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Paper Abstract: History, suicide, types, patient rights, social & legal aspects, religion. Paper Introduction: Aronson reports that all individuals have Thanatos, or the death instinct, which can manifest itself in a variety of self-destructive ways. These ways include suicide, which occurs when Thanatos is turned inwardly; or, when turned outwardly, Thanatos can become hostility, destructiveness, and murder (Aronson, 1988, pp. 186-187). Whether or not individuals are aware of Thanatos, they all at some point in life consider their own mortality. Sheehy concurs that all individuals manifest knowledge regarding their own mortality. This knowledge, however, does not occur until the late thirties or forties, until there is an unexpected brush with death, or until the individual becomes aware of impending death from serious illness. Further, all individuals fear their deaths, particularly when they have not accepted dying as a part of life, a passage that all individuals must transcend. 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The President's Commission for the Study of Ethical Problems inMedicine and Biomedical and Behavioral Research, which was established in1979, has put forth six recommendations for the ethical analysis of theimplications of medical practice for the terminally ill: (1) the choices ofcompetent individuals are to be respected relative to the termination oflife-sustaining treatment; (2) mechanisms and guidelines are to be providedfor patients who are incapable of making such decisions; (3) life-sustenance is to be maintained as a presumption; (4) the medical optionsopen to such patients are to be improved; (5) respectful and responsivecare is to be provided to those patients not requiring further medicaltreatment; and (6) health care institutions are to be encouraged to takeresponsibility for ensuring the availability of decision making proceduresfor these cases (Alessandroni, 1984, p. Only one pediatricianwho reported using this practice was prosecuted during 1991, as per theRoyal Dutch Medical Association. (198 ).Abnormal Psychology and Modern Life, 6th ed. C4). A3).Moreover, this proposal would allow for death by lethal injection andassisted suicide by a lethal dose of pills (Associated Press, 1991, p.A12). (1992, February 24). (1984, Spring). Thereare also similar proposals pending in Oregon, Florida and Washington, D.C.(Associated Press, 1991, p. A3). Withthe enactment of SB 762, Durable Power of Attorney for Health Care (DPHAC),which became effective in January, 1984, those terminally ill or otherwiseincapacitated elderly can have their conservator make health-care decisionsregarding dying. 1, that requires patients be informedof their right to refuse life-prolonging care (p. (1991, March 31). Aronson reports that all individuals have Thanatos, or the deathinstinct, which can manifest itself in a variety of self-destructive ways.These ways include suicide, which occurs when Thanatos is turned inwardly;or, when turned outwardly, Thanatos can become hostility, destructiveness,and murder (Aronson, 1988, pp. Coleman, Butcher and Carson report that suicide has historically beenperceived in various ways, many of which were negative, althoughindividuals have resorted to this act for centuries. A1. In delivering apresentation on "Coping with Cancer: Myth and Reality," Humphrey reports,"I know doctors who have done it five or 1 times. As of April, 1992, the Dutch Parliament ruled against theadoption of guidelines for newborn euthanasia, thus disallowingpediatricians to avoid prosecution for engaging in this practice (Cox NewsService, 1992, p. Dr. Jack Kevorkian, who resides in Royal Oak, Michigan, has gainedinternational fame because of his approach to death with dignity viaphysician assisted suicide. A1). Shoemaker, Donald. Further, as a specialist in oncology andhospice medicine, Dr. Cundiff notes that patients with cancer or AIDS tendto fear the suffering that comes with terminal illness, as opposed to deathitself. Although the 1988 proposal tolegalize euthanasia in the state of California was rejected, Humphreyreports that another is forthcoming in 1992. The passage of this initiative would make for greater patient controlover death: If the initiative passes, terminally ill patients would be allowed to commit suicide with the help of their doctors, and it would clarify the conditions under which life-support systems could be withdrawn from patients who already have stated their intentions in a living will (Egan, 1991, p. Generations, 8(13): pp. Long Beach Press-Telegram, p. Glenview: Scott, Foresman. Euthanasia not proper cure forpain. Moreover, given