But Oregon has never sponsored a confidential survey, and probably never will. If you know, just know , there are no abuses, why bother? The flavor of the proposed law in Washington does not suggest a survey will ever be carried out there either. Regulations of that kind, protected from public scrutiny, but with the ring of authority and oversight, are a Potemkin village form of regulatory obfuscation. They look good, sound good, feel good, but have nothing behind them. The Questionable Circumstances of Oregon Deaths There are additional troubling aspects of how assisted suicide is practiced in Oregon.
One is that there are no monitoring mechanisms or, indeed, controls of any kind once the prescription for lethal drugs has been written. No one knows what may happen to the lethal agents that are not taken by the patients who originally request them, and the Oregon reports have made it clear that some patients have died of other causes.
As if to underscore this point, Dr. Our job is to make sure that all the steps happened up to the point the prescription was written. Concern about the fate of unused lethal barbiturates is compounded by the fact that the Oregon law does not necessarily require that the drugs be ingested by mouth. There is at least one documented example in Oregon in which assistance by others in the dying process has been acknowledged. Discussing a case in which a man said he helped his brother-in-law take the prescribed drugs, Dr.
But if a patient or someone assisting uses a feeding tube or an injection, intravenous or intramuscular, abuse is far more difficult to detect and prove. The ambiguity about what happens after the prescription is written—the actual manner of death—is highly problematic. Again contrary to the impressions created by assisted suicide supporters, the lethal drugs are not at all simple to take quickly.
According to Kenneth R. Stevens, Jr. Use of secobarbital, a powder, requires a person to take the contents of 90 to large capsules. These capsules cannot feasibly be swallowed, because the individual would fall asleep before ingesting enough to achieve the intended purpose.
So the capsules must be emptied into applesauce or pudding, which cannot disguise the very strong and exceptionally bitter, distasteful flavor. Taking a substance to numb the mouth is not necessarily a good way to make the drug more palatable, because it could interfere with swallowing. The other agent, pentobarbital, is only available as an injectable liquid. Four bottles, or approximately seven ounces of liquid, must be taken to reach the needed dose of ten grams, and this potion is also exceptionally distasteful.
Stevens commented on how bitter a death oral ingestion provides, and he pointed out that in at least one known Oregon case, a feeding tube was used. Moreover, once the injectable pentobarbital leaves the pharmacy, there is nothing to prevent it from being used through an intravenous IV line, or as a lethal injection.
If a patient or someone assisting appears to have used a feeding tube or an injection, abuse is far more difficult to detect and prove. This slide away from self-administration is a cause of considerable concern to the disability community, which has known a long history of involuntary euthanasia at the hands of others, whether governments, medical establishments, or families that did not necessarily value their presence. Despite the reporting requirements, death by physician-assisted suicide in Oregon largely occurs in the dark.
There is little accurate information about what actually happens at the time of death, as physicians are not required to be present at the time …. Between and , the time between ingestion and death ranged from four minutes to 48 hours. It is hard not to imagine that those patients who required 48 hours to die might have experienced suffering over and above that brought on by the terminal illness. Other physicians specializing in end-of-life care have also questioned the circumstances of Oregon deaths.
Both of those times are problematic. It is very unlikely that someone would die within 2 minutes of taking an overdose of sleeping medication. Likewise, the major effect of the short-acting sleeping medication would have worn off by 25 hours. So what was the cause of death in these circumstances? He agreed that nobody dies five minutes—or even twenty minutes—following oral ingestion of a lethal dose of barbiturates. Once society authorizes assisted suicide for … terminally ill patients experiencing unrelievable suffering, it will be difficult if not impossible to contain the option to such a limited group.
Individuals who are not [able to make the choice for themselves], who are not terminally ill, or who cannot self-administer lethal drugs will also seek the option of assisted suicide, and no principled basis will exist to deny [it]. The Dutch example provides the longest experience with assisted suicide in any country.
Although it remained technically illegal until , the Netherlands first began to legally tolerate assisted suicide in the early 70s. The Netherlands has become a frightening laboratory experiment because of how far assisted suicide and lethal injections have spread.
