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INTRODUCTION
In a war of ideologies, the first casualties are the definitions of the terms used. Euphemisms
abound when people are determined to convince others. The word "euthanasia" comes straight
out of the ancient Greek, "eu" means goodly or well and “thanatos” means death.1 In the 18th-
century, writers in England translated its Greek root which meant, a "good" death, a welcome
way to depart quietly and well from life. In the language of the day, administering a lethal
injection becomes "aid in dying;" the deliberate ending of a person's life to reduce their suffering
becomes “mercy killing”. More commonly used today, however, is the phrase the "right to die."
These are noble sounding words that literally mean that someone can request that a doctor may
kill him. In the terminology battle, the proponents of euthanasia are seeking to redefine the term
euthanasia to gain popularity and acceptance. Notwithstanding the proponents’ effort to
camouflage this moral dilemma with noble sounding words, it remains controversial because it
pits the plight of suffering, dying individuals against religious beliefs, legal tradition, and, in the
case of physician-assisted death, medical ethics.2 In the opposite extreme end of the moral
spectrum, Euthanasia is considered, from a traditional Judeo-Christian point of view, as murder
and a blatant violation of the biblical commandment “Thou shalt not kill.”3 From a secular
perspective, one of the principal purposes of law is to uphold the sanctity of human life. Despite
contrary views, new development shows how values and practices can change over time. Some
practices that were considered barbaric at one time in history have become acceptable in the
twenty-first century.
In April 2002, Netherlands became the first country in the world to legalize euthanasia.
Subsequently, legalization of euthanasia took place in Belgium in September of the same year.4
With the increase acceptance and legalization of euthanasia in other countries, does a staunchly
85% Catholic country embrace the same? The current "debate" on the legitimacy of euthanasia is
a good indicator of the overall moral state of Philippines today. This three-part series addresses
the issues of euthanasia. In part one, it argues on what makes euthanasia legal and illegal. While
1 http://en.wikipedia.org/wiki/Euthanasia#Etymology2 http://www.enotes.com/euthanasia-article3 http://www.inplainsite.org/html/euthanasia.html4 http://ask.yahoo.com/20030710.html
in part two, it argues on what makes euthanasia moral and immoral. Lastly, the conclusion
provides a unanimous stand on the legal and ethical issues surrounding euthanasia.
Historical Background
Date Events
5th Century B.C.-1st
Century B.C.
Ancient Greeks and
Romans Tend to
Support Euthanasia
"In ancient Greece and Rome, before the coming of Christianity,
attitudes toward infanticide, active euthanasia, and suicide had tended
to be tolerant. Many ancient Greeks and Romans had no cogently
defined belief in the inherent value of individual human life, and
pagan physicians likely performed frequent abortions as well as both
voluntary and involuntary mercy killings. Although the Hippocratic
Oath prohibited doctors from giving 'a deadly drug to anybody, not
even if asked for,' or from suggesting such a course of action, few
ancient Greek or Roman physicians followed the oath faithfully.
1st Century A.D.-
Late Middle Ages
During Middle Ages
Christians and Jews
Tend to Oppose
Euthanasia
"There was a remarkable continuity in Church medical ethics
regarding suicide and euthanasia between the dawn of Christianity and
the late Middle Ages. Medieval references to voluntary death were
rare, suggesting that the actual practice of euthanasia had tapered off
dramatically since the fall of Rome. Laws in some parts of Europe
dictated that a suicide's corpse be dragged through the streets or nailed
to a barrel and left to drift downriver. The medieval ethos was
distinctly uncongenial to any kind of self-murder."5
"The ascendancy of Christianity, with its view that human life is a
trust from God, reinforced the views of the Hippocratic school [which
forbid euthanasia]. By the twelfth through fifteenth centuries, it
culminated in the near unanimity of medical opinion in opposing
euthanasia."6
17th Century
Common Law
Tradition Prohibits
Suicide and Assisted
Suicide in the
American Colonies
"For over 700 years, the Anglo American common law tradition has
punished or otherwise disapproved of both suicide and assisting
suicide... For the most part, the early American colonies adopted the
common law approach. For example, the legislators of the Providence
Plantations, which would later become Rhode Island, declared, in
1647, that '[s]elf murder is by all agreed to be the most unnatural, and
it is by this present Assembly declared, to be that, wherein he that doth
it, kills himself out of a premeditated hatred against his own life or
other humor...his goods and chattels are the king's custom." 7
17th-18th Century "No serious discussion of euthanasia was even possible in Christian
5 Ian Dowbiggin, PhD .A Merciful End: The Euthanasia Movement in Modern America, 20036 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 19987 Washington v. Glucksberg (63KB) , 1997
Renaissance and
Reformation Writers
Challenge Church
Opposition to
Euthanasia
Europe until the eighteenth-century Enlightenment. Suddenly, writers
assaulted the church's authoritative teaching on all matters, including
euthanasia and suicide... While writers challenged the authority of the
church with regard to ethical matters, there was no real widespread
interest in the issues of euthanasia or physician-assisted suicide during
that time."8
8 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998
Late 18th Century
American
Evangelical
Christians Reject
Suicide and
Euthanasia
"Enlightenment toleration of suicide proved to be temporary. Under
the leadership of evangelicals...a vigorous religious counterattack
gained momentum as the late eighteenth century drew to a close. The
various waves of religious revivalism, starting with the Great
Awakening of the mid-1700s, prevented secularists and agnostics on
either side of the Atlantic Ocean from generating popular support for
taking one's life. These events dovetailed with the Second Great
Awakening of intense evangelical fervor in the first years of the
nineteenth century and strengthened the condemnation of suicide and
euthanasia that stretched back to the earliest days of colonial America.
The rejection of suicide and euthanasia remained firm, even after
many of the new states decriminalized suicide in the wake of the
Revolutionary War. The majority of Americans rejected suicide's
common-law punishment...but no matter how sympathetic they were
toward the suicide's family, most Americans stopped far short of
condoning self-murder. As late as the antebellum period there existed
in the United States a firm consensus...against suicide and mercy
killing."9
9 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003
1828
The earliest American statute explicitly to outlaw assisting suicide is
enacted in New York. It is the Act of Dec. 10, 1828, ch. 20, §4, 1828
N. Y. Laws 19. "Many of the new States and Territories followed New
York's example… Between 1857 and 1865, a New York commission
led by Dudley Field drafted a criminal code that prohibited 'aiding' a
First US Statute
Outlawing Assisted
Suicide Enacted in
New York
suicide and, specifically, 'furnish[ing] another person with any deadly
weapon or poisonous drug, knowing that such person intends to use
such weapon or drug in taking his own life'… By the time the
Fourteenth Amendment was ratified, it was a crime in most States to
assist a suicide… The Field Penal Code was adopted in the Dakota
Territory in 1877, in New York in 1881, and its language served as a
model for several other western States' statutes in the late 19th and
early 20th centuries… California, for example, codified its assisted
suicide prohibition in 1874, using language similar to the Field
Code's."10
1870s
Samuel Williams
"An important milestone in the euthanasia debate was the isolation of
morphine in the nineteenth century and its widespread use as an
10 Washington v. Glucksberg (63KB) , 1997
Begins to Publically
Advocate Using
Morphine and Other
Drugs for Euthanasia
analgesic [a pain-relieving agent]... When the practice of analgesia had
become reasonably well established, Samuel Williams, a non-
physician, began to advocate the use of these drugs not only to
alleviate terminal pain, but to intentionally end a patient's life... During
the late 1800s, Williams' euthanasia proposal received serious
attention in the medical journals and at scientific meetings. Still, most
physicians held the view that pain medication could be administered to
alleviate pain, but not to hasten death."11
11 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998
1885
American Medical
Association Opposes
Euthanasia
The Journal of the American Medical Association attacks Samuel
Williams' euthanasia proposal as an attempt to make "the physician on
the robes of an executioner."12
1905-1906
Bills to Legalize
Euthanasia Are
Defeated in Ohio
"By the turn of the century, medical science had made great strides. As
physicians who used the modern scientific method and modern
principles of pharmacology consolidated their control over university
and medical school training, the euthanasia debate entered the lay
press and political forums. In 1905-1906, a bill to legalize euthanasia
was defeated in the Ohio legislature by a vote of 79 to 23. In 1906, a
similar initiative that would legalize euthanasia not only for terminal
adults, but also for 'hideously deformed or idiotic children' was
introduced and defeated as well. After 1906, the public interest in
euthanasia receded."13
1915
Dr. Haiselden Allows
Deformed Baby to
"In the early hours of 12 November 1915, at Chicago's German-
American Hospital, Anna Bollinger gave birth to her fourth child, who
is a seven-pound baby boy...the baby was blue and badly deformed.
After conferring with the father, the doctor awakened Harry J.
Haiselden, the hospital's forty-five-year-old chief of staff. Haiselden
diagnosed a litany of physical defects. He predicted that, without
surgery...the child would die shortly. In a decision whose shockwaves
12 Ezekiel Emanuel, MD, PhD .The History of Euthanasia Debates in the United States and Britain," Annals of Internal Medicine, Nov. 15, 1994
13 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998
Die Rather Than
Give It Possibly Life-
saving Surgery
would ripple from coast to coast, and mark a milestone in the history
of euthanasia in America, Haiselden advised against surgery. The
Bollingers tearfully agreed and, on 16 November, Haiselden called a
news conference to announce that, rather than operate, he would
'merely stand by passively' and 'let nature complete its bungled job.'
The child died on 17 November, amid growing controversy.By
declining to operate, Haiselden...almost singlehandedly managed to
accomplish what other defenders of euthanasia before him had not. He
not only got more Americans than ever before talking about
euthanasia, but also won endorsements from numerous prominent
figures. The publicity surrounding his professional conduct, briefly
eclipsing news from World War I, inspired other Americans to speak
out in favor of letting deformed infants die for the good of society...
