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A Brief Review By Tom Smith, Ph.D.
The entire text of this comprehensive and complete report can be found on the website of the International Task Force on Euthanasia and Assisted Suicide: https://www.patientsrightscouncil.org/site/euthanasia-assisted-suicide-health-care-decisions-toc/
The introduction of this well researched report, “Euthanasia, Assisted Suicide and Health Care Decisions: Protecting Yourself and Your Family “, states that the first part “discusses the reasons used by activists to promote changes in the law; the contradictions that the actual proposals have with those reasons; and the logical progression that occurs when euthanasia and assisted suicide are transformed into medical treatments. It explores the failure of so-called safeguards and outlines the impact that euthanasia and assisted suicide have on families and society in general.”
And, “Part II of this report includes information about practical ways to protect oneself and loved ones during any time of incapacity and a discussion of some of the policies that have led to patients being denied care that they or their decision-makers have requested. It concludes with an examination of the ethical distinction between treatment and care.”
This exhaustive and detailed examination of the subject is provocative and disturbing. It opens with observations surrounding the widespread realization of the involuntary euthanasia of severely disabled newborns, children and teens with severe brain damage or mental retardation and other incompetent patients that has been taking place in Holland. In 2004, Dutch doctors were explaining that euthanasia of infants (infanticide) was a necessary part of pediatric care. A boundary was moved that changed the whole conversation about this difficult subject. Even in the United Kingdom, the British Medical Association’s ethics committee in May 2006 recommended that doctors end the lives of some patients “swiftly, humanely and without guilt”. What is disconcerting is that this type of debate has now become respectable.
The current situation in the developed world is this: Euthanasia is a medical treatment in the Netherlands and Belgium and assisted suicide is a medical treatment in the Netherlands, Belgium and Oregon. In those places both acts are considered to be private and personal, but legislation has to do with medicine, ethics, public policy, families, children and the law. Currently, the legalization of euthanasia and assisted suicide is being considered in Great Britain, Canada, California, Vermont, Hawaii and Washington state.
As mentioned earlier, the Karen Ann Quinlan and Terri Schiavo cases and the public concern and outcry over how they were handled demonstrate that these acts are not simply a “private and personal matter”. Society is still struggling with and will continue to debate the morality and ethics involved in euthanasia and assisted suicide.
As the debate rages, advocates emphasize the primacy of the individual and their autonomy and the importance of the elimination of unbearable suffering. These arguments are muddled by the logical extension that if “individual autonomy” is primary, why cannot anybody and not just terminally ill people choose to legally die? Moreover, if the end of “unbearable suffering” is the goal, why is it just limited to adults? Why cannot we dispatch teens, children and infants? This back and forth has now motivated advocates to use a “step-by-step” strategy to legalize euthanasia and assisted suicide.
Oregon is the only state in the United States to have legalized physician-assisted suicide, the Death with Dignity Act, and so it is carefully examined in this article. Since the passage of Oregon’s law in 1994, a number of official and some news reports have been published and are summarized, describing statistics, complications, deaths of people with impaired judgment, suicide for financial reasons and coerced and botched suicides. Other troubling aspects of the law that are discussed include, but are not limited to the difficulty of tracking lethal drugs once they are received; the broad interpretation of “self-administration”; disregard of safeguards; the destruction of records; HMO and advocacy groups’ facilitation of assisted suicide; state payment for the assisted suicide of the poor; that no notification of family is required; the question of who decides what “residency” in the state of Oregon means; and the lack of adequate pain control in Oregon since the passage of the Act.
For those who oppose euthanasia and assisted suicide, a number of practical action items are offered that promote effective advocacy against ballot initiatives and legislative proposals for euthanasia and assisted suicide.
In Part II of this report, how to protect yourself and family from losing control of the dying process is explained. Areas considered include: Who makes the medical decisions? What happens when one has or does not have an “advance directive” and how does its implementation differ from state to state? Interestingly, in answer to this question, not every state in the U.S., for a patient without an Advance Directive, are there consistent laws specifying who can make decisions for the patient; a spouse does not necessarily have first priority, followed by adult children, parents and siblings
Other questions considered include: What are the differences from state to state between “advance directives”, “living wills”, “durable power of attorney for health care” and the “protective medical decisions document” and can a person be coerced to sign any of these documents? Who needs to sign these documents, which ones and why? Must healthcare providers honor your wishes? If something is legal, is it ethical? Is withdrawing tube feeding and fluids wrong? Is it wrong to stop offering food by spoon and water by mouth? What is treatment and what is care? Briefly, the answer is that the provision of warmth, hygiene, food and fluids and repositioning or moving an immobile patient is considered care and not treatment.
The report concludes with some caveats: When drafting an Advance Directive or Durable Power of Attorney for Health Care, the person named to carry out one’s wishes should be an adult who shares and will assert your views and values; this may, but need not be, a family member. Additionally, although it is certainly prudent to have an Advance Directive, both federal and state laws prohibit health facilities from requiring anyone to sign an Advance Directive. Be informed about legal and political development regarding these highly charged issues. Actively support patients’ rights. Protect yourself with proper documentation and inform others of your wishes and give them copies of your documents. Do not be intimidated by any part of the system, be it nurses, doctors, aides, administrators or insurance companies. Once the dying process has been identified and has begun, stay informed at all times, every day and hour, of what is going on. There are no simple and clear cut answers to the questions about the necessary decisions that must be made when the situation is determined to be terminal or futile. Each case is unique and original.
The entire report is worth reading and will answer the questions posed above.
References
Marker, Rita; Euthanasia, Assisted Suicide & Health Care Decisions: Protecting Yourself & Your Family; International Task Force on Euthanasia and Assisted Suicide, 2006
INTERNATIONAL TASK FORCE EXECUTIVE DIRECTOR
Rita L. Marker, JD
P.O. Box 760
Steubenville, OH 43952
Phone: 740-282-3810
email: rmarker@internationaltaskforce.org