An In-Depth Look at Euthanasia

George wakes to the sound of his alarm clock. He opens his eyes to the bright sunny day. A small smile creeps across his aged lips. Today is the day for his deliverance. The deliverance from an enemy that has tormented him for years; cancer.

Slowly he gets dressed while he looks over his will. After he is sure that everything is in place, he walks outside where a van is waiting for him. He enters and is met by the man that is going to assisted in his deliverance; his euthanasia; his good death.

This situation is becoming more common within today's society. It seems that this topic is discussed in the media just about every week. Euthanasia, suicide, assisted suicide and many other forms are common within our society. This paper will discuss many implications concerning euthanasia.

Euthanasia is derived from the Greek word eu, "good", and thanatos,"death." It literally means, "good death." There are several types of euthanasia that are described. Albright (1995), defined four types. Passive euthanasia involves an individual's choice to deny interventions that might prolong his or her life. This allows death to occur through the omission of life saving measures. An example of this would be a terminally ill person's signing of a "Do Not Resuscitate" order. This would forbid medically trained persons from performing extraordinary interventions to save his or her life, such as performing CPR. The second type of euthanasia described by Albright (1995) is active euthanasia. Active euthanasia is also known as mercy killing. This is directly intended to shorten a person's life rather than simply allowing it to end. Voluntary euthanasia is the next type of euthanasia that Albright (1995) described. Voluntary euthanasia is often described as assisted suicide and involves a competent person asking for assistance in ending his or her life. The final type of euthanasia described by Albright (1995) is Involuntary euthanasia in which the individual plays no active role. An example of involuntary euthanasia would be a son deciding that his father was suffering from too much pain from his old age and deciding to speed up his dying process.

Improvements in the science of medicine have greatly increased the life expectancy of the average American. Unfortunately, combined with this increase in life expectancy is also an increased period of chronic illness and disability. These chronic illnesses and diseases can be fought through treatments and medications, but these treatments raises an important question. Does the quality of life or simple existence best define the concept of human dignity (Albright, 1995)?

Recent public opinion polls in the United States showed that 50% to 60% of Americans are now in favor of legalizing euthanasia and physician assisted suicide under certain conditions (Steinbrook, 1991). This is why the debate continues so furiously today.

There are many reasons why people favor legalizing euthanasia. Many feel that the values and goals of older aged adults should be the largest concern when considering the welfare of the individuals. Decisions to end life because of the onset of a terminal disease, or chronic disability are considered to be rational and proper. In an essay written by Derek Humphry, (1995) he defined two forms of suicide, emotional and justifiable. Emotional involves the irrational self murder which involves all of it's complexities and sadness. Justifiable was defined as the rational and planned self deliverance from a painful and hopeless disease or disability which would shortly end in death.

Albright (1995) argued that a dying person wants to experience a peaceful death. They, therefore, can justify euthanasia because their life is no longer acceptable to them. They are not in a rush to have their lives ended or to end them. They instead want the needless suffering, both emotional and physical, to end. By allowing them to make this decision, the individual is then allowed to move towards death as a person and not a disease (Fiefel, 1990). The alternative to this death would be meaningless suffering.

Humphry (1995) argued that euthanasia is not for everyone. He believes that it should only be applied when an individual is suffering from advanced stages of terminal illnesses that are causing unbearable suffering. The second application would concern an individual with grave physical handicaps which are so restricting that the person could no long tolerate such a limited existence.

In his article, Albright (1995) added to Humphry's (1995) applications for euthanasia. Albright said that in addition to unbearable suffering or grave physical handicaps, an individual must also consider several of the following: what are the personal, legal and moral issues involved in their decision; where are their philosophic and religious believes about Euthanasia; what type of support system is available to them and how do their relatives view their decision; how hopeless is their condition; and have other alternatives been thoroughly explored.

There are several reasons that these topics mus be explored before considering euthanasia. It becomes extremely important to consider the psychological well being of the individual when making a decision of this nature. If a support system is not available to them, or if the family is not informed and educated as to why they are making the decision, then the probability of this causing greater harm is vastly increased.

There are many ways to avoid this from happening. Before considering euthanasia, Albright (1995) says that the person should become as knowledgeable as possible about their condition including prognosis and treatments tried and not tried. They should explore all alternatives. Most importantly they should discuss with others that death is different for every person and that they should consider their death to be unique. They should not try to experience their death in the same manner as someone who has died before them.

Humphrey (1995) argued that knowledge is comfort. Knowing as much as you can about your condition including prognosis and treatments allows the individual to have ownership in his or her life and condition. He also stated that this is why some people consider and talk about killing themselves, but do not always do it right away. He said that many people just want to know how to do it and then do not do it. This provides them the comfort of knowing that they have control over their lives, illness, and condition. He argued that it gives them assurance to fight harder and extend their lives just a bit longer.

