INTRODUCTION In a war of ideologies, the first casualties are the definitions of the terms used.

Euphemisms abound when people are determined to convince others. The word "euthanasia" comes straight out of the ancient Greek, "eu" means goodly or well and thanatos means death.1 In the 18thcentury, writers in England translated its Greek root which meant, a "good" death, a welcome way to depart quietly and well from life. In the language of the day, administering a lethal injection becomes "aid in dying;" the deliberate ending of a person's life to reduce their suffering becomes mercy killing. More commonly used today, however, is the phrase the "right to die." These are noble sounding words that literally mean that someone can request that a doctor may kill him. In the terminology battle, the proponents of euthanasia are seeking to redefine the term euthanasia to gain popularity and acceptance. Notwithstanding the proponents effort to camouflage this moral dilemma with noble sounding words, it remains controversial because it pits the plight of suffering, dying individuals against religious beliefs, legal tradition, and, in the case of physician-assisted death, medical ethics.2 In the opposite extreme end of the moral spectrum, Euthanasia is considered, from a traditional Judeo-Christian point of view, as murder and a blatant violation of the biblical commandment Thou shalt not kill.3 From a secular perspective, one of the principal purposes of law is to uphold the sanctity of human life. Despite contrary views, new development shows how values and practices can change over time. Some practices that were considered barbaric at one time in history have become acceptable in the twenty-first century. In April 2002, Netherlands became the first country in the world to legalize euthanasia. Subsequently, legalization of euthanasia took place in Belgium in September of the same year.4 With the increase acceptance and legalization of euthanasia in other countries, does a staunchly 85% Catholic country embrace the same? The current "debate" on the legitimacy of euthanasia is a good indicator of the overall moral state of Philippines today. This three-part series addresses the issues of euthanasia. In part one, it argues on what makes euthanasia legal and illegal. While

1 2

http://en.wikipedia.org/wiki/Euthanasia#Etymology http://www.enotes.com/euthanasia-article 3 http://www.inplainsite.org/html/euthanasia.html 4 http://ask.yahoo.com/20030710.html

in part two, it argues on what makes euthanasia moral and immoral. Lastly, the conclusion provides a unanimous stand on the legal and ethical issues surrounding euthanasia.
Historical Background

Date

Events

5th Century B.C.-1st Century B.C.

"In ancient Greece and Rome, before the coming of Christianity, attitudes toward infanticide, active euthanasia, and suicide had tended to be tolerant. Many ancient Greeks and Romans had no cogently

Ancient Greeks and Romans Tend to Support Euthanasia

defined belief in the inherent value of individual human life, and pagan physicians likely performed frequent abortions as well as both voluntary and involuntary mercy killings. Although the Hippocratic Oath prohibited doctors from giving 'a deadly drug to anybody, not even if asked for,' or from suggesting such a course of action, few ancient Greek or Roman physicians followed the oath faithfully.

"There was a remarkable continuity in Church medical ethics 1st Century A.D.Late Middle Ages regarding suicide and euthanasia between the dawn of Christianity and the late Middle Ages. Medieval references to voluntary death were rare, suggesting that the actual practice of euthanasia had tapered off dramatically since the fall of Rome. Laws in some parts of Europe dictated that a suicide's corpse be dragged through the streets or nailed to a barrel and left to drift downriver. The medieval ethos was During Middle Ages Christians and Jews Tend to Oppose Euthanasia distinctly uncongenial to any kind of self-murder."5 "The ascendancy of Christianity, with its view that human life is a trust from God, reinforced the views of the Hippocratic school [which forbid euthanasia]. By the twelfth through fifteenth centuries, it culminated in the near unanimity of medical opinion in opposing euthanasia."6
5 6

Ian Dowbiggin, PhD .A Merciful End: The Euthanasia Movement in Modern America, 2003 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998

17th Century

"For over 700 years, the Anglo American common law tradition has punished or otherwise disapproved of both suicide and assisting

Common Law Tradition Prohibits Suicide and Assisted Suicide in the American Colonies

suicide... For the most part, the early American colonies adopted the common law approach. For example, the legislators of the Providence Plantations, which would later become Rhode Island, declared, in 1647, that '[s]elf murder is by all agreed to be the most unnatural, and it is by this present Assembly declared, to be that, wherein he that doth it, kills himself out of a premeditated hatred against his own life or other humor...his goods and chattels are the king's custom." 7

17th-18th Century

"No serious discussion of euthanasia was even possible in Christian Europe until the eighteenth-century Enlightenment. Suddenly, writers

Renaissance and Reformation Writers Challenge Church Opposition to Euthanasia

assaulted the church's authoritative teaching on all matters, including euthanasia and suicide... While writers challenged the authority of the church with regard to ethical matters, there was no real widespread interest in the issues of euthanasia or physician-assisted suicide during that time."8

"Enlightenment toleration of suicide proved to be temporary. Under the leadership of evangelicals...a vigorous religious counterattack gained momentum as the late eighteenth century drew to a close. The Late 18th Century various waves of religious revivalism, starting with the Great Awakening of the mid-1700s, prevented secularists and agnostics on American Evangelical
7 8

either side of the Atlantic Ocean from generating popular support for taking one's life. These events dovetailed with the Second Great

Washington v. Glucksberg (63KB) , 1997 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998

Christians Reject Suicide and Euthanasia

Awakening of intense evangelical fervor in the first years of the nineteenth century and strengthened the condemnation of suicide and euthanasia that stretched back to the earliest days of colonial America. The rejection of suicide and euthanasia remained firm, even after many of the new states decriminalized suicide in the wake of the Revolutionary War. The majority of Americans rejected suicide's common-law punishment...but no matter how sympathetic they were toward the suicide's family, most Americans stopped far short of condoning self-murder. As late as the antebellum period there existed in the United States a firm consensus...against suicide and mercy killing."9

The earliest American statute explicitly to outlaw assisting suicide is enacted in New York. It is the Act of Dec. 10, 1828, ch. 20, 4, 1828 N. Y. Laws 19. "Many of the new States and Territories followed New 1828 York's example Between 1857 and 1865, a New York commission led by Dudley Field drafted a criminal code that prohibited 'aiding' a First US Statute Outlawing Assisted Suicide Enacted in New York suicide and, specifically, 'furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such person intends to use such weapon or drug in taking his own life' By the time the Fourteenth Amendment was ratified, it was a crime in most States to assist a suicide The Field Penal Code was adopted in the Dakota Territory in 1877, in New York in 1881, and its language served as a model for several other western States' statutes in the late 19th and early 20th centuries California, for example, codified its assisted

Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003

suicide prohibition in 1874, using language similar to the Field Code's."10

1870s

"An important milestone in the euthanasia debate was the isolation of morphine in the nineteenth century and its widespread use as an

Samuel Williams Begins to Publically Advocate Using Morphine and Other Drugs for Euthanasia

analgesic [a pain-relieving agent]... When the practice of analgesia had become reasonably well established, Samuel Williams, a nonphysician, began to advocate the use of these drugs not only to alleviate terminal pain, but to intentionally end a patient's life... During the late 1800s, Williams' euthanasia proposal received serious attention in the medical journals and at scientific meetings. Still, most physicians held the view that pain medication could be administered to alleviate pain, but not to hasten death."11

1885 American Medical Association Opposes Euthanasia

The Journal of the American Medical Association attacks Samuel Williams' euthanasia proposal as an attempt to make "the physician on the robes of an executioner."12

"By the turn of the century, medical science had made great strides. As physicians who used the modern scientific method and modern 1905-1906
10 11

Washington v. Glucksberg (63KB) , 1997 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998 12 Ezekiel Emanuel, MD, PhD .The History of Euthanasia Debates in the United States and Britain," Annals of Internal Medicine, Nov. 15, 1994

principles of pharmacology consolidated their control over university Bills to Legalize Euthanasia Are Defeated in Ohio and medical school training, the euthanasia debate entered the lay press and political forums. In 1905-1906, a bill to legalize euthanasia was defeated in the Ohio legislature by a vote of 79 to 23. In 1906, a similar initiative that would legalize euthanasia not only for terminal adults, but also for 'hideously deformed or idiotic children' was introduced and defeated as well. After 1906, the public interest in euthanasia receded."13

"In the early hours of 12 November 1915, at Chicago's GermanAmerican Hospital, Anna Bollinger gave birth to her fourth child, who is a seven-pound baby boy...the baby was blue and badly deformed. 1915 After conferring with the father, the doctor awakened Harry J. Haiselden, the hospital's forty-five-year-old chief of staff. Haiselden Dr. Haiselden Allows diagnosed a litany of physical defects. He predicted that, without Deformed Baby to Die Rather Than surgery...the child would die shortly. In a decision whose shockwaves would ripple from coast to coast, and mark a milestone in the history

Give It Possibly Life- of euthanasia in America, Haiselden advised against surgery. The saving Surgery Bollingers tearfully agreed and, on 16 November, Haiselden called a news conference to announce that, rather than operate, he would 'merely stand by passively' and 'let nature complete its bungled job.' The child died on 17 November, amid growing controversy.By declining to operate, Haiselden...almost singlehandedly managed to accomplish what other defenders of euthanasia before him had not. He not only got more Americans than ever before talking about euthanasia, but also won endorsements from numerous prominent

13

Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998

figures. The publicity surrounding his professional conduct, briefly eclipsing news from World War I, inspired other Americans to speak out in favor of letting deformed infants die for the good of society... Haiselden demonstrated how support for euthanasia was nurtured by a cultural climate punctuated by science, naturalism, and humanitarian reform." 14

