Euthanasia in the United States

Euthanasia is illegal in most of the United States. Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and "legislation bills" within the United States of America in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Oregon passed the Death with Dignity Act in 1997, Michigan included Proposal B in their ballot in 1998, and Washington's Initiative 1000 will be on the ballot in 2008.

Early history

The first major effort to legalize euthanasia in the United States arose as part of the eugenics movement in the early years of the twentieth century. In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. The driving force behind this movement was social activist Anna S. Hall. Canadian historian Ian Dowbiggen's 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

Euthanasia advocacy in the U.S. peaked again during the 1930's and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960's and 1970's, under the right-to-die rubric, physician assisted death in liberal bioethics, and through advance directives and do not resuscitate orders.

Several major court cases advanced the legal rights of patients, or their guardians, to practice at least voluntary passive euthanasia (physician assisted death). These include the Karen Ann Quinlan (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case.

Legislation and political movements

Oregon

Ballot Measure 16 in 1994 established the Oregon Death with Dignity Act, which legalizes physician-assisted dying with certain restrictions, making Oregon the first U.S. state and one of the first jurisdictions in the world to officially do so. The measure was approved in the 8 November 1994 general election in a tight race. The final tally showed 627,980 votes (51.3%) in favor, and 596,018 votes (48.7%) against. The law survived an attempted repeal in 1997, which was defeated at the ballot by a 60% vote. In 2005, after several attempts by lawmakers at both the state and federal level to overturn the Oregon law, the Supreme Court of the United States ruled 6-3 to uphold the law after hearing arguments in the case of "Gonzales v. Oregon".

California

The California Compassionate Choices Act was introduced in 2005, patterned after Oregon's Death with Dignity Act. After being defeated in 2006, it was launched with broader support in the leadership as AB 374 in 2007. [http://www.internationaltaskforce.org/cabqa.htm]

Texas

In 1999, the state of Texas passed the Texas Futile Care Law. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support on a patient whom they declare terminally ill.

On March 15, 2005, six month old infant Sun Hudson was the first patient in which "a United States court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child's parent." [ [http://lawprofessors.typepad.com/healthlawprof_blog/2005/03/lifesupport_sto.html HealthLawProf Blog: Life-Support Stopped for 6-Month-Old in Houston ] ]

In December 2005, doctors removed Tirhas Habtegiris, a young woman and legal immigrant from Africa, from life support against her family's wishes. [http://www.baylorhealth.com/articles/habtegiris/response.htm]

Medical Ethics on Euthanasia

Euthanasia has many pros and cons dealing with ethical issues of assisting in a patient’s death. Some physicians say euthanasia is a rational choice for competent patients to choose to die to escape unbearable suffering (11). On the other hand, medical experts comment that aiding in the patient’s death goes against a physician’s duty to preserve life (11).

For Euthanasia:

Physicians who are in favor of euthanasia state that to keep euthanasia or physician-assisted suicide (PAS) illegal, the law is against personal autonomy. They believe that any competent terminally-ill patient should have the right to choose death or refuse life saving treatment (11). Nowhere in the constitution state that the government can keep a person from committing suicide and if PAS was a right, patients could die with dignity and leave others with a positive memory and not what had they become (13). Also, physicians believe that the government needs to “treat like cases alike,” and by that, not all terminally-ill patients can refuse life-saving treatment and that their will hasten death. Suicide and assistance from their physician is the only option those patients have (11). The pain and agony, or psychological suffering, the patient goes through and the doctor should have the knowledge to know when the days of the patient’s are numbered (13). Not only is the stress on the terminally-ill patient, but also on the family. By allowing PAS and euthanasia, the patient can say their final goodbyes to their loved ones and not leave the world in a sudden and unconscious state (13). With the suffering and the knowledge from the doctor, this may also suggest that PAS is a humane answer to the excruciating pain (11).