Herbert Hendin documented how assisted suicide and lethal injections have become not the rare exception, but the rule for people with terminal illness in the Netherlands. Hendin was one of only three foreign observers given the opportunity to study these medical practices in the Netherlands in depth, to discuss specific cases with leading practitioners, and to interview Dutch government-sponsored euthanasia researchers.
Once the Dutch accepted assisted suicide it was not possible legally or morally to deny more active medical [assistance to die], i. Nor could they deny assisted suicide or euthanasia to the chronically ill who have longer to suffer than the terminally ill or to those who have psychological pain not associated with physical disease.
To do so would be a form of discrimination. Involuntary euthanasia has been justified as necessitated by the need to make decisions for patients not [medically] competent to choose for themselves. But in fact, the number of people requesting lethal drugs has steadily increased. There is no reason to believe that legalization in the U. Assisted suicide proponents and medical personnel alike have established that taking lethal drugs by mouth is often ineffective in causing a quick and simple death.
The body sometimes expels the drugs through vomiting, or the person falls into a lengthy state of unconsciousness rather than dying promptly, as assisted suicide advocates wish. Such ineffective suicide attempts happen in a substantial percentage of cases—estimates range from 15 percent to 25 percent.
This is the likely next step if society first accepts assisted suicide as a legitimate legal option. Assisted suicide proponents tell us that none of these things will happen in the United States. But once assisted suicide is legalized, no significant barriers remain to prevent them.
The very existence of assisted suicide as a legal option is likely to gradually erode social resistance, as it has in the Netherlands. In fact, the leading public champion for assisted suicide in Washington State, former Governor Booth Gardner, openly articulated a vision of its expansion as his dream.
Gardner wants a law that would permit lethal prescriptions for people whose suffering is unbearable, a standard that can seem no standard at all; a standard that prevails in the Netherlands, the Western nation that has been boldest about legalizing aid in dying; a standard that elevates subjective experience over objective appraisal and that could engage the government and the medical profession in the administration of widespread suicide.
If he can sway Washington to embrace a restrictive law, then other states will follow. Thus, the danger of expansion is another reason why it is important to maintain the legal barriers prohibiting assisted suicide. The movement to legalize assisted suicide would do far better to advocate for high quality end-of-life care. Within the context of prevailing negative attitudes about disability and a profit-driven health care system, people with disabilities pay a high price for legalizing assisted suicide.
But we are not alone in doing so, because the negative consequences of legalization affect many dimensions of society, extending well beyond the disability community and the health care system. Leading disability rights organizations and advocates in the U. In place of legalization, we will call for adequate home and community-based long-term care, universal health coverage, and a range of social supports that provide true self-determination for everyone.
It is fictional freedom; it is phony autonomy. Many state and local disability community leaders and organizations have declared their opposition in states where assisted suicide proposals have been introduced, and the Disability Section of the American Public Health Association has also declare opposition.
Studies have demonstrated that dying patients who received morphine lived longer than those who did not receive morphine. For the first sentence, Hendin and Foley cite Frank J. Brescia et al. For the second sentence, they cite William C.
Wilson et al. The Kevorkian Debate. Style, p. These near-fatal encounters with anti-disability prejudice in the health care system are not limited to the U. See, e. Linda Peeno. In , before the U. It brought me an improved reputation in my job, and contributed to my advancement afterwards.
Sulmasy, M. Linas, B. Gold, Ph. Schulman, M. Toffler, M. For example, the latest data ranks Oregon ninth not first in Medicare-age use of hospice; four out of the top five are states that have criminalized assisted suicide.
See Kenneth R. Fromme, M. Tilden, D. Drach, M. Tolle, M. Hendin and Foley are drawing on Erik K. Fromme et al. Tolle and Susan E. It showed that, in , , elders age 60 and over were abused, according to a study of observed cases. In almost 90 percent of the elder abuse and neglect incidents with a known perpetrator, the perpetrator was a family member, and two-thirds of the perpetrators were adult children or spouses. Personal correspondence, March 13, Lamont et al. Maltoni, et al. Christakis and T.
Lynn et al. This roughly coincides with data collected by the National Hospice and Palliative Care Organization, which in showed that 13 percent of hospice patients around the country outlived their six-month prognoses. Fully 70 percent of the patients eligible for hospice care lived longer than six months, according to a paper published in the Journal of the American Medical Association.