"The Black Stork, a feature film from 1917, dramatically expresses the anxieties people had about medicine and disability during this period: disability was equated with disease, doctors claimed absolute 1917 authority. The film was inspired by the sensational case of Dr. Harry Haiselden, a Chicago surgeon who convinced the parents of a newborn The Black Stork Film Causes Controversy over Infant Euthanasia with multiple disabilities to let the child die instead of performing surgery that would save its life. Haiselden's activities brought forth a storm of public controversy in which all of the currently popular attitudes toward disability were expressed. Many prominent thinkers, including Clarence Darrow and Helen Keller, argued that physicians had the right and the duty to decide whether a life was worth living. Although it was widely accepted that doctors should make these decisions and act on them in their private practices, it was rare that the subject was argued in public."15

"The dispute over mercy killing, after subsiding in the 1920s, caught 1930s fire again in the 1930s, making these years a pivotal juncture in the history of euthanasia in America. With the coming of the Depression Public Support for
14 15

Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003 National Public Radio"The Black Stork: Movie Ads," www.npr.org (accessed May 8, 2009)

Euthanasia Increases and more troubled economic times, Americans began talking again as US Endures Great Depression about suicide and controlled dying... Public opinion polls indicated in 1937 that fully 45 percent of Americans had caught up with Harry Haiselden's belief that the mercy killing of 'infants born permanently deformed or mentally handicapped' was permissible."16

1935 The Voluntary Euthanasia Legislation Society (VELS) is founded in England by C. Killick Millard, a retired public health physician.17

Voluntary Euthanasia Legislation Society Founded

"The euthanasia debate was not limited to this side of the Atlantic. A 1936 bill to legalize euthanasia was debated in the British House of Lords in 1936, but was rejected... The defeat of this bill, along with the Bill to Legalize Euthanasia Defeated in British House of Lords outbreak of World War II, the subsequent discovery of the Nazi death camps, and the recognition of the complicity of German physicians in the extermination camps quelled but did not eliminate discussion of the euthanasia question."18

1937 Nebraska Senator John Comstock introduces legislation called the

16 17

Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003 Ezekiel Emanuel, MD, PhD "The History of Euthanasia Debates in the United States and Britain," Annals of Internal Medicine, Nov. 15, 1994 18 Michael Manning, MD .Euthanasia and Physician-Assisted Suicide: Killing or Caring?, 1998

Voluntary Euthanasia Act Introduced in US Senate

Voluntary Euthanasia Act, which calls for the legalization of active euthanasia. It is never voted on but demonstrates an emerging interest in legislating euthanasia.19

On January 16th, 1938 Charles Francis Potter announces the founding 1938 of the National Society for the Legalization of Euthanasia (NSLE), which is soon renamed the Euthanasia Society of America (ESA). National Society for the Legalization of Euthanasia Founded According to TIME magazine, "he and a sizable group of other notable men believe[d] so strongly in the right of an incurably diseased individual to have his life terminated gently that they... organized a National Society for the Legalization of Euthanasia... its trustees included Dr. Clarence Cook Little of the American Society for the Control of Cancer and of the American Birth Control League, and Secretary Leon Fradley Whitney of the American Eugenics Society."20

1940s

"When the 1940s dawned, many in the euthanasia movement believed it was only a matter of time before euthanasia became legal in the

Nazi Use of Involuntary Euthanasia Changes Public Perception of Euthanasia in the US

United States...But euthanasia advocates were in for a surprise... World War II broke out, and as Hitler's war machine Marched eastward across Europe...news of Nazi atrocities against mental patients and handicapped children filtered back to America... As word spread in the late 1940s, the euthanasia movement found itself

19

Bryan Hilliard, PhD ."The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the PatientPhysician Relationship," Issues in Integrative Studies, 2000 20 TIME Magazine "Potter and Euthanasia," www.time.com, Jan. 31, 1938

increasingly on the defensive, scrambling to deny that the form of euthanasia it supported was the same as Nazi murder." 21

1946

Committee of 1776 Physicians for The Committee of 1776 Physicians for Legalizing Voluntary

Legalizing Voluntary Euthanasia in New York State comes into existence.22 Euthanasia Founded

1950

The World Medical Association votes to recommend to all national medical associations that euthanasia be condemned "under any

World Medical Association Condemns Euthanasia; Poll Shows Declining Support for Physician-Assisted Suicide

circumstances." In the same year, the American Medical Association issues a statement that the majority of doctors do not believe in euthanasia. "When an opinion poll in 1950 asked Americans whether they approved of allowing physicians by law to end incurably ill patients' lives by painless means if they and their families requested it, only 36 percent answered 'yes,' approximately 10 percent less than in the late 1930s."23

21 22

Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003 Bryan Hilliard, PhD "The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the PatientPhysician Relationship," Issues in Integrative Studies, 2000 23 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003

1952

The British and American Euthanasia Societies submit a petition to the United Nations Commission on Human Rights to amend the UN

Groups Petition the UN to Amend the Declaration of Human Rights to Include Euthanasia

Declaration of Human Rights to include "...the right of incurable sufferers to euthanasia or merciful death... Inasmuch as this right is, then, not only consonant with the rights and freedoms set forth in the Declaration of Human Rights but essential to their realization, we hereby petition the United Nations to proclaim the right of incurable victims to euthanasia. Eleanor Roosevelt, the Chairperson of the Commission, did not present the petition to the Commission.24

1962

Charles Potter dies and theologian Joseph Fletcher assumes Potter's unoffical title as the chief philosopher of the euthanasia movement.

Pauline Taylor Becomes President of the Euthanasia Society of America

"Fletcher fashions a new rationale for euthanasia based primarily on the notion of patient autonomy." Pauline Taylor becomes president of the Euthanasia Society of America (ESA). "Taylor...began the ESA's soul-searching process that led to a major shift in the philosophy for the entire American euthanasia movement. She believed the ESA in the past had overemphasized the soundness of an individual's decision to have his or her life ended if terminally ill and in unbearable pain... Taylor concluded that the time was ripe to...begin convincing the public that letting someone die, instead of resorting to extreme measures, was both humane and ethically permissible." 25

24 25

Marjorie Zucker, PhD The Right to Die Debate: A Documentary History, 1999 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003

1965

Donald McKinney becomes president of the Euthanasia Society of America (ESA).

Donald McKinney Becomes President of the Euthanasia Society of America

"Over the next two decades [McKinney] would help to transform the euthanasia movement by leading a sizeable faction opposed to active euthanasia or physician-assisted suicide. In the process he eventually concluded...that there was a fundamental distinction between passive and active euthanasia." 26

1967 The first living will is written by attorney Luis Kutner and his arguments for it appear in the Indiana Law Journal.27

First Living Will Written

1968

The Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death publishes its report in the Journal of the

Harvard Medical School Committee Defines Irreversible Coma as a Criterion for Death

American Medical Association in August 1968. The committee defines "irreversible coma" as a new criterion for death. According to the committee, a new definition of death was needed because of the great burden that trying to revive irreversibly comatose patients puts on the patients themselves, their families, hospitals and the community.
28

1969

The Hastings Center was founded in 1969 by Daniel Callahan to study

26 27

Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the Millenium," www.finalexit.org, Feb. 27, 2005 28 Peter Singer Rethinking Life & Death, 1994

Hastings Center Founded

ethical problems in medicine and biology and was instrumental in the development of bioethics as a discipline. The original focus of the center concerned death and dying, genetics, reproductive biology and population issues, and behavior control.29

1970

In the early 1970s, the widely accepted authority of the medical profession came under concerted attack in the name of patient

Idea of Patients' Rights Gains Acceptance

autonomy. This challenge has been embodied in the progressive enumeration of patient rights, especially the right to refuse medical care, even life-sustaining care. The goals have been to remove physicians from decision making and to let individual patients weigh the benefits and burdens of continued life.30

The US Senate Special Commission on Aging (SCA) holds the first 1972 national hearings on death with dignity entitled "Death with Dignity: An Inquiry into Related Public Issues. US Senate Holds First National Hearings on Euthanasia "The SCA hearings, chaired by Senator Frank Church, proved to be a superb opportunity for professionals and laypeople to discuss a range of issues relating to aging and terminal illness, including the evolving doctor-patient relationship and the difficulties about defining death itself. Overall, the hearings showed that Americans were becoming increasingly unhappy about 'the brutal irony of medical miracles,' which extended the dying process only to diminish patient dignity and quality of life. Church insisted that the hearings were not about

29 30

Daniel Callahan, PhD "The Hastings Center and the Early Years of Bioethics," Kennedy Institute of Ethics Journal, Mar. 1999 Ezekiel Emanuel, MD, PhD "The History of Euthanasia Debates in the United States and Britain," Annals of Internal Medicine, Nov. 15, 1994

euthanasia, but try as he might, he could not keep the subject from surfacing." 31

1973 The American Hospital Association adopts a "Patient's Bill of Rights" which recognizes the right of patients to refuse treatment.32

American Hospital Association (AHA) Adopts Patient's Bill of Rights

1974

"The founding of the Society for the Right to Die [formerly the Euthanasia Society of America] marked a renewed dedication to

Society for the Right to Die Founded; First US Hospice Opens

pursuing the legalization of active euthanasia, a reenergized campaign to seek euthanasia laws through the political process."33 The first American hospice opens in New Haven, Connecticut.34

March 31, 1976

21-year-old Karen Ann Quinlan had fallen into an irreversible coma at a party in 1974. After doctors declared that she was in a "persistent

Supreme Court Rules in Quinlan Case that Respirator Can Be Removed

vegetative state," her parents went to court to have her respirator removed. The New Jersey Supreme Court rules in 1976 that Karen Quinlan can be detached from her respirator. The case becomes a legal

31 32

Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003 AHA Patients Bill of Rights, 1973 33 Ian Dowbiggin, PhD. A Merciful End: The Euthanasia Movement in Modern America, 2003
34

