Few people likes to discuss death. The concept makes most of us uncomfortable, and the discussion (in America, at least) is taboo to the degree that even discussing one’s advanced directives for end-of-life care is unsettling.
This needs to change.
The Greek word for death is thanatos, from which is derived the word “euthanasia.” A literal translation for euthanasia would be “good death,” and who among us wouldn’t want that? But what qualifies as “a good death?”
There are various nuances to euthanasia or, in effect, mercy killing — but the words are not interchangeable, even though the intent and the outcome is the same.
Mercy killing implies ending someone’s life to “put them out of their misery” without that person’s consent. On the other hand, the term euthanasia encompasses a spectrum of merciful deaths that revolve around the concept of consent.
Cases can be classified as voluntary, where people decides their fate and give consent; nonvoluntary, where the fate is chosen for a person incapable of giving consent; or involuntary, where the decision is against the will of the individual, ignoring the individual’s autonomy.
To further delineate these cases, there are active and passive classifications. An active form of euthanasia would involve introducing an agent to cause death as opposed to the passive form, which withholds agents that promote living, such as food, water or medical treatment.
Passive euthanasia is widely practiced in America when life-support machinery is turned off, comfort measures but not sustenance is provided, or pain medications are given even though they may hasten death. The remainder of this column deals with active, voluntary euthanasia.
Several European countries and a few American states — Montana, Oregon, Washington and, most recently, Vermont — have legalized euthanasia and/or physician-assisted suicide. The difference in terms refers to which person administers the lethal drug — the doctor (euthanasia) or the patient (physician-assisted suicide).
The most extensive research and experience come from the Netherlands, where euthanasia and physician-assisted suicide were legalized in 2002. For more than 20 years before that, though, there had been political, medical and social debate and research into the frequency and characteristics of these procedures, which had been widely practiced under fear of prosecution.
Since the passage of the law, the Dutch medical community is protected from prosecution when the following criteria are met: The patient’s suffering must be unbearable with no hope for its diminishment, and their request must be voluntary, be repetitive, and not be under the influence of drugs, psychoses or pressure from others. The individual also must be aware of the alternatives. At least one outside doctor must verify that the conditions above have been met. The death must be carried out in a medically appropriate way, either by the doctor or the individual (but with the doctor present). Finally, a multidisciplinary review board ensures after the fact that the due care criteria were met.
Since 2002, the Netherlands has not seen an increase in life-ending procedures. In effect, the law merely legalized what already was taking place.
Opposition to euthanasia and physician-assisted suicide takes many forms. The often-raised argument of a slippery slope has not been borne out by Dutch studies, where adhering to strict protocol has been followed in the vast majority of cases. There has been no evidence for increased euthanasia among vulnerable groups.
One may ask what the effect of causing death has upon the medical doctor, who swore to do no harm. While it’s agreed that performing euthanasia is not part of “normal medical practice,” physicians are not obligated to perform the procedure. Most foreign physicians studied view “minimizing suffering” as a higher goal than “doing no harm,” because most patients are terminal and the patient-physician relationship extends over many years. Furthermore, non-American cultures have different values than our religious and political framework permits.
Euthanasia does not devalue life. A 2005 Dutch study sited “pointless suffering” and “loss of dignity” as the most frequent reasons euthanasia was sought. When other alternatives are unavailable, why should we prolong someone else’s agony at their expense?
We should respect a person’s autonomy to end life when certain criteria have been met. This decision is too critical and irreversible; it needs to be handled on the personal level, with care and counsel. In addition to advanced directives, it’s time for our country to do its own studies, lead discussions and document the debate on dying well.