Right to Die

Stacey Huff

History

shuff@lhup.edu

 

Overview-What is Right to Die?

    The issue of a person’s right to choose his or her time and method of death has come to the forefront in America over the last several years.  Emotions run high on either side of the controversy as people argue the meanings of life and freedom of choice, the morality of taking one’s own life, the ethics of people involved in such actions, and the laws related to this issue. Right to Die deals with many things.  It is not only a mission to help the terminally ill, but also deals with brain death and issues that surround when a person is actually dead.  This website stems from an article about a woman named Terri Schiavo.  Terri has become a poster child for the Right to Die discussion.  Her story will be used as a case study of the brain death/injury issue. This website not only describes her story but also euthanasia as a whole as well as Jack Kevorkian, and Living wills.

Euthanasia

Information taken from:

1. euthanasia.com

Facts/Figures

    Netherlands

Physician-assisted suicide and euthanasia are legal and widely practiced in the Netherlands where:

Summary

Although euthanasia has been permitted in the Netherlands since 1973 by various court decisions, it was officially codified in 2001. In order to be legal, euthanasia must be performed according to “careful medical practice” guidelines. Requests for euthanasia must be voluntary, well considered and persistent, and be made by patients who are experiencing unbearable suffering without hope of improvement. There is no requirement that the patient be terminal, and courts have declared that the patient’s unbearable suffering may be purely psychological, rather than physical. More than one physician must be involved in the decision, and both patient and physician must agree that euthanasia is the only reasonable option. Minors between the ages of 12 and 18 may request and receive euthanasia or assisted suicide provided their parents consent to it.

All cases of euthanasia must be reported to and evaluated by regional committees composed of a lawyer, physician and an ethicist/philosopher. Acts of euthanasia and assisted suicide will be lawful if performed by a physician who has complied with the guidelines and reported to the coroner. The coroner must send his or her report to the Public Prosecutor, as well as to the regional euthanasia committee. The report must demonstrate that all the requirements for legal euthanasia have been met. In the event of a significant violation of the guidelines, the prosecutor will not give consent for burial or cremation until further investigations have been conducted.

The law also provides for an advance declaration authorizing euthanasia should the patient later become incompetent.

Information taken from

2. Nightingale Alliance

        Oregon is the only US state to have legalized Physician assisted suicide.

                    Oregon was the first state to legalize assisted suicide. In 1994 Oregon voters, by a margin of 51% to 49%, passed the Death With Dignity Act. The act was delayed by a legal injunction. On October 27, 1997 the Ninth Circuit Court of Appeals lifted the injunction and physician assisted suicide became a legal option for terminally ill patients.

 

Jack Kevorkian

Kevorkian Timeline

Early On

    -His fascination with death began with a desire to extend life. He argued for anesthetizing death row inmates before execution, if they consented, for the

purpose of organ harvesting and medical experiments.  This campaign was undercut by a swing at that time in the public opinion against capital punishment.  

    -He earned the nickname "Dr. Death" when he did research on the eyes of dying patients.  He would photograph the retinas of their eyes at the exact moment

of death and found that the corneas become invisible at this moment.  He did this in hope of helping doctors distinguish between death and comas.   

The Suicide Machine

    -In the late 80s Kevorkian built a machine that helped people to commit suicide by giving them a narcotic followed by a lethal dose of potassium chloride.

    -This machine enables disabled suicide candidates to kill themselves at the mere touch of a button

Click Here to See Pictures of Machines!

Dr. Death's Advertising Tactics

    -His search for a first patient began when he started placing ads in the newspaper classified section

    -Example Business Card:  Jack Kevorkian, MD...Bioethics...Special Death Counseling.  By Appointment Only.

    -In March of 1990 a Detroit newspaper carried this article:  "Applications are being accepted.  Oppressed by a fatal disease, a severe handicap, or a

crippling deformity?  Write BOX 264, Royal Oak, Mich. 48068-0261. Show him proper compelling medical evidence that you should die, and Dr. Jack Kevorkian will

help you kill yourself free of charge."

    -One rejected "patient" was a woman with multiple sclerosis who, he explained, was "not a suitable candidate for the first use of his death machine" because

her situation wouldn't garner the favorable coverage he needed for the "initial event".

    -1990- 1st client was Jane Adkins, a 54-year-old Alzheimer's patient, from Portland Oregon.  Since then he has helped over 130 people kill themselves.  

Crossing the Line

    -In 1998 Kevorkian stepped outside of the boundaries of passive euthanasia to active euthanasia when he gave a man lethal injection, rather than simply

providing the means for the man to kill himself.

