Some Arguments Against Voluntary Active Euthanasia
Germain Grisez and Joseph M. Boyle, Jr., authors of Life and Death with Liberty and Justice (University of Notre Dame Press, 1979, pp. 149-170), offered the following objections to legalizing voluntary active euthanasia:
Patients will have to be told the full extent of the pain, suffering and hopelessness of their medical condition all at once rather than in gradual, tolerable stages, in order to safeguard the legal requirements of informed consent needed for truly voluntary euthanasia.
Patients not wanting euthanasia would inevitably hear about their dreadful prognosis from other patients with similar medical conditions, relatives and so on, and have to bear the burden of such unwanted information.
It will cause conflict for people who are morally opposed to euthanasia but who might be tempted to accept it anyway to avoid the burden of suffering. This will add a second burden of feeling guilty for having violated their consciences.
Patients may be tempted to choose euthanasia from altruistic motives, even though morally or otherwise opposed, so as not to be a “burden” or from a feeling of guilt for using scarce medical and economic resources.
No matter what the safeguards, patients not wanting euthanasia may become anxious that they will be included as victims. Very sick or debilitated people in hospitals or nursing homes are often confused, anxious and not too reasonable. Emotional regression is common. Just knowing that people around them are being killed could arouse in them tremendous apprehension that all the reassurance in the world will not ease.
The family or loved ones of a patient choosing euthanasia may find it morally repugnant (as with suicide) and suffer much more grief than if it were a natural death. Most of the objections concern the harmful effects of legalizing euthanasia on those who are opposed to euthanasia. Grisez and Boyle argued, “From the point of view of sound jurisprudence, the self-interest of the opponents of euthanasia can no more be excluded from consideration than the self-interest of its proponents.” They stated that legalizing voluntary euthanasia would serve no public interest but only the personal, private interest of those demanding legalization. The authors believe that the most decisive argument against legalization is the one based on the “jurisprudential principles of justice and liberty.” The argument is as follows:
“If voluntary active euthanasia is legalized without regulation, those who do not wish to be killed are likely to become its unwilling victims; this would deny them the protection they presently enjoy of the law of homicide. And since the denial is to serve a private interest, it will be an injustice.
“If voluntary active euthanasia is legalized with close regulation, which will involve the government in killing, those who abhor such killing will be involved against their wishes, at least to the extent that the government and institutions will be utilized for this purpose.
“Since the government’s involvement will be required only as a means to the promotion of a private interest, this state action will unjustly infringe the liberty of all who do not consent to mercy killing as a good to whose promotion state action might legitimately be directed.
“A solution involving a compromise between legalization of voluntary active euthanasia without regulation of the practice and legalization with close regulation, which will involve the government in mercy killing, would mean some degree of lessened protection together with some degree of government involvement, a situation which will result in injustice partly due to the reduced protection of the lives of those who do not wish to be killed and partly due to the unwilling involvement of those who do not wish to kill.
“Since the stated conditions are all the possible conditions under which voluntary active euthanasia could be legalized, legalization is impossible without injustice.
“Therefore, the legalization of voluntary active euthanasia must be excluded” (p. 153).
On these points, the authors further argued that “The public has a liberty to stand aloof from the killing of human beings. This consideration, together with the already well-argued point that even voluntary euthanasia cannot be legalized without undue danger or extensive public involvement, poses a very serious dilemma for proponents of legalization. . . . Nor will it do to say that the liberty of those who abhor mercy killing to stand aloof would only be slightly infringed by governmental involvement in this practice. Reading a few Bible verses each day in the public schools is only a little establishment of religion. But that little is too much for those who take conscientious objection to it” (pp. 169, 170).
The psychological burden of having to make such a decision rests on an already overburdened patient. Most of us find making major decisions very difficult. We are often filled with conflict, ambivalence and anxiety and would be over the enormous consequences of that choice.