Cameron et al. Ray and J. Eisenberg and C. State of Montana , No. DA Mont. They held closed-door hearings on December 9 and 10, and published the proceedings on April 4, Rather, depression, psychological distress, and fear of loss of control are identified as the key end of life issues. This has been borne out in numerous studies and reports. Moreover, in the same study, patients demonstrating suicidal ideation were much more likely to be suffering from depression or anxiety, but not somatic symptoms such as pain.
An important study from the Netherlands of a cohort of cancer patients with a life expectancy of three months or less demonstrated similar findings.
In this study, the authors had hypothesized that patients requesting euthanasia would be unlikely to have depressed mood or affect, since it would be expected that such a request would be a well-thought out decision, particularly since euthanasia has been legal in the Netherlands since The authors expected that these patients would be more accepting of their terminal diagnosis and therefore better adjusted.
What they found surprised them—depressed patients were more than four times as likely to request euthanasia as patients who were not depressed. Of those who requested euthanasia, about half were depressed. The statement cites ME Suarez-Almazor et al.
II, pp. Also see N. Goy, and Steven K. Leong, M. Fenn, Ph. Arturo Silva, M. Ganzini, et al. Chin, et al. But no reports suggest that any disciplinary action was ever taken. Stevens Jr.
The mostly Christian protesters view the measure as an assault on the sanctity of life. About cases of voluntary euthanasia are carried out each year in the Netherlands. Mr Rob Jonquierre, managing director of the Dutch Voluntary Euthanasia Society, believes that the new legislation will not lead to a massive increase in the number of cases.
Belgium could be the next country to change its laws on mercy killing, as a bill to partially decriminalize euthanasia is currently before parliament.
The issue of euthanasia is likely to remain high on the medicolegal or ethical agendas of many countries in coming years. Another reason is that people are living longer and because of medical advances increasing numbers are surviving with debilitating conditions, such as cancer and heart disease.
The public peace is shattered, and the protection of human rights compromised. For these reasons the concrete norm "Do not murder" has been translated into public law. It is understood to be part of the public morality. At issue, then, is how we translate our foundational principle—Do not directly attack innocent human life—into a concrete norm when confronted with the possibility of death.
I could argue that the earlier discussion about the natural "sacredness" of life, the integrity of personhood, and the trustworthiness necessary to sustain human community can be drawn together to support a concrete moral norm saying that it would be wrong to directly take or assist in the taking of human life to relieve pain or suffering.
Although originally grounded in a Christian foundational principle, this concrete norm opposing euthanasia now has a nonsectarian basis, like the concrete norm regarding murder. It can, if you will, be called a human or a natural norm.
Although many persons might agree this is a worthy concrete norm to guide the development of personal morality, they would question whether it is so exceptionless, or the consequences of its violation so significant, as to also make it a matter of public morality. For this reason, some are questioning the validity of the existing societal presumption—namely, they question whether the concrete norm opposing euthanasia should be a matter of public morality.
To answer this question, we must return to the grounding for our foundational principle. Will that natural sense of awe about life, that natural desire not to be vulnerable or at risk, be enhanced or threatened by making euthanasia legal? Are enough protections available in the human community, in light of human foibles and limitations, to ensure that this practice will not make individuals more vulnerable to outside attack?
In other words, will the "safe harbor" that laws against murder and euthanasia have created for human existence be enhanced or diminished?
We must consider whether, as a society, we want to say that human life is but another "thing" to be used and discarded at will, like a broken toy. Is this the understanding of life we wish to celebrate as a civil society?
We must ask whether we are happy living as lone rangers on the frontier of life or whether community is essential to our well-being. And if it is, what are the mutual commitments of trust necessary to support and sustain such community? Will the legalization of euthanasia enhance these commitments or detract? Meeting the Challenge All too often the euthanasia discussion has not addressed these more fundamental issues. The image of persons dying needlessly painful deaths controlled by insensitive medical technology dominates the discussion.