    -He videotaped this and it was aired on CBS's Sixty Minutes.  He dared prosecutors to charge him with murder. 

    -In 1999 prosecutors found him guilty of murder and sentenced him 10 to 25 years in prison.

 

 

Jack Kevorkian has constantly violated most of the rules and stands he publicly claims to follow

(Data taken from June 1990 (total= 47 suicides)

 

Kevorkian says that those who qualify for his help suffer from afflictions that are incurable or cannot be treated without intolerable side effects

    -60 % of his patients were not terminal.  At least 17 could have lived indefinitely and, in 13 cases the people had no complaints of pain

    -Autopsies of  at least 3 of  his suicides revealed no disease at all

Kevorkian says that it is always necessary to bring in a psychiatrist because a person's "mental state is of paramount importance"

   -In 19 cases Kevorkian did not contact psychiatrists 

   -In 5 of those 19 cases the person who dies had a history with depression

Kevorkian says that it is always necessary to contact a pain specialist  or other medical experts when the patient is dealing with pain at all

   -In 33 cases which people complained of pain, he failed to contact a pain specialist in 17 of those cases

Kevorkian stated that after signing a final request, a person must always wait 24 hours before getting help to commit suicide

   -17 cases where Kevorkian's first meeting with the patient was also his last

    -in 5 of those cases less than 3 hours went by from the signing of the request to the moment of death

    -in one case the waiting period was one hour

 

 

Kevorkian section compiled from information taken from:

3. www.msu.edu

4. www.trinity.edu

 

Jack Kevorkian Patients: A Case Study-Assisted Suicide-Terminally Ill

Profiles of some of Kevorkian's patients-Click Here for Information on these and other patients assisted in their deaths by Kevorkian!

 

Kevorkian's first patient was Janet Adkins. A former college instructor on disability, she decided to commit suicide the day she was diagnosed with Alzheimer's disease. Kevorkian agreed to help without ever speaking to her, only her husband. Adkins died of a lethal injection from Kevorkian's first suicide machine in his van at a campsite in Groveland Oaks County Park in rural Oakland County.

Kevorkian's seventeenth patient was Thomas Hyde. A divorced landscaper and carpenter, Hyde began talking about suicide shortly after he was diagnosed in August 1992 with ALS, or Lou Gehrig's disease. He rescheduled his appointment with Kevorkian so he could first cash a Social Security check. Hyde died from inhaling carbon monoxide in the back of Kevorkian's van.

Kevorkian's thirty-third patient was Rebecca Badger. A single mother of two, Badger had a history of drug and alcohol abuse, and psychiatric and emotional problems. She was diagnosed with multiple sclerosis but an autopsy found no sign of the disease. Badger died from a lethal injection. California police believe her mother may have encouraged her to seek Kevorkian's help after assisting Badger in two failed suicide attempts.

Kevorkian's thirty-seventh patient was Pat DiGangi. A college history professor, DiGangi was diagnosed with multiple sclerosis in 1981 and by 1987 needed a wheelchair to get around. He talked of suicide for about two years but didn't arrange to come to Michigan to see Kevorkian until he became incontinent. His wife said DiGangi's great fear was "to live for a long time and keep getting worse." He died from a lethal injection.

Kevorkian's forty-seventh patient was Elaine Day. A widowed retired law office employee, Day was an avid golfer, dancer and swimmer who was being increasingly disabled by ALS. She detailed her suffering in a letter to the Los Angeles Daily News and expressed support for assisted suicide. Day died of a lethal injection. Her body was found in Kevorkian's Volkswagen van parked at the Oakland County Medical Examiner's office.

Information taken from:

5. Detroit Free Press

 

 

For a graph detailing the percentage of deaths by the patients illness click here!

For a full list of patients and their afflictions click here!

 

Euthanasia not only deals with the terminally-ill but also with brain death/injury and deciding when dead is dead.

 

Brain Death-What is Death?

 

 

Brain death is defined by medical authorities as irreversible cessation of all brain activity. Simply stated, this means that the brain is no longer alive and cannot be brought back to life.

The determination of brain death depends on very definite clinical and laboratory findings.

Clinically, a person is brain dead when all of the following conditions are met:

1. There are no spontaneous respirations (the person cannot take a single breath on his/her own).

2. The pupils are dilated and fixed (the black of the eyes is wide and does not react to light).

3. There is no response to noxious stimulation (painful stimulation provokes no eye blink, no grimacing, no movements of any part of the body).