If we were asked to choose regarding euthanasia, which conflicts with our instinct for self-preservation, the pain of having to choose could put an unbearable pressure on most people.
If we choose death, there is no undoing the choice and no way of knowing from experiences of others who have made that choice if it is a good one or a bad one, because those who have made it are no longer alive to advise us.
It is also relatively rare to find a patient with a fixed and enduring wish to die. What we claim we would do while in good health and under no threat is not an indicator at all.
Avery Weisman, M.D., of the department of psychiatry at Harvard Medical School, brought up this point in his book On Dying and Denying: “When healthy people are asked what they would do should they be found to have an incurable illness, many promptly declare they would commit suicide. Actually, evidence indicates suicide is rather infrequent among cancer patients. . . .
“The intention to take one’s own life rather than submit to fatal illness is rarely implemented. . . . The option to destroy oneself is not an expression of freedom, but one of despair . . .” (pp. 25-38).
Elisabeth Kubler Ross, M.D., who has done extensive studies involving dying patients, stated in Attitudes Towards Euthanasia (publication of the Third Euthanasia Conference), “Our interviews have shown that all patients have kept a door open to continued existence and not one of them has at all times maintained that there is no wish to live at all.”
Euthanasia portends harmful effects on good medical care. Alfred Jatetzki, M.D., associate professor of surgery at Columbia-Presbyterian Medical School, stated in Dilemmas of Euthanasia (publication of the Fourth Euthanasia Conference), that it was hard to be certain a patient was really dying in many cases.
He cautioned that many doctors have had patients whom they thought hopeless recover, and stated, “As the medical sciences progress, it becomes more and more of a problem . . .
“If we … are thinking of ten patients who were put through a great ordeal and only one or two or three benefit from it, then this becomes a major moral issue. . . . The doctors cannot help but be influenced by maybe even those two or three . . .”
Lawrence V. Foye, M.D., in his statement before the Senate Special Committee on Aging, August 7, 1972 (as reported in the AARP News Bulletin, September 1972), expressed a similar concern:
“If a physician withholds maximum efforts from patients he considers hopelessly ill, he will unavoidably withhold maximum effort from the occasional patient who could have been saved.” He reasoned that the only way to be sure a case is hopeless is to try all available therapies and find them of no avail.
Jonathan H. Pincus, M.D., associate professor of neurology at Yale University School of Medicine, declared in a New York Times letter on January 24, 1973, “Many patients who could have been allowed to die are alive and doing well because of some new advance in therapeutics which occurred during the course of their illness . . . when a doctor is considering possible therapeutic courses of action for his patient, homicide would not be among them!”
Another of his concerns was that fewer health care resources would be allocated to those considered “better off dead.”
A Dr. Lebensohn spoke at the Third Euthanasia Conference, according to Attitudes Towards Euthanasia: “His [the physician’s] mere presence in the room is a symbol of hope. . . . If he is associated in the mind of the patient or of the public with being also the terminator of life . . . there is going to be a great conflict, fear and distrust, similar to that which occurred in the time of Rome, where the poisoners were very prevalent.”
There are the subtle but nonetheless powerful pressures exerted by those who are involved in the care of the hopelessly ill. If the patient decides to hang on to life rather than choose to be put to death, hard-pressed medical personnel and economically and emotionally exhausted families may become less tolerant of these “better-off-dead” patients.
Their feelings could be expressed in countless unspoken and even spoken ways, exerting pressure on the patient to choose death against his own real wishes or making him feel unloved and unwanted while he remains alive. Perhaps those few who would truly choose euthanasia if it were legal might find a meaning in their suffering, knowing that a liberty for themselves is a liberty worth rejecting if it would cause great harm to many others.
Arguments Against Non-Voluntary Active Euthanasia
Grisez and Boyle in Life and Death with Liberty and Justice moved the debate to non-voluntary active euthanasia. The basis of their argument against it is, as with voluntary euthanasia, that to legalize it would be a violation of the jurisprudential principles of justice and liberty.