Haiselden demonstrated how support for euthanasia was nurtured by a
cultural climate punctuated by science, naturalism, and humanitarian
reform." 14
1917
The Black Stork Film
Causes Controversy
over Infant
Euthanasia
"The Black Stork, a feature film from 1917, dramatically expresses the
anxieties people had about medicine and disability during this period:
disability was equated with disease, doctors claimed absolute
authority. The film was inspired by the sensational case of Dr. Harry
Haiselden, a Chicago surgeon who convinced the parents of a newborn
with multiple disabilities to let the child die instead of performing
surgery that would save its life. Haiselden's activities brought forth a
storm of public controversy in which all of the currently popular
attitudes toward disability were expressed. Many prominent thinkers,
including Clarence Darrow and Helen Keller, argued that physicians
had the right and the duty to decide whether a life was worth living.
14 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003
Although it was widely accepted that doctors should make these
decisions and act on them in their private practices, it was rare that the
subject was argued in public."15
1930s
Public Support for
Euthanasia Increases
as US Endures Great
Depression
"The dispute over mercy killing, after subsiding in the 1920s, caught
fire again in the 1930s, making these years a pivotal juncture in the
history of euthanasia in America. With the coming of the Depression
and more troubled economic times, Americans began talking again
about suicide and controlled dying... Public opinion polls indicated in
1937 that fully 45 percent of Americans had caught up with Harry
Haiselden's belief that the mercy killing of 'infants born permanently
deformed or mentally handicapped' was permissible."16
1935
Voluntary
Euthanasia
Legislation Society
Founded
The Voluntary Euthanasia Legislation Society (VELS) is founded in
England by C. Killick Millard, a retired public health physician.17
1936
Bill to Legalize
Euthanasia Defeated
"The euthanasia debate was not limited to this side of the Atlantic. A
bill to legalize euthanasia was debated in the British House of Lords in
1936, but was rejected... The defeat of this bill, along with the
outbreak of World War II, the subsequent discovery of the Nazi death
camps, and the recognition of the complicity of German physicians in
15 National Public Radio"The Black Stork: Movie Ads," www.npr.org (accessed May 8, 2009)16 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200317 Ezekiel Emanuel, MD, PhD "The History of Euthanasia Debates in the United States and Britain," Annals of
Internal Medicine, Nov. 15, 1994
in British House of
Lords
the extermination camps quelled but did not eliminate discussion of
the euthanasia question."18
1937
Voluntary
Euthanasia Act
Introduced in US
Senate
Nebraska Senator John Comstock introduces legislation called the
Voluntary Euthanasia Act, which calls for the legalization of active
euthanasia. It is never voted on but demonstrates an emerging interest
in legislating euthanasia.19
1938
National Society for
the Legalization of
Euthanasia Founded
On January 16th, 1938 Charles Francis Potter announces the founding
of the National Society for the Legalization of Euthanasia (NSLE),
which is soon renamed the Euthanasia Society of America (ESA).
According to TIME magazine, "he and a sizable group of other notable
men believe[d] so strongly in the right of an incurably diseased
individual to have his life terminated gently that they... organized a
National Society for the Legalization of Euthanasia... its trustees
included Dr. Clarence Cook Little of the American Society for the
Control of Cancer and of the American Birth Control League, and
Secretary Leon Fradley Whitney of the American Eugenics Society."20
1940s"When the 1940s dawned, many in the euthanasia movement believed
it was only a matter of time before euthanasia became legal in the
18 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 199819 Bryan Hilliard, PhD ."The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-
Physician Relationship," Issues in Integrative Studies, 200020 TIME Magazine "Potter and Euthanasia," www.time.com, Jan. 31, 1938
Nazi Use of
Involuntary
Euthanasia Changes
Public Perception of
Euthanasia in the US
United States...But euthanasia advocates were in for a surprise...
World War II broke out, and as Hitler's war machine Marched
eastward across Europe...news of Nazi atrocities against mental
patients and handicapped children filtered back to America... As word
spread in the late 1940s, the euthanasia movement found itself
increasingly on the defensive, scrambling to deny that the form of
euthanasia it supported was the same as Nazi murder." 21
1946
Committee of 1776
Physicians for
Legalizing Voluntary
Euthanasia Founded
The Committee of 1776 Physicians for Legalizing Voluntary
Euthanasia in New York State comes into existence.22
1950
World Medical
Association
Condemns
Euthanasia; Poll
Shows Declining
Support for
The World Medical Association votes to recommend to all national
medical associations that euthanasia be condemned "under any
circumstances." In the same year, the American Medical Association
issues a statement that the majority of doctors do not believe in
euthanasia. "When an opinion poll in 1950 asked Americans whether
they approved of allowing physicians by law to end incurably ill
patients' lives by painless means if they and their families requested it,
21 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200322 Bryan Hilliard, PhD "The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-
Physician Relationship," Issues in Integrative Studies, 2000
Physician-Assisted
Suicide
only 36 percent answered 'yes,' approximately 10 percent less than in
the late 1930s."23
1952
Groups Petition the
UN to Amend the
Declaration of
Human Rights to
Include Euthanasia
The British and American Euthanasia Societies submit a petition to the
United Nations Commission on Human Rights to amend the UN
Declaration of Human Rights to include "...the right of incurable
sufferers to euthanasia or merciful death... Inasmuch as this right is,
then, not only consonant with the rights and freedoms set forth in the
Declaration of Human Rights but essential to their realization, we
hereby petition the United Nations to proclaim the right of incurable
victims to euthanasia. Eleanor Roosevelt, the Chairperson of the
Commission, did not present the petition to the Commission.24
1962
Pauline Taylor
Becomes President of
the Euthanasia
Society of America
Charles Potter dies and theologian Joseph Fletcher assumes Potter's
unoffical title as the chief philosopher of the euthanasia movement.
"Fletcher fashions a new rationale for euthanasia based primarily on
the notion of patient autonomy." Pauline Taylor becomes president of
the Euthanasia Society of America (ESA). "Taylor...began the ESA's
soul-searching process that led to a major shift in the philosophy for
the entire American euthanasia movement. She believed the ESA in
the past had overemphasized the soundness of an individual's decision
to have his or her life ended if terminally ill and in unbearable pain...
Taylor concluded that the time was ripe to...begin convincing the
public that letting someone die, instead of resorting to extreme
23 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200324 Marjorie Zucker, PhD The Right to Die Debate: A Documentary History, 1999
measures, was both humane and ethically permissible." 25
1965
Donald McKinney
Becomes President of
the Euthanasia
Society of America
Donald McKinney becomes president of the Euthanasia Society of
America (ESA).
"Over the next two decades [McKinney] would help to transform the
euthanasia movement by leading a sizeable faction opposed to active
euthanasia or physician-assisted suicide. In the process he eventually
concluded...that there was a fundamental distinction between passive
and active euthanasia." 26
1967
First Living Will
Written
The first living will is written by attorney Luis Kutner and his
arguments for it appear in the Indiana Law Journal.27
1968
Harvard Medical
School Committee
Defines Irreversible
Coma as a Criterion
for Death
The Ad Hoc Committee of the Harvard Medical School to Examine
the Definition of Brain Death publishes its report in the Journal of the
American Medical Association in August 1968. The committee defines
"irreversible coma" as a new criterion for death. According to the
committee, a new definition of death was needed because of the great
burden that trying to revive irreversibly comatose patients puts on the
patients themselves, their families, hospitals and the community. 28
25 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200326 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200327 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the
Millenium," www.finalexit.org, Feb. 27, 200528 Peter Singer Rethinking Life & Death, 1994
1969
Hastings Center
Founded
The Hastings Center was founded in 1969 by Daniel Callahan to study
ethical problems in medicine and biology and was instrumental in the
development of bioethics as a discipline. The original focus of the
center concerned death and dying, genetics, reproductive biology and
population issues, and behavior control.29
1970
Idea of Patients'
Rights Gains
Acceptance
In the early 1970s, the widely accepted authority of the medical
profession came under concerted attack in the name of patient
autonomy. This challenge has been embodied in the progressive
enumeration of patient rights, especially the right to refuse medical
care, even life-sustaining care. The goals have been to remove
physicians from decision making and to let individual patients weigh
the benefits and burdens of continued life.30
1972
US Senate Holds
First National
Hearings on
Euthanasia
The US Senate Special Commission on Aging (SCA) holds the first
national hearings on death with dignity entitled "Death with Dignity:
An Inquiry into Related Public Issues.”
"The SCA hearings, chaired by Senator Frank Church, proved to be a
superb opportunity for professionals and laypeople to discuss a range
of issues relating to aging and terminal illness, including the evolving
doctor-patient relationship and the difficulties about defining death
itself. Overall, the hearings showed that Americans were becoming
increasingly unhappy about 'the brutal irony of medical miracles,'
which extended the dying process only to diminish patient dignity and
29 Daniel Callahan, PhD "The Hastings Center and the Early Years of Bioethics," Kennedy Institute of Ethics Journal, Mar. 199930 Ezekiel Emanuel, MD, PhD "The History of Euthanasia Debates in the United States and Britain," Annals of Internal Medicine,
Nov. 15, 1994
quality of life. Church insisted that the hearings were not about
euthanasia, but try as he might, he could not keep the subject from
surfacing." 31
1973
American Hospital
Association (AHA)
Adopts Patient's Bill
of Rights
The American Hospital Association adopts a "Patient's Bill of Rights"
which recognizes the right of patients to refuse treatment.32
1974
Society for the Right
to Die Founded; First
US Hospice Opens
"The founding of the Society for the Right to Die [formerly the
Euthanasia Society of America] marked a renewed dedication to
pursuing the legalization of active euthanasia, a reenergized campaign
to seek euthanasia laws through the political process."33
The first American hospice opens in New Haven, Connecticut.34
March 31, 1976
Supreme Court
Rules in Quinlan
Case that Respirator
Can Be Removed
21-year-old Karen Ann Quinlan had fallen into an irreversible coma at
a party in 1974. After doctors declared that she was in a "persistent
vegetative state," her parents went to court to have her respirator
removed. The New Jersey Supreme Court rules in 1976 that Karen
Quinlan can be detached from her respirator. The case becomes a legal
landmark, drawing national and international attention to end-of-life
31 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200332 AHA Patients’ Bill of Rights, 197333 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 200334 Bryan Hilliard, PhD "The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-Physician
Relationship," Issues in Integrative Studies, 2003
from Coma Patient issues.35
October 1, 1976
Nation's First Aid in
Dying Statute Signed
into Law in CA
California Governor Edmund G. Brown Jr. signs the California
Natural Death Act into law and California becomes the first state in
the nation to grant terminally ill persons the right to authorize
withdrawal of life-sustaining medical treatment when death is believed
to be imminent.36
1980
World Federation of
Right to Die Societies
Forms; Hemlock
Society Forms
The World Federation of right to Die Societies was founded in 1980.
