Pain or Glory
As between a person's right to die and the society's role in preserving life, which one should prevail? For many years, physician-assisted death (PAD) has been the subject of debate because it concerns two of the most important roles of a nation: its role in safeguarding the Constitutional rights of its people; and its role in preserving the life of its citizens. Physician-assisted death (PAD) is normally equated with something bad. It is often perceived as an immoral and unethical practice. The immorality of PAD is based on the belief that a person, no matter what pain he is going through, should be given the absolute right to live. Life should not be taken from someone simply because a person chooses to end his suffering. On the contrary, the Constitution of the United States is enacted to give every citizen of the nation their respective rights and freedom, and included in these rights and freedom is the right of a person to make his own choice when confronted with death. When faced with the idea of euthanasia or assisted suicide the legal system must ensure that the constitutional rights of the patient are maintained, while protecting society interests in preserving life, preventing suicide, and maintaining the integrity of each medical professional.
Physician assisted death (PAD) refers to the practice wherein patients who are terminally ill, of competent mind and not clinically depressed can will to end their lives either through euthanasia (the active assisted death) or physician-assisted suicide (the passive kind of assisted death) (Dixon 25). Euthanasia involves the active intervention of the physician in terminating the life of his patient. On the contrary, in physician-assisted suicide, the patient who wills to die stop receiving life-supporting therapy, thus leading to the death of the patient. Currently, there are three states in the United States where PAD is legal by virtue of a state law. These states are Vermont, Washington and Oregon. Likewise, PAD is legal in Montana, however this time by virtue of a court ruling. This legalized practice however has not increased the number of death in significant number because there are different processes that must be observed before a doctor can perform either euthanasia or assisted suicide.
There are many reasons for performing a PAD. First, euthanasia or assisted suicide helps patients with terminal illnesses alleviate their pains and sufferings. As further argued by Biller-Andorno (1451), physicians have an obligation to mitigate the pain that their patients are suffering from. It is in fact a way of respecting the dignity of those patients who have terminal conditions and are in extreme pain. Such patients would rather choose to end their lives in a dignified manner rather than constantly suffer from the unbearable condition that is incapacitating them to function in any dignified human manner. If not for PAD, such patients would be compelled to suffer further as their condition continuously deteriorates. Physicians should be legally allowed to cooperate and comply with the wishes of such patients [the terminally ill patients] when the time comes that they pray for a merciful end to their indignity and suffering. In fact, according to Biller-Andorno (1451), "responding to such a carefully considered request can be compatible with the goals and ethos of medicine, as well as with a trusting patient-physician relationship." Second, if a terminally ill person can choose when they are going to die, they can save their loved ones from a lot of pain (Salem 33). No person would want to see their loved one suffering. Physician-assisted suicide will therefore give friends and family members the opportunity to expect the death of their loved one and say their goodbyes. Third, is the so-called "right to die" of every person recognized by the Constitution.
The "right to die" argument is perhaps the most persuasive reason why some states legally allow PAD. Like the right to live, the right to die should be a fundamental freedom accorded to every individual. These states recognize and respect the choice of those who have terminal illnesses to die in a dignified and peaceful manner. All individuals have a moral right to freely choose what they want to do with their lives provided that their options do not step into the rights of or injure other people.
The so-called "right to die" has indeed a Constitutional foundation that has been established in various court decisions. In the case of Compassion in Dying v State of Washington, the Federal Ninth Circuit Court of Appeals ruled that the constitution gives people the right to end their lives provided that they are terminally ill and competent enough to give their acquiescence to the act. Specifically, the ruling in the case declared unconstitutional, as being violative of the substantive due process protected under the 14th Amendment, a Washington law that banned physician-assisted suicide. The ruling further discussed that a person's right to die is guaranteed within the zone of privacy safeguarded by the very word "liberty" in the 14th Amendment (Drinan 6). Such right of privacy provides individuals their personal autonomy to choose to die if their death is imminent and they want to end their lives in dignity.
In fact, even prior to the case of Compassion in Dying v State of Washington, there had been previous court decisions that recognized the right of the people to die as being included under the "liberty interest" protected under the 14th Amendment. The first legal case that resolved the issue on the right to die was the Quinlan Case where the New Jersey Supreme Court ruled that the right of the parents of Quinlan to discontinue the ventilator and let their daughter die rooted from the citizens' unwritten constitutional right to privacy which was implied in the Bill of Rights and acknowledged by the Supreme Court of the United States (Kollas & Boyer-Kollas 1150). In the case of Cruzan v Director, Missouri Department of Health, the U.S. Supreme Court made a decision in favor of the family of Cruzan asking for the latter's feeding tube to be removed. The ruling the U.S. Supreme Court was mainly based on the "liberty interest" under the Due Process Clause in the 14th Amendment.