Not only will PAS and euthanasia help with psychological suffering and give autonomy to the patient, PAS can help reduce health care costs and free up doctors and nurses. By keeping a terminally-ill patient alive, the patient must pay for any medical necessary procedures. These procedures can include x-rays, prescribed drugs, or any lab tests that needs to be performed. All of these procedures can run up a medical costs ranging from $50,000 to $100,000. Since the bills will continue to come for the patient, they will lose more of the money they would want to leave behind for their family. If the patient wants to end the suffering, the reason for racking up the bills and keeping the patient alive are lacking (13). Also, the costly treatment to keep the terminally-ill patient alive from medical funding cannot be used for other types of care, like prenatal, where it would save lives and improve long-term quality of life (12). Along with reduced health care costs, more doctors and nurses could be freed up. A shortage of medical staff is a critical problem hospitals face and studies have found that understaffed hospitals make many mistakes and provide less quality care. Attending to terminally-ill patients, who would rather die, is not the best use of the medical staff. If PAS and euthanasia were legalized, more staff would have time to care for others and there would be an increase in the quality of care administered (13).

Physician-assisted suicide and euthanasia can lower health care costs, free up doctors and nurses, and give back the right to the patient to practice autonomy. By keeping PAS and euthanasia illegal, each terminally-ill patient is being discriminated against because they are not able put this option into action. Those patients because of their disability do not have the same right as any other person in the United States (12).

Against Euthanasia:

Many physicians and medical staff have numerous reasons for prohibiting the legalization of PAS and euthanasia. A main reason for illegal PAS is the violation of the Hippocratic oath that all aspiring doctors are required to take. The Hippocratic oath says “I will not administer poison to anyone where asked,” and the doctor is to “be of benefit,” (11). By being a part of PAS and prescribing a lethal dosage of a drug would weaken the doctor-patient relationship because of the oath medical students take (13). Not only would it deteriorate the trust of the doctor by the patient, PAS and euthanasia would also injure the image doctors exhibit to the public (11).

Another reason for prohibiting PAS and euthanasia is the option of abusing PAS if it were to become legal. Poor or uninsured patients may not have the money or no access to proper care will have limited options, and they could be pressured towards assisted death (11). For emotionally and physiologically disturbed patients, they could abuse the PAS option and those patients could convince their doctor to help end their life. Also, the fact that doctors can play God and have a tremendous amount of power could contribute to the unethical reasoning for euthanasia. By keeping PAS and euthanasia illegal, doctors have opportunity to right their wrong diagnoses and prevent leaning towards suicide of a redeemable person (13). By having more time with the terminally-ill patient, the doctor is giving them constant care and medical attention. Many people believe that the unbearable pain can be controlled to tolerable levels if given proper care from the hospital staff (12). With the advances the medicine takes every day, there could be a possibility of recovery for the patient (13). In the United States, life is valued and is recognized by ceremonies and funerals, with months of mourning (13). Many people also believe that suicide is “considered as a rejection of God’s sovereignty and loving plan,” because He is the one who gives life, and therefore should be the one who takes life. Not only would suicide be against God’s plan but keeping PAS illegal could be positive for the patient, and thought of as “a divinely appointed opportunity for learning or purification.” This could be positive for any member of a faith group because they would relate their suffering to the “sufferings of Christ crucified,” (12). Since life is cherished, many believe it would be unethical to assist in suicide because the patient’s health care is expensive and inconvenient for the doctor (13).

U.S. public opinion on euthanasia

Reflecting the religious and racial diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public opinion research shows that views on euthanasia tend to correlate with religious affiliation and race, though not gender.

A 2002 Gallup survey showed that 72% of Americans supported euthanasia. [Gallup, George H. (2002, September 10). Views on Doctor-Assisted Suicide Follow Religious Lines Retrieved on March 27, 2008, from The Gallup Web site: http://www.gallup.com/poll/6754/Views-DoctorAssisted-Suicide-Follow-Religious-Lines.aspx]

Opinion by religious affiliation

In one recent study dealing primarily with Christians, Southern Baptists, Pentecostals, and Evangelicals and Catholics tended to be opposed to euthanasia. Moderate Protestants, (e.g., Lutherans and Methodists)showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were similar to those of non-affiliates. Within all groups, religiosity (i.e., self-evaluation and frequency of church attendance) also correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity. [Burdette, Amy M; Hill, Terrence D; Moulton, Benjamin E. Religion and Attitudes toward Physician-Assisted Suicide and Terminal Palliative Care. Journal for the Scientific Study of Religion, 2005, 44, 1, Mar, 79-93.]