By giving older aged adults the ability to make rational decisions concerning their lives, existence, and illness, you allow them to move towards their deaths as individuals and not an illness (Cartwright, 1995). All too often, society focuses on pain relief and overlooks the concerns of the older aged individual. These concerns might be loss of dignity and independence, and a wish to exercise some control over this stage of their lives. By denying a person of this, you are depriving them of something that they feel the need. This may lead to other problems like depression.

Albright (1995) described several principles that might have significant impact on the decision of an older aged adult. The first is autonomy. By refusing a competent person's request to end therapies or to end his life, you are showing disrespect for that person's autonomy or personal choices. The second principle that must be considered is non-maleficence. This is directly related to any counselors or psychologists that the person might be seeing at the time. Counselors, psychologists, and other health care officials have a duty to do no harm to their client or patient. Albright (1995) says that the decision being made should not be concerned with what is right and what is wrong, but which should take precedence over the given situation. The final principle that should be considered is beneficence, the counselor's duty to benefit their client. Albright (1995) argues that by allowing the individual to participate in euthanasia, you are providing the largest benefit to them to the best of your ability. It is important to remember that the counselor's obligation is to respect the integrity and promote the welfare of their clients.

Humphrey (1995) said that euthanasia is not for everyone. There are several parameters that must be met before a person can be considered competent to make a rational decision about euthanasia. First the person must be a mature adult. This is definitely not something that should involve minors, who would fall under different laws. The individual must make an informed decision. They must know as much about their condition as possible. This applies to the third parameter which is making sure that euthanasia is not being carried out at the first knowledge of a life threatening illness. The final part is to talk with the treating physician and take their opinion into account. This makes sure that the patient has not misunderstood the diagnosis.

The arguments for legalizing and making euthanasia more available for older aged adults are compelling, but the arguments against it are also very compelling. Today's society is incredibly harsh towards older aged adults. As time progresses, you see a devaluation of old age along with a deep fear of it. Of the two million people who died in 1985, 70% of them were over the age of 65. Older aged adults 65 years old and up account for 12% of the population but also account for 21% of the suicides (Humphry & Wickett, 1987). Of this 21%, 64% of the cases were over the age of 60 and 51% were over the age of 70. This is very alarming rate of suicide and must be looked at in-depth. Osgood (1995) said that compared to other age groups, older adults are most at risk of suicide and are the most likely to request assistance in ending their lives. What is causing these older adults to commit suicide at such a large rate?

One of the biggest causes is blamed on ageism. Osgood (1995) defined ageism as a profound prejudice against older adults. This included the systematic stereotyping of older aged people just because of their age. Ageism can be found in many places. Because of society's emphasis on the value of things, people who can no longer produce due to physical and mental changes or because of social polices, such as retirement, are viewed as worthless. Most of the value is placed on beauty and youth. Youth is looked at as vitality, activity, and freshness while old age is looked at as decline, disability and death rather than wisdom, inner peace and other positive qualities. Older aged adults are also used as scapegoats and blamed for several problems. Some say that the reason that the federal deficit is so large is because too much money is spent on Medicare and Social Security (Osgood, 1995).

Society's indifference to life is being reflected in the way the elderly are treated (Paris, 1992). Older aged adults continue to be devalued as time goes on. They become expendable because of their economic burden. They are often neglected or pushed into corners where adequate care is not provided for them. This leads to an individual feeling as if they were abnormal, deviant, or marginal members of the culture.

Ageism leads to a sense of powerlessness and hopelessness for the older individual. They begin to see themselves in negative terms. They view themselves as a burden to society or to their families. They feel that they should take their lives to relieve these people of the burden. This also leads to disengagement.

There is a huge misconception that exists in today's society that says that most older people who commit suicide are sick and in pain or are suffering from a terminal illness. This is drastically incorrect. Only 2% to 4% of suicides involving older aged adults are suffering from a terminal illness. A study done by Seigle and Tuckel (1995) found that the rates of suicide with in patients suffering from cancer did not exceed that of the general population as had been previously thought. They suggested that it is the patient's intrapsychic organization and not the disease that was the critical factor.

Travis (1991) posed the question of whether people were ending their lives because they have a terminal illness or because they feel that they have nothing left to live for. If it is because they feel that they have nothing left to live for, then they might be suffering from depression. This depression might be from a variety of things from ageism, the death of a spouse, or abuse. Community based psychological autopsy studies have shown that most older adults that commit suicide are suffering from depression and/or substance abuse (Seigle & Tuckel, 1985). This depression prohibits the person from seeing a better future leading them to the decision of ending their lives. What needs to be recognized is that both depression and substance abuse are treatable conditions. By legalizing Euthanasia in this context, people can refer to suicide as Euthanasia when indeed there was no need. These individuals need to seek help or help needs to find them. This help might be achieved through further education about their lives and about death specifically. People who see Euthanasia as an option do not see the meaning and the value in the later stages of life. It does bring about loss, but it also offers challenges and surprises. By choosing Euthanasia, these individuals might be depriving themselves of some very unique and precious memories or experiences. Travis (1991) said that by committing suicide, the individual can no longer benefit from what society has to offer. They don't see that life is the gift that keeps on giving throughout the entire natural life span. Euthanasia deprives the individual, the family, and society.