Its membership included dozens of organizations from countries
around the world that were concerned with euthanasia and the the right
to die.37
May 5, 1980
Pope John Paul II
Issues Declaration
Opposing Mercy
Killing
Pope John Paull II issues the Declaration on Euthanasia, opposing
mercy killing but permitting increased use of painkillers and a patient's
refusal of extraordinary means for sustaining life.38
Dec. 1984The American Medical Association publishes two reports,
35 In Re Quinlan , 197636 New York Times "California Grants Terminally Ill Right to Put an End to Treatment," Oct. 2, 197637 World Federation of Right to Die Societies "Ensuring Choices for a Dignified Death, www.woldtd.net (accessed
May 9, 2009)38 Marjorie Zucker, PhD The Right to Die Debate: A Documentary History, 1999
American Medical
Association Supports
Withholding or
Withdrawing Life-
Prolonging Medical
Treatment in Certain
Circumstances
"Withholding or Withdrawing Life-Prolonging Medical Treatment,
and "Withholding or Withdrawing Life-Prolonging Medical Treatment
-- Patients' Preferences."
The reports detail the American Medical Association's formal position
that with informed consent, a physician can withhold or withdraw
treatment from a patient who is close to death, and may also
discontinue life support of a patient in a permanent coma.39
1987
California State Bar
Becomes First Public
Body to Support
Physician Aid in
Dying
The California State Bar Conference passes Resolution #3-4-87 to
become the first public body to approve of physician aid in dying.40
1988
Unitarian
Universalist
Association Passes
Resolution in
Support of Aid in
Dying
The Unitarian Universalist Association of Congregations passes a
national resolution titled "The Right to Die With Dignity." The
resolution favors aid in dying for the terminally ill, thus the Unitarian
Universalist Association of Congregations becomes the first religious
body to affirm a right to die.41
Jan. 8, 1988The Journal of the American Medical Association publishes an
39 American Medical Association "Opinion 2.20: Withholding or Withdrawing Life-Sustaining Medical Treatment," www.ama-assn.org, (accessed May 12, 2009)
40 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the Millenium," www.finalexit.org, Feb. 27, 2005
41 "The Right to Die With Dignity" , 1988
Journal of the
American Medical
Association Publishes
Article By Hospital
Worker Who
Euthanized a Patient
anonymous article entitled "It's Over Debbie."
The article describes how a gynecology resident in a large private
hospital had injected a patient suffering from painful ovarian cancer
with an overdose of morphine. The article stirs controversy and
debate, and many condemn the resident for what he had done.42
1990s
Public Opinion
Surveys Show More
Than Half of
Americans Support
Physician-Assisted
Death
By the early 1990s, the growing interest in the right-to-die movement
became apparent in public opinion surveys. These showed that more
than half of the American public was now in favor of physician-
assisted death and membership of the Hemlock Society rose
dramatically to reach 50,000... With increased public interest, the
stage was set for an explosive swell of activity: in the courts, in
professional medical journals and institutions, and, most significantly,
in the homes of the American people.43
June 4, 1990
Jack Kevorkian
Participates in His
First Assisted Suicide
Jack Kevorkian, MD, assists Janet Adkins, a Hemlock Society
member, in committing suicide in Michigan. Adkins' death is the first
of many suicides in which Dr. Kevorkian assists.44
Cruzan v. Director, Missouri Department of Health comes before the
United States Supreme Court. The case receives national attention, as
42 Jonathan Moreno, PhD Arguing Euthanasia: The Controversy Over Mercy Killing, Assisted Suicide, and the "Right to Die," 1995
43 Sue Woodman Last Rights: The Struggle over the Right to Die, 200044 Wesley Smith, JD The Slippery Slope From Assisted Suicide to Legalized Murder, 1997
June 25, 1990
Supreme Court
Rules in Cruzan
Case that a Person
Has the Right to
Refuse Life Saving
Medical Service
it is the first right-to-die case that the court has agreed to hear. In
1983, a car accident had left Nancy Cruzan permanently unconscious
(by most accounts). Her parents requested to withdraw her feeding
tube, but the Missouri Supreme Court refused. The United States
Supreme Court ruled that a competent person has a constitutionally
protected right to refuse any medical treatment, but upholds Missouri's
right to insist on clear and convincing evidence as to the wishes of
patients who do not have decision-making capacity. In light of the
ruling, the Cruzans' lawyer goes back to court with new evidence as to
Nancy's prior wishes, and Nancy's feeding tube is removed. She dies
on December 26th, 1990.45
November 5, 1990
US Congress Passes
Patient Self-
Determination Act
Congress passes the Patient Self-Determination Act, requiring
hospitals that receive federal funds to tell patients that they have a
right to demand or refuse treatment. It takes effect the next year.46
1991
Choice in Dying
Formed
Choice in Dying is formed by the merger of two aids in dying
organizations, Concern for Dying and Society for the Right to Die.
The new organization becomes known for defending patients' rights
and promoting living wills, and grows in five years to 150,000
members.47
45 Wesley Smith, JD The Slippery Slope From Assisted Suicide to Legalized Murder, 199746 Patient Self Determination Act, Nov. 5, 199047 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the
Millenium," www.finalexit.org, Feb. 27, 2005
November 1991
Washington Voters
Defeat Physician-
Aid-in-Dying
Initiative
Washington State introduces ballot Initiative 119 to legalize
"physician-aid-in-dying." The initiative is defeated.48
November 3, 1992
California Death
with Dignity Act Is
Defeated
California voters defeat Proposition 161, the California Death with
Dignity Act, which would have allowed physicians to hasten death by
actively administering or prescribing medications for self
administration by suffering, terminally ill patients. The vote is 54-46
percent.49
April 1993
Compassion in Dying
Formed
Compassion in Dying is founded in Washington state to counsel the
terminally ill and provide information about how to die without
suffering and 'with personal assistance, if necessary, to intentionally
hasten death.' The group sponsors suits challenging state laws against
assisted suicide.50
May 1994
48 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 200149 Wesley J. Smith, JD Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder, 199050 Compassion & Choices "Aid-In-Dying Timeline," www.compassionandchoices.org (accessed May 12, 2009)
New York Task
Force Publishes
Report Against
Physician-Assisted
Suicide
The New York State Task Force on Life and the Law publishes When
Death Is Sought, a report that argues against the legalization of
physician-assisted suicide.51
November 1994
Oregon Death With
Dignity Act Passed
The Oregon Death With Dignity Act is passed, becoming the first law
in American history permitting physician-assisted suicide.52
April 30, 1997
President Clinton
Prohibits Using
Federal Funds for
Assisted Suicide
President Clinton signs the Assisted Suicide Funding Restriction Act
of 1997, which prohibits the use of federal funds to cause a patient's
death.53
June 26, 1997
US Supreme Court
Rules There Is No
Right to Die
The Supreme Court rules in Washington v. Glucksberg and Vacco v.
Quill that there is not a constitutional right to die.54
51 New York State Task Force on Life and the Law , May 199452 Oregon Death With Dignity Act , 199453 Assisted Suicide Funding Restriction Act of 1997, 199754 Washington v. Glucksberg and Vacco v. Quill, 1997
November 1997
Oregon Voters Keep
Death With Dignity
Act
Oregonians vote 60 to 40 percent in favor of keeping the Death With
Dignity Act.55
November 1998
Jack Kevorkian
Assists a Suicide on
National Television
Jack Kevorkian, MD, is a guest on 60 Minutes, during which he shows
a videotape of him administering a lethal injection to Thomas Youk, a
man suffering from Lou Gehrig's disease.56
November 1998
Michigan Defeats
Physician-Assisted
Suicide Proposal
Michigan introduces Proposal B to legalize physician-assisted suicide.
The proposal fails by a vote of 29% to 71%.57
1999
Jack Kevorkian
Convicted of Murder
A Michigan court convicts Jack Kevorkian, MD, for the murder of
55 Oregon Department of Human Services "Death With Dignity Act History," www.oregon.gov, Mar. 200656 People v. Kevorkian , 200157 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 2001
Thomas Youk and sentences him to 10-25 years in prison.58
2000
Maine Death with
Dignity Act Is
Defeated
Maine introduces a ballot initiative, the Maine Death with Dignity
Act, which reads "Should a terminally ill adult, who is of sound mind,
be allowed to ask for and receive a doctor's help to die?" The initiative
is defeated by a margin of 51% to 49%.59
2001
Netherlands
Legalizes Euthanasia
The Netherlands officially legalizes euthanasia.60
2003
Attorney-General
Aschroft Challenges
the Oregon Death
with Dignity Act
US Attorney-General John Ashcroft asks the 9th Circuit Court of
Appeals to reverse the finding of a lower court judge that the Oregon
Death With Dignity Act of 1994 does not contravene federal powers.61
2005The Terri Schiavo case garners national media attention. Terri Schiavo
had been brain damaged since 1990 when, aged 26, her heart stopped
58 People v. Kevorkian, 200159 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 200160 International Task Force on Euthanasia and Assisted Suicide "Frequently Asked Questions,"
www.internationaltaskforce.org, 200661 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the
Millenium," www.finalexit.org, Feb. 27, 2005
Terri Schiavo Has
Her Feeding Tube
Removed after Long
Court Battle
beating temporarily and oxygen was cut off to her brain. In 1998, her
husband Michael Schiavo filed a petition to have her feeding tube
removed. Seven years of legal battles ensued between Michael
Schiavo and Terri's parents, the Schindlers. After a Florida Circuit
Judge ruled that Terri Schiavo's feeding tube be removed and the
Florida Supreme Court overturned "Terri's Law," a law intended to
reinsert the feeding tube, the United States Supreme Court refuses for
the sixth time to intervene in the case. Terri Schiavo dies on Mar. 31,
2005, 13 days after her feeding tube is removed.62
January 17, 2006
US Supreme Court
Upholds Oregon's
Death With Dignity
Act in Gonzales v.
