Death — Our Final Destination

By Maria Runde, March 16, 2014

Published in the La Crosse Tribune.

No one likes to discuss death, much less their own. The concept makes most of us extremely uncomfortable, and the discussion (in America at least) is taboo to the degree that even discussing one’s advanced directives for end of life care is unsettling. This needs to change. The Greek word for death is thanatos, from which is derived the word “euthanasia.” A literal translation for euthanasia would be “good death,” and who among us wouldn’t want that? But what qualifies as “a good death?”

There are various nuances to euthanasia or, in effect, mercy killing; the words are not interchangeable even though the intent and the outcome would be the same. Mercy killing implies ending someone’s life to “put them out of their misery” without that person’s consent. On the other hand, the term euthanasia encompasses a spectrum of merciful deaths that revolve around the concept of consent. Cases can be classified as voluntary (where the person decides his/her fate, therefore giving their consent), non-voluntary (where the fate is chosen for a person incapable of giving consent), or involuntary (where the decision is against the will of the individual, thereby ignoring the individual’s autonomy to give consent).

To further delineate these cases, there are active and passive classifications. An active form of euthanasia would involve introducing an agent (chemical, weapon, or other) to cause death, as opposed to the passive form, which withholds agents that promote living such as food, water, or medical treatment. Passive euthanasia is widely practiced in America, e.g. when life support machinery is turned off, comfort measures but not sustenance is provided, or pain medications are given even though they have the potential to hasten death. The remainder of this article deals with active, voluntary euthanasia.

Several European countries and a few American states (Montana, Oregon, Washington, and most recently, Vermont) have legalized euthanasia and/or physician-assisted suicide. The difference in terms refers to which person administers the lethal drug: the doctor (euthanasia) or the patient (physician-assisted suicide/death). The most extensive research and experience come from the Netherlands, where euthanasia and physician-assisted suicide were legalized in 2002. For more than twenty years before that time though, there had been political, medical, and social debate and research into the frequency and characteristics of these procedures, which had been widely practiced but under fear of prosecution.

Since the passage of the law, the Dutch medical community is protected from prosecution when the following criteria are met. The patient’s suffering must be unbearable with no hope for its diminishment; their request must be voluntary, be repetitive, and not be under the influence of drugs, psychoses, or pressure from others. The individual must be aware of the alternatives. At least one outside doctor must verify that the conditions above have been met. The death must be carried out in a medically appropriate way either by the doctor or the individual (but with the doctor present). Finally, a multidisciplinary review board ensures after the fact that the due care criteria were met and it refers the case for legal action if not.

Since 2002, the Netherlands has not seen an increase in life-ending procedures. In effect, the law merely legalized what was already taking place. Cases that were referred to the public prosecutor by the review committees most often sited lack of a consultation with an independent physician; however, upon further investigation none of the physicians involved have been prosecuted.

Opposition to euthanasia/physician-assisted suicide takes many forms. The often-raised argument of slippery slope has not been borne out by Dutch studies where adhering to strict protocol has been followed in the vast majority of cases. There has been no evidence for increased euthanasia among vulnerable groups, e.g. those with lower economic or education status, among others.

One may ask what the effect of causing death has upon the medical doctor, who swore to do no harm? While it is agreed that performing euthanasia is not part of “normal medical practice,” physicians are not obligated to perform the procedure. Most foreign physicians studied view “minimizing suffering” as a higher goal than “doing no harm,” because most patients are terminal and the patient/physician relationship extends over many years (unlike our American system where health insurance dictates with whom one may doctor). Furthermore, non-American cultures have different values than our religious and political framework permits.

Some may argue that the practice of euthanasia devalues life, but I disagree. A 2005 Dutch study sited “pointless suffering” and “loss of dignity” as the most frequent reasons euthanasia was sought. When other alternatives are unavailable, why should we prolong someone else’s agony at their expense? We should respect a person’s autonomy to end life when certain criteria have been met. This decision is too critical and irreversible; it needs to be handled on the personal level, with care and counsel. In addition to advanced directives, it is time for our country to do its own studies, lead discussions, and document the debate on dying well.

Maria Runde is a member of the La Crosse Area Freethought Society

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