Euthanasia: a Greek word meaning "a good death." For many, the word connotates a death that is anything but good. For others, such as Derek Humphry, founder of the Hemlock Society, "The right to choose to die when in advanced terminal or hopeless illness is the ultimate civil liberty." Good or bad, euthanasia has risen to the forefront of American debate, and is not likely to recede in the near future.
The flames of this debate were fanned on Tues., Apr. 2, when the U.S. Second Circuit Court of Appeals in New York legalized the prescription of lethal drugs to terminally ill patients. As a reversal of a prior New York law which prohibited physician-assisted suicide, the Quill v. Vacco decision will be regarded as a national precedent for the judicial regulation of euthanasia.
One of the three judges on the case, Guido Calabresi, is a Sterling Professor of Law at Yale and an ex-dean of the Yale Law School. However, Calabresi was not at liberty to discuss the details of the case because it is likely to be appealed.
Even members of the medical community who support euthanasia express discontent about the decision. Dr. Robert J. Levine, a professor at Yale Medical School and scholar of medical ethics, said that he found the decision "terribly disappointing."
Dr. Sherwin Nuland, MED '55, author of How We Die: Reflections on Life's Final Chapter and a Yale Medical School professor, said the ruling "makes no sense." He mentioned a colleague who, after the decision, said, "the judges must have been smoking dope."
Why do Levine and Nuland, neither of whom adamantly oppose physician-assisted suicide, groan in reaction to the recent court decision?
Nuland's answer is simple. "Courts shouldn't have anything to do with it," he said. Nuland argues that the decision to die is a personal one which is best made in private between a doctor and his patient.
Levine believes the court decision trivializes the issue. "People concerned with medical ethics have spent years distinguishing active from passive euthanasia, and the court's opinion utterly disregards these distinctions," he said.
Others wholeheartedly embrace the Second Circuit's decision as an important stepping-stone toward legalized euthanasia in all 50 states. Humphry, while pleased, admitted the decision is hardly a unanimous declaration of support. "Judges decide issues like abortion and euthanasia on personal moral grounds and look for parts of the law to support their decision," he said.
Humphry, an advocate of an individual's "right to die," falls in line with Dr. Jack Kevorkian, who is perhaps the biggest reason that euthanasia has become such a hot topic. Kevorkian, who was originally scheduled to speak at Yale this spring, has been present at over 24 assisted suicides. Despite numerous trials, Kevorkian has yet to be convicted.
Even those who do not approve of Kevorkian's methods see a positive result from the publicity surrounding him. "Kevorkian is a terrible, terrible problem," Nuland said, "but he's good in that he's forced the rest of us [doctors] to talk about it."
"If you polled 100 doctors over the age of 50-and they were completely honest with you-a great number would admit to having assisted a terminally ill patient in committing suicide," Nuland said. "It's been going on in private for so long, it's about time we can talk about it.
"It's a doctor's duty to do anything in his or her power to relieve the suffering of their patient," Nuland said, "And if I've exhausted every effort...it's my obligation to my patient to help him die."
Nuland finds both support for and against his argument in, of all places, the Hippocratic oath. He acknowledges that the oath reads, "I will give no deadly medicine to anyone if asked, nor suggest any such counsel." Nuland, however, points to another passage: "I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious or mischievous." He regards this passage as justification for a doctor to assist in suicide if and when all other options have been considered.
But Nuland is quick to point out that physician-assisted suicide isn't always the answer. Levine brought up the psychology of euthanasia. "By bringing up euthanasia," he said, patients may hope to "get the doctor to start offering other solutions."
Others fear patients may opt for euthanasia in a state of depression. Euthanasia Research and Guidance Organization (ERGO!), founded by Humphry, advocates a 14-day waiting period to think about the decision and a psychological profile to insure against depression-motivated decisions.
ERGO! also seeks to allay concerns that courts may legalize euthanasia without setting standards for its practice. "The public appears to approve [euthanasia], so there ought to be laws that govern it," Humphry said.
The opponents of euthanasia are equally convincing. They generally see euthanasia as a "sin against nature, and if you're a person of faith, it's a sin against God," Nuland said. And indeed, the most vocal opponents of euthanasia are the Catholic Church and those on the religious right.
Kagan spoke of other arguments against euthanasia. The "slippery slope" theory states that a small step in the wrong direction-such as legalizing termination of life support-will lead to more drastic measures, until we advocate the murder of people who are perceived as a burden on society. The "slippery slope" theory has been gaining strength, with recent fears that HMOs may regard euthanasia as an economical alternative to long-term care for terminally ill patients, and thus fail to take adequate meaures to ensure that assisted suicide is not requested from depression.
"If [you believe that] life has some intrinsic value, then killing-even if you're suffering-goes against the basic value of life," Kagan said. He continued, "Then again, is it denying one's autonomy by not letting them die?"
Levine said, "Any thoughtful person can't be either [pro or con]. The answer has to be, 'it depends.'"
Copyright 1996, The Yale Herald, Inc. All rights reserved.
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