Bryan Hilliard, PhD "The Moral and Legal Status of Physician-Assisted Death: Quality Of Life and the Patient-Physician Relationship," Issues in Integrative Studies, 2003

from Coma Patient

landmark, drawing national and international attention to end-of-life issues.35

October 1, 1976

California Governor Edmund G. Brown Jr. signs the California Natural Death Act into law and California becomes the first state in

Nation's First Aid in Dying Statute Signed into Law in CA

the nation to grant terminally ill persons the right to authorize withdrawal of life-sustaining medical treatment when death is believed to be imminent.36

1980

The World Federation of right to Die Societies was founded in 1980. Its membership included dozens of organizations from countries

World Federation of Right to Die Societies Forms; Hemlock Society Forms

around the world that were concerned with euthanasia and the the right to die.37

May 5, 1980

Pope John Paull II issues the Declaration on Euthanasia, opposing mercy killing but permitting increased use of painkillers and a patient's refusal of extraordinary means for sustaining life.38

Pope John Paul II Issues Declaration Opposing Mercy Killing

35 36

In Re Quinlan , 1976 New York Times "California Grants Terminally Ill Right to Put an End to Treatment," Oct. 2, 1976 37 World Federation of Right to Die Societies "Ensuring Choices for a Dignified Death, www.woldtd.net (accessed May 9, 2009) 38 Marjorie Zucker, PhD The Right to Die Debate: A Documentary History, 1999

Dec. 1984

The

American

Medical

Association

publishes

two

reports,

"Withholding or Withdrawing Life-Prolonging Medical Treatment, American Medical Association Supports Withholding or Withdrawing LifeProlonging Medical The reports detail the American Medical Association's formal position that with informed consent, a physician can withhold or withdraw and "Withholding or Withdrawing Life-Prolonging Medical Treatment -- Patients' Preferences."

Treatment in Certain treatment from a patient who is close to death, and may also discontinue life support of a patient in a permanent coma.39 Circumstances

1987 The California State Bar Conference passes Resolution #3-4-87 to become the first public body to approve of physician aid in dying.40

California State Bar Becomes First Public Body to Support Physician Aid in Dying

1988

The Unitarian Universalist Association of Congregations passes a national resolution titled "The Right to Die With Dignity." The

Unitarian Universalist Association Passes Resolution in Support of Aid in

resolution favors aid in dying for the terminally ill, thus the Unitarian Universalist Association of Congregations becomes the first religious body to affirm a right to die.41

39

American Medical Association "Opinion 2.20: Withholding or Withdrawing Life-Sustaining Medical Treatment," www.ama-assn.org, (accessed May 12, 2009) 40 Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the Millenium," www.finalexit.org, Feb. 27, 2005 41 "The Right to Die With Dignity" , 1988

Dying

Jan. 8, 1988 Journal of the American Medical

The Journal of the American Medical Association publishes an anonymous article entitled "It's Over Debbie."

Association Publishes The article describes how a gynecology resident in a large private Article By Hospital hospital had injected a patient suffering from painful ovarian cancer Worker Who Euthanized a Patient with an overdose of morphine. The article stirs controversy and debate, and many condemn the resident for what he had done.42

1990s

By the early 1990s, the growing interest in the right-to-die movement became apparent in public opinion surveys. These showed that more

Public Opinion Surveys Show More Than Half of Americans Support Physician-Assisted Death

than half of the American public was now in favor of physicianassisted death and membership of the Hemlock Society rose dramatically to reach 50,000... With increased public interest, the stage was set for an explosive swell of activity: in the courts, in professional medical journals and institutions, and, most significantly, in the homes of the American people.43

June 4, 1990 Jack Kevorkian, MD, assists Janet Adkins, a Hemlock Society Jack Kevorkian

42

Jonathan Moreno, PhD Arguing Euthanasia: The Controversy Over Mercy Killing, Assisted Suicide, and the "Right to Die," 1995 43 Sue Woodman Last Rights: The Struggle over the Right to Die, 2000

Participates in His

member, in committing suicide in Michigan. Adkins' death is the first

First Assisted Suicide of many suicides in which Dr. Kevorkian assists.44

Cruzan v. Director, Missouri Department of Health comes before the United States Supreme Court. The case receives national attention, as June 25, 1990 it is the first right-to-die case that the court has agreed to hear. In 1983, a car accident had left Nancy Cruzan permanently unconscious Supreme Court Rules in Cruzan Case that a Person Has the Right to Refuse Life Saving Medical Service (by most accounts). Her parents requested to withdraw her feeding tube, but the Missouri Supreme Court refused. The United States Supreme Court ruled that a competent person has a constitutionally protected right to refuse any medical treatment, but upholds Missouri's right to insist on clear and convincing evidence as to the wishes of patients who do not have decision-making capacity. In light of the ruling, the Cruzans' lawyer goes back to court with new evidence as to Nancy's prior wishes, and Nancy's feeding tube is removed. She dies on December 26th, 1990.45

November 5, 1990

Congress passes the Patient Self-Determination Act, requiring hospitals that receive federal funds to tell patients that they have a right to demand or refuse treatment. It takes effect the next year.46

US Congress Passes Patient SelfDetermination Act

1991
44 45

Choice in Dying is formed by the merger of two aids in dying

Wesley Smith, JD The Slippery Slope From Assisted Suicide to Legalized Murder, 1997 Wesley Smith, JD The Slippery Slope From Assisted Suicide to Legalized Murder, 1997 46 Patient Self Determination Act, Nov. 5, 1990

organizations, Concern for Dying and Society for the Right to Die. Choice in Dying Formed The new organization becomes known for defending patients' rights and promoting living wills, and grows in five years to 150,000 members.47

November 1991 Washington State introduces ballot Initiative 119 to legalize "physician-aid-in-dying." The initiative is defeated.48

Washington Voters Defeat PhysicianAid-in-Dying Initiative

November 3, 1992

California voters defeat Proposition 161, the California Death with Dignity Act, which would have allowed physicians to hasten death by

California Death with Dignity Act Is Defeated

actively percent.49

administering

or

prescribing

medications

for

self

administration by suffering, terminally ill patients. The vote is 54-46

April 1993

Compassion in Dying is founded in Washington state to counsel the terminally ill and provide information about how to die without

Compassion in Dying Formed

47

suffering and 'with personal assistance, if necessary, to intentionally

Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the Millenium," www.finalexit.org, Feb. 27, 2005 48 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 2001 49 Wesley J. Smith, JD Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder, 1990

hasten death.' The group sponsors suits challenging state laws against assisted suicide.50

May 1994 The New York State Task Force on Life and the Law publishes When Death Is Sought, a report that argues against the legalization of physician-assisted suicide.51

New York Task Force Publishes Report Against Physician-Assisted Suicide

November 1994 The Oregon Death With Dignity Act is passed, becoming the first law in American history permitting physician-assisted suicide.52

Oregon Death With Dignity Act Passed

April 30, 1997 President Clinton signs the Assisted Suicide Funding Restriction Act of 1997, which prohibits the use of federal funds to cause a patient's death.53

President Clinton Prohibits Using Federal Funds for Assisted Suicide

50 51

Compassion & Choices "Aid-In-Dying Timeline," www.compassionandchoices.org (accessed May 12, 2009) New York State Task Force on Life and the Law , May 1994 52 Oregon Death With Dignity Act , 1994 53 Assisted Suicide Funding Restriction Act of 1997, 1997

June 26, 1997 The Supreme Court rules in Washington v. Glucksberg and Vacco v. Quill that there is not a constitutional right to die.54

US Supreme Court Rules There Is No Right to Die

November 1997 Oregonians vote 60 to 40 percent in favor of keeping the Death With Dignity Act.55

Oregon Voters Keep Death With Dignity Act

November 1998 Jack Kevorkian, MD, is a guest on 60 Minutes, during which he shows a videotape of him administering a lethal injection to Thomas Youk, a man suffering from Lou Gehrig's disease.56

Jack Kevorkian Assists a Suicide on National Television

54 55

Washington v. Glucksberg and Vacco v. Quill, 1997 Oregon Department of Human Services "Death With Dignity Act History," www.oregon.gov, Mar. 2006 56 People v. Kevorkian , 2001

November 1998 Michigan introduces Proposal B to legalize physician-assisted suicide. The proposal fails by a vote of 29% to 71%.57

Michigan Defeats Physician-Assisted Suicide Proposal

1999 A Michigan court convicts Jack Kevorkian, MD, for the murder of

Jack Kevorkian

58 Convicted of Murder Thomas Youk and sentences him to 10-25 years in prison.

2000 Maine introduces a ballot initiative, the Maine Death with Dignity Act, which reads "Should a terminally ill adult, who is of sound mind, be allowed to ask for and receive a doctor's help to die?" The initiative is defeated by a margin of 51% to 49%.59

Maine Death with Dignity Act Is Defeated

2001 The Netherlands officially legalizes euthanasia.60

Netherlands

57 58

John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 2001 People v. Kevorkian, 2001 59 John Dombrink, PhD and Daniel Hillyard, PhD Dying Right: The Death with Dignity Movement, 2001 60 International Task Force on Euthanasia and Assisted Suicide "Frequently Asked Questions," www.internationaltaskforce.org, 2006

Legalizes Euthanasia

2003 US Attorney-General John Ashcroft asks the 9th Circuit Court of Appeals to reverse the finding of a lower court judge that the Oregon Death With Dignity Act of 1994 does not contravene federal powers.61

Attorney-General Aschroft Challenges the Oregon Death with Dignity Act

2005

The Terri Schiavo case garners national media attention. Terri Schiavo had been brain damaged since 1990 when, aged 26, her heart stopped

