Death, Society, and
Human Experience
9th Edition
Robert Kastenbaum
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Copyright © Allyn & Bacon 2007
Chapter Nine:
Euthanasia, Assisted Death,
Abortion, and the Right to Die
This multimedia product and its contents are protected under copyright law. The following are prohibited by law:
•Any public performance or display, including transmission of any image over a network;
•Preparation of any derivative work, including the extraction, in whole or in part, or any images;
•Any rental, lease, or lending of the program.
•
Copyright © Allyn & Bacon 2007
Key Terms
•
Hippocratic Oath – an ancient, optional code of ethical
principles
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Euthanasia – intentional shortening of the life of a person
or animal to spare further suffering
• Active Euthanasia – taking some action to cause death
• Passive Euthanasia – withholding treatment that might
prolong life (generally tolerated by society)
• Key question: Should actions be introduced, continued,
done, or discontinued?
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Key Terms
Terminal Sedation – relieving dying patients’ distress by
keeping them in a deep sedation or coma until death
• An alternative to active euthanasia
• Called “slow euthanasia”
• Liberty Principle – individuals can make their own
decisions
• Informed Consent – patients must be fully informed before
proceeding with treatments
• Competence – the mental ability to understand the
information and make a rational decision
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Key Terms
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Nazi “euthanasia” – the false name given to the murder of
innocent people and associated genocide
Black Stork – The movement in the U.S. in the early 1900s
to allow “defective” infants to die
Eugenics – The movement aimed at sterilizing people with
“defective genes”
• Led to other ideas, such as letting “defective” infants die and ending
the lives of “incurable” patients
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Slippery Slope Argument – Opposing any instance of
assisted death because it could contribute to widespread
abuse in other instances
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Right-To-Die Cases
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Estimated that 10,000 to 35,000 Americans exist in
persistent vegetative states
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Estimated that another 150,000 have minimal
consciousness syndrome
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In the news: Karen Ann Quinlan, Debbie, Nancy Cruzan,
Terri Schiavo
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Not in the news: People in similar situations who are not
young, white, attractive females
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Right-To-Die Cases:
Karen Ann Quinlan
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Suffered severe, irreversible brain damage as a result of
oxygen deprivation (April 14, 1975)
• Spent months on a ventilator, dropped to 60-pounds,
curled into a fetal position, in a “persistent vegetative state”
• Parents asked physicians to turn off ventilator; they refused
• Parents took their request to court; it was denied
• New Jersey Supreme Court ruled that a ventilator could be
turned off if physicians agreed that the patient had no
reasonable chance of regaining consciousness
• The ventilator was removed (in 1976)
• She remained alive until she had pneumonia in 1985
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Right-To-Die Cases:
Debbie
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Story published in the Journal of the American
Medical Association in 1988 by “Anonymous”
• Debbie, 20 years old, dying of ovarian cancer,
emaciated, hadn’t eaten or slept in two days,
hadn’t responded to chemotherapy, breathing with
great difficulty
• Her only words to the doctor were “Let’s get this
over with.”