Oregon
The Supreme Court, in a 6-3 opinion in Gonzales v. Oregon, holds that
the Controlled Substances Act does not authorize the Attorney General
to ban the use of controlled substances for physician-assisted suicide.
Oregon's Death With Dignity Law is upheld.63
June 1, 2007
Jack Kevorkian Released on Parole
Jack Kevorkian, MD, the pathologist sentenced on Apr. 13, 1999 to
10-25 years in prison for his role in the euthanasia of Thomas Youk is
paroled after serving 8 years.64
62 BBC "Timeline: Terri Schiavo Case," Mar. 31, 200563 Gonzales v. Oregon, Jan. 17, 200664 New York Times "Kevorkian Is Released from Prison," June 1, 2007
February 19, 2008
Luxembourg
Legalizes Physican-
Assisted Suicide and
Euthanasia
The Luxembourg parliament adopts a law legalizing physician-
assisted suicide and euthanasia.65
November 4, 2008
Washington Death
with Dignity Act Is
Passed
Washington voters approve the Washington Death with Dignity Act
(Initiative 1000) making Washington the second US state to legalize
physician-assisted suicide.66
December 5, 2008
State of Montana
Legalizes Physician-
Assisted Suicide
Montana district judge Dorothy McCarter rules in the case of Baxter v.
State of Montana that Montana residents have the legal right to
physician assisted suicide, thus making it the third US state to legalize
physican aid in dying.67
December 31, 2009
State of Montana
Affirms Physician-
The Montana Supreme Court affirmed 4-3 in the case of Baxter v.
State of Montana that physician-assisted suicide is not "against public
policy" in Montana. The Court further ruled that state law protects
doctors in Montana from prosecution for helping terminally ill patients
65 Reuters , "Luxembourg Parliament Adopts Euthanasia Law," www.reuters.com, Feb. 20, 200866 Washington Death with Dignity Act , Nov. 4, 200867 Baxter v. State of Montana , Dec. 5, 2008
Assisted Suicide Not
Against Public Policy
die. The court declined to rule on the larger question of whether
physician-assisted suicide is a right guaranteed under Montana's
Constitution.68
68 Opinion/Order of the Montana Supreme Court on Baxter v. State of Montana, Dec. 31, 2009
Definition of Terms:
1. Euthanasia - The act of a physician or other third party ending a patient's life in response
to severe pain and suffering69.
2. Voluntary Euthanasia - refers to the action taken by the physician and the patient, who
both agree (with informed consent) to end the patient's life70.
3. Involuntary Euthanasia - refers to a third party taking a patient's life without the
informed consent of the patient. This is commonly practiced in veterinary medicine when
animals are "put down" or "put to sleep." In modern medicine, it could conceivably be
applied to the act of taking a terminally ill, suffering patient's life, which has lost all
mental capacity to make his/her own decisions71.
4. Active Euthanasia - In active euthanasia a person directly and deliberately causes the
patient's death72.
5. Passive Euthanasia - In passive euthanasia death is brought about by an omission - i.e.
by withdrawing or withholding treatment in order to let the person die73.
6. Competence - A competent patient is one who understands his or her medical condition,
what the likely future course of the disease is, and the risks and benefits associated with
the treatment of the condition; and who can communicate their wishes74.
7. Palliative Care - Medical, emotional, psychosocial, or spiritual care given to a person
who is terminally ill and which is aimed at reducing suffering rather than curing75.
69 http://en.wikipedia.org/wiki/Euthanasia70 Ibid71 Ibid72 http://en.wikipedia.org/wiki/Euthanasia73 Ibid74 http://www.bbc.co.uk/ethics/euthanasia/overview/keywords.shtml75 http://www.bbc.co.uk/ethics/euthanasia/overview/keywords.shtml
8. Terminally Ill - is a medical term popularized in the 20th century to describe a disease
that cannot be cured or adequately treated and that is reasonably expected to result in the
death of the patient within a relatively short period of time76.
76 http://en.wikipedia.org/wiki/Terminal_illness
PART I
Arguments on legality of Euthanasia
1. Futility of living a poor quality life
The right to life entails a right to a good quality life, one wherein an individual can fully enjoy
the essence of his existence – to feel happiness, or sadness, or excitement -- one that is not bereft
of consciousness or emotions.
In a landmark case in Western Australia, the Supreme Court confirmed the right of a
quadriplegic to refuse tube feeding. Being quadriplegic and losing the vigor of his existence, the
petitioner, Mr. Rossiter, told his caregivers to stop giving him food down his feeding tube. The
nurses reported that they have given him food and care but what Rossiter only wanted was his
mobility. Being paralyzed is not the kind of life that Rossiter wanted.77
Nancy Cruzan lost control of her car one day in January 1983 in Missouri. When the paramedics
arrived, they were able to restore her breathing and heartbeat and she was transported,
unconscious, to hospital. She continued to be fed through a surgically- implanted gastrostomy
tube. After several years, a court found that, although her respiration and circulation continued
unaided, she was oblivious to her surroundings except for reflexive responses to sound and
perhaps painful stimuli; her brain had degenerated, irreversibly; she was a spastic quadriplegic;
she suffered contraction of her four extremities, with irreversible muscle and tendon damage; and
had no cognitive or reflex ability to swallow food or water or to maintain her essential daily
needs nor would she ever recover such an ability. She lay in persistent vegetative state.78
In the cases mentioned, the patients are diagnosed as being in a vegetative state. These are the
situations when only the respirators, gastrostomy, and other machines keep the patients alive. As
in Cruzan, her responsive reflexes only respond to painful stimuli. This is not the kind of life that
is worth living. This is artificial life sustained by machines. Biological death is very imminent.
Without these machines, the patient dies, but then at least she dies to rest from a poor quality life.
77 http://edition.cnn.com/2009/WORLD/asiapcf/09/21/australia.right.to.die/index.html78 http://www.law.umkc.edu/faculty/projects/ftrials/conlaw/cruzan.html
2. Compassionate killing over invasive medical treatments
Medical treatments and procedures can be invasive such as those employed to cancer patients,
especially those who are already in the terminal stage. Physicians usually assume that what
patients and families want in a crisis is resuscitating life at all costs. However, surveys show that
public opinion is on the side of withdrawing all "invasive" and "extraordinary" treatment in such
cases.79
Gayle Stelter writes, "For almost seven years I have been living with cancer, mostly joyously and
gratefully, but gradually seeing the disease encroaching relentlessly on my once healthy body.
Throughout these years, I have thought long and hard about death and I've discovered that it's not
the prospect of death itself that is so frightening, but the process of dying…”
The court case of Karen Ann Quinlan tells of a poignant example of medical technology’s ability
to prolong life. It was in 1975 when Quinlan collapsed into an irreversible coma that left her in a
vegetative state, unable to breathe without a respirator, or eat without a feeding tube. After
seeing Karen like this for several months, her family finally came to the conclusion that she was
beyond hope, and decided to remove her from the ventilator. The New Jersey Supreme Court
case that followed was the first to bring the issue of euthanasia into the public eye. Although
Quinlan was removed from mechanical ventilation during 1976, she lived on in a persistent
vegetative state for nine years until her death from pneumonia in 1985. The case set a precedent
for a right to refuse unwanted medical treatment.80
Quinlan case presented one form of “passive euthanasia” wherein the immediate family of the
terminally ill patients decides to pull the plug. Out of compassion, the parents of Quinlan chose
to let her die peacefully than to continue suffering the invasive treatments for a comatose patient
such as the respirator and feeding tube.
3. Medical Care Costs More Than the Family Can Afford
79 Ethanasia: What is Good Death?80 http://en.wikipedia.org/wiki/Karen_Ann_Quinlan
Patients with terminal illness do not want to diminish their assets by incurring large medical
costs as their death approaches. As an act of generosity, they would rather die sooner, and pass
on their assets to their beneficiaries. Some, due to poverty or lack of health-care coverage cannot
afford pain killers as medications.
In China 80% are poor peasants, who cannot afford expensive medical technology use by a
hospital. A reported case tells of woman who is diagnosed of cervical cancer. Due to
medications, she has been suffering a lot. Yet there was still no assurance as that she will be
cured. Because of financial constraints, she chose to surrender and refuses to get further
medication.81
4. Euthanasia presents a new take on medical practitioners.
Euthanasia comes from a Greek word which means ‘good death’. Many observers note that good
death can hardly be achieved due to the advances of medicine which have increased people’s
health and life span. But then these advances have also greatly affected the dying process. For
example, in the early twentieth century the majority of Americans died at home, usually victims
of pneumonia or influenza. Today most people die in the hospital, often from degenerative
diseases like cancer that may cause a painful, lingering death.82 Many countries have raised the
flag for legalizing euthanasia. Among them are The Netherlands, Belgium, and Luxembourg.
The first country to legalize euthanasia is The Netherlands. Euthanasia in The Netherlands is
regulated by the “Termination of Life on Request and Assisted Suicide (Review Procedures)
Act" which took effect on April 2002. It states that euthanasia and physician-assisted suicide are
not punishable if the attending physician acts in accordance with criteria of due care. The patient
must be informed of the presence of reasonable alternatives and the applied method of ending
life. He must have consultation of another physician. The Act also requires physicians to report
euthanasia to a review committee to demonstrate their compliance.83
81 www.eubios.info/EJ63/EJ63D.htm82 http://www.enotes.com/euthanasia-article83 Buiting H, van Delden J, Onwuteaka-Philpsen B, et al. (2009) "Reporting of euthanasia and physician-assisted
suicide in the Netherlands: descriptive study". BMC Med Ethics 10: 18.