that the technology and medicationsexist that can prevent the pain of the terminally ill suffer, physicianscan assist these patients in controlling their pain. People see the church's efforts as an erosion of the separationof church and state that they expect from their upbringing as Americans"(p. In that theseproblems exist, the hospice approach should be given more support, ratherthan the proposition being passed. (1991, October 14). Although the Catholic Church Bishops argue that they are againstthis proposition because it erodes the separation between church and state,some of the Church's parishioners see the efforts of the Bishops as doingthis. The Presbyterian Church has reminded its churchmembers that they should become knowledgeable on all aspects of Proposition161 before voting (Segura, 1992, p. . WithChristianity, suicide was thus denounced: With the advent of Christianity, suicide was denounced as a grievous sin in most of the Western world. Hemlock founder: Doctors aidsuicides. These cases have been disguised as deaths fromnatural causes as a means of avoiding prosecution. Cox News Service. Legal attitudes tended to follow those of the church; in early English law suicide was considered a crime, and it was directed that the body of a person who had committed suicide have a stake driven through the heart and be buried at a crossroads. The proposal to have this practice legalized entails that the attendingphysician decide whether life termination of the severely disabled infant'slife is indicated, along with parental approval and consensus from otherphysicians. A15). D3). In fact, some pediatricians do not consider the practice withnewborns to be euthanasia, since these infants cannot request their deaths. (1992, August 8). Sheehy concurs that all individuals manifest knowledgeregarding their own mortality. Washington initiative wouldlegalize euthanasia state's voters, doctors grapple with ethics ofprecedent-setting measure. New York: W.H. The position of the Roman Catholic Church isthat this legislation will contradict traditional church morality, attackthe principles of government, and threaten the lives of the poor and thosewho lack power. To live or die. Also, two people who have no family or financial ties to the patient must witness the written death request (p. 1 -13 . Dr.Shoemaker notes that there are several thoughts that can be used to guidepastors in advising families in situations similar to that of Nancy Cruzanand Janet Atkin. As a result, these patients should be viewed by physicians asbeing in need of relief from suffering (Cundiff, 1992, p. For these patients, consentcan be obtained by medical staff from the patient or a family member whohas legal guardianship to allow for death. There are severalproblems that impeded this approach, however. McKay, Jack B. The Presbyterian Church, in contrastto the Roman Catholic Church and the Lutheran Church, has remained neutralon the euthanasia debate. In contrast, the medical establishmentin general and the Roman Catholic Church denounce this initiative, notingthat it could establish a dangerous precedent. . (1991, November 7). Maclean's, pp.46-49. This proposal offers three options for terminally illpatients: As written, the initiative says a patient can request 'aid in dying,' doctor-assisted suicide or euthanasia, only if two doctors have concluded that the patient has less than six months to live. The Roman Catholic Church is not alone in its position againstProposition 161. Cundiff, David. A3).The controversy over this proposal has resulted in physicians and otherssupporting and not supporting it. Dr. David Cundiff, the director of the Cancer Pain Service at LosAngeles County-USC Medical Center reports that Initiative 161, "TerminalIllness, Assistance with Dying," is due on the California ballot inNovember, 1992. Living dead should haveright to die in peace, comfort: More and more, many pastors will be calledupon to advise families in these difficult situations. Who decides for patients whocan't? 28). The root of this precedentis that suicide and related sanctions go against religious and medicaltraditions (Egan, 1991, p. This society has been active in attempting tochange the laws that prevent this practice and hold assisting physicianslegally and professionally accountable. A15). Egan reports that the Washington initiative to legalize euthanasia,Initiative 119, would be the first ballot in the nation to accord legalauthority to this practice (Egan, 1991, p. A12. AttorneyRobyn A. The DPHAC allows the conservator to make all health-caredecisions (except regarding placement of the individual in a mental healthtreatment program, the commencement of convulsive treatment, psychosurgery,sterilization, or abortion); the power to consent to a physicianadministering or not administering treatment to keep alive the principal;and the power to arrange for the donation of organs. Beyond these measures, the clear legalization ofeuthanasia evades the United States. 