The authors reasoned that even though euthanasia advocates attempt to show that Anglo-American legal conceptions of justice have religious roots, this point is irrelevant, since “they are an essential part of the consensus upon which the legitimacy of American government rests” (p. 217).
Further, the authors pointed out “that no advocate of euthanasia has challenged the requirement of equal protection of the laws. . . . The manner in which they argue for their proposals shows they are seeking to meet the requirement of equal protection of the laws with respect to the law of homicide” (p. 217).
Instead of denying equal protection, euthanasia advocates have three ways of arguing against applying the principle:
They assert that killing some human beings is a benefit to the ones killed rather than a harm, since their quality of life is so poor: life is no longer a good to be protected by the law.
They believe that even though some human beings may belong to the human species, they don’t merit equal protection because they should not be legally classified as persons.
They argue that there is a compelling state interest sufficient to deny equal protection of the law to a certain class of people: those who are permanently dependent, institutionalized, not able to contribute to society and being cared for by public funds.
The compelling state interest they see rests on the high public expense of the care of these people, which they say is sufficient to override the right of these unfortunates not to be killed.
They further claim that the state interest overrides the “liberty [of other citizens] to stand aloof” from killing. Therefore, this class of dependent people should be killed to ease the economic burden and, it is further asserted, it would be less unjust to kill them than to let them die of neglect, as we do now.
(Richard Trubo gave examples of some institutions for the retarded spending less for food on each patient a day than a pet owner spends on his cat.)
Grisez and Boyle made the following points to refute this argument:
Killing these patients is not a necessity (that is, not the only way) to solve the problem of great economic costs. There are certainly alternatives short of the drastic one of killing the patients!
Even if the state ceased to pay for their care (a step certainly not advocated by any means), it would be no more unjust than killing them and would at least leave open the possibility that other private interests would provide the care.
Killing them would offer no hope at all. At the very least, the state, in refraining from killing them, is not violating its duty to provide equal protection of the law of homicide and has protected other citizens’ liberty to remain aloof from killing.
The authors maintained, “Money is only a means, not a substantial public purpose in itself. The preamble to the Constitution of the U.S. mentions justice and liberty, public tranquility and the common defense, civil unity and the general welfare.
“It does not mention saving money . . . [Therefore] budgetary considerations as such never offer a compelling reason to override the liberty of citizens.”
Euthanasia advocates claim that these dependent people make no contribution to society in return for the economic costs of their care. Grisez and Boyle questioned why the contribution is considered only in economic terms, rather than non-economic ones:
“The non-economic contribution of the helpless to society can be much more significant if it not merely generates psychological satisfactions but provides an occasion for exercising moral qualities of compassion and fairness.” They contended that the economic and the non-economic view each represent a particular worldview and asked, “Why should it be fair to impose one of these worldviews rather than the other upon helpless individuals? Equal protection of the law of homicide ought not to be modified to leave some class of individuals unprotected on the ground that on one or another worldview – perhaps even a widely held set of ideals and interests – such individuals contribute nothing” (pp. 228, 229).
If net burden to society is the criterion, the authors pointed out that “The wealthy consume tremendous amounts of scarce resources” and questioned whether they contribute sufficiently “to approximate the costs they impose on society.” Is a handicapped child or a millionaire a greater burden? The answer is purely subjective, depending on personal values or worldview. The rich and the powerful, of course, are in little danger of losing their right to equal protection. It might also be argued there are numerous other classes of dependent citizens receiving enormous amounts of public funds: prisoners, those in drug or alcoholic abuse programs, people on Medicaid, Medicare and Social Security, welfare recipients, farmers receiving subsidies.
The list could go on and on. It is surely unfair discrimination to single out one group as candidates for killing because of a compelling state interest in saving funds.
It Used to Be Killing
Changes in dictionary definitions reflect changed perceptions on the part of the dictionary makers as to how the public uses the word in question. Check the definitions for “euthanasia” below and ask yourself, “Have we really forgotten that euthanasia is killing?”