The legal debate concerning euthanasia took off with the "Postma case" in 1973. The case
concerned a physician who had facilitated the death of her mother following repeated explicit
requests for euthanasia. The physician was convicted but then the case had opened the court's
judgment to set out the criteria when a doctor would not be required to keep a patient alive
contrary to their will. A course of a number of court cases during the 1980s had formalized such
criteria.84
Second to The Netherlands, Belgium has also legalized Voluntary Euthanasia in September
2002. The law requires that the patient requesting voluntary euthanasia must be in the terminal
stage of their illness lest, a third medical opinion needs to be sought. Belgium provides all the
patients with access to free painkilling medication so as to ensure that no patient shall resort to
euthanasia as a result of poverty or because of their pain. Its law also necessitates that the patient
must be over eighteen (18) years of age. 85
Luxemburg also followed suit. On February 2008, the bill legalizing euthanasia has been
approved. It bears stressing that the decision making when a patient plea for euthanasia to end
his suffering calls for the discretion of the doctor. This burden is unique from the regular
transaction between the doctor and the individual patient who has come for help. Many
physicians have been looking back to the Hippocratic Oath when faced with the situation.
However, it must be noted that with the burden presented, physicians need to come out of their
refuge from ancient aphorisms. Situations faced by the patients and physicians centuries ago are
different from today. Taken from the oath are the words, “I will apply dietic measures for the
benefit of the sick according to my ability and judgment; I will keep them from harm and
injustice.” 86When the patient has been subjected to too much pain and suffering because of his
terminal illness, and he asked to be released from the oppression of his disease, what else are the
other forms of harm could he possibly fear? What injustice could be given to the person who
asked to be release from the injustice of his pain?
84 Rietjens JA, van der Maas PJ, Onwuteaka-Philipsen BD, van Delden JJ, van der Heide A (September 2009). "Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?"
85 http://www.euthanasia.net/page/Belgium86 http://euthanasia.procon.org/view.answers.php?questionID=000198
5. Terminally Ill patients have the right to a dignified death.
"In ancient Greece and Rome, before the coming of Christianity, attitudes toward euthanasia
tended to be tolerant. Many ancient Greeks and Romans had no cogently defined belief in the
inherent value of individual human life, and pagan physicians likely performed frequent
abortions as well as both voluntary and involuntary mercy killings. Although the Hippocratic
Oath prohibited doctors from giving 'a deadly drug to anybody, not even if asked for,' or from
suggesting such a course of action, few ancient Greek or Roman physicians followed the oath
faithfully. However, throughout classical antiquity, there was widespread support for voluntary
death as opposed to prolonged agony, and physicians complied by often giving their patients the
poisons they requested The ancients stressed the voluntary nature of the dying, provided that it
was done for the right reasons; for example, to end the suffering of a terminal illness." 87 During
the recent years, there have been cases of patients suffering terminal illness who asked for help
to end their suffering. There is no reason to deviate from the past practice when the patient is
suffering from a degenerative disease which leads to the deterioration of his body.
The wife of Derek Humphry was dying of bone cancer. Thrombosis had set in, her bones were
cracking and she was losing control of her bowels. One day, after a very close brush with death,
she sat up in her hospital bed and said to her husband, "Will you help me die?"88 There is also a
70 year old patient of Dr. Cox. Mrs. Boyes was persistent in request for voluntary active
euthanasia. She was so ill that she "screamed like a dog" if anyone touched her and conventional
medicine did not relieve her agony. In her last days, she repeatedly requested to die. 89 The
testimonies of Humphry and Dr. Cox are of the many instances when the emotional, mental, and
physical being of a person is giving up. These situations show the circumstance when death lies
beside a terminally ill person. As what the people believed during the classical antiquity, the time
of the blossoming of the Hippocratic Oath, it is a voluntary nature of man to die. The body of a
terminally ill person becomes a poison to his emotional health. These persons have the right to a
dignified death. To prolong their agony is to deprive them of their right of choice. Law must also
recognize, as it now does implicitly, the principle of personal autonomy and self-determination,
87 http://euthanasia.procon.org/view.resource.php?resourceID=13088 http://www.scu.edu/ethics/publications/iie/v4n2/euthanasia.html89 http://www.euthanasia.cc/cases.html
the right of every human being to have his [her] wishes respected in decisions involving his [her]
own body. It is essential to recognize that every human being is, in principle, master of his own
destiny. He may, of course, for moral or religious reasons, impose restrictions or limits on his
own right of self-determination.
Arguments on Illegality of Euthanasia
1. Alternative treatment exist for the ends of euthanasia
Euthanasia is not the only solution for relieving the pains and sufferings of the terminally ill. The
same purpose is sought to be achieved by providing palliative care.
The World Health Organization defines palliative care as the active total care of patients whose
disease is not responsive to curative treatment. Control of pain, of other symptoms, and of
psychological, social, and spiritual problems, is paramount. The goal of palliative care is the
achievement of the best quality of life for patients and their families.90 It seeks to provide relief
from pain and uncomfortable symptoms while integrating psychological and spiritual features of
patient care. 91
The legalization of euthanasia negates the purpose of practitioners in providing palliative care.
In the results of a 2010 study in The New England Journal of Medicine showed that lung cancer
patients receiving early palliative care experienced less depression, increased quality of life and
survived 2.7 months longer than those receiving standard oncologic care.92 Palliative care may
not totally abrogate the pains and sufferings of which euthanasia can provide by ending the life
of the terminally ill. However, legalizing euthanasia limits the possibility that meticulous
research in palliative care may provide a more prolonged pain free life of the terminally ill.
Moreover, it is noteworthy to consider that in palliative care, terminally ill patients are not only
provided pain relief but also psychological and spiritual care to maximize their remaining life.
The goal is not to cure, but to provide comfort and maintain the highest possible quality of life
for as long as life remains.
90 Bill Muehlenberg’s commentary on palliative versus euthanasia91 Christian Nordqvist , Medical News Today92 Temel, J.S., et al, Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer, N Engl J Med
2010; 363:733-742, August 19, 2010
Well-rounded palliative care programs also address mental health and spiritual needs. The focus
is not on death, but on compassionate specialized care for the living. Palliative care is well-suited
to an interdisciplinary team model that provides support for the whole person and those who are
sharing the person's journey in love.93
In the Philippines,, the growth of the hospice and palliative care movement in the country now
makes it possible for the terminally ill and those suffering from life-threatening ailments to stay
at home where their physical and spiritual needs could be met. Hospice care does not seek to
cure. It seeks to provide a “better” quality of life during the remaining days of the patient.
Formally introduced in the Philippines in 1993, the hospice movement now counts 23 institutions
and 520 service providers as members. These organizations, which are generally supported by
private individuals and groups, have formed the National Hospice and Palliative Care Council of
the Philippines Inc. (Hospice Philippines) to promote palliative care across the country.94
In this light, the necessity of legalizing euthanasia is not as apparent as it seems for there are
palliative care which caters not only to the same end but also to those ends which euthanasia
cannot provide such as maintaining the highest quality of life considering the patient’s condition.
2. Euthanasia undermines medical research
One of the major driving forces behind the exceptional medical advances made this century has
been the desire to develop treatments for previously fatal illnesses, and the eagerness to alleviate
hitherto unmanageable symptoms. Medical research is essential if medicine is to advance further.
When the focus changes from curing the condition to killing the individual with the condition,
this whole process is threatened. The increasing acceptance of prenatal diagnosis and abortion
for conditions like spina bifida, Down's syndrome and cystic fibrosis is threatening the very
dramatic progress made in the management of these conditions, especially over the last two
93 James Hallenbeck, MD. Pallative care perspective94 Inquirer, 9/16/2007, Hospices offer compassionate care
decades. Rather than being employed to care and console, funds are being diverted to fuel the
strategy of 'search and destroy'.95
The purpose of medical research is to find cure for what is, at the present, considered to be
incurable illnesses. If the rest of countries in the world legalize euthanasia, it will weaken and
undermine the improvement of medical research. Any physicians or doctors related and have
potential to make advanced in scientific and health care knowledge will not get enough
motivation that some people who are terminally ill will simply ended by euthanasia. They will
not feel encouraged and urged to make the improvement.
3. Euthanasia violates physician’s code of conduct
Traditional medical ethical codes have never sanctioned euthanasia, even on request for
compassionate motives. The Hippocratic Oath states 'I will give no deadly medicine to anyone if
asked, nor suggest such counsel....' The International Code of Medical Ethics as originally
adopted by the World Medical Association in 1949, in response to the Nazi holocaust, declares 'a
doctor must always bear in mind the obligation of preserving human life from the time of
conception until death'. In its 1992 Statement of Marbella, the World Medical Association
confirmed that assisted suicide, like euthanasia, is unethical and must be condemned by the
medical profession. When a doctor intentionally and deliberately enables an individual to end his
life, his actuation is unethical. 96 Legalizing euthanasia would render physician’s duty and
obligation to cure patients nugatory since in euthanasia the physician is assisting to an easy way
out that is to kill the person whom he is obliged to cure.
4. Euthanasia is driven by a cynical desire to cut health care costs
Remember, for H.M.O.s (health-maintenance organizations), profits come not through providing
services but from limiting costs, meaning reducing services in some cases. Imagine the money
95 Peter Saunders, Twelve Reasons Why Euthanasia Should Not Be Legalized96 International Code of Medical Ethics adopted by 3rd World Medical Assembly, London, England, October
1949
that could be saved--and thus profits earned--by H.M.O.s by not treating cancer patients because
they 'choose' instead to be killed; in not treating AIDS patients because they choose instead to be
killed; in not treating M.S. patients because they 'choose' instead to be killed; in not treating
quadriplegic patients because they 'choose' instead to be killed.97 This disturbing paradigm is one
reason why managed care is now called 'managed death' by those who worry about legalized
euthanasia in a health-care system dominated by H.M.O.s.
The same is true with government funded health care program. With euthanasia as a means of
saving expenses and making budget cuts, government will inevitably abuse this scheme.
Although this may seem favorable to the government in cutting down costs, it would be
contradicting to the purpose of euthanasia. The government, instead of providing sufficient
health care budget, would cut down the same by rationalizing that there is a way out of
unnecessary medical care to terminally ill patients that is to kill them. This insufficient budget
would then mean that proper health care of those who are not supposed to be terminally ill
(especially the poor) will be inadequate. The inadequacy of medical care may be, in turn, the
reason for patient’s condition to worsen.