575-576). B6. Unlike the regularDurable Power of Attorney, the DPAHC does not take effect until the elderlyindividual becomes incapacitated to provide informed consent; and the poweris terminated in seven years if the individual becomes capacitated (McKay,1984, pp. Protective services give elders moreautonomy. The family, physicians, health-carefacility, and courts should not intervene in such a personal choice. Long Beach Press-Telegram, p. Dutton. The Roman Catholic Church is also in disagreement with Proposition161 in California. Coleman, James C., James N. Dr. Cundiff reports that polls denote most Americans aspreferring to die in the comfort of their homes and surrounded by lovedones, rather than in a hospital. McKay reports that conservatorship, rather than guardianship, for theperson allows the terminally ill patient to appoint, or to have appointed,an individual who is responsible for making health care decisions. This is because individuals eventuallyaccept their own mortality, recognizing that death is just another part oflife, a phase of life that all must endure. The Associated Press reports that the Washington initiative wasdefeated by voters, although there is optimism regarding the upcomingCalifornia initiative. In contrast, the religions of Judaism and Islamcondemned suicide (Coleman, Butcher and Carson, 198 , pp. The problem here is that fewphysicians receive training in such technology, particularly in Californiamedical schools or post-graduate medical training programs (Cundiff, 1992,p. D3). (1991, April 8). Bishop David Pollard noted: "We've gotten a ton of calls andletters. Dr. Cundiff concludes that, regardlessof the passage of Proposition 161, the problem of euthanasia will continueto exist until more humane care of the terminally ill is brought on bymarked changes in the practice of Western medicine. Humphrey notes thateuthanasia will be legal prior to the close of this century. In fact, the Lutheran Church is also against euthanasia.Despite this, the ministers of Lutheran churches have been informed thatthey are free to inform church members of their political views ordisseminate informational material. In contrast, proponents of this initiative indicated that pollsdenote Americans favoring assisted suicide for the terminally ill. During this time, the Romans acceptedsuicide as a viable form of death and as a solution to personal problems.The only exceptions to this were when suicide involved property rights orinterests of the state. These trends are particularly significant for those patientswho are terminally ill or who have irreversible brain damage. Derek Humphrey, the executive director of the Hemlock Society,informed physicians that euthanasia is already occurring as patients areassisted in committing suicide by their doctors. There has beenconsiderable support for this initiative by the Hemlock Society, whichespouses and embraces euthanasia. 46). Long Beach Press-Telegram, p. While Dr. Kevorkian was charged with the death ofAdkins, charges were dropped lacking a Michigan law against assistedsuicide. As per the Cox News Service, the Dutch Parliamentdecriminalized euthanasia for adults, and four months after this, severalpediatricians in Holland requested the same status for severely disablednewborn infants. This knowledge, however, does not occuruntil the late thirties or forties, until there is an unexpected brush withdeath, or until the individual becomes aware of impending death fromserious illness. Segura, Joe. B6). The National Cancer Institute acknowledges that cancer pain management training and practice is inadequate in the USA yet allocates less than $1 million to this problem out of a $1.7 billion budget. (199 , September 11). Dutch seek Ok for mercykillings of babies. While the Roman Catholic Church seldom takes a stand onpolitical issues, euthanasia is viewed by them as constituting a moraldilemma. Butcher, and Robert Carson. (1976). A3). These infants are classified as having severe congenitalmalformations or severe brain damage from oxygen deprivation (Cox NewsService, 1992, p. Neidi and Barber, 1983) supported the notion; if the patient is dying, is comatose or is not made uncomfortable by the withholding of fluids, and if the family is prepared for the patient's death, then it is ethically acceptable to withhold IV therapy in dying patients (Alessandroni, 1984, p. While charges