Terri Schiavo Has Her Feeding Tube Removed after Long Court Battle

beating temporarily and oxygen was cut off to her brain. In 1998, her husband Michael Schiavo filed a petition to have her feeding tube removed. Seven years of legal battles ensued between Michael Schiavo and Terri's parents, the Schindlers. After a Florida Circuit Judge ruled that Terri Schiavo's feeding tube be removed and the Florida Supreme Court overturned "Terri's Law," a law intended to reinsert the feeding tube, the United States Supreme Court refuses for the sixth time to intervene in the case. Terri Schiavo dies on Mar. 31, 2005, 13 days after her feeding tube is removed.62

January 17, 2006 The Supreme Court, in a 6-3 opinion in Gonzales v. Oregon, holds that the Controlled Substances Act does not authorize the Attorney General
61

US Supreme Court

Derek Humphry "Chronology of Euthanasia and Right-to-Die Events During the 20th Century and into the Millenium," www.finalexit.org, Feb. 27, 2005 62 BBC "Timeline: Terri Schiavo Case," Mar. 31, 2005

Upholds Oregon's Death With Dignity Act in Gonzales v. Oregon

to ban the use of controlled substances for physician-assisted suicide. Oregon's Death With Dignity Law is upheld.63

June 1, 2007 Jack Kevorkian, MD, the pathologist sentenced on Apr. 13, 1999 to Jack Kevorkian Released on Parole 10-25 years in prison for his role in the euthanasia of Thomas Youk is paroled after serving 8 years.64

February 19, 2008 The Luxembourg parliament adopts a law legalizing physicianassisted suicide and euthanasia.65

Luxembourg Legalizes PhysicanAssisted Suicide and Euthanasia

November 4, 2008 Washington voters approve the Washington Death with Dignity Act (Initiative 1000) making Washington the second US state to legalize physician-assisted suicide.66

Washington Death with Dignity Act Is Passed

63 64

Gonzales v. Oregon, Jan. 17, 2006 New York Times "Kevorkian Is Released from Prison," June 1, 2007 65 Reuters , "Luxembourg Parliament Adopts Euthanasia Law," www.reuters.com, Feb. 20, 2008 66 Washington Death with Dignity Act , Nov. 4, 2008

December 5, 2008 Montana district judge Dorothy McCarter rules in the case of Baxter v. State of Montana that Montana residents have the legal right to physician assisted suicide, thus making it the third US state to legalize physican aid in dying.67

State of Montana Legalizes PhysicianAssisted Suicide

December 31, 2009

The Montana Supreme Court affirmed 4-3 in the case of Baxter v. State of Montana that physician-assisted suicide is not "against public

State of Montana Affirms PhysicianAssisted Suicide Not Against Public Policy

policy" in Montana. The Court further ruled that state law protects doctors in Montana from prosecution for helping terminally ill patients die. The court declined to rule on the larger question of whether physician-assisted suicide is a right guaranteed under Montana's Constitution.68

67 68

Baxter v. State of Montana , Dec. 5, 2008 Opinion/Order of the Montana Supreme Court on Baxter v. State of Montana, Dec. 31, 2009

Definition of Terms:

1. Euthanasia - The act of a physician or other third party ending a patient's life in response to severe pain and suffering69.

2. Voluntary Euthanasia - refers to the action taken by the physician and the patient, who both agree (with informed consent) to end the patient's life70.

3. Involuntary Euthanasia - refers to a third party taking a patient's life without the informed consent of the patient. This is commonly practiced in veterinary medicine when animals are "put down" or "put to sleep." In modern medicine, it could conceivably be applied to the act of taking a terminally ill, suffering patient's life, which has lost all mental capacity to make his/her own decisions71.

4. Active Euthanasia - In active euthanasia a person directly and deliberately causes the patient's death72.

5. Passive Euthanasia - In passive euthanasia death is brought about by an omission - i.e. by withdrawing or withholding treatment in order to let the person die73. 6. Competence - A competent patient is one who understands his or her medical condition, what the likely future course of the disease is, and the risks and benefits associated with the treatment of the condition; and who can communicate their wishes74. 7. Palliative Care - Medical, emotional, psychosocial, or spiritual care given to a person who is terminally ill and which is aimed at reducing suffering rather than curing75.

69 70

http://en.wikipedia.org/wiki/Euthanasia Ibid 71 Ibid 72 http://en.wikipedia.org/wiki/Euthanasia 73 Ibid 74 http://www.bbc.co.uk/ethics/euthanasia/overview/keywords.shtml 75 http://www.bbc.co.uk/ethics/euthanasia/overview/keywords.shtml

8. Terminally Ill - is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a relatively short period of time76.

76

http://en.wikipedia.org/wiki/Terminal_illness

PART I Arguments on legality of Euthanasia

1. Futility of living a poor quality life The right to life entails a right to a good quality life, one wherein an individual can fully enjoy the essence of his existence to feel happiness, or sadness, or excitement -- one that is not bereft of consciousness or emotions.

In a landmark case in Western Australia, the Supreme Court confirmed the right of a quadriplegic to refuse tube feeding. Being quadriplegic and losing the vigor of his existence, the petitioner, Mr. Rossiter, told his caregivers to stop giving him food down his feeding tube. The nurses reported that they have given him food and care but what Rossiter only wanted was his mobility. Being paralyzed is not the kind of life that Rossiter wanted.77

Nancy Cruzan lost control of her car one day in January 1983 in Missouri. When the paramedics arrived, they were able to restore her breathing and heartbeat and she was transported, unconscious, to hospital. She continued to be fed through a surgically- implanted gastrostomy tube. After several years, a court found that, although her respiration and circulation continued unaided, she was oblivious to her surroundings except for reflexive responses to sound and perhaps painful stimuli; her brain had degenerated, irreversibly; she was a spastic quadriplegic; she suffered contraction of her four extremities, with irreversible muscle and tendon damage; and had no cognitive or reflex ability to swallow food or water or to maintain her essential daily needs nor would she ever recover such an ability. She lay in persistent vegetative state.78

In the cases mentioned, the patients are diagnosed as being in a vegetative state. These are the situations when only the respirators, gastrostomy, and other machines keep the patients alive. As in Cruzan, her responsive reflexes only respond to painful stimuli. This is not the kind of life that is worth living. This is artificial life sustained by machines. Biological death is very imminent. Without these machines, the patient dies, but then at least she dies to rest from a poor quality life.
77 78

http://edition.cnn.com/2009/WORLD/asiapcf/09/21/australia.right.to.die/index.html http://www.law.umkc.edu/faculty/projects/ftrials/conlaw/cruzan.html

2. Compassionate killing over invasive medical treatments

Medical treatments and procedures can be invasive such as those employed to cancer patients, especially those who are already in the terminal stage. Physicians usually assume that what patients and families want in a crisis is resuscitating life at all costs. However, surveys show that public opinion is on the side of withdrawing all "invasive" and "extraordinary" treatment in such cases.79

Gayle Stelter writes, "For almost seven years I have been living with cancer, mostly joyously and gratefully, but gradually seeing the disease encroaching relentlessly on my once healthy body. Throughout these years, I have thought long and hard about death and I've discovered that it's not the prospect of death itself that is so frightening, but the process of dying The court case of Karen Ann Quinlan tells of a poignant example of medical technologys ability to prolong life. It was in 1975 when Quinlan collapsed into an irreversible coma that left her in a vegetative state, unable to breathe without a respirator, or eat without a feeding tube. After seeing Karen like this for several months, her family finally came to the conclusion that she was beyond hope, and decided to remove her from the ventilator. The New Jersey Supreme Court case that followed was the first to bring the issue of euthanasia into the public eye. Although Quinlan was removed from mechanical ventilation during 1976, she lived on in a persistent vegetative state for nine years until her death from pneumonia in 1985. The case set a precedent for a right to refuse unwanted medical treatment.80 Quinlan case presented one form of passive euthanasia wherein the immediate family of the terminally ill patients decides to pull the plug. Out of compassion, the parents of Quinlan chose to let her die peacefully than to continue suffering the invasive treatments for a comatose patient such as the respirator and feeding tube.

79 80

Ethanasia: What is Good Death? http://en.wikipedia.org/wiki/Karen_Ann_Quinlan

3. Medical Care Costs More Than the Family Can Afford

Patients with terminal illness do not want to diminish their assets by incurring large medical costs as their death approaches. As an act of generosity, they would rather die sooner, and pass on their assets to their beneficiaries. Some, due to poverty or lack of health-care coverage cannot afford pain killers as medications.