4. All extremities are flaccid (there is no movement, no muscle tone and no reflex activity in any of the limbs - arms or legs).

5. There are no signs of brain stem activity:

    a. The eyeballs are fixed in the orbits.

    b. There are no corneal reflexes (stroking the clear part of the eye with a fine wisp of cotton fails to produce any movement of the eyelids).

    c. There is no response to caloric testing (exposing the tympanic membrane of the ear to ice cold water fails to produce movement of the eyes).

    d. There is no gag reflex or cough reflexing

Information taken from

6. www.comarecovery.org

But there is another side to the argument-Clinically dead is not necessarily dead in all people's opinions! Brain Death is not always the case. There are comas in which there is no regaining of consciousness but  there also can be brain injuries that affect the brain but the person regains "consciousness" (eyes are open but there is nothing else happening). That's where Terri Schiavo comes in!

Terri Schiavo: A Case Study-Euthanasia by Omission

    The fight of Terri Schiavo revolves around the removing of her feeding tube.  Terri is awake and can breath on her own but she can not feed herself.  If Terri's feeding tube were to be removed (which it was in 2003 and then ordered to be put in by Governor Jeb Bush of Florida) she would die due to starvation.

Click Here for a detailed timeline of Terri's life and struggle!

What happened to Terri?
 

On February 25, 1990, . . . Terri, age 27, suffered a cardiac arrest as a result of a potassium imbalance. Her husband called 911, and Theresa was rushed to the hospital. She never regained consciousness.

Since 1990, Terri has lived in nursing homes with constant care. She is fed and hydrated by tubes. The staff changes her diapers regularly. She has had numerous health problems, but none have been life threatening.

Over the span of this last decade, Terri's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. Unless an act of God, a true miracle, were to recreate her brain, Terri will always remain in an unconscious, reflexive state, totally dependent upon others to feed her and care for her most private needs

Although the physicians are not in complete agreement concerning the extent of Terri Schiavo's brain damage, they all agree that the brain scans show extensive permanent damage to her brain. The only debate between the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex.

 

Much of the debate over Terri Schiavo centers on her state of consciousness.  Many doctors say she is in a persistent vegetative state with no hope of recovery, while her parents disagree.

Comas: "A coma is a profound or deep state of unconsciousness. An individual in a state of coma is alive but unable to move or respond to his or her environment," according to the National Institute of Neurological Disorders and Stroke. Comas can be the result of illnesses or injuries.

Persistent Vegetative State: What Terri's Husband, Michael Schiavo Believes

Some people in comas lapse into a persistent vegetative state. The NINDS says: "Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain noncognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands."

 Minimally Conscious: What Terri's Parents Believe

A group of neurologists has proposed a new category called "the minimally conscious state." People in this state are impaired, but have some capabilities. Time magazine recently described them this way: "Patients may reach for and grasp things, track moving objects, locate sounds, process and respond to words. Patients may inconsistently verbalize or gesture to communicate. Patients may gain full consciousness."

 

Information taken from:

7. Abstract Appeal

8. National Institute of Neurological Disorders and Stroke

9. Understanding Terri Schiavo

Explanations for each side of the issue can be argued by watching and evaluating films taken of Terri by her family! These videos can be found @ http://www.terrisfight.org/.

To find the arguments go to www.sptimes.com/2003/10/28/Tampabay/Understanding_Terri_S.shtml

Pros vs. Cons-Arguments For and Against Euthanasia

Perspective #1:

Recognize the right to die with dignity, with a physician's assistance

What should be done-

  • Legalize physician-assisted suicide and make it a socially accepted, stigma-free medical procedure for those patients who need it.
  • Enact rules to determine that patients seeking such assistance are mentally competent, in great pain or mental anguish, and intent on ending their lives.
  • Prosecute physicians who assist in ending life when these various rules have not been met.
  • Require insurers to provide health and life insurance benefits to people who die with medical assistance.