are rarely brought for suchpractices, Dr. Versluys, a Netherlands pediatrician who is interested inthe legalization of euthanasia, is requesting that clear legal criteria beestablished the same as for adults. Having done this, the fear ofdeath subsides for individuals, particularly those aged 45+ (pp. This Death with DignityProposal obtained in excess of 223, signatures from those individualsbelieving that euthanasia is a basic right, in that it allows persons totime their deaths. A3. For Nancy Cruzan: The U.S. 575).With the Renaissance, philosophers questioned suicide's being a sin, notingthat emotional imbalance was at issue. B1. LikeAdkins, I think that the terminally ill should have the right to choosewhen and how they want to die. Associated Press. The social animal, 5th ed. C4). (1992, August 2). 28). The use of DPAHC, Meinhardtreports, can be confusing to physicians, particularly when contradictorystatements are contained in such forms that allow one form of treatment anddisallow another form of treatment. Currently, suicide is among the top1 causes of death in Western society, with an estimated 26, suicidesoccurring on an annual basis in the United States (Coleman, 198 , p. inthis country, covertly" (Segura, 199 , p. Supreme Court upheld Missouri's right to require 'clear and convincing evidence' of a patient's prior wish not to be kept alive in a persistent vegetative state by 'heroic' means. Suicide doctor sees life indeath. Segura, Joe. 575). However, the California Appellate Court(People v. Long Beach Press-Telegram, p. Given these situations involving euthanasia, Dr. Shoemaker notes thatministers can take a: (1) pro-life position (i.e., life is the mostvaluable gift given to humans by God); (2) personal choice position (i.e.,the individual has the right to chose about accepting medical treatment);(3) position in opposition to euthanasia (i.e., view this practice as aform of killing); (4) position in support for the hospice and churchministry to the dying (i.e., terminally ill patients dying in a caring andloving atmosphere with family and church members in attendance); and/or (5)position in support for organ transplants (i.e., as Christian stewards,families should be advised to donate organs of their loved ones)(Shoemaker,m 1992, p. Freeman. It has been estimated that approximately 2,3 mercy killings occur in Holland on an annual basis, despite the fact thateuthanasia is illegal. Further, physicians cannotwithhold the indicated treatment for such patients, based on moral groundsand when treatment is considered to be ordinary or standard care(Alessandroni, 1984, p. B1). There have of late been severalefforts to legalize euthanasia by the states of Oregon, Washington andCalifornia (Segura, 1991, p. (1984, Spring). The belief that suicide was morally and legally wrong prevailed throughout the Middle Ages in Western Society (p. Dr. Donald Shoemaker, the senior pastor of Grace CommunityChurch of Seal Beach, presents differing views as regards euthanasia. Egan, Timothy. For example, prior toChristianity, suicide was less negative for many people, with individualscommitting euthanasia for a variety of reasons, including painfulconditions as a part of old age. Meinhardt reports that " the shifting trend has led to a newfederal law, which takes effect Dec. The opponents ofthis proposal reportedly think that there were insufficient safeguards toprotect the applicable individuals (i.e., the elderly, poor and thedisabled). Sheehy recommends a variety of ways in whichindividuals can cope with their impending death or thoughts about death.These include acquiring the correct knowledge about the situation, askingfor assistance in meeting this challenge, and working (Sheehy, 1976, pp. It's going on... Whether or not individuals areaware of Thanatos, they all at some point in life consider their ownmortality. Should this proposition pass, it will make for the firsttime in modern history that euthanasia and assisted suicide by physicianswill be legal. Dr. Kevorkian provided Janet Adkinswith his $3 machine so that she could end her life; she had been diagnosedwith Alzheimer's Disease and told that her mental faculties would markedlydecline in five to 1 years. Sometimes referred to as Dr. Death, Dr.Kevorkian contends, "The highest ethical principle to me is individual self-determination" (Martin, 1991, p. They should not besubjected to long periods of hospitalization, constant medication, forcedfeedings, if needed, or the psychic pain of being in such a position.Should such patients choose to die in a hospice, this is acceptable, aslong as they have this choice. Long Beach Press-Telegram, p. B1). Long Beach Press-Telegram, p. Aronson, Elliot. Martin, Antoinette. Attorney: Sentiment shifting on rightto die, state vote on euthanasia may be near. D3. The Hemlock Society isclearly pro-euthanasia. 