People also need to be taught to look at death as a part of the process of life as opposed to something entirely unrelated to life and living. This allows death to become a stage in development like birth. This way, death becomes more accepted and not avoided (Albright, 1995).

Travis (1991) described three deterrents from euthanasia. The first would be to teach people to accept suffering as a natural part of life. The second was to provide isolated individuals someone to talk to. This person could also help perform task that the older aged adult was having difficulties doing. The final deterrent would be to link the older adult with social organizations so that he or she would feel included in programs and then find a new reason for living.

Pain management is another reason that people consider euthanasia. Many medical practitioners argue that there is no need for active or voluntary euthanasia or physician assisted suicide (Cartwright, 1995). They claim that most patients' pain can be controlled. They blame the difficulty in obtaining medications and the high cost of care as the reasons that pain is not controlled. Osgood (1995) also stated that pain can be controlled without the use of expensive or elaborate interventions. She stated that doctors need to become more educated because pain sometimes is not properly managed for terminally ill patients.

Clark (1992) reported that the majority of people who took their lives were suffering from depression and/or substance abuse. Only 23% were chronically or severely medically ill and 14% were terminally ill. Rather than educate people on why euthanasia should be allowed, education about depression and substance abuse might be more appropriate. This would lead to a decrease in the number of suicides due to depression and/or substance abuse.

All to often in American today, the cure is focuses upon. Euthanasia is being looked at as a cure for dying. Perhaps the humanity and the individuality should become the focus, rather than just the cure. Problems concerning death need to be examined from and addressed from a psychological standpoint (Fiefel, 1990). Society is shielding its members from death. People need to be taught that death is for everyone, old or young, and that it is a part of life. It should not be looked at as a barrier to overcome. Society needs to also allow its members to experience death in their own way Fiefel (1990) argued. Death is different for people, cultures, and times. Most dying people do not expect miracles concerning their biological well-being. What they do expect is confirmation of care and concern for their well being. He believes that if the psychological and emotional needs of these people are met that the person will become more competent and thus reflect more responsible behavior concerning their lives. Fiefel (1990)stated that if we take care of the emotional and psychological well being of an individual, we can assure that the patient experiences the least amount of stress and depression concerning their condition.

Cartwright (1995) stated the view point of most older aged adults is that they want more information and consultation to enable them to think more clearly about the issues. Often, doctors and family members are unwilling to discuss death with the older individuals. But these individuals need to talk about it. This allows them to settle the issues that they need to and allows the other members to do the same.

If these older individuals are to be more involved in the decision making at the end stages of their lives, then they need more community based education. This is so that the people are not considering the issues surrounding death for the first time when faced with a terminal illness. This allows them a better sense of mind when confronted with such decisions like euthanasia. These older adults are more concerned that their treatment preferences are known and respected, especially in terminal care.

In conclusion, it has become evident that euthanasia is a very complex topic to consider. It must be looked at as not only a social issue, but as a personal issue. It is imperative that society is educated about death and all of its implications. Depression and/or substance abuse must be closely looked at. Too many people are committing suicide that are not even suffering from a terminal illness or chronic disability. When all of these issues are considered, only then can a person make a rational, informed decision concerning their care and well being.

References

Albright, R. (1995). A right to die? Ethical dilemmas of euthanasia.Counseling & Values, 39, 177- 187.

Carolyn S. & Tuckel, P. (1985). Rational suicide and the terminally ill cancer patient. Omega Journal of Death and Dying, 14, 263-270.

Cartwright, M. (1995). Decision-making in terminal care: Older people seek more involvement. Social Alternatives, 14, 7-13.

Chinese doctor fights for right of terminally ill to die. (1996, July 14). Los Angeles Times, p. A2.

Clark, D. (1992). "Rational" suicide and people with terminal conditions or disabilities. Issues in Law and Medicine, 8, 147-160.

Humphry, D. Why I believe in Voluntary Euthanasia (1995).

Humphry, D. & Wickett, A. The right to die: Understanding euthanasia (1987).

Fiefel, H. (1990). Psychology and death: Meaningful rediscovery. American Psychologist, 45, 537-543.

Osgood, N. (1995). Assisted suicide and older people--a deadly combination: ethical problems in permitting assisted suicide. Issues in Law & Medicine, 10, 415-436.

Paris, J. (1992). Active euthanasia. Theological Studies, 53, 113- 125.

Siegle, C., Tuckel, P. (1985). Rational Suicide and the Terminally Ill Cancer Patient. Omega Journal of Death and Dying, 14, 263-269.

Steinbrook, R. (1991). Support grows for euthanasia. The Los Angeles Times, April 19, 1, 24, 25.

Travis, R. (1991). Two arguments against euthanasia. The Gerontologist, 31, 561-562.

© Tanner Trombly 1998