 

 

 

  

 

Perspective #2:

Focus on giving comfort and recognizing the patient's preferences

What should be done-

  • Take additional steps to improve patients' comfort and quality of life, rather than helping to hasten their death.
  • Allow patients to issue directives, not just preferences, about end-of-life care and treatment, and provide additional incentives for medical professionals to follow those directives.
  • Improve training so medical professionals are able to provide relief from pain, and also the emotional support people need as they near death.
  • Expand palliative care in medical facilities. Even acute care facilities should be able to provide as much comfort and pain relief as possible.
  • Expand hospice care, both facilities designed specifically for this purpose and in-home hospice care.
  • Remove barriers to effective pain management, such as overly restrictive regulation of narcotics.
  • Provide mental health care for terminally ill patients, who are prone to suffering and depression
Perspective #3:

Reaffirm the commitment to preserve life

 

What should be done-

  • Enact a federal law banning all forms of physician-assisted suicide, and strike down initiatives such as Oregon's "Death with Dignity Act" that seek to legalize it.
  • Strengthen criminal laws to deter physician-assisted suicide. Prosecute and penalize physicians who practice it.
  • Enact civil laws to deter physician-assisted suicide, including measures to make it easier to bring malpractice suits against physicians who do so.
  • Insist that physicians make every effort to sustain life except when patients and their families explicitly decline further treatment.
  • Respond to requests for physician-assisted suicide with mental health treatment and counseling.

 

Arguments-Pro

  • Society has a pressing interest in preserving life, but not when further treatment is futile, pain is intolerable, or when the patient wishes to die.

  • Society should recognize the needs and wishes of individuals who are near death. They deserve compassionate assistance, and should be able to get such assistance openly.

  • This approach respects individual autonomy and the need for personal dignity. It does not force the terminally ill to linger helplessly and hopelessly, often at great cost.

  • Physician-assisted suicide, which is generally accomplished by administering a lethal drug, is more humane than the current practice of withdrawing life-sustaining treatment.

  • Many physicians secretly help incurable patients to end their lives. Making such assistance legal would permit the practice to be regulated, which would prevent abuse, and permit physicians to be do legally what many are currently doing illegally.

  • There is no real difference between recognizing the legal right to medical assistance in dying, and the already accepted practice of responding to the patient's desire to end life- sustaining treatment.

  • As long as regulations about the circumstances under which individuals may seek a physician's assistance in dying are clear and consistently enforced, the danger of abuse can be kept to a minimum

 

 

 Arguments-Pro
  • Many hospital patients endure needless pain. If patient care were improved and additional measures taken to reduce pain and suffering, fewer patients would want to hasten their deaths.
  • If medical professionals consistently honored the right to refuse treatment, which is already recognized, there would be less demand for physician-assisted suicide.
  • Many terminally ill patients would be better served, at lower cost, by hospice care than by acute care hospitals. Health coverage should be expanded to include hospice care.
  • Most suicidal people suffer from depression. If depression among seriously ill patients were treated seriously, fewer people would seek assistance in dying.
  • Unwanted treatment of terminally ill patients wastes money and medical resources.

 

 

 

 

 

 

 

 

 Arguments-Pro
  • By prohibiting physician-assisted suicide, society affirms the unconditional value of human life.
  • Suicide is a tragic individual act. Legalizing suicide would make this tragedy the social norm, and encourage others to kill themselves.
  • The physician's only role is to save lives and relieve symptoms. Permitting doctors to assist suicides would compromise their role and undermine trust in the medical profession.
  • By prohibiting physician-assisted suicide, we minimize the likelihood that patients will feel pressured to end their lives as a way of relieving emotional or financial strains on their family.

 

 

 

 

 

 

 

 

 

 

 

 

Arguments-Con
  • The severe pain that leads many patients to consider suicide is treatable.
  • Seriously ill patients who consider suicide are not necessarily close to death. It is often hard to determine whether patients are terminally ill. But doctors are in a better position to make that determination than patients are.
  • Many suicidal people are not terminally ill, they are depressed. They need treatment for depression, not assistance in dying.
  • The "right to die" could easily become the "duty to die." By recognizing the right to physician assistance in dying we condone situations in which people especially the old and the poor are deprived of medically necessary treatment.
  • If physician-assisted suicide is legally sanctioned, the practice is likely to get out of hand. Severely incapacitated patients might feel emotional or financial pressure from relatives, or insurers, to end their lives.
  • Recognizing the right to die compromises society's commitment to life.
  • Under growing pressure to control the cost of health care, physicians who have the option of helping patients end their lives would face a severe conflict of interest.

 

 Arguments-Con
  • If terminally ill people want to die, they have the right to do so. Some people would prefer to end their lives rather than lingering in a coma-like state induced by heavy sedation and opiates.
  • Medicating patients to the point of death is a form of mercy killing, which skirts the central moral and legal issues in the right-to-die debate.
  • By calling for more attention to patients' preferences about end-of-life treatment, this choice ignores a fundamental fact: physicians are the medical experts, and they are in the best position to determine when illness is terminal.
  • Hospice care is strictly limited. It is appropriate only when patients have given up hope for a cure or treatment that might extend their lives.
  • Short of terminally sedating patients, physicians cannot relieve the pain experienced by many patients. It's unrealistic to think that additional attention to pain relief would reduce the number of cases in which people seek assistance in dying.