In China 80% are poor peasants, who cannot afford expensive medical technology use by a hospital. A reported case tells of woman who is diagnosed of cervical cancer. Due to medications, she has been suffering a lot. Yet there was still no assurance as that she will be cured. Because of financial constraints, she chose to surrender and refuses to get further medication.81

4. Euthanasia presents a new take on medical practitioners. Euthanasia comes from a Greek word which means good death. Many observers note that good death can hardly be achieved due to the advances of medicine which have increased peoples health and life span. But then these advances have also greatly affected the dying process. For example, in the early twentieth century the majority of Americans died at home, usually victims of pneumonia or influenza. Today most people die in the hospital, often from degenerative diseases like cancer that may cause a painful, lingering death. 82 Many countries have raised the flag for legalizing euthanasia. Among them are The Netherlands, Belgium, and Luxembourg. The first country to legalize euthanasia is The Netherlands. Euthanasia in The Netherlands is regulated by the Termination of Life on Request and Assisted Suicide (Review Procedures) Act" which took effect on April 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. The patient must be informed of the presence of reasonable alternatives and the applied method of ending

81 82

www.eubios.info/EJ63/EJ63D.htm http://www.enotes.com/euthanasia-article

life. He must have consultation of another physician. The Act also requires physicians to report euthanasia to a review committee to demonstrate their compliance.83

The legal debate concerning euthanasia took off with the "Postma case" in 1973. The case concerned a physician who had facilitated the death of her mother following repeated explicit requests for euthanasia. The physician was convicted but then the case had opened the court's judgment to set out the criteria when a doctor would not be required to keep a patient alive contrary to their will. A course of a number of court cases during the 1980s had formalized such criteria.84

Second to The Netherlands, Belgium has also legalized Voluntary Euthanasia in September 2002. The law requires that the patient requesting voluntary euthanasia must be in the terminal stage of their illness lest, a third medical opinion needs to be sought. Belgium provides all the patients with access to free painkilling medication so as to ensure that no patient shall resort to euthanasia as a result of poverty or because of their pain. Its law also necessitates that the patient must be over eighteen (18) years of age. 85

Luxemburg also followed suit. On February 2008, the bill legalizing euthanasia has been approved. It bears stressing that the decision making when a patient plea for euthanasia to end his suffering calls for the discretion of the doctor. This burden is unique from the regular transaction between the doctor and the individual patient who has come for help. Many physicians have been looking back to the Hippocratic Oath when faced with the situation. However, it must be noted that with the burden presented, physicians need to come out of their refuge from ancient aphorisms. Situations faced by the patients and physicians centuries ago are different from today. Taken from the oath are the words, I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. 86When the patient has been subjected to too much pain and suffering because of his
83

Buiting H, van Delden J, Onwuteaka-Philpsen B, et al. (2009) "Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study". BMC Med Ethics 10: 18. 84 Rietjens JA, van der Maas PJ, Onwuteaka-Philipsen BD, van Delden JJ, van der Heide A (September 2009). "Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain?" 85 http://www.euthanasia.net/page/Belgium 86 http://euthanasia.procon.org/view.answers.php?questionID=000198

terminal illness, and he asked to be released from the oppression of his disease, what else are the other forms of harm could he possibly fear? What injustice could be given to the person who asked to be release from the injustice of his pain?

5. Terminally Ill patients have the right to a dignified death.

"In ancient Greece and Rome, before the coming of Christianity, attitudes toward euthanasia tended to be tolerant. Many ancient Greeks and Romans had no cogently defined belief in the inherent value of individual human life, and pagan physicians likely performed frequent abortions as well as both voluntary and involuntary mercy killings. Although the Hippocratic Oath prohibited doctors from giving 'a deadly drug to anybody, not even if asked for,' or from suggesting such a course of action, few ancient Greek or Roman physicians followed the oath faithfully. However, throughout classical antiquity, there was widespread support for voluntary death as opposed to prolonged agony, and physicians complied by often giving their patients the poisons they requested The ancients stressed the voluntary nature of the dying, provided that it was done for the right reasons; for example, to end the suffering of a terminal illness."87 During the recent years, there have been cases of patients suffering terminal illness who asked for help to end their suffering. There is no reason to deviate from the past practice when the patient is suffering from a degenerative disease which leads to the deterioration of his body. The wife of Derek Humphry was dying of bone cancer. Thrombosis had set in, her bones were cracking and she was losing control of her bowels. One day, after a very close brush with death, she sat up in her hospital bed and said to her husband, "Will you help me die?"88 There is also a 70 year old patient of Dr. Cox. Mrs. Boyes was persistent in request for voluntary active euthanasia. She was so ill that she "screamed like a dog" if anyone touched her and conventional medicine did not relieve her agony. In her last days, she repeatedly requested to die.89 The testimonies of Humphry and Dr. Cox are of the many instances when the emotional, mental, and physical being of a person is giving up. These situations show the circumstance when death lies beside a terminally ill person. As what the people believed during the classical antiquity, the time
87 88

http://euthanasia.procon.org/view.resource.php?resourceID=130 http://www.scu.edu/ethics/publications/iie/v4n2/euthanasia.html 89 http://www.euthanasia.cc/cases.html

of the blossoming of the Hippocratic Oath, it is a voluntary nature of man to die. The body of a terminally ill person becomes a poison to his emotional health. These persons have the right to a dignified death. To prolong their agony is to deprive them of their right of choice. Law must also recognize, as it now does implicitly, the principle of personal autonomy and self-determination, the right of every human being to have his [her] wishes respected in decisions involving his [her] own body. It is essential to recognize that every human being is, in principle, master of his own destiny. He may, of course, for moral or religious reasons, impose restrictions or limits on his own right of self-determination.

Arguments on Illegality of Euthanasia

1. Alternative treatment exist for the ends of euthanasia

Euthanasia is not the only solution for relieving the pains and sufferings of the terminally ill. The same purpose is sought to be achieved by providing palliative care.

The World Health Organization defines palliative care as the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems, is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families.90 It seeks to provide relief from pain and uncomfortable symptoms while integrating psychological and spiritual features of patient care. 91

The legalization of euthanasia negates the purpose of practitioners in providing palliative care. In the results of a 2010 study in The New England Journal of Medicine showed that lung cancer patients receiving early palliative care experienced less depression, increased quality of life and survived 2.7 months longer than those receiving standard oncologic care.92 Palliative care may not totally abrogate the pains and sufferings of which euthanasia can provide by ending the life of the terminally ill. However, legalizing euthanasia limits the possibility that meticulous research in palliative care may provide a more prolonged pain free life of the terminally ill.

Moreover, it is noteworthy to consider that in palliative care, terminally ill patients are not only provided pain relief but also psychological and spiritual care to maximize their remaining life. The goal is not to cure, but to provide comfort and maintain the highest possible quality of life for as long as life remains.

90 91

Bill Muehlenbergs commentary on palliative versus euthanasia Christian Nordqvist , Medical News Today 92 Temel, J.S., et al, Early Palliative Care for Patients with Metastatic NonSmall-Cell Lung Cancer, N Engl J Med 2010; 363:733-742, August 19, 2010

Well-rounded palliative care programs also address mental health and spiritual needs. The focus is not on death, but on compassionate specialized care for the living. Palliative care is well-suited to an interdisciplinary team model that provides support for the whole person and those who are sharing the person's journey in love.93

In the Philippines,, the growth of the hospice and palliative care movement in the country now makes it possible for the terminally ill and those suffering from life-threatening ailments to stay at home where their physical and spiritual needs could be met. Hospice care does not seek to cure. It seeks to provide a better quality of life during the remaining days of the patient. Formally introduced in the Philippines in 1993, the hospice movement now counts 23 institutions and 520 service providers as members. These organizations, which are generally supported by private individuals and groups, have formed the National Hospice and Palliative Care Council of the Philippines Inc. (Hospice Philippines) to promote palliative care across the country.94

In this light, the necessity of legalizing euthanasia is not as apparent as it seems for there are palliative care which caters not only to the same end but also to those ends which euthanasia cannot provide such as maintaining the highest quality of life considering the patients condition.

2. Euthanasia undermines medical research

One of the major driving forces behind the exceptional medical advances made this century has been the desire to develop treatments for previously fatal illnesses, and the eagerness to alleviate hitherto unmanageable symptoms. Medical research is essential if medicine is to advance further. When the focus changes from curing the condition to killing the individual with the condition, this whole process is threatened. The increasing acceptance of prenatal diagnosis and abortion for conditions like spina bifida, Down's syndrome and cystic fibrosis is threatening the very dramatic progress made in the management of these conditions, especially over the last two

93 94

James Hallenbeck, MD. Pallative care perspective Inquirer, 9/16/2007, Hospices offer compassionate care

decades. Rather than being employed to care and console, funds are being diverted to fuel the strategy of 'search and destroy'.95

The purpose of medical research is to find cure for what is, at the present, considered to be incurable illnesses. If the rest of countries in the world legalize euthanasia, it will weaken and undermine the improvement of medical research. Any physicians or doctors related and have potential to make advanced in scientific and health care knowledge will not get enough motivation that some people who are terminally ill will simply ended by euthanasia. They will not feel encouraged and urged to make the improvement.

3. Euthanasia violates physicians code of conduct

Traditional medical ethical codes have never sanctioned euthanasia, even on request for compassionate motives. The Hippocratic Oath states 'I will give no deadly medicine to anyone if asked, nor suggest such counsel....' The International Code of Medical Ethics as originally adopted by the World Medical Association in 1949, in response to the Nazi holocaust, declares 'a doctor must always bear in mind the obligation of preserving human life from the time of conception until death'. In its 1992 Statement of Marbella, the World Medical Association confirmed that assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. When a doctor intentionally and deliberately enables an individual to end his life, his actuation is unethical.
96

Legalizing euthanasia would render physicians duty and

obligation to cure patients nugatory since in euthanasia the physician is assisting to an easy way out that is to kill the person whom he is obliged to cure.

4. Euthanasia is driven by a cynical desire to cut health care costs

Remember, for H.M.O.s (health-maintenance organizations), profits come not through providing services but from limiting costs, meaning reducing services in some cases. Imagine the money that could be saved--and thus profits earned--by H.M.O.s by not treating cancer patients because
95 96

Peter Saunders, Twelve Reasons Why Euthanasia Should Not Be Legalized International Code of Medical Ethics adopted by 3rd World Medical Assembly, London, England,

October 1949

they 'choose' instead to be killed; in not treating AIDS patients because they choose instead to be killed; in not treating M.S. patients because they 'choose' instead to be killed; in not treating quadriplegic patients because they 'choose' instead to be killed.97 This disturbing paradigm is one reason why managed care is now called 'managed death' by those who worry about legalized euthanasia in a health-care system dominated by H.M.O.s.

The same is true with government funded health care program. With euthanasia as a means of saving expenses and making budget cuts, government will inevitably abuse this scheme. Although this may seem favorable to the government in cutting down costs, it would be contradicting to the purpose of euthanasia. The government, instead of providing sufficient health care budget, would cut down the same by rationalizing that there is a way out of unnecessary medical care to terminally ill patients that is to kill them. This insufficient budget would then mean that proper health care of those who are not supposed to be terminally ill (especially the poor) will be inadequate. The inadequacy of medical care may be, in turn, the reason for patients condition to worsen.

