Medicus

It Used to Be Simple

John Grauke

he really hard work of not having God is in having to be god in the myriad of areas where He expresses Himself. "I am the Alpha and the Omega the First and the Last" (Rev. 1:7). To the Alpha we say, "not so fast there," to the dirge of 1.5 million abortions a year. And now to the Omega we coin phrases like "physician-assisted suicide" and "voluntary active euthanasia." This topic has provoked a wealth of scholarly work, has inspired grass-roots movements for the liberalization of current law and policies, has informed state referenda, and has been a focus of attention for national media. [1]

Despite the growing popular support, strong professional, legal, and moral restrictions against murdering a patientoops, I meant to say, aiding the death of a patientexist. Since at least the 19th century, physicians in the United States have expressed strict opposition to any form of physician aid in dying even when faced with extreme nonphysical suffering. [2]

The American Medical Association (AMA) has declared an official stance consistent with the principle of double effect. Adherents deduce that an action that has both known beneficial and harmful effects can be justified by the beneficial intention that motivates the person who initiated the action. Thus, morphine can be given to relieve suffering, not to hasten death, a known side effect. [3]

The AMA's Council on Ethical and Judicial Affairs also stated its opposition to physician-assisted suicide or euthanasia. Although the council recognizes that the purpose of physician-assisted suicide and euthanasia is to relieve a patient's "intolerable and incurable suffering," it objects to the risks such actions pose to maintaining the integrity of the medical profession. [4] However, with no more moral ballast than "maintaining integrity," the journey to the bottom of the slippery slope may be short indeed.

Frank G. Miller and Howard Brody in an article in "The Hastings Center Report" in May-June of 1995 concluded: "The practice of voluntary physician-assisted death as a last resort is compatible with doctors' duties to practice competently, to avoid harming patients unduly, to refrain from medical fraud, and to preserve patients' trust. It therefore does not violate physicians' professional integrity."[5]

And so the battle goes as physicians, medical ethicists and others jockey to occupy the ground underneath the tree in the center of the garden. The game is played like the childhood game of "Apple Core." A moral, ethical, economic, or administrative argument is posed and players hurl missiles gleaned from the tree above at the latest target. Unfortunately, as Christians join in the fray, they have already conceded defeat. The missiles they are throwing also came from the tree above. The remnant of Christian world view is apparent in many of the more cogent arguments against euthanasia, but it still amounts to throwing cores rather than obeying the admonitions regarding the tree.

The arguments made by proponents of euthanasia include the following: (1) The moral claim of individual self-determination and well-being; (2) the moral irrelevance of the difference between killing and allowing to die; (3) the supposed paucity of evidence to show likely harmful consequences of legalized euthanasia; and (4) the compatibility of euthanasia and medical practice.[6]

Opponents argue:

(1) that persons cannot consent to be killed and that individuals do not have the right to make a positive claim for euthanasia. [7] Additionally, Kass points out that "Euthanasia for one's own dignity is at best paradoxical, even self-contradictory: [asking] how can I honor myself by making myself nothing?" He asks, "even if dignity were to consist solely in autonomy, is it not an embarrassment to claim that autonomy reaches its zenith precisely as it disappears?[8]

(2) Not to acknowledge the difference between killing and allowing to die is to confuse causality with culpability, nature with human actions.

(3) Even those who regard the slippery slope arguments as "the last refuge of conservative defenders of the status quo," admit that legalization of voluntary euthanasia would lead to pressure to legalize some non-voluntary euthanasia of incompetent patients unable to express their own wishes."[9]

(4) "It is not medicine's place to determine when lives are not worth living or when the burden of life is too great." [10]

As the debate rages, it is interesting to note that physicians are not the ones fanning the fires. In my twenty years of practice I have been asked for help in dying only one time. A study designed to elicit physician attitudes toward end-of-life decisions showed the vast majority objected to direct euthanasia (87%) and 74% objected to physician-assisted suicide.[11] Medical ethicists, liberal clergy, politicians, and the media are in the thick of the battle throwing the cores from apples off the tree with the sign clearly stated, "Thou shalt not kill."