And I suspect many persons who might vote to legalize euthanasia are doing so out of desperation. Ironically, they view their votes as the only way to preserve the sacredness of life and community. What they fail to see is how in fact euthanasia compromises what they most deeply believe. I agree with the cardinal. The reasoned and sophisticated arguments against the legalization of euthanasia will never be heard and the real discussion will not take place unless, as individuals and providers of healthcare, we first meet this critical challenge.
In the Catholic tradition euthanasia is understood "as an action or omission which of itself or by intention causes death in order that all suffering may in this way be eliminated" Congregation for the Doctrine of the Faith, "Declaration on Euthanasia," Origins , vol.
Euthanasia may be voluntary or involuntary. The difference is found in the patient's intention. Voluntary euthanasia is when a patient ends his or her own life with the assistance of a care giver, or when a care giver does it at a patient's request.
Involuntary euthanasia occurs when a care giver ends a patient's life without the patient's consent. Also, euthanasia may be either active or passive. Active euthanasia occurs when death is induced through an external method, such as Dr. Jack Kevorkian's machine. Passive euthanasia occurs "if the cause of death is present within one's body, but is not resisted when there is a moral obligation to do so" Kevin O'Rourke, "Assisted Suicide: An Evaluation," Journal of Pain and Symptom Management , vol.
Within the Catholic theological tradition, no moral distinction is made between active and passive euthanasia. Both are described as causing the death of a person who is ill when there is a moral obligation to prolong that person's life. Key to this ethical analysis is the assumption that there is a moral obligation to preserve and protect human life. The existence of such an obligation is relevant because, according to the Catholic theological tradition, there are times when no moral obligation exists to prolong life—namely, when the care or treatment would be futile or disproportionately burdensome.
Consequently, when there is no such obligation and a person is allowed to die from a fatal pathological condition, "then the act by which one is allowed to die is not euthanasia" O'Rourke.
This is an important point. Catholic tradition does not require that persons who are dying be kept alive needlessly. Rather, it opposes reversing a centuries-old tradition enshrined in our civil law saying that no one should directly take the life of another innocent person or assist in the taking of that life even if that person is dying or is seriously ill.
Log in Forgot Password? Create Account Please Log In. Log In. Forgot Password? Create Account. Summary The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning.
Such participation, however, is based on two distinctions: The distinction between civil law and morality. Although our legal tradition is rooted in moral principles, "the scope of law is more limited and its purpose is not the moralization of society. This should only happen when the mutually agreed-on demands of the public good or the public order require it. The distinction between public moral questions and private moral questions. Something is a matter of public morality if it affects the public order of society.
Catholic thinker John Courtney Murray defined public order as encompassing three goods: public peace, essential protection of human rights, and commonly accepted standards of moral behavior in a community. As a general principle, the domain of law and public policy is public morality, not private morality. Obviously, in a pluralistic society, arriving at a consensus on what pertains to public policy is never easy.
But we have been able to achieve such consensus in the past by a process of dialogue, decision making and review of our decisions. They are as follows: That an individual's life belongs to the individual to dispose of entirely as he or she wishes; That the dignity that attaches to personhood by reason of the freedom to make moral choices demands also the freedom to take one's life; That there is such a thing as a life not worth living, whether by reason of distress, illness, physical or mental handicaps, or even sheer despair for whatever reason; That what is sacred or supreme in value is the "human dignity" that resides in man's own rational capacity to choose and control life and death.
Gula, SS, identifies three: They are arbitrary in that they identify a few values to define the significance of human life and fail to put them in the context of a full spectrum of human values and their consequences. Taken as a freestanding composite, they are too risky. It is not self-evident why their application could not be extended to the most vulnerable members of society such as the elderly and the handicapped.
They erode the "character of a helping community of trust and care. As Courtney S. Campbell has pointed out: Disagreements regarding the end of life choices open to dying persons reflect non-moral assumptions about the source of meaning and good in human life; the significance of suffering and death in human experience; the relation between dependency, dignity and control; the moral character of caring relationships; and the nature of the human self.
We must keep in mind that: Actions reflect and give expression to certain values and beliefs. The more people perform a certain action and the more frequently they perform it, the more those values and beliefs are expressed. The effect is cumulative and eventually influences the moral tone and character of a society.
0コメント