This is similar to the situation feared in New Zealand. Most of the beds are occupied by the elderly, but in the coming years there will be huge increase in younger patients with diabetes needing expensive dialysis treatment. Treatment is expected to be rationed, with those not making the list potentially facing palliative care in the later stages or assisted suicide. It is feared that physicians and other health care providers, will pressure patients to request assisted suicide.
98

5. Legal euthanasia is prone to abuse

In Netherlands where euthanasia is legal, a recent Dutch government investigation of euthanasia has come up with some disturbing findings. In 1990, 1,030 Dutch patients were killed WITHOUT THEIR CONSENT. And of 22,500 deaths due to withdrawal of life support, 63% (14,175 patients) were denied medical treatment WITHOUT THEIR CONSENT. Twelve per-

97 98

Wesley Smith, Consultant to the International Anti-Euthanasia Task Force. Forced Exit. 1997 www.internationaltaskforce.org/ascc.htm

cent (1,701 patients) were mentally competent but were NOT CONSULTED.99 The primary philosophical support for euthanasia is represented by a demand for radical personal autonomy. Personal autonomy is a difficult concept to develop safeguards around for vulnerable persons who often have a diminished ability or opportunity to make decisions concerning selfdetermination. Many vulnerable people have other people who are responsible for making decisions for them.100 In the Terri Schiavo case, it was a legal battle between the husband and the parents of Teresa Marie "Terri" Schiavo that lasted from 1998 to 2005. At issue was whether the equipment that had been used to sustain her life since 1990 specifically a feeding tube should be disconnected, thereby allowing her to die. Terri Schiavo collapsed in her St. Petersburg, Florida home in full cardiac arrest on February 25, 1990. She suffered massive brain damage due to lack of oxygen and, after two and a half months in a coma, her diagnosis was elevated to vegetative state. 1998 Schiavo's husband, Michael, petitioned the Sixth Circuit Court of Florida (Pinellas County), to remove her feeding tube pursuant to Florida Statutes Section 765.401(3). He was opposed by Terri's parents, Robert and Mary Schindler, who argued that she was conscious. The court determined that she would not wish to continue life-prolonging measures and on April 24, 2001 Terri's feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge ordered the removal of Terri Schiavo's feeding tube. After all attempts at appeals through the federal court system were unsuccessful, Schiavo's feeding tube was disconnected on March 18, 2005. She died at a Pinellas Park hospice on March 31. In all, the Schiavo case involved 14 appeals and numerous motions, petitions, and hearings in the Florida courts; five suits in federal district court; Florida legislation struck down by the Supreme Court of Florida; a subpoena by a congressional committee to qualify Schiavo for witness protection federal legislation; and four denials of certiorari from the Supreme Court of the United States.

99

http://www.euthanasia.com, Shreyansh Mardia on July 14, 2008, Euthanasia- Mercy Killing- An Unconstitutional Act 100 Alex Schadenberg, The Interim: Can euthanasia safeguards protect interests of vulnerable persons?

In the above case, medical practitioners are in debate of whether or not Terri was terminally ill or that her case could be cured and whether her consent and wishes are represented by her husbands affirmation. The determination of when to qualify a patient as euthanasia candidate is subjective to the doctors recommendations. Doctors, like any other professionals, are not infalliable. As such, there can never be an absolute assurance that a patient who is terminally ill today will never be cured. This scenario is often the reason why legal euthanasia is abused. In countries where there are laws regarding the conduct of euthanasia, its implementation is still abused for personal reasons. Mercy killing has become a leeway for people to justify killing either for personal or economic reasons such as their own interests in the disposition of estate through wills of the terminally ill patients.

PART II Arguments on the Morality of Euthanasia 1. Principle of Well-Being Patients well-being ought to be promoted (if not for its own sake, then because of the derivative importance of well-being). There have been several high-profile legal battles over the right to die in the UK. Perhaps most famously is the case of Dianne Pretty, a woman in the terminal phase of motor neurone disease who wanted assurance that her husband would not be prosecuted if he helped her commit suicide.

Dianne and her husband fought an unsuccessful legal battle which ended on April 29th 2002 when the European Court of Human Rights dismissed her claim that the British courts were breaching her human rights by refusing to allow her husband to help her commit suicide. Dianne, who was paralysed from the neck down, had to be fed through a tube and used a computer attached to her wheelchair to communicate, died after suffering breathing difficulties three days after the ruling the frightening death she wanted to avoid. 101

The idea of intentionally ending life due to quality of life assessment is not a feature unique to utilitarian though. Ronald Dworkin (The New York Review of Books, Ronald Dworkin, an American philosopher, and scholar of constitutional law, advocate of moral reading of the United States Constitution and an interpretivist approach to law and morality) claims that there is a sense in which most people think that life is sacred. When they say life is sacred, they mean that personal life, able to sustain critical interests, is inherently valuable. It is this sense of life that is sacred, not mere biological life that is no longer capable of sustaining personal creativity. A valuable life therefore, requires more than natural investment. A valuable life requires creative personal investment. Our lives are judged valuable as long as we are able to maintain and appreciate the value of this creative investment. There is no intrinsic value to be had in bodily life, only in the conscious control of life which individuals shape their lives. When the condition

101

Clare Dyer, The Guardian, Diane Pretty makes final death with dignity plea

of the body no longer acts in the service of this creative life of authorship, it is reasonable to intentionally seek to end life. 102 For Dworkin, then, the quality of a persons life is crucial to forming a judgment about whether or not a life is worth preserving. That decision, at least for competent patients will be determined by the judgment of individual patients. People should have the right to choose a painless and dignified end, either at the time or beforehand, perhaps in a "living will". The right circumstances might include: extreme pain and suffering; helplessness and loss of personal dignity; permanent loss of those things which have made life worth living for this individual. To postpone the inevitable with no intervening benefit is not a moral act. 103 Each individual has a right to make the most intimate and personal choices central to personal dignity and autonomy. That right encompasses the right to exercise some control over the time and manner of ones death. The patient-plaintiffs in these cases were all mentally competent individuals in the final phase of terminal illness and died within months of filing their claims. Jane Doe described how her advanced cancer made even the most basic bodily functions such as swallowing, coughing, and yawning extremely painful and that it was not possible for [her] to reduce [her] pain to an acceptable level of comfort and to retain an alert state. Faced with such circumstances, she sought to be able to discuss freely with [her] treating physician [her] intention of hastening [her] death through the consumption of drugs prescribed for that purpose.104

Clearly, it is contrary to the right to a well being to prevent persons who have clearly no other option but to await such undignified and excruciating circumstances. Moreover, it is in contradiction to a persons conscience to allow a patient to suffer instead of allowing him the right to choose to avoid such suffering.

102 103

Craig Paterson , A Natural Ethics Approach, Asisted Suicide and Euthanasia , 2008 A humanist discussion of EUTHANASIA, BHA submission to the Committee considering the Assisted Dying Bill (2004) 104 Quill v. Vacco, 80 F.2d 716, 720 (2d Cir. 1996) (quoting declaration of Jane Doe).

2. Right of Ownership

A claim in favor of a right to self determination is based on the concept of ownership. If one has a right of dominion over his property, including the disposal and destruction, the right of dominion can be extended to cover body parts and ultimately life itself. Self ownership is a concept invoked to justify freedom of the individual from the dominion of others. In a free society, you own your life, and your only obligation is to respect the legitimate rights of others. Everyone is entitled to be treated as the sole owner of his or her own life. However such concept is limited only if such exercise would infringe the right of others. In euthanasia, however, no other right except of the patients right is encroached.

3. Equal Concern and Respect

Ronald Dworkin has championed the claim that a right to make a momentous personal decision, free from coercive interference, is derived from the notion of equality of persons. In failing to respect another persons conception of what constitutes the good life, we devalue that person as a true equal. As Dworkin states in Taking Right Seriously, Government must not only treat people with concern and respect, but with equal concern and respect. It must not constrain liberty on the ground that one citizens conception of a good life is nobler or superior to anothers. 105 To say that other persons idea of what is a good life, that is free from pains and sufferings, is not the true idea of life is to say that the person saying the same has a superior notion of a good life. This paradigm is, according to Dworkin, disrespect for the other person.

4. Principle of autonomy Patients autonomy ought to be respected (if not for its own sake, then because of the derivative importance of autonomy, i.e. the fact that promoting and respecting someones autonomy generally speaking enhances this persons well-being).
105

Ronald Dworkin, A Special Supplement: Taking Rights Seriously, The New York Review of Books

Joel Feinberg has advanced one of the most comprehensive accounts of the personal autonomous self. He lists the qualities that inhere in an autonomous life; qualities such as authenticity, integrity and distinct self-identity. These qualities provide a kind of overview of the self in whom these qualities in here. The autonomous self, for Feinberg, strives to maintain self-direction in a world where external factors impinge on personal deliberations.106

In terms of the characteristics that distinguish autonomous persons, most highlight forms of selfdirectedness that distinguish autonomous persons from the condition of being subject to the controlling influence of others. The truly autonomous person forges his or her own tastes, opinions and values.

In order to genuinely respect persons as autonomous persons, we must recognize that they are able to direct their own lives and actions in accordance with their own plans, projects and personal commitments. For Feinberg, an autonomous person can reach a choice consonant with self to be free from the burdens of life providing that the choice is genuinely an expression of the self and not the result of other factors that can radically impinge upon and distort considered judgment. Hence, to compel or order a person not to have the choice to express his freedom from lifes uncertainties is congruent to infringing his right to autonomy.