This is similar to the situation feared in New Zealand. Most of the beds are occupied by the
elderly, but in the coming years there will be huge increase in younger patients with diabetes
needing expensive dialysis treatment. Treatment is expected to be rationed, with those not
making the list potentially facing palliative care in the later stages or assisted suicide. It is feared
that physicians and other health care providers, will pressure patients to request assisted suicide. 98
5. Legal euthanasia is prone to abuse
In Netherlands where euthanasia is legal, a recent Dutch government investigation of euthanasia
has come up with some disturbing findings. In 1990, 1,030 Dutch patients were killed
WITHOUT THEIR CONSENT. And of 22,500 deaths due to withdrawal of life support, 63%
(14,175 patients) were denied medical treatment WITHOUT THEIR CONSENT. Twelve per-
97 Wesley Smith, Consultant to the International Anti-Euthanasia Task Force. Forced Exit. 199798 www.internationaltaskforce.org/ascc.htm
cent (1,701 patients) were mentally competent but were NOT CONSULTED.99 The primary
philosophical support for euthanasia is represented by a demand for radical personal autonomy.
Personal autonomy is a difficult concept to develop safeguards around for vulnerable persons
who often have a diminished ability or opportunity to make decisions concerning self-
determination. Many vulnerable people have other people who are responsible for making
decisions for them.100
In the Terri Schiavo case, it was a legal battle between the husband and the parents of Teresa
Marie "Terri" Schiavo that lasted from 1998 to 2005. At issue was whether the equipment that
had been used to sustain her life since 1990 – specifically a feeding tube – should be
disconnected, thereby allowing her to die. Terri Schiavo collapsed in her St. Petersburg, Florida
home in full cardiac arrest on February 25, 1990. She suffered massive brain damage due to lack
of oxygen and, after two and a half months in a coma, her diagnosis was elevated to vegetative
state. 1998 Schiavo's husband, Michael, petitioned the Sixth Circuit Court of Florida (Pinellas
County), to remove her feeding tube pursuant to Florida Statutes Section 765.401(3). He was
opposed by Terri's parents, Robert and Mary Schindler, who argued that she was conscious. The
court determined that she would not wish to continue life-prolonging measures and on April 24,
2001 Terri's feeding tube was removed for the first time, only to be reinserted several days later.
On February 25, 2005, a Pinellas County judge ordered the removal of Terri Schiavo's feeding
tube. After all attempts at appeals through the federal court system were unsuccessful, Schiavo's
feeding tube was disconnected on March 18, 2005. She died at a Pinellas Park hospice on March
31.
In all, the Schiavo case involved 14 appeals and numerous motions, petitions, and hearings in
the Florida courts; five suits in federal district court; Florida legislation struck down by the
Supreme Court of Florida; a subpoena by a congressional committee to qualify Schiavo for
witness protection federal legislation; and four denials of certiorari from the Supreme Court of
the United States.
99 http://www.euthanasia.com, Shreyansh Mardia on July 14, 2008, Euthanasia- Mercy Killing- An Unconstitutional Act
100 Alex Schadenberg, The Interim: Can euthanasia safeguards protect interests of vulnerable persons?
In the above case, medical practitioners are in debate of whether or not Terri was terminally ill
or that her case could be cured and whether her consent and wishes are represented by her
husband’s affirmation. The determination of when to qualify a patient as euthanasia candidate is
subjective to the doctors’ recommendations. Doctors, like any other professionals, are not
infalliable. As such, there can never be an absolute assurance that a patient who is terminally ill
today will never be cured. This scenario is often the reason why legal euthanasia is abused.
In countries where there are laws regarding the conduct of euthanasia, its implementation is still
abused for personal reasons. Mercy killing has become a leeway for people to justify killing
either for personal or economic reasons such as their own interests in the disposition of estate
through wills of the terminally ill patients.
PART II
Arguments on the Morality of Euthanasia
1. Principle of Well-Being
Patients’ well-being ought to be promoted (if not for its own sake, then because of the derivative
importance of well-being). There have been several high-profile legal battles over the right to die
in the UK. Perhaps most famously is the case of Dianne Pretty, a woman in the terminal phase of
motor neurone disease who wanted assurance that her husband would not be prosecuted if he
helped her commit suicide.
Dianne and her husband fought an unsuccessful legal battle which ended on April 29th 2002
when the European Court of Human Rights dismissed her claim that the British courts were
breaching her human rights by refusing to allow her husband to help her commit suicide. Dianne,
who was paralysed from the neck down, had to be fed through a tube and used a computer
attached to her wheelchair to communicate, died after suffering breathing difficulties three days
after the ruling – the frightening death she wanted to avoid. 101
The idea of intentionally ending life due to quality of life assessment is not a feature unique to
utilitarian though. Ronald Dworkin (The New York Review of Books, Ronald Dworkin, an
American philosopher, and scholar of constitutional law, advocate of moral reading of the United
States Constitution and an interpretivist approach to law and morality) claims that there is a
sense in which most people think that life is “sacred”. When they say life is sacred, they mean
that personal life, able to sustain critical interests, is inherently valuable. It is this sense of life
that is sacred, not mere biological life that is no longer capable of sustaining personal creativity.
A valuable life therefore, requires more than natural investment. A valuable life requires creative
personal investment. Our lives are judged valuable as long as we are able to maintain and
appreciate the value of this creative investment. There is no intrinsic value to be had in bodily
life, only in the conscious control of life which individuals shape their lives. When the condition
101 Clare Dyer, The Guardian, Diane Pretty makes final “death with dignity” plea
of the body no longer acts in the service of this creative life of authorship, it is reasonable to
intentionally seek to end life. 102
For Dworkin, then, the quality of a person’s life is crucial to forming a judgment about whether
or not a life is worth preserving. That decision, at least for competent patients will be determined
by the judgment of individual patients. People should have the right to choose a painless and
dignified end, either at the time or beforehand, perhaps in a "living will". The right
circumstances might include: extreme pain and suffering; helplessness and loss of personal
dignity; permanent loss of those things which have made life worth living for this individual. To
postpone the inevitable with no intervening benefit is not a moral act. 103
Each individual has a right to make the “most intimate and personal choices central to personal
dignity and autonomy.” That right encompasses the right to exercise some control over the time
and manner of one’s death. The patient-plaintiffs in these cases were all mentally competent
individuals in the final phase of terminal illness and died within months of filing their claims.
Jane Doe described how her advanced cancer made even the most basic bodily functions such as
swallowing, coughing, and yawning extremely painful and that it was “not possible for [her] to
reduce [her] pain to an acceptable level of comfort and to retain an alert state.” Faced with such
circumstances, she sought to be able to “discuss freely with [her] treating physician [her]
intention of hastening [her] death through the consumption of drugs prescribed for that
purpose.”104
Clearly, it is contrary to the right to a well being to prevent persons who have clearly no other
option but to await such undignified and excruciating circumstances. Moreover, it is in
contradiction to a person’s conscience to allow a patient to suffer instead of allowing him the
right to choose to avoid such suffering.
102 Craig Paterson , A Natural Ethics Approach, Asisted Suicide and Euthanasia , 2008103 A humanist discussion of …EUTHANASIA, BHA submission to the Committee considering the Assisted Dying
Bill (2004)104 Quill v. Vacco, 80 F.2d 716, 720 (2d Cir. 1996) (quoting declaration of Jane Doe).
2. Right of Ownership
A claim in favor of a right to self determination is based on the concept of ownership. If one has
a right of dominion over his property, including the disposal and destruction, the right of
dominion can be extended to cover body parts and ultimately life itself. Self ownership is a
concept invoked to justify freedom of the individual from the dominion of others. In a free
society, you own your life, and your only obligation is to respect the legitimate rights of others.
Everyone is entitled to be treated as the sole owner of his or her own life.
However such concept is limited only if such exercise would infringe the right of others. In
euthanasia, however, no other right except of the patient’s right is encroached.
3. Equal Concern and Respect
Ronald Dworkin has championed the claim that a right to make a momentous personal decision,
free from coercive interference, is derived from the notion of equality of persons. In failing to
respect another person’s conception of what constitutes the good life, we devalue that person as a
true equal.
As Dworkin states in Taking Right Seriously, “Government must not only treat people with
concern and respect, but with equal concern and respect. It must not constrain liberty on the
ground that one citizen’s conception of a good life is nobler or superior to another’s.” 105
To say that other person’s idea of what is a good life, that is free from pains and sufferings, is not
the true “idea of life” is to say that the person saying the same has a superior notion of a good
life. This paradigm is, according to Dworkin, disrespect for the other person.
4. Principle of autonomy
Patients’ autonomy ought to be respected (if not for its own sake, then because of the derivative
importance of autonomy, i.e. the fact that promoting and respecting someone’s autonomy
generally speaking enhances this person’s well-being).
105 Ronald Dworkin, “A Special Supplement: Taking Rights Seriously, The New York Review of Books”
Joel Feinberg has advanced one of the most comprehensive accounts of the personal autonomous
self. He lists the qualities that inhere in an autonomous life; qualities such as authenticity,
integrity and distinct self-identity. These qualities provide a kind of overview of the self in whom
these qualities in here. The autonomous self, for Feinberg, strives to maintain self-direction in a
world where external factors impinge on personal deliberations.106
In terms of the characteristics that distinguish autonomous persons, most highlight forms of self-
directedness that distinguish autonomous persons from the condition of being subject to the
controlling influence of others. The truly autonomous person forges his or her own tastes,
opinions and values.
In order to genuinely respect persons as autonomous persons, we must recognize that they are
able to direct their own lives and actions in accordance with their own plans, projects and
personal commitments. For Feinberg, an autonomous person can reach a choice consonant with
self to be free from the burdens of life providing that the choice is genuinely an expression of the
self and not the result of other factors that can radically impinge upon and distort considered
judgment. Hence, to compel or order a person not to have the choice to express his freedom from
life’s uncertainties is congruent to infringing his right to autonomy.
