."
The model separates society into "social locations," and "cultural requests" for PAS. The model suggests that PAS is not a society as a whole issue, but is one that should be decided based on social location and cultural traditions and beliefs.
The social subject of the right to die began with the well-known assisted suicides of the now infamous Dr. Jack Kevorkian.
As most people might recall, Kevorkian was a former medical examiner in the state of Michigan, whose own personal beliefs about sickness and death led him to embark upon a path of assisting terminally ill people in dying unnaturally. Kevorkian became a widely recognized public figure, and, as he gained public sympathy for some of the cases he assisted in bringing about unnatural death. He also put on the forefront of the American public forum the debate about assisted suicide. At first, Kevorkian gained national attention, but as he continued to maneuver through the legal loopholes that prevented his being prosecuted for murder, the public seemed to grow accustomed to hearing about Kevorkian's assisted suicides.
The State of Oregon is a state with a high Medicaid population and extreme disparities in income. But in November of 1994, the burdens of the indigent and the extreme gap between wealth and poverty compelled voters to vote in favor of the Oregon Death with Dignity Act (Jones 55). The act gave people the right to access assisted medical suicide in cases with a prognosis of death (Jones 55).
"Oregon citizens affirmed the following question in a very close vote (the final tally was 51% in favor to 49% opposed) "Shall law allow terminally ill adult patients voluntarily informed choice to obtain physician's prescriptions for drugs to end life?"
Oregon became the first state in the union and the first place in the world to legalize PAS (Jones 55). The idea of assisted suicide was one that appeared to have been decided along socio-economic lines. The public had been introduced to the idea of PAS for years with the news of Kevorkian's assisted suicides; now, the concept was put to the first public vote in the state of Oregon, and it won.
PAS gained great, albeit controversial, success in the Florida case of a coma patient, a young woman, named Terri Schiavo. Schiavo remained in what physicians described as a "persistent vegetative state (Humphrey 178)." That is:
"The medical condition of a severely brain damaged person in a permanent coma from which he or she will not recover. Almost always calls for life support systems. A crude but popular way of describing a person who is in a long-term coma is "vegetable (Humphrey 178)."
After years in a "vegetative," but demonstrating some outward signs of awareness, Schiavo's husband and physicians successfully pursued legal action all the way to the Supreme Court, which returned the case to the state court in Florida upholding that court's decision; and won the right to disconnect a living, breathing without assisted medical technology, but who was receiving nourishment that kept her alive through feeding tubes. She was a young woman who simply would not otherwise have died, or at least no one could accurately say how long she would live -- and continue to cost hundreds of thousands of dollars in continued medical care. The case vibrated through the American public opinion to the White House, Congress, and the decision was that Schiavo would be disconnected from the feeding apparatus, after which she would be left, breathing and living, to starve to death -- and she did.
The act was a victory for the right to die movement. It was a legal ruling at the State and Supreme Court levels that perpetuated the debate over the right to die. The Kantian "categorical imperative" that holds morality is subject to rationality was the result of the Florida court's victory in the Schiavo case.
The Right to Live
The right to live and to pursue medical treatments and potential cures for life threatening disease and illnesses has long been woven into the fabric of American medicine. The Hippocratic Oath is sworn to by physicians (most keep it on their office walls where patients can gain confidence in them), and in taking the oath they swear to use their skills and knowledge to preserve human life. It preempts them from assisting in suicides the way Kevorkian did -- and it should have prevented Oregon physicians from knowingly prescribing drugs that would be used to deliberately bring about death for a patient.
Schiavo's attorney, David Gibbs, who fought for Terri's life on behalf of her parents and other friends and loved ones to keep her alive; wrote this about the legal decision to let Schiavo die:
"I believe that if "We the People" fail to stand for life in the wake of Terri's death, the intrinsic value of life for the infirm, the elderly, will be severely diluted. Even the self-proclaimed atheist and liberal journalist Nat Hentoff called the dehydration and starvation of Terri Schiavo "the longest public execution in American history," and he believes America has already lost her way (15)."
The issue of quality of life has, with the Schiavo case, been relegated to law and courts to decide whether a person should live or die. The Oregon act involves the popular opinion of a public divided along socio-economic lines, and that becomes a condition of survival of the fittest. When society as a whole embraces the concept of survival of the fittest, it relegates to the lowest order of importance those members of society whose resources then become the measure by which they are chosen to live or to die by society. It is rationality without morality.
While PAS may be rational, it is not ethical or moral, because it targets the people who have lesser resources -- for whatever reason. It is a judgment that their life is not of the same value as their wealthy counterparts because they have not achieved wealth. It is what Margaret Sommerville (2002) calls:
"the evolution of a new cultural paradigm (on which to base a new societal one): the store of values, attitudes, beliefs, commitments, and myths. This is the shared story -- the shared culture -- that informs both our collective and our individual lives. Societal phenomena that have given rise to the need for a new paradigm give rise to mind-altering scientific technological advances, especially…