In Harm to Self, Feinberg rejects the paternalistic idea that the state or other individuals can legitimately interfere with the mainly self-regarding interest of autonomous persons. Selfdetermination is characterized by the significant capacity persons have for personal autonomy. The moral freedom of people to shape their lives for themselves, without being subject to undue external control, is held central to the idea of respect of persons. In order to genuinely respect persons, we need to recognize an extensive autonomy derived right to choose how to live and die.107

In the case of In re Quinlan I, a 21-year-old Karen Ann Quinlan was admitted to the hospital in a coma, and was later declared by doctors to be in a "persistent vegetative state." After five months
106

Joel Feinberg, Voluntary Euthanasia and the Inalienable right to life, April 1, 1977, University of Michigan Craig Paterson , A Natural Ethics Approach, Assisted Suicide and Euthanasia , 2008

107

on a ventilator, her parents requested that the ventilator be removed and that Ms. Quinlan be allowed to die. After doctors refused, her parents brought the matter to court. The New Jersey Superior Court denied her parents' request, but the New Jersey Supreme Court reversed and ruled that Quinlan's "right to privacy" included her right to be removed from the ventilator. It further held that the termination of treatment pursuant to the right of privacy is, within the limitations of this case, ipso facto lawful. Thus, a death resulting from such an act would not come within the scope of the homicide statutes proscribing only the unlawful killing of another. There is a real and in this case determinative distinction between the unlawful taking of the life of another and the ending of artificial life-support systems as a matter of self-determination." 108

In the subsequent case of Cruzan, US Court held that State is not required to accept the 'substituted judgment' of close family members in the absence of substantial proof that their views reflect the patient's.
109

In another case, US Court held that the assumption of a right to

refuse treatment was grounded not, as the Court of Appeals supposed, on the proposition that patients have a general and abstract 'right to hasten death'... but on well established, traditional rights to bodily integrity and freedom from unwanted touching." worth to note that the principle of autonomy is greatly considered.
110

In the above cases, it is

108 109

In re Quinlan, 70 N.J. 10 Mar. 31, 1976 Cruzan v. Director, Missouri Dept. of Health 497 U.S. 261June 25, 1990 110 Vacco v.Quill 526 U.S. 793 June 26, 1997

Arguments on the Immorality of Euthanasia

1. Disrespect for human life and human dignity To the argument that euthanasia promotes dying with dignity by ending terminally ill patients lives, is it disrespect to human dignity in taking a life which based on the above discussion is still dignified? When physicians choose to end a persons life, is he not saying also that the person has no more human dignity? And if so, are they in a position to suggest when dignity can be breached? And in cases where the patient chooses to die due to incapacities, does he attribute his dignity to mere intellectual capacity to choose? Essentially, Keown111 and Gormally112 write from the unacknowledged perspective of neonaturalism. The fundamental assertion of these authors is the recognition that every human being, however mentally, impaired, possesses a fundamental worth and dignity which are not lost as he or she is alive. For Kewon and Gornmally, this concept is absolute. Kneown and Gormally suggest that attaching any diminished worth to brain-dead individuals makes the possession of human worth depend on an arbitrary discrimination between individuals.113 It is necessary to begin with the recognition that every human being, however immature or mentally impaired, possesses a fundamental worth and dignity which are not lost as long as he or she is alive. Contrary to the view of some, human worth and dignity do not depend on acquiring and retaining some particular level of intellectual ability or capacity for choice or for communication. On that view of human worth and dignity, it turns out that the relevant level of intellectual ability or whatever other characteristic is asserted to be morally decisive always require to be determined in an arbitrary fashion. In making the possession of human worth and dignity depend on an arbitrary discrimination between individuals; this view destroys the indispensable foundation of justice in society. For basic human rights belong to human beings precisely because of their worth and dignity, and if the possession of the latter is to be determined arbitrarily ( as between those who are terminally ill or those who lack intellectual ability such as brain dead and other incompetents ( persons in vegetative state) so will be the
111 112

http://en.wikipedia.org/wiki, Damien Keown is a prominent bioethicist and authority on Buddhist bioethics. http://ajgoddard.webnode, Luke Gormally is a leading Roman Catholic bio-ethicist who is Senior Research Fellow and former Executive Director of the Linacre Centre for Healthcare Ethics in London 113 Ian Harriss, Ethics and euthanasia: Natural law philosophy and latent utilitarianism

possession of the former ,but there cannot be a framework conducive to just relationships in a society if who are to count as the subjects of justice is determined in an arbitrary fashion. For this reason, the recognition of the fundamental worth and dignity of every human being is the indispensable foundation of justice in society. In other words, human rights are enjoyed in virtue of common humanity, not the possession of some arbitrarily stipulated human ability at some arbitrarily stipulated level.114 Further, this arbitrary fashion is exhibited in the view that those who have suffered severe brain damage, resulting in permanent loss of consciousness or of cognitive abilities, no longer possess worthwhile lives. But this view of certain gravely impaired human beings is incompatible with recognition of their basic worth and dignity. It is the view which underlies the claim that it is reasonable to aim, at least by omitting treatment and care, to end the lives of these persons when they are patients. This judgment may also be arrived at on the basis of the assertion that such persons, being unaware, no longer have any `interests' 115, so that, there being no positive good of theirs at which one could aim, one may rather aim at ending their lives. But none of us has to be conscious of all prospective benefits or interests to be the recipient of the same. And if we can be the recipients of benefits, we can have an interest in being benefited without that interest being a conscious interest. All of us, indeed, have an interest in not being treated in ways which are inconsistent with recognition of our dignity as human beings, whether or not we are aware of that interest.116 Another way in which the fault of denying worth to certain human lives is exhibited is in the judgment that the value of a life depends wholly on the value and importance a person gives to his or her life through his choices. If that were so, then loss of the capacity to choose would bring about a state of affairs in which the only value one's continued existence would have would depend on the value one had chosen to attach to it when competent or when still intellectually conscious. This is the understanding of the value of a life behind the view that, in respect of a person's own life, his or her choices made prior to loss of competence should be allowed to

114

(John Keown MA (Cantab) DPhil (Oxon), Human Dignity, Autonomy and Mentally Incapacitated Patients: A Critique of Who Decides? A view entertained by Who Decides? at 5.24, following LawCom231: 6.17, following Lord Mustill in Bland http://www.linacre.org/whodec.html citing Johns Keown: Human Dignity, Autonomy and Mentally Incapacitated Patients: A Critique of Who Decides?

115 116

determine when his or her life is to be ended, in cases, when that may be purposefully achieved by omission of treatment or care. 2. Euthanasia is against human nature Every human being has a natural inclination to continue living. Our reflexes and responses fit us to fight attackers, flee wild animals, and dodge out of the way of trucks. Our bodies are similarly structured for survival right down to the molecular level. When we are cut, our capillaries seal shut, our blood clots, and fibrogen is produced to start the process of healing the wound. When we are invaded by bacteria, antibodies are produced to fight against alien organisms, and their remains are swept out of the body by special cells designed for clean-up work117. To allow pre-emption of death violates this natural goal of survival. It contradicts this nature because all processes are bent towards the end of bodily survival. By human beings bodily composition alone indicates that our natural inclination is survival. Allowing human beings to artificially interfere with the natural process of death violates human nature and in so doing, it violates dignity. Dignity comes from seeking human beings ends. When one of the goals is survival, and actions are taken that eliminate the goal, then the natural dignity suffers. Unlike animals, human beings are conscious through reason of their nature and their ends. Euthanasia involves acting as if this dual nature, the inclination towards survival and awareness of this as an end, did not exist. Thus, euthanasia denies our basic human character and requires that human beings regard themselves or others as something less fully human. 3. Euthanasia is against self interest Because death is final and irreversible, euthanasia contains within it the possibility that human beings will work against their own interests if they practice it or allow it to be practiced on them. Although contemporary medicine has high standards of excellence and a proven record of accomplishment, it does not possess perfect and complete knowledge. A mistaken diagnosis is possible, and so is mistaken prognosis. Consequently, belief of dying may be made in error. They may believe that there is no hope when, as a matter of fact, the chances are good. Also,

117

J. Gay-Williams, The Wrongfulness of Euthanasia, 1992 In Ronald Munson, ed., Intervention and Reflection: Basic Issues in Medical Ethics, Belmonth, CA: Wadsworth

there is always the possibility that an experimental procedure or a hitherto untried technique will pull as through. It is viewing the body as a target to be dominated and killed that differentiates an act of euthanasia from the morally acceptable practice of withdrawing futile medical treatments. Letting a dying person die without prolonging his or her death allows us to give up useless and burdensome interventions. In a naturally inevitable death, a whole person as an embodied self dies from an irremediable medical condition. 4. Policy of slippery slope Many people worry that if voluntary euthanasia were to become legal, it would not be long before involuntary euthanasia would start to happen.118 A person apparently hopelessly ill may be allowed to take his own life. Then he may be permitted to deputize others to do it for him should he no longer be able to act. The judgment of others then becomes the ruling factor. Already at this point euthanasia is not personal and voluntary, for others are acting on behalf of the patient as they see fit. This may well incline them to act on behalf of other patients who have not authorized them to exercise their judgment. It is only a short step, then from voluntary euthanasia, to directed euthanasia administered to a patient who has given no authorization, to involuntary euthanasia conducted as part of social policy. Moreover, when euthanasia becomes involuntary, the right to autonomy and self determination becomes nugatory as the person who wants to die are not the entirely and solely the one taking his life.119 Holland has euthanasia. They started out killing the terminally ill, but have veered markedly from this approach. Some estimate that over 50% of those euthanized in Holland are killed

118

Lord Walton, Chairman, House of Lords Select Committee on Medical Ethics looking into euthanasia, 1993 We concluded that it was virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law in the United Kingdom could not be abused. We were also concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to request early death.