Opinion by race and gender

Recent studies have shown European-Americans to be more accepting of euthanasia than African-Americans, though this difference may be explained by other factors. They are also more likely to have advance directives and to use other end-of-life measures. [Werth Jr., James L.; Blevins, Dean; Toussaint, Karine L.; Durham, Martha R. The influence of cultural diversity on end-of-life care and decisions. The American Behavioral Scientist; Oct 2002; 46, 2; pg 204-219.] African-Americans are almost 3 times more likely to oppose euthanasia than European-Americans. The main reason for this discrepancy is attributed to the lower levels of trust in the medical establishment. [Jennings, Patricia K.,Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; pg. 42.] Researchers believe that past history of medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. Studies have also found that there are significant disparities in the medical treatment and pain management that European-Americans and other Americans receive. [Werth Jr., James L.; Blevins, Dean; Toussaint, Karine L.; Durham, Martha R. The influence of cultural diversity on end-of-life care and decisions. The American Behavioral Scientist; Oct 2002; 46, 2; pg 204-219]

Among African-Americans, education correlates to support for euthanasia. African-Americans without a four-year degree are twice as likely to oppose euthanasia than those with at least that much education. Level of education, however, does not significantly influence other racial groups in the US. Some researchers suggest that African-Americans tend to be more religious, a claim that is difficult to substantiate and define. [Jennings, Patricia K.,Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; pg. 42.] Only African and European Americans have been studied in extensive detail. Although it has been found that non European-American groups are less supportive of euthanasia than European-Americans, there is still some ambiguity as to what degree this is true.

A recent Gallup Poll found that 84% of males supported euthanasia compared to 64% of females. [Moore, D. (2005 May 17). “Three in Four Americans Support Euthanasia.” The Gallup Organization.] Some cite the prior studies showing that women have a higher level of religiosity and moral conservatism as an explanation. Within both sexes, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that African-American women are 2.37 times more likely to oppose euthanasia than European-American women. African-American men are 3.61 times more likely to oppose euthanasia than European-American men. [Jennings, Patricia K.,Talley, Clarence R.. A Good Death?: White Privilege and Public Opinion. Race, Gender, & Class. New Orleans: Jul 31, 2003. Vol. 10, Iss. 3; pg. 42. the public opinion]

References

11. University of Washington School of Medicine (2008) “Ethics in Medicine” http://depts.washington.edu/bioethx/topics/pas.html#ques2 12. Ontario Consultants on Religious Tolerance (2001) “Euthanasia and Physician-Assisted Suicide” http://www.religioustolerance.org/euth2.htm#ethi

13. Joe Messerli (2007) “Should an incurably-ill patient be able to comment Physician- Assisted Suicide?” http://www.balancedpolitics.org/assisted_suicide.htm

For further reading

* Appel, Jacob M. 2004. "A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906" in "Bulletin of the History of Medicine", Volume 78, Number 3, pp. 610-634.

* Emanuel, Ezekiel J. 2004. "The history of euthanasia debates in the United States and Britain" in "Death and dying: a reader", edited by T. A. Shannon. Lanham, MD: Rowman & Littlefield Publishers.

*Kamisar, Yale. 1977. "Some non-religious views against proposed 'mercy-killing' legislation" in "Death, dying, and euthanasia", edited by D. J. Horan and D. Mall. Washington: University Publications of America. Original edition, Minnesota Law Review 42:6 (May 1958).

* Magnusson, Roger S. “The sanctity of life and the right to die: social and jurisprudential aspects of the euthanasia debate in Australia and the United States” in Pacific Rim Law & Policy Journal (6:1), January 1997.

* Stone, T. Howard, and Winslade, William J. “Physician-assisted suicide and euthanasia in the United States” in "Journal of Legal Medicine" (16:481-507), December 1995.

See also

*Karen Ann Quinlan and Terri Schiavo - Cases of persistent vegetative state
*Principle of double effect
*Terry Wallis