Saturday, March 18, 2006

Euthanasia, Part 2 (Finally)

Note: new picture up at FMPhoto.

Sorry it took so long to post this follow-up to my previous discussion of the subject. My thoughts are still somewhat all over the place on euthanasia. But here I go anyway.

Assisted Suicide

Implementation of legalized euthanasia is no easy task. What grounds for euthanasia are permissible? Who is capable of making the decision?

The easiest area to deal with (aside from passive euthanasia) is when a person decides for himself or herself to end his or her own life. But I think we all agree that suicide is more often than not a bad choice. There should be safeguards to prevent using legalized euthanasia to act out the suicidal choice of someone who is mentally unstable. Here is one process that I envision for ensuring responsible assisted suicide:
1. The person must file a petition with a court of law.
2. Interested parties must be given notice. These would include:
a. Close relatives, named in the will or otherwise, if any
b. Dependents, if any
c. Spouse, if any
d. Anyone else who would have standing to challenge the will
3. The court would appoint a psychiatrist
4. An informal trial would be held on the issue of mental capacity to choose euthanasia, as well as whether the grounds for choosing euthanasia are acceptable.

Another advantage of this system is that any challenges to the will could be litigated with the testator present to give evidence. The most important issue is often the intent of the testator, and who would be better to give evidence on that issue?

But should any grounds be acceptable? Depression by itself I think would not be enough. I think anyone amenable to legalized euthanasia would agree that painful terminal illness would be sufficient grounds. Should we otherwise limit it?

Nursing homes can cost a lot of money—about $70,000 a year. Many people, when forced into nursing homes, will first convey most or all of their property to relatives so the nursing home can’t seize all of their assets to pay for care. This makes them wards of the state. It’s quite natural, I think, for people to want to pass on their assets to their loved ones, and to keep it out of the grubby hands of the care providers. Should you be able to end your life simply to avoid these massive expenses?

What about the early onset of Alzheimer’s or some other disease? Personally, if I was diagnosed with a disease that will destroy my mental capacity, I think I would want to end it all. Paralysis is a similar situation. Many people go on from paralysis to lead very fulfilling lives, but many others simply sink into a deep depression from which they never recover. I think assisted suicide should be available in these circumstances, although if I was a legislator I may require a waiting period after onset of paralysis or some other diseases.

But these questions are relatively easy to answer. What about involuntary euthanasia?

Involuntary Euthanasia

I limit this part of the discussion to “active” euthanasia, the administering of lethal treatment rather than the denial of life-saving measures.

Should active, involuntary euthanasia ever be permissible? I established in the previous discussion on this subject that the impossibility of leading a happy life is the basic premise behind the support for euthanasia. But many people that are incapable of leading a happy life are also incapable of choosing to end that life. Examples include people in the later stages of Alzheimer’s disease. They are very expensive (and mentally taxing) to care for, and are certainly unhappy and confused a majority of the time. Perhaps the severely retarded would also qualify, as well as possibly some others.

But the question here is, who gets to decide? We naturally loathe letting some people decide. A very rich man with Alzheimer’s may be at the mercy of the people named in his will or who would receive property through intestacy statutes. At the same time, however, those who stand to gain nothing also likely don’t know what the wishes of the person would be. And we certainly don’t want the government to decide, especially when the person’s life at issue is a life supported by the government’s treasury. Most people could handle these issues in a living will, and I think that’s probably the best option. But then there are still countless others who can’t decide for themselves. Can we trust the parents of a severely retarded child to make the right choice? Most such parents love their children without regard to any mental or physical defect. But what about the others? And when you get into this area, I think you are getting dangerously close to the issue of abortion.


This is why it took me so long to post. Note all the question marks in the post. I think it’s very difficult to answer most of these questions, and I personally don’t know how. I’m not immediately opposed to involuntary, active euthanasia, but once these questions start to pop up then sometimes my gut squirms a bit. Maybe some of you will be able to help the discussion along.


  1. Sorry if this is a bit confusing. It is for me, too. I'll add quickly that I don't mean to say that loving a severely disabled child necessarily rules out the possibility that you may want to euthanize that child. In fact, the idea is that you would euthanize them because you love them.

  2. After my father learned that he had cancer and before he finally died from it, I had a conversation with him about assisted suicide. I asked him what he thought of it. He said what scared him about it was that it would get out of hand and we would start deciding who should live and who should die. I believe we have already started thinking that way with talk about the cost of nursing home care.

    So that is what scares me and what seems to scare nearly everyone I talk to about assisted suicide, that it will get out of hand and reach that point. My father went on to tell me what happened to my maternal grandmother when she died.

    It was during the early 1970's when euthanasia was deplored and the word struck fear in people's hearts. Grandma ended up in the hospital with bleeding from the rectum and severe pain. The doctor discovered that she had a large malignant tumor in the colon that was inoperable. She was going to die. So the good doctor gathered her children together and explained to them that their mother was in great pain and was going to die. He told them that with their permission he could administer an overdose of pain killer, unbeknown to Grandma, and she would slip away in her sleep none the wiser. The children gave their permission.

    The night that Grandma was scheduled to receive this overdose, the children gathered together in her room to say their final goodbyes to her. Of course, she had not been fully informed about the severity of her condition or the fact that she would be dying that very night. So, she did not know these were their final goodbyes.

    That night the doctor administered the lethal dose of pain killer, and, sure enough, Grandma died in her sleep none the wiser.

    I guarantee you that this was not the first time the good doctor had put someone down like they were an animal. I guarantee you that he wasn't the only doctor doing it either. So it was bad back then even.