 

 

 

 Arguments-Con
  • Government shouldn't force people to live when they want to die. In a free society, individuals should be able to control how and when they die.
  • The purpose of medicine is to alleviate suffering. Sometimes ending a life is the only way to do that.
  • If patients are denied the right to die, medical professionals are likely to continue costly and aggressive end-of-life treatment.
  • Physician-assisted suicide is widely practiced in secret. It's in the public interest to make it legal, and minimize error and abuse by regulating it.

 

 

 

 

 

 

 

 

 

 

Information taken from:

10. Public Agenda

For more Information:

    http://www.hemlock.org/index.jsp

            End of Life Choices

    http://www.nrlc.org/-National

            National Right to Life

 

Living Wills

The highly publicized case of Terri Schiavo, has people pondering the uncomfortable question of whether they would want to be kept alive when their brain has essentially died. Schiavo did not have a living will.

A living will spells out exactly what kind of treatment would be acceptable if a person is incapacitated and has a terminal illness or is permanently unconscious. Under federal law, any medical facility that receives federal funding -- that includes nearly all of them -- must ask a patient whether he or she has a living will. The facility can also provide the form to create a living will but cannot deny treatment to someone because he or she does not have one,

Statements on the form:

* Do not authorize that life-prolonging treatment be withheld or withdrawn.

* Authorize the withholding or withdrawing of artificially provided food, water, or other artificially provided nourishment or fluids.

The document must be witnessed by two non-family members or a notary. People involved in a patient's medical treatment cannot be witnesses

 living wills are often confused with a "do not resuscitate" order. A do-not-resuscitate order is usually used by those with a serious or terminal illness.,  it lets medical providers know that if a heart stops or someone stops breathing that no measure should be made to resuscitate the patient.

It is suggested to provide copies of your living will to every medical facility you use and keep a copy in your car. However, the most important thing is that people get proper information.

"There are a lot of misconceptions about living wills. People think, 'If I have a living will, they are just going to give me pain killers and let me die.'" but a living will can also ensure that everything possible is done to extend a person's life.

Information taken from:

. 11. Lexington Herald

Here is an Example of a living will.

 

 

Bibliography

1. Euthanasia.com (2004)Euthanasia Facts.  http://www.euthanasia.com/page4.html > (September 21, 2004).

2. Nightingale Alliance (2004) Fast Facts. http://www.nightingalealliance.org/cgi-bin/home.pl?section=3 >(September 19, 2004).

3. Wrigh196 (2002) The Right to Die. http://www.msu.edu/~wrigh196/atl/ > (October 4, 2004).

4. M Kearl (December 2002) Jack Kevorkian, The Right to Die. http://www.trinity.edu/mkearl/death02/euthan/Jack%20Kevorkian.htm >(October 9, 2004).

5. Detroit Free Press (1997) The Suicide Machine. http://www.freep.com/suicide/index.htm > (October 4. 2004).

6. Coma Recovery Association Inc. (December 2002) Brain Death. http://www.comarecovery.org/artman/publish/BrainDeath.shtml >(September 16, 2004).

7. Abstract Appeal (October 2003) Terry Schiavo Information Page. http://abstractappeal.com/schiavo/infopage.html > (September 2004).

8. National Institute of Neurological Disorders and Stroke (June 2003) Coma Information Page http://www.ninds.nih.gov/health_and_medical/disorders/coma_doc.htm > (October 9, 2004).

9. Krueger, Curtis (October 2003). Understanding Terri Schiavo http://www.sptimes.com/2003/10/28/Tampabay/Understanding_Terri_S.shtml > (September 16, 2004).

10. Public Agenda (October 2004). Right to Die-Issues. http://www.publicagenda.org/issues/frontdoor.cfm?issue_type=right2die > (September 16, 2004).

11. Meehan. Mary (November 11 2003) Florida Case Puts Focus On Living Wills
More Now See Benefits To Planning Ahead. Lexington-Herald.

 

Other Sites Consulted but not used directly:

http://www.finalexit.org/ -Euthanasia World View

http://www.knowdeep.org/euthanasia/ - links to many different topics on Euthanasia

http://www.usresolve.org/euthanasia-the-right-to-die.php - multiple perspectives on the Right to Die