In Harm to Self, Feinberg rejects the paternalistic idea that the state or other individuals can
legitimately interfere with the mainly self-regarding interest of autonomous persons. Self-
determination is characterized by the significant capacity persons have for personal autonomy.
The moral freedom of people to shape their lives for themselves, without being subject to undue
external control, is held central to the idea of respect of persons. In order to genuinely respect
persons, we need to recognize an extensive autonomy derived right to choose how to live and
die.107
In the case of In re Quinlan I, a 21-year-old Karen Ann Quinlan was admitted to the hospital in a
coma, and was later declared by doctors to be in a "persistent vegetative state." After five months
106 Joel Feinberg, Voluntary Euthanasia and the Inalienable right to life, April 1, 1977, University of Michigan
107 Craig Paterson , A Natural Ethics Approach, Assisted Suicide and Euthanasia , 2008
on a ventilator, her parents requested that the ventilator be removed and that Ms. Quinlan be
allowed to die. After doctors refused, her parents brought the matter to court. The New Jersey
Superior Court denied her parents' request, but the New Jersey Supreme Court reversed and ruled
that Quinlan's "right to privacy" included her right to be removed from the ventilator. It further
held that the termination of treatment pursuant to the right of privacy is, within the limitations of
this case, ipso facto lawful. Thus, a death resulting from such an act would not come within the
scope of the homicide statutes proscribing only the unlawful killing of another. There is a real
and in this case determinative distinction between the unlawful taking of the life of another and
the ending of artificial life-support systems as a matter of self-determination." 108
In the subsequent case of Cruzan, US Court held that State is not required to accept the
'substituted judgment' of close family members in the absence of substantial proof that their
views reflect the patient's. 109In another case, US Court held that the assumption of a right to
refuse treatment was grounded not, as the Court of Appeals supposed, on the proposition that
patients have a general and abstract 'right to hasten death'... but on well established, traditional
rights to bodily integrity and freedom from unwanted touching." 110 In the above cases, it is worth
to note that the principle of autonomy is greatly considered.
108 In re Quinlan, 70 N.J. 10 Mar. 31, 1976109 Cruzan v. Director, Missouri Dept. of Health 497 U.S. 261June 25, 1990110 Vacco v.Quill 526 U.S. 793 June 26, 1997
Arguments on the Immorality of Euthanasia
1. Disrespect for human life and human dignity
To the argument that euthanasia promotes dying with dignity by ending terminally ill patients’
lives, is it disrespect to human dignity in taking a life which based on the above discussion is still
dignified? When physicians choose to end a person’s life, is he not saying also that the person
has no more human dignity? And if so, are they in a position to suggest when dignity can be
breached? And in cases where the patient chooses to die due to incapacities, does he attribute his
dignity to mere intellectual capacity to choose?
Essentially, Keown111 and Gormally112 write from the unacknowledged perspective of neo-
naturalism. The fundamental assertion of these authors is “the recognition that every human
being, however… mentally, impaired, possesses a fundamental worth and dignity which are not
lost as he or she is alive. For Kewon and Gornmally, this concept is absolute. Kneown and
Gormally suggest that attaching any diminished worth to brain-dead individuals makes “the
possession of human worth depend on an arbitrary discrimination between individuals.113
It is necessary to begin with the recognition that every human being, however immature or
mentally impaired, possesses a fundamental worth and dignity which are not lost as long as he or
she is alive. Contrary to the view of some, human worth and dignity do not depend on acquiring
and retaining some particular level of intellectual ability or capacity for choice or for
communication. On that view of human worth and dignity, it turns out that the relevant level of
intellectual ability or whatever other characteristic is asserted to be morally decisive always
require to be determined in an arbitrary fashion. In making the possession of human worth and
dignity depend on an arbitrary discrimination between individuals; this view destroys the
indispensable foundation of justice in society. For basic human rights belong to human beings
precisely because of their worth and dignity, and if the possession of the latter is to be
determined arbitrarily ( as between those who are terminally ill or those who lack intellectual
ability such as brain dead and other incompetents ( persons in vegetative state) so will be the
111 http://en.wikipedia.org/wiki, Damien Keown is a prominent bioethicist and authority on Buddhist bioethics.112 http://ajgoddard.webnode, Luke Gormally is a leading Roman Catholic bio-ethicist who is Senior Research
Fellow and former Executive Director of the Linacre Centre for Healthcare Ethics in London 113 Ian Harriss, Ethics and euthanasia: Natural law philosophy and latent utilitarianism
possession of the former ,but there cannot be a framework conducive to just relationships in a
society if who are to count as the subjects of justice is determined in an arbitrary fashion. For
this reason, the recognition of the fundamental worth and dignity of every human being is the
indispensable foundation of justice in society. In other words, human rights are enjoyed in virtue
of common humanity, not the possession of some arbitrarily stipulated human ability at some
arbitrarily stipulated level.114 Further, this arbitrary fashion is exhibited in the view that those
who have suffered severe brain damage, resulting in permanent loss of consciousness or of
cognitive abilities, no longer possess worthwhile lives. But this view of certain gravely impaired
human beings is incompatible with recognition of their basic worth and dignity. It is the view
which underlies the claim that it is reasonable to aim, at least by omitting treatment and care, to
end the lives of these persons when they are patients. This judgment may also be arrived at on
the basis of the assertion that such persons, being unaware, no longer have any `interests'115, so
that, there being no positive good of theirs at which one could aim, one may rather aim at ending
their lives. But none of us has to be conscious of all prospective benefits or interests to be the
recipient of the same. And if we can be the recipients of benefits, we can have an interest in
being benefited without that interest being a conscious interest. All of us, indeed, have an interest
in not being treated in ways which are inconsistent with recognition of our dignity as human
beings, whether or not we are aware of that interest.116
Another way in which the fault of denying worth to certain human lives is exhibited is in the
judgment that the value of a life depends wholly on the value and importance a person gives to
his or her life through his choices. If that were so, then loss of the capacity to choose would bring
about a state of affairs in which the only value one's continued existence would have would
depend on the value one had chosen to attach to it when competent or when still intellectually
conscious. This is the understanding of the value of a life behind the view that, in respect of a
person's own life, his or her choices made prior to loss of competence should be allowed to
114 (John Keown MA (Cantab) DPhil (Oxon), Human Dignity, Autonomy and Mentally Incapacitated Patients: A Critique of Who Decides?
115 A view entertained by Who Decides? at 5.24, following LawCom231: 6.17, following Lord Mustill in Bland116 http://www.linacre.org/whodec.html citing John’s Keown: Human Dignity, Autonomy and Mentally
Incapacitated Patients: A Critique of Who Decides?
determine when his or her life is to be ended, in cases, when that may be purposefully achieved
by omission of treatment or care.
2. Euthanasia is against human nature
Every human being has a natural inclination to continue living. “Our reflexes and responses fit us
to fight attackers, flee wild animals, and dodge out of the way of trucks. Our bodies are similarly
structured for survival right down to the molecular level. When we are cut, our capillaries seal
shut, our blood clots, and fibrogen is produced to start the process of healing the wound. When
we are invaded by bacteria, antibodies are produced to fight against alien organisms, and their
remains are swept out of the body by special cells designed for clean-up work”117.
To allow pre-emption of death violates this natural goal of survival. It contradicts this nature
because all processes are bent towards the end of bodily survival. By human beings bodily
composition alone indicates that our natural inclination is survival. Allowing human beings to
artificially interfere with the natural process of death violates human nature and in so doing, it
violates dignity. Dignity comes from seeking human being’s ends. When one of the goals is
survival, and actions are taken that eliminate the goal, then the natural dignity suffers. Unlike
animals, human beings are conscious through reason of their nature and their ends. Euthanasia
involves acting as if this dual nature, the inclination towards survival and awareness of this as an
end, did not exist. Thus, euthanasia denies our basic human character and requires that human
beings regard themselves or others as something less fully human.
3. Euthanasia is against self interest
Because death is final and irreversible, euthanasia contains within it the possibility that human
beings will work against their own interests if they practice it or allow it to be practiced on them.
Although contemporary medicine has high standards of excellence and a proven record of
accomplishment, it does not possess perfect and complete knowledge. A mistaken diagnosis is
possible, and so is mistaken prognosis. Consequently, belief of dying may be made in error.
They may believe that there is no hope when, as a matter of fact, the chances are good. Also,
117 J. Gay-Williams, The Wrongfulness of Euthanasia, 1992 In Ronald Munson, ed., Intervention and Reflection: Basic Issues in Medical Ethics, Belmonth, CA: Wadsworth
there is always the possibility that an experimental procedure or a hitherto untried technique will
pull as through.
It is viewing the body as a target to be dominated and killed that differentiates an act of
euthanasia from the morally acceptable practice of withdrawing futile medical treatments.
Letting a dying person die without prolonging his or her death allows us to give up useless and
burdensome interventions. In a naturally inevitable death, a whole person as an embodied self
dies from an irremediable medical condition.
4. Policy of slippery slope
Many people worry that if voluntary euthanasia were to become legal, it would not be long
before involuntary euthanasia would start to happen.118
A person apparently hopelessly ill may be allowed to take his own life. Then he may be
permitted to deputize others to do it for him should he no longer be able to act. The judgment of
others then becomes the ruling factor. Already at this point euthanasia is not personal and
voluntary, for others are acting “on behalf of” the patient as they see fit. This may well incline
them to act on behalf of other patients who have not authorized them to exercise their judgment.
It is only a short step, then from voluntary euthanasia, to directed euthanasia administered to a
patient who has given no authorization, to involuntary euthanasia conducted as part of social
policy. Moreover, when euthanasia becomes involuntary, the right to autonomy and self
determination becomes nugatory as the person who wants to die are not the entirely and solely
the one taking his life.119
Holland has euthanasia. They started out killing the terminally ill, but have veered markedly
from this approach. Some estimate that over 50% of those euthanized in Holland are killed
118 Lord Walton, Chairman, House of Lords Select Committee on Medical Ethics looking into euthanasia, 1993 “We concluded that it was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law in the United Kingdom could not be abused.
We were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death.”