    My father was a witness to the conversation the doctor had with Grandma's children. He was there to support my mother (one of the children) during this difficult time. He told me that he thought what the doctor did, what the children did was very wrong.

    Some of you might be inclined to get misty-eyed and say to yourselves, "What a kind man that doctor was to spare the poor old woman of the pain of knowing she was doomed to die and to spare her of any further physical pain." But let me tell you something about my grandmother.

    Grandma was a strong woman who had given birth to seven children at home and who had gone through hard times and knew all about pain and suffering. She had proven she was up to the task of dealing with her own death. In addition, she had a right to know about her condition. She had a right to say goodbye to her family on her own terms and to leave them with her parting thoughts. She had a right to make peace with her Creator if necessary before death overtook her. The kind and compassionate doctor robbed her of all of that.

    Now I related this story of my grandmother's death to a friend of mine who was visiting me shortly after Terri Schiavo had been done away with. My friend is of a certain mind set which I don't share. We had been talking about the Schiavo case and, so, I told her about my grandmother. When I was finished with the story, my friend's face brightened up and she gushed "ASSISTED SUICIDE!" I replied, "No, MURDER!" I was very disappointed in my friend. I found her reaction very telling. It told me that she was in love with the idea of assisted suicide so much that she could not immediately tell the difference between it and murder in my grandmother's case. Let's not fall in love with the ideas of assisted suicide and euthanasia.

    My father died in 2000 of pancreatic cancer. According to his wishes, he died at home in his own bed surrounded by family. We were with him during the dying process and, with the help of Hospice, we gave him palliative care his final few weeks. He suffered little pain if any. His death was dignified. He was noble.

    Nursing homes and useless eaters: The average stay in a nursing home is five years times $70,000 equals $350,000. Is that truly a lot of money? I have some thoughts on this and some solutions in mind. I also have some thoughts about the severely disabled and what we should be doing for them. But I am going to give all of this a rest tonight.

    Thank you, Kelly, for initiating this discussion with your posts.

  3. Kelly, your proposed process looks good on paper (and hey, another good way to keep lawyers in business!), but think about it in practical terms: unless such requests get booted to the front of the docket for express action by the court, there's a distinct possibility that the process will prolong the suffering. (I don't have any objection to it in the case of people deemed mentally incompetent (e.g., in a coma, severely retarded) to decide for themselves, however.) For the competent, why not create a consent form to be signed in the presence of witnesses (with the whole thing video-taped for later review)?

    Also, the suggestion of involving the parties to the will seems like a really bad idea. Wills are meant to apply after a person's death. (What's to keep someone who feels slighted from contesting and further delaying the process out of spite?)

    Susieq: I agree with you that the doctor committed murder. Unfortunately, your mother and her siblings share in the guilt. That's a heavy load.

  4. I want to correct something. I used the link you provided, Kelly, and learned that the average stay in a nursing home is about 2 1/2 years, not 5 years. I was mistaken. I don't have time to write much tonight. Maybe tomorrow.

    Ron, I don't hold my mother and her siblings as responsible as I do the doctor for what was done to Grandma. Naturally they loved their mother and did not want to see her suffer. So, when the doctor approached them, they were moved by their love for her which makes it sound okay, except it wasn't.

  5. I must admit I am a bit confused. I don't favor beaurocratizing the process of allowing people to die with dignity. I think that can only be a bad thing, and doing so in the name of paternalism doesn't fly in my view. The only people who are equipped to make these decisions are the people closest to the person who is going to die. If we don't trust them as a general matter, then it should be illegal. We should not permit the government to involve itself, except in cases with truly compelling reasons.

    However, my confusion could be a result of the fact that I'm not getting your definitions. Euthanasia is putting someone to death out of compassion. Assisted suicide or dying with dignity are quite different. Euthanizing one's self, with or without assistance is still suicide. Euthanizing another is homicide, whether it is by permission or not. Dying with dignity, or exercising a degree of dignified control over the manner in which one dies while suffering a terminal illness, technically is a form of suicide that involves balancing of interests rather than application of absolutes.

  6. Hi Kelly, I'm back.
    The 'blank slate' :) says, No one wants to die in pain, We all would like to die peacefully in our sleep (how many times have you heard that?) Since technology has given us the advantage of prolonging life; sometimes beyond reason or practicality, we must address the issue of terminating life. That in itself makes it a legal/moral issue.
    You yourself say in certain circumstances that you'd want to "end it all"
    I say the same.
    Could we say prehaps in certain circumstance that all human beings feel the same?
    This is what I believe we were trying to do in Oregon, when we voted to pass the assisted suicide law.
    Even I, a confirmed Humanist, have trouble w/terms like 'legalized euthanasia' or 'responsible assisted suicide'. (My fundimentally religious parents flip their lids over it) Death is an emotional issue, apparently.
    On the other hand, there are other countrys that practice assisted suicide w/pretty good results, so it's not something that people do arbitrarily.
    It is an important issue & will be interesting to see what the courts make of it.

  7. Thanks for your comments everyone, especially SusieQ. That does sound like murder (or at least voluntary manslaughter). My grandmother had the benefit of planning her own funeral and all of the other issues attendant with death before she died of colon cancer.

    You guys have helped make things a little clearer for me.

    The beauracracy of my ideas is probably bad in any case where the person can decide for himself or herself. Notarizing and videotaping probably would be a better option, and as long as we have doctors involved in the decision-making process then we may be able to avoid assisted suicide performed for the wrong reasons. And maybe we should never actively euthanize those who can't decide.

    Thanks again, everyone!