27). References Alessandroni, Marian. Further, all individuals fear their deaths, particularlywhen they have not accepted dying as a part of life, a passage that allindividuals must transcend. We prefer that more issues be settled in the hearts of men andwomen" (Segura, 1992, p. Long Beach Press-Telegram, p. I personally feel that terminally ill patients should have the rightto choose euthanasia as a way to maintain dignity. 25-27 . Long Beach Press-Telegram,p. B5).In addition, the hospice approach to the terminally ill has disincentives,given that the last month of hospice care for such patients cost at maximumaround $3, , versus $12, for the standard medical treatment ofterminally ill cancer patients (Cudniff, 1992, p. Euthanasia issue buds inCalifornia. 5,8-9). While some physicians think that theirrole as healer will be compromised, others contend that the initiative ishumane and has been long needed for those patients wanting control overtheir deaths. A15. In addition, as individuals grow older, they learn not to fear deathas much as they did when younger. The American Cancer Society does not currently award grants to support professional education in cancer pain management (p. B5). B5). Long Beach Press-Telegram, p. The debate of whether euthanasia should become legalized is a mootcase for individuals in several countries, including the Netherlands,"where doctors help thousands of terminally ill patients to die each year"(Fennell, 1992, p. C4.----------------------- 3 Sheehy, Gail. The California Catholic Conference of Bishops noted ina letter to be read to all parishioners in the state that this initiativemakes for "'an unacceptable way of terminating care' for a gravely illpeople. The enactment of thisinitiative would effectively overturn a 2, -year-old medical tradition ofnot euthanizing patients because they want to die. Segura reports that the vote for thelegalization of euthanasia was to occur October, 1991, and later inCalifornia, primarily because of the shifting trends in the medical, legaland political arena as regards patients' rights to refuse life-prolongingcare (p. Social workers contend that poor terminally ill patients orthose patients lacking medical health coverage will choose the option ofeuthanasia over the mounting of medical treatment costs. (1988). 242-243). In fact, the practice of euthanasia on severely disabled newborninfants has been occurring in Holland, with approximately 1 babies beingover-medicated per year. B5). 186-187). Generations, 8(13): pp. Her feeding tube which had supplied her body with nourishment since 1983 was disconnected and she was allowed to die, which she did 12 days later (Shoemaker, 1991, p. B5. Alessandroni reports that terminally ill and cancer patients havesome rights regarding making the decision to die, but there are severalethical considerations to be given attention. Further, I do not think that physicians whoassist such patients should be held legally, professionally, nor ethicallyresponsible. Although Dr. Kevorkian inserted the needleinto Adkins, she pushed the button that sent first tranquilizer and thenpoison into her veins. B1). (1992, October 24). 1 , 12, 13). While legal authority has not been grantedpediatricians to perform such euthanasia, these physicians have used thispractice judiciously. Bishops oppose euthanasiainitiative. Segura, Joe. Passages - predictable crises of adult life.New York: P. With thisphilosophy, physicians should consider what they can do to alleviate thesuffering of terminally ill patients before supporting euthanasia orassisted suicide. D3). We know that a court was eventually convinced of comatose patient Nancy Cruzan's wish not to be kept alive. A12). Fennell, Tom. (1991, January 19). C4).For Janet Adkin, who was an Alzheimer's patient, suicide was committed withthe assistance of a physician who lacked the qualifications to provide suchaid (Shoemaker, 1991, p. While the federallaw is unpopular, because of patients being confronted upon admission tothe hospital with this decision, other legislation may pass that allows thepatient to discuss this subject in private. Washington's Initiative 119 was defeated with 54%of the votes against and 46% in support of this proposal. There is considerable controversy onthis subject, with Netherlands pediatricians split as to their view of thispractice. Not all religious leaders agree with the Roman Catholic and Lutheranchurches. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.

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