119

J. Gay-Williams, The Wrongfulness of Euthanasia, 1992 In Ronald Munson, ed., Intervention and Reflection: Basic Issues in Medical Ethics, Belmonth, CA: Wadsworth

without consent. Some of the elderly are afraid to go to the doctor, for fear they will receive involuntary euthanasia.120 5. Argument on individualistic decisions Whence would come such an individualistic moral right or assumption of absolute dominant power? After all, each persons self-consciousness like each individuals body, has been created and received from the persons parents and forebears, and nourished by the community and culture in which the persons life is organically embedded. A human life and identity is a gift from evolutionary biology, natural ecological conditions, parental procreative child rearing, and collective cultural socialization- all transcending the individual power of self-determining will claiming unilateral life or death powers121. Feminists understand that individuals cannot be treated or treat others as though they are alienate monads cut off from all bonds with one another. Having received the gift of life and social identity, one has a moral obligation to preserve and respect each human life and refrain from suppressing, killing or destroying self or others. Which one is permitted to do to ones self and which others are permitted to do to one these cannot be morally or psychologically separated122. When a person seeks or assists an act of euthanasia, he acts to end all human relationships. No more comfort can be given or received; no more befriending or watching and waiting with another will take place. Interpersonal bonds will be decisively cut off, all human dependence and interdependence rejected. Exercises of autonomy, of the capacity for self-determining choice are not the fundamental source of worth and value in a person's life. Human beings possess an ineradicable value prior and subsequent to the possibility of exercising autonomy. Autonomy itself as a capacity is to be valued precisely in so far as its exercise makes for the well-being and flourishing of the human beings who possess it. But it is plain that many exercises of the capacity, that is, many self-

120 121

R. Tom Tolomeo, "Big Brother, M.D.," All About Issues, July-August 1993

Sydney Callahan, A feminist case against euthanasia, Women should be especially wary of arguments for the freedom to die. 122 Ibid.,

determining choices, are destructive of human well-being -- both in the life of the chooser and in the lives of others affected by his or her choices. The mere fact that someone has elected to act or to be treated in a certain way establishes no title to moral respect for what has been chosen. The character of the choice must satisfy certain criteria in order to warrant our respect. The most basic criterion is that a choice should be consistent with respect for the fundamental dignity both of the chooser and of others. Since justice in society rests on belief in the ineradicable value of every human life, whatever its condition, a just legal system cannot look favorably on choices to kill a person based on the judgment that his or her life is no longer worthwhile123.

123

(John Keown MA (Cantab) DPhil (Oxon), Human Dignity, Autonomy and Mentally Incapacitated Patients: A Critique of Who Decides?

Part III Proponents Position

Considering the present circumstances involving euthanasia, the proponents believe that euthanasia should not be legalized. Before dealing with the morality of euthanasia, considerations of its potential impact on society should be dealt with.

First, it will affect medical research. One of the major driving forces behind the exceptional medical advances made available in this century has been the desire to develop treatments for previously fatal illnesses, and the eagerness to alleviate hitherto unmanageable symptoms. At present, medical research is being funded to provide cure for those illnesses which are proven to be fatal and incurable. The research for AIDS pandemic, for example, has greatly been advanced at present in that a person infected can survive up to 50 years with proper treatment. This was not the case 20 years ago. What made this and all other kind of researches to advance such considerable extent is the inevitable possibility that even the most fit and healthy people may fatally suffer from these illnesses. If our way to counter the pain and suffering of terminally ill patients is to kill them or allow them to die without medical treatment, then the efforts of scientists and physicians to advance in scientific discovery and research will become futile.

Second, it will impact health care cost. It may seem that legalizing euthanasia may shorten hospital confinement and potentially save cost for both private individuals and the government through health care system following the save the money by killing the sick argument. It is still a shaky ground where public confidence must rest upon. In Oregon, for example, where euthanasia is legal, there had been instances where the Oregon Medicare denied chemotherapy, and offered to pay for killing the patients instead124. Moreover, it would become contrary to public policy when people, instead of being given medical assistance, are provided with a less costly solution of ending their lives. Although this is more likely speculative, the fact that it happened in places where euthanasia is legal does not preclude the probability that the same may also happen.

124

Wesley J. Smith, June 20, 2009, Save Money by Killing the Sick: Euthanasia as Health Care Cost Containment Not Such a Parody as the Author May Think

Third, it will require further legislation for its procedure for checks and balances. In countries where euthanasia is legal, there are certain legislations, such as Australias Terminally Ill Act of 1995, that were enacted to prescribe the procedures for the administration of euthanasia. In these legislations, a heavier burden is given to physicians in ascertaining if the patients condition is terminal. There are also requirements imposed upon the medical practitioners like the consensus of a third opinion is necessary to ascertain the condition of the candidate of euthanasia. Although there are procedures to ensure propriety of the execution, these legislations still did not prevent cases like the Schiavo case where medical practitioners are in debate of whether or not Terri was terminally ill, or that her case could be cured; and, whether her consent and wishes are represented by her husbands affirmation. The determination of when to qualify a patient as a qualified euthanasia candidate is subjective to the doctors recommendations. This is definitely a scenario that can potentially be terrifying, considering that misdiagnosis often times occur in the medical field. People may be killed in the premise that their conditions are incurable when in fact the same can be treated.

Fourth, it will negate palliative care. One of euthanasias goals is to end the patients unbearable pain. Palliative care, on the other hand, seeks to provide relief from pain and uncomfortable symptoms while integrating psychological and spiritual features of patient care. Although Palliative care may not totally abrogate the pain and suffering of the patient, it still seeks to minimize such. Not only does it provide physical relief, but also it addresses the psychological and spiritual needs of patients through varied programs. Formally introduced in the Philippines in 1993, the hospice movement now counts 23 institutions and 520 service providers as members.

Lastly, it will afford religious scrutiny at least to Christian countries like the Philippines. There are cases where euthanasia is impliedly and indirectly practice in hospitals as when comatose patients, by family members request or financial incapacity, opt to put off life support machine and allow such patient to breathe naturally, which is not sufficient to sustain his or her life, hence, eventually die. To legalize euthanasia is to put affront such practice and make it more evident. Recognizing the scrutiny which the Reproductive Health Bill is receiving by the

religious sectors, there is no reason to believe that the same will not receive such scrutiny. Moreover, considering the moral norms and beliefs system of the country, it is evident that life is valued greatly regardless of the incapacities of the human person. This will only be a subject to political and religious intervention that will bring about pickets and potentially boycotts of hospitals.

As to its morality or immorality, the proponents believe that euthanasia should not be countenanced.

The debate over the morality of euthanasia lies essentially between the sanctity of life, on one hand and the quality of life on the other. If a person who is terminally ill has only a month to live, pro-euthanasia argues that if the person wants to die to avoid having to suffer a month of agonizing and tremendous pain, he should be allowed to do so. On the other hand, antieuthanasia would argue that ending ones life would be disrespecting the sanctity of life. Essentially the proponents find that the arguments rest on the question: When do we consider the sacredness of life? Is it a life without personal creativity or personal competency? Or is the respect absolute in as long as life remains? It is in this position that the proponents believe that dignity of human life should not be arbitrarily determined. The proponents believe that human dignity is fundamental in every human being and that it is not lost by the absence of some degree of personal creativity or intellectual ability. Moreover, the determination of the candidacy for euthanasia, as observed in other countries where it is legal, rests upon the recommendations and opinions of medical practitioners. Hence, when a person is terminally ill and is recommended by the doctor to be put to death to avoid either useless costs or insurmountable suffering, is the doctor saying that his life has no more worth and that he be better off dead? It is in this note that the proponents find euthanasia, in a way, disrespectful of the intrinsic value of human dignity. The proponents believe that no human reason can entirely and succinctly grasp the determination of human dignity for only the Supreme Being according to the divine law has monopoly of it. Thus, no one should be allowed to determine when a human being is undignified. Worthy to note also is that human beings possess an ineradicable value prior and subsequent to the possibility of exercising

autonomy. A baby who cannot decide on his own does not have autonomy or personal creativity yet but it is of common conviction that he or she possesses dignity. The same should also hold true of terminally ill patient who is bereft of such autonomy.

As to the principle of autonomy and principle of self determination, the group finds the same contradicting to the nature of man. Proponents of euthanasia argue that in order to genuinely respect persons as autonomous beings, we must recognize that they are able to direct their own lives and actions in accordance with their own plans, projects and personal commitments. The proponents believe, as J. Gay Williams posits that human beings have the natural inclination to continue surviving. Bodily human self-healing mechanism provides that inclination of continued survival. To allow people to decide to kill themselves based on respect for personal autonomy and self determination would be in contradiction to the nature of human beings to fight for survival rather than succumb to extinction.

Moreover, the proponents believe that pro-euthanasia is at fault by denying worth to certain human lives exhibited by the judgment that the value of a life depends wholly on the value and importance a person (or his family member) gives to his or her life through his choices. It is in this position that the proponents adhere to the feminist view that human life and identity is a gift from evolutionary biology, natural ecological conditions, parental procreative child rearing, and collective cultural socialization- all transcending the individual power of self-determining will claiming unilateral life or death powers. Self determination and autonomy should be actualized in the context of communal responsibility and not only of personal determination. When a person decides to die, that such person not only chooses to be dead but also to be cut off from all interpersonal relationships, he chooses to be cut off from the bonds that he has to his family, as well as to the community.

Lastly, as to the battle between pain versus relief, the proponents find that though a patient in pain may be better off dead to save him from the insurmountable pain, the weight accorded to value for human life and dignity outweighs emotional feelings from such circumstance. Further, the group also believes that such predicament can also be an opportunity

to provide care and compassion to loved ones, thus strengthening the interpersonal bond while awaiting the natural and eventual death.