• The doctor gave her a lethal injection
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Kastenbaum’s Issues With
Debbie’s Case
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The physician had no prior acquaintance with the patient
• The physician was fatigued, had high anxiety, and make a
quick decision
• The room’s atmosphere made an impact on the physician
• The nurse was ordered to prepare a lethal injection
• The physician could have provided non-lethal relief or
halted the procedure that produced distressing symptoms
• The physician could have tried more communication
• The physician projected his/her own feelings and didn’t
seem to be concerned with “leave taking”
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Right-To-Die Cases:
Nancy Cruzan
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26 y.o., auto accident, brain trauma, oxygen deprivation
• Maintained with feeding tube; no communication
• Parents decided to stop tube feeding; hospital refused
without court order
• U.S. Supreme Court ruling: a competent person had the
right to refuse medical treatment, and if the person wasn’t
competent the State could decide what constituted clear
evidence of the person’s wishes
• Nancy’s physician withdrew his opposition after 6 years
• Nancy died after the tubes were removed
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Right-To-Die Cases:
Terri Schiavo
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Suffered a heart attack (2-25-90)
• On life support; showed only reflexive movements, random
eye opening, and no communication ability
• Terri’s husband and parents had intense conflict
• 1994 Terri developed a urinary tract infection; husband and
physician agreed not to treat it; also DNR posted
• 1997 husband petitions to discontinue life support; many
court battles between husband and parents
• Much rested on testimony that Terri said she wouldn’t want
life support
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Right-To-Die Cases:
Terri Schiavo
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On several occasions courts ruled in favor of removing life
support, but each time it was blocked
Media got involved; Florida Governor Jeb Bush passed
“Terri’s Law” to return feeding tube; the U.S. House and
Senate agreed to a federal bill to return feeding tube
Terri died (3-31-05) of dehydration
Autopsy showed that her brain had shrunk to half its size;
she had severe and irreversible damage
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Objections of the Medical
Community to Assisted Death
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Taking a life is inconsistent with the responsibilities and
values of a physician
Religious convictions forbid taking a person’s life under any
circumstances, with the possible exception of self-defense
The life might be mis-taken
Serious legal consequences might be expected to befall
any physician who engaged in assisted death
The dying person accuses the physician of being a failure
(actually the physician’s self-accusations)
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Evaluating Dr. Kevorkian’s Approach:
Summary of 93 Cases
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Most of the people were not terminally ill
Gender bias - encouraged and increased suicidality among
women
Clients fit the profile of suicide attempters rather than
terminally ill
He functioned without adequate medical information and
consultation
Death is much too extreme a solution for the relief of
suffering
Despite his disclaimers, it appears that he has rushed
people into assisted death without adequate safeguards
and consideration
He uses “silencing” techniques to defend his actions
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Assisted Death in
The Netherlands
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Requirements for a physician to assist in ending a
patient’s life:
• The patient is terminally ill
• The patient has made an explicit request for lifetermination
• The physician informs the coroner of his actions and
provides a detailed check list regarding the patient’s
situation and the physician’s own actions
•
First nation to make it legal
• Belgium now has similar laws
• Australia had such a law, but later overturned
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Current Status of
Assisted Death in the U.S.
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Merging of The Hemlock Society and Compassion in Dying
in 2005 to form Compassion and Choices
• Has many requirements and safeguards
• Will help clients arrange for assisted death
Oregon Death with Dignity Act
• Has many requirements and safeguards
• Physicians write prescriptions for lethal doses of
medication after an adequate waiting period
• Patient must be 18 or older with an incurable,
irreversible terminal illness and life expectancy of less
than 6 months
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Abortion Facts
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9 out of 10 abortions occur in the first trimester
• Common techniques
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Drugs (for early and later abortions)
Vacuum Aspiration
Dilation and Curettage (D and C)
Dilation and Evacuation (D and E)
Partial-Birth Abortion (late-term, banned in many states)
Estimated that 46 million abortions occur
throughout the world each year
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Abortion: Difficult Issues
Kastenbaum states, “I have not come across
anybody who believes it is a good thing to destroy
a fetus that would otherwise be viable. People on
both sides of the issue would prefer that the
situation never arises.”
• Challenges:
• State policy vs. individual and family needs
• General principle or particular situation
• When does life and personhood begin?
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Glossary: New Terms
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Advance Directive
• Assisted Death
• Competence
• Double Effect
• Durable Power of Attorney
for Health Care
• EEG Tracings
• Euthanasia
• Hippocratic Oath
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Informed Consent
• Living Will
• Mercy Killing
• Orbitoria
• Patient Self-Determination
Act
• Slippery Slope Argument
• Terminal Sedation
• Ventilator
Copyright © Allyn & Bacon 2007