119 J. Gay-Williams, The Wrongfulness of Euthanasia, 1992 In Ronald Munson, ed., Intervention and Reflection: Basic Issues in Medical Ethics, Belmonth, CA: Wadsworth
without consent. Some of the elderly are afraid to go to the doctor, for fear they will receive
involuntary euthanasia.120
5. Argument on individualistic decisions
Whence would come such an individualistic moral right or assumption of absolute dominant
power? After all, each person’s self-consciousness like each individual’s body, has been created
and received from the person’s parents and forebears, and nourished by the community and
culture in which the person’s life is organically embedded. A human life and identity is a gift
from evolutionary biology, natural ecological conditions, parental procreative child rearing, and
collective cultural socialization- all transcending the individual power of self-determining will
claiming unilateral life or death powers121.
Feminists understand that individuals cannot be treated or treat others as though they are alienate
monads cut off from all bonds with one another. Having received the gift of life and social
identity, one has a moral obligation to preserve and respect each human life and refrain from
suppressing, killing or destroying self or others. Which one is permitted to do to one’s self and
which others are permitted to do to one – these cannot be morally or psychologically
separated122.
When a person seeks or assists an act of euthanasia, he acts to end all human relationships. No
more comfort can be given or received; no more befriending or watching and waiting with
another will take place. Interpersonal bonds will be decisively cut off, all human dependence and
interdependence rejected.
Exercises of autonomy, of the capacity for self-determining choice are not the fundamental
source of worth and value in a person's life. Human beings possess an ineradicable value prior
and subsequent to the possibility of exercising autonomy. Autonomy itself as a capacity is to be
valued precisely in so far as its exercise makes for the well-being and flourishing of the human
beings who possess it. But it is plain that many exercises of the capacity, that is, many self-
determining choices, are destructive of human well-being -- both in the life of the chooser and in 120 R. Tom Tolomeo, "Big Brother, M.D.," All About Issues, July-August 1993
121 Sydney Callahan, A feminist case against euthanasia, Women should be especially wary of arguments for “the freedom to die”.
122 Ibid.,
the lives of others affected by his or her choices. The mere fact that someone has elected to act or
to be treated in a certain way establishes no title to moral respect for what has been chosen. The
character of the choice must satisfy certain criteria in order to warrant our respect. The most
basic criterion is that a choice should be consistent with respect for the fundamental dignity both
of the chooser and of others. Since justice in society rests on belief in the ineradicable value of
every human life, whatever its condition, a just legal system cannot look favorably on choices to
kill a person based on the judgment that his or her life is no longer worthwhile123.
123 (John Keown MA (Cantab) DPhil (Oxon), Human Dignity, Autonomy and Mentally Incapacitated Patients: A Critique of Who Decides?
Part III
Proponents Position
Considering the present circumstances involving euthanasia, the proponents believe that
euthanasia should not be legalized. Before dealing with the “morality” of euthanasia,
considerations of its potential impact on society should be dealt with.
First, it will affect medical research. One of the major driving forces behind the exceptional
medical advances made available in this century has been the desire to develop treatments for
previously fatal illnesses, and the eagerness to alleviate hitherto unmanageable symptoms. At
present, medical research is being funded to provide cure for those illnesses which are proven to
be fatal and incurable. The research for AIDS pandemic, for example, has greatly been advanced
at present in that a person infected can survive up to 50 years with proper treatment. This was not
the case 20 years ago. What made this and all other kind of researches to advance such
considerable extent is the inevitable possibility that even the most fit and healthy people may
fatally suffer from these illnesses. If our way to counter the pain and suffering of terminally ill
patients is to kill them or allow them to die without medical treatment, then the efforts of
scientists and physicians to advance in scientific discovery and research will become futile.
Second, it will impact health care cost. It may seem that legalizing euthanasia may shorten
hospital confinement and potentially save cost for both private individuals and the government
through health care system following the “save the money by killing the sick” argument. It is still
a shaky ground where public confidence must rest upon. In Oregon, for example, where
euthanasia is legal, there had been instances where the Oregon Medicare denied chemotherapy,
and offered to pay for killing the patients instead124. Moreover, it would become contrary to
public policy when people, instead of being given medical assistance, are provided with a less
costly solution of ending their lives. Although this is more likely speculative, the fact that it
happened in places where euthanasia is legal does not preclude the probability that the same may
also happen.
124 Wesley J. Smith, June 20, 2009, Save Money by Killing the Sick: Euthanasia as Health Care Cost Containment Not Such a Parody as the Author May Think
Third, it will require further legislation for its procedure for checks and balances. In
countries where euthanasia is legal, there are certain legislations, such as Australia’s Terminally
Ill Act of 1995, that were enacted to prescribe the procedures for the administration of
euthanasia. In these legislations, a heavier burden is given to physicians in ascertaining if the
patient’s condition is terminal. There are also requirements imposed upon the medical
practitioners like the consensus of a third opinion is necessary to ascertain the condition of the
candidate of euthanasia. Although there are procedures to ensure propriety of the execution,
these legislations still did not prevent cases like the Schiavo case where medical practitioners are
in debate of whether or not Terri was terminally ill, or that her case could be cured; and, whether
her consent and wishes are represented by her husband’s affirmation. The determination of when
to qualify a patient as a qualified euthanasia candidate is subjective to the doctors’
recommendations. This is definitely a scenario that can potentially be terrifying, considering that
misdiagnosis often times occur in the medical field. People may be killed in the premise that
their conditions are incurable when in fact the same can be treated.
Fourth, it will negate palliative care. One of euthanasia’s goals is to end the patient’s
unbearable pain. Palliative care, on the other hand, seeks to provide relief from pain and
uncomfortable symptoms while integrating psychological and spiritual features of patient care.
Although Palliative care may not totally abrogate the pain and suffering of the patient, it still
seeks to minimize such. Not only does it provide physical relief, but also it addresses the
psychological and spiritual needs of patients through varied programs. Formally introduced in
the Philippines in 1993, the hospice movement now counts 23 institutions and 520 service
providers as members.
Lastly, it will afford religious scrutiny at least to Christian countries like the Philippines.
There are cases where euthanasia is impliedly and indirectly practice in hospitals as when
comatose patients, by family members’ request or financial incapacity, opt to put off life support
machine and allow such patient to breathe naturally, which is not sufficient to sustain his or her
life, hence, eventually die. To legalize euthanasia is to put affront such practice and make it more
evident. Recognizing the scrutiny which the Reproductive Health Bill is receiving by the
religious sectors, there is no reason to believe that the same will not receive such scrutiny.
Moreover, considering the moral norms and beliefs system of the country, it is evident that life is
valued greatly regardless of the incapacities of the human person. This will only be a subject to
political and religious intervention that will bring about pickets and potentially boycotts of
hospitals.
As to its morality or immorality, the proponents believe that euthanasia should not be
countenanced.
The debate over the morality of euthanasia lies essentially between the sanctity of life, on
one hand and the quality of life on the other. If a person who is terminally ill has only a month
to live, pro-euthanasia argues that if the person wants to die to avoid having to suffer a month of
agonizing and tremendous pain, he should be allowed to do so. On the other hand, anti-
euthanasia would argue that ending one’s life would be disrespecting the sanctity of life.
Essentially the proponents find that the arguments rest on the question: When do we consider the
sacredness of life? Is it a life without personal creativity or personal competency? Or is the
respect absolute in as long as life remains?
It is in this position that the proponents believe that “dignity” of human life should not be
arbitrarily determined. The proponents believe that human dignity is fundamental in every
human being and that it is not lost by the absence of some degree of personal creativity or
intellectual ability. Moreover, the determination of the candidacy for euthanasia, as observed in
other countries where it is legal, rests upon the recommendations and opinions of medical
practitioners. Hence, when a person is terminally ill and is recommended by the doctor to be put
to death to avoid either useless costs or insurmountable suffering, is the doctor saying that his
life has no more worth and that he be better off dead? It is in this note that the proponents find
euthanasia, in a way, disrespectful of the intrinsic value of human dignity. The proponents
believe that no human reason can entirely and succinctly grasp the determination of human
dignity for only the Supreme Being according to the divine law has monopoly of it. Thus, no one
should be allowed to determine when a human being is undignified. Worthy to note also is that
human beings possess an ineradicable value prior and subsequent to the possibility of exercising
autonomy. A baby who cannot decide on his own does not have autonomy or personal creativity
yet but it is of common conviction that he or she possesses dignity. The same should also hold
true of terminally ill patient who is bereft of such autonomy.
As to the principle of autonomy and principle of self determination, the group finds the
same contradicting to the nature of man. Proponents of euthanasia argue that in order to
genuinely respect persons as autonomous beings, we must recognize that they are able to direct
their own lives and actions in accordance with their own plans, projects and personal
commitments. The proponents believe, as J. Gay Williams posits that human beings have the
natural inclination to continue surviving. Bodily human self-healing mechanism provides that
inclination of continued survival. To allow people to decide to kill themselves based on respect
for personal autonomy and self determination would be in contradiction to the nature of human
beings to fight for survival rather than succumb to extinction.
Moreover, the proponents believe that pro-euthanasia is at fault by denying worth to
certain human lives exhibited by the judgment that the value of a life depends wholly on
the value and importance a person (or his family member) gives to his or her life through
his choices. It is in this position that the proponents adhere to the feminist view that human life
and identity is a gift from evolutionary biology, natural ecological conditions, parental
procreative child rearing, and collective cultural socialization- all transcending the individual
power of self-determining will claiming unilateral life or death powers. Self determination and
autonomy should be actualized in the context of communal responsibility and not only of
personal determination. When a person decides to die, that such person not only chooses to be
dead but also to be cut off from all interpersonal relationships, he chooses to be cut off from the
bonds that he has to his family, as well as to the community.
Lastly, as to the battle between pain versus relief, the proponents find that though a patient
in pain may be better off dead to save him from the insurmountable pain, the weight
accorded to value for human life and dignity outweighs emotional feelings from such
circumstance. Further, the group also believes that such predicament can also be an opportunity
to provide care and compassion to loved ones, thus strengthening the interpersonal bond while
awaiting the natural and eventual death.