From a pre-1950 dictionary: “Mode or act of inducing death painlessly or as a relief from pain.”
From Webster’s Third International Unabridged Dictionary (1968): “1. An easy death or means of inducing one. 2. The act or practice of painlessly putting to death persons suffering from incurable conditions or diseases.”
From Taber’s Cyclopedic Medical Dictionary (1981): “1. Dying easily, quietly and painlessly. 2. The act of willfully ending life in individuals with an incurable disease.” (References provided by Mrs. Mary Stone, Allentown, PA.)
Should Voluntary Euthanasia Be Legalized?: Second Thoughts
The propaganda onslaught for legalizing voluntary euthanasia has been “sweet talking” the nation into believing that this is a beneficial private choice imposing no burdens or harm to others so why should those who wish it for themselves be denied the legal right to have it?
On the contrary, we argue that the legalization of voluntary euthanasia would impose enormous harmful consequences on the lives of many, including the person requesting it!
Harm to the Patient Requesting Euthanasia
It would rarely be a truly free choice. It would be very difficult to obtain valid informed consent. It is rare to find a patient with a fixed, rational, enduring wish to die. Fear of pain, rejection, loneliness and lowered self-esteem because of dependency are all variables that can influence the patient’s wishes. As these needs are met the desire for death recedes.
If a patient is depressed or in pain, informed consent is not possible and the physician may not be able to assess depression in a patient he does not know well.
The result could be that a goodly number of patients would be killed who didn’t really want it. Uncontrolled depression and pain are thought to be the two most frequent reasons why patients seek euthanasia. Both can be controlled so that the reason for seeking euthanasia vanishes.
Diagnoses and prognoses are not always accurate. Errors would lead to unnecessary deaths for some patients.
Harm to Others
There would be subtle pressure on other patients to request death to ease the burden on family and overworked doctors and nurses. There would be financial pressures, especially for the elderly, incurably ill or disabled. This might be in conflict with the patient’s moral code and real desire to live, and could cause enormous suffering for the patient already burdened by his illness. If such a patient actually did sign for euthanasia it would be a totally invalid consent.
For patients morally opposed to euthanasia who courageously accept their difficult end, the temptation to take the easy way out of suffering could cause great conflict, weakening their resolve to do the right thing. With little support from society, this could impose an additional burden on their already overburdened lives.Care and advances in treatment may deteriorate for those so-called “better off dead” patients who refuse the option to die.
Some families of patients choosing euthanasia will be morally opposed and angry at the patient for causing conflict. Or the family may feel they let the patient down in not meeting his needs for care and, just as in cases of suicide, feel guilt and anger directed against the patient. Death under such circumstances would hardly be the peaceful one promised by the death-with- dignity crowd.
Giving doctors the legal power to kill their patients gives them power that no human being should have. Killing an innocent human being, for whatever reason, can have terrible moral consequences for the killer. It is unfair to demand that the healer become the killer on request! And nurses are inevitably involved as parties to the killing. To be obligated to work in a profession contaminated by killing turns the hospital into a schizoid world of curing some and killing others.
There could be a loss of trust in their doctors by patients fearful of the healer/killer role. (In Holland elderly people are often afraid to go into the hospital, where doctors might kill them!)
Physicians and nurses might be required to participate in what is to them morally and ethically wrong.
Harm to Society
Voluntary euthanasia would soon lead to non-voluntary euthanasia. If legalized, voluntary euthanasia statutes would eventually be brought before the Supreme Court. The Court would have to decide that these laws are either a violation of the unalienable right to life or that there is an unalienable right to die. If it decides the former, then euthanasia could not be legalized, but if it decides the latter, then all people would have to be allowed the same constitutional right to die. Then guardians could demand this right for children and incompetent persons. State-appointed guardians could exercise the right for the mentally ill or mentally retarded who have no next of kin. Thus we have non-voluntary euthanasia. It would also extend to those who are not terminally ill, since the law may not discriminate but must be granted to all as a constitutional right. This would extend the killing on a massive scale, and would be very tempting as a solution to skyrocketing medical costs of federal and state budgets! But think of the moral cost of all this killing to our American society!