The case of Terri Schiavo is another controversial issue that raised several concerns about the rights of citizens protected under the United States Constitution. Particularly, Terri Schiavo's case raised the issue on a person's right to die and whether such right has indeed a legal or constitutional basis (Miller). Terri suffered from a cardiac arrest allegedly because of her eating disorder. She was immediately rushed to the hospital. Due to the coma status of Terri, she was declared by the Circuit Court of the Sixth Judicial Court of Florida incapacitated and assigned her husband, Michael Shiavo, as her legal guardian. Seven years after the collapse of Terri, Michael petitioned the court to remove the feeding tube of Terri. Michael, the proponent in the case, argued that Terri, who died without a living will, would have prayed to remove her feeding tube to end her sufferings. On the other hand, the parents of Terri, the opponents in the case, argued that Terri would have wanted to continue fighting for her life. The favorable ruling in Terri Schiavo's case on the part of the proponent was also predicated upon the implied constitutional right to privacy of individuals. According to Kollas & Boyer-Kollas (1150), the implied constitutional right to privacy ensures the people of the United States the right to decline any unwanted medical treatment. The fact that the person who wanted to exercise such right was incapacitated should not be a ground for the extinguishment of such basic personal right. To implement such right, another individual should exercise such personal right on behalf of the incapacitated person. In Terri Shiavo's case, it was her husband and legal guardian, Michael, who exercised the right which belonged to Terri who was in a persistent vegetative state.
Additionally, the court decided to remove the feeding tube of Terri Schiavo based on the Due Process Clause in the 14th Amendment. As mentioned in the previous right to die cases before the U.S. Supreme Court, the "liberty interest" within the Due Process Clause in the said Amendment gave Terri Shiavo her personal autonomy to decide when to die and how to die. Through Terri's husband and legal guardian Michael, it was made clear that Terri, if she was capacitated, would not have chosen to prolong her sufferings through a life support. Michael further communicated the prayer of Terri to remove the tube to end her life. Given her constitutional right not to be deprived of her liberty to live her life the way she wanted, the court favored the arguments of Michael. Her feeding tube was eventually ordered by the court to be removed. In further scrutinizing the decision of the court based on this personal autonomy right embedded in the liberty interest within the Due Process Clause of the 14th Amendment, the court recognized the importance and fundamentality of such right, hence should not be infringed upon by the government or the court unless there is a compelling state interest (Gostin 2403). However, in the case of Terri Shiavo, the right of the latter to remove her feeding tube outweighed the compelling interest to prevent such action because of the state's role in protecting and preserving lives (Gostin 2404). Terri Shiavo's liberty of personal privacy took precedence over any opposition to her option to remove her feeding tube.
The case of Terri Shiavo, with respect to her right to die, proved to be an important court decision as regards the application of the 8th and 14th Amendments. In this case, it was made clear that private actions of individuals, such as the decision to remove a life support, is beyond the protection of the 8th Amendment against cruel and unusual punishment-the parents of Terri Shiavo alleged that removing the feeding tube and letting Terri die of hunger and dehydration was a cruel and unusual form of punishment under the 8th Amendment. However, the protection against cruel and unusual punishment applies only when the punishment is inflicted by the government or any of its agents, and not when it is inflicted by a private individual in a private action (Miller). As to the issue on right to die, such right is granted by the "liberty interest" within the Due Process Clause of the 14th Amendment. Such liberty interest gives people their personal autonomy and right to privacy to decide what to do with their lives with very minimal interference from the government.
Yet, despite the Constitutional justification for euthanasia and assisted suicide, the medical profession is still confronted with ethical issues regarding the performance of PAD. Physicians have a moral responsibility to preserve and protect the lives of their patients. Physicians who are permitted to assist people in terminating their lives violate the primary duty to respect life. Additionally, it is perceived that the very concept of PAD violates that International Code of Medical Ethics, particularly provision stating "A physician shall always bear in mind the obligation to respect human life" (WMA International Code of Medical Ethics). There are physicians who perceive that PAD is unethical as it runs counter to their Hippocratic Oath. As mentioned, the very idea of PAD challenges the primary role of doctors as healers of the people. Furthermore, PAD might put friends and family members in an undue moral and ethical problem, specifically in instances when the doctor is unavailable in the process of the suicide attempt of the patient (Ardelt 426). In such case, the patient might call for a friend or a family member to help him administer the lethal medication, and if the process does not work, the family member or friend might be compelled to take some actions to accelerate the dying process of the patient. According to Ardelt (426) , for a family member or a friend who has witnessed and participated in the suicide of his or her loved one, the emotional and psychological effect might be too adverse. There is also the issue on "slippery slope" view-that the legalization of PAD for patients who are terminally sick might open the gate for PAD for patients who are psychologically depressed, or physically disabled, or those vulnerable patients who seek early death (Ardelt 425).