Granting a constitutional right to die as a fundamental right would so undermine the fundamental constitutional right to life that it would be virtually cancelled out as a guaranteed right. This would put the protection of all citizens’ lives on very shaky legal ground. (Fortunately, in Cruzan v. Harmon, in 1990, the U.S. Supreme Court found that there is no right to die in the U.S. Constitution. The U.S. Supreme Court also found in Cruzan v. Harmon that a patient’s medical care can be cut off pursuant to state law if the patient has previously expressed a wish that medical care be cut off under the existing circumstances, even if cutting off medical care would cause the death of the patient.)
Granting a private right serving no public interest and indeed causing so much harm to others and society would involve the government in sanctioning killing merely to serve the private interests of the few at the expense of the many whose liberty and life would be put at risk. Those who request that euthanasia be legalized may come to realize that it would be unfair to impose such harm on others merely to “benefit” the few.
Consequences of the Euthanasia Movement’s Goals
If the strategy of the euthanasia movement to legalize voluntary and non-voluntary euthanasia should be successful in securing a “constitutional right to die” or a “redefinition of personhood,” what are the probable long-term consequences for American society?
Consequences of a Constitutional Right to Die
The Supreme Court abortion decisions granted women the right to abortion as a fundamental constitutional right under a “right to privacy.” Such a right is disputed by many constitutional law scholars, but as long as the decision is not reversed it is operative and serves as a precedent.
A number of state court decisions have used this same right to privacy as a precedent to declare the right to die, or the refusal of medical care, to be a fundamental right under the right to privacy.
In a 1973 Pennsylvania case, a patient in a state mental institution refused surgery for cancer. The state court ruled in her favor: “. . . The right to privacy includes the right to die which the state should not interfere with . . .”
In reviewing the case, Prof. Robert Byrn questioned the “court’s resort to the right of privacy” rather than the “traditional right of bodily self-determination which includes the right to refuse life-saving treatment in a non-emergency” (Byrn, Robert M., Fordham Law Review, October 1975.)
The New Jersey Supreme Court, in its Karen Quinlan decision, declared that the constitutional right to privacy “is broad enough to encompass a patient’s decision to decline medical treatment under certain circumstances in much the same way as it is broad enough to encompass a woman’s decision to terminate pregnancy. . . .”
The court cited as precedent the abortion decision of Roe v. Wade (Matter of Quinlan, 355, A2d at p. 663).
A Massachusetts state court in the Saikewicz case recognized that there was a constitutional right of privacy involved in decisions about medical care and that the non-competent patient had the same rights as the competent patient. The court allowed a mental patient’s guardian to refuse chemotherapy for leukemia on his behalf (Superintendent of Belchertown State School v. Saikewicz, 370 NE2d 417).
A New York State Appellate Court, in a case involving a Brother Fox who was on a respirator and in a coma, ruled that this non- competent patient had a right to refuse treatment (the respirator). The ruling was based on the “constitutional right of privacy” cited by the Supreme Court abortion decisions and that non-competent patients have the same constitutional right of privacy as competent patients (Matter of Eichner v. Dillon, March 27, 1980).
Fundamental U.S. Constitutional Rights
U.S. Constitutional rights can be fundamental or non-fundamental. Fundamental rights cannot be restricted unless there is a compelling state interest. The U.S. Supreme Court will strictly scrutinize any restriction of a fundamental U.S. constitutional right. If a future U.S. Supreme Court holds that the right to die is a fundamental right, every state will have unrestricted euthanasia on demand, in spite of contrary state laws, in the same way every state had unrestricted abortion on demand after Roe v. Wade.