Considering the moral and ethical issues associated with PAD as well as the Constitutional right of a person to die as protected by his right to privacy under the Due Process Clause of the 14th Amendment, the legal system recognizes its role in protecting the interest of the society in preserving life and maintaining the integrity of the medical profession. Thus, in deciding whether or not to legally allow PAD, the court carefully determines whether the guidelines set for the performance of PAD are strictly followed. These guidelines safeguard the rights of the patient and of the physician who are going to perform PAD. Also these guidelines ensure that euthanasia or assisted suicide will not be arbitrarily used and abused. The guidelines for euthanasia or assisted suicide vary from state to state, but these guidelines have common requirements. One of the common requirements is that the patient must be diagnosed as terminally ill or declared permanently unconscious (Salem 30). The patient must be able to give his full consent to euthanasia or assisted suicide. The patient must be of sound mind to give his consent. If the patient cannot give his consent due to his condition, an advance directive (like a living will) stating the patient's wishes concerning his personal medical treatment in case he becomes terminally ill or permanently unconscious should be taken into careful consideration (Snyder and Sulmasy 211). In the absence of a patient's full consent or advance directive, the court will honor the substitute judgment of the surrogate decision-maker, who is appointed by the court or by virtue of a power of attorney, regarding the personal health care of the patient represented by the surrogate (Snyder and Sulmasy 211). The court applies the doctrine of best interest in determining whether or not to honor the decision of the surrogate. The doctrine of best interest provides that that the surrogate should make a substitute judgment that would give the patient he is representing the most benefit (Snyder and Sulmasy 211). Apart from the aforesaid requirements, it is also necessary that two doctors validate the diagnosis of terminal disease and that the patient has roughly six months to live (Salem 31). Apart from the validation of the doctors, two other witnesses must corroborate the request of the patient.
Every person should not be denied of their freedom to choose to end their sufferings. Every person deserves to have a peaceful and dignified death. Besides, the Constitution provides people their right to privacy which is broad enough to encompass the right of every individual to die according to their wishes. Again, euthanasia or physician-assisted suicide is not an invitation to arbitrarily resort to it simply to escape life. It requires careful considerations and a lot of tests to ensure that rights are protected and that the guidelines are strictly followed. Given the issues at stake, the administration of euthanasia or assisted suicide should be carefully studied and all requirements for its administration must be strictly complied with.
Works Cited
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Cruzan v. Director, Missouri Department of Health. 497 U.S. 261. 1990. Web. 21 May 2015.
Dixon, Nicholas. "On the Difference between PhysicianâAssisted Suicide and Active Euthanasia." Hastings Center Report, 28.5 (1998): 25-29. Print.
Drinan, Robert Frederick. "The Constitution and the Right To Die." America, 20.174 (1996): 6-7. Print.
Gostin, Lawrence O. "Ethics, the Constitution, and the Dying Process: The Case of Theresa Marie Schiavo." Jama, 293.19 (2005): 2403-2407. Print.
In Re Quinlan. 70 N.J. 10, 355 A.2d 647. 1976. Web. 21 May 2015.
Kollas, Chad D., and Beth Boyer-Kollas. "Closing the Schiavo Case: An Analysis of Legal Reasoning." Journal of Palliative Medicine, 9.5 (2006): 1145-1163. Print.
Miller, Robert T. The Legal Death of Terri Shiavo. May 2005. Web. 21 May 2015.
Salem, Tania. "PhysicianâAssisted Suicide: Promoting Autonomy-Or Medicalizing Suicide?." Hastings Center Report, 29.3 (1999): 30-36. Print.
Snyder, Lois, and Daniel P. Sulmasy. "Physician-Assisted Suicide." Annals of Internal Medicine, 135.3 (2001): 209-216. Print.
WMA International Code of Medical Ethics. 2015. Web. 4 Apr. 2015.
