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Paper Abstract: Types, govt. interference, legal & ethical considerations. Paper Introduction: Euthanasia The word euthanasia comes from the Greek which means "a good death". Black's Law Dictionary defines euthanasia as "the act or practice of painlessly putting to death persons suffering from incurable and distressing disease as an act of mercy" (Black, 1979, p. 407). It would seem by these definitions that euthanasia is a good thing, a positive act that is to be supported by ethics and the law. And yet, euthanasia does not have only one single, simple aspect. Many varied ethical and legal considerations come into play when different forms of euthanasia are concerned. One type is active euthanasia where active administration of a death-producing agent is used to accelerate death. The opposite side Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. There seems no reason tosuppose that a patient's desire to ignore, or refuse, the recommendation oftheir doctor to maintain life support systems is any less within thepatient's right to decide. Nancy Cruzan was an incompetentward in a persistent vegetative state, but not terminally ill. Indeed, current medicalstandards now incline toward comforting a terminally ill patient andreducing his suffering, rather than toward extraordinary measures tomaintain treatment and life support. It wouldseem by these definitions that euthanasia is a good thing, a positive actthat is to be supported by ethics and the law. In the latter case, the child would also have to go through theadditional suffering of watching their parent die slowly and in oftenterrible pain. As was mentioned, each of these forms ofeuthanasia presents different ethical and legal dilemmas. (1981). Closely related to the issues discussed above are the issues andconflicts involved with passive incompetent euthanasia. In such cases, thereis likely to be a conflict with the physician if the physician feels thatthe family may be acting prematurely or against the patient's interest. The countering arguments to Mill's doctrine have been made that thestate's interest in 1) preserving life; 2) protecting innocent thirdparties; 3) preventing suicide; and 4) maintaining the ethical integrity ofthe medical profession, outweigh the individual's right to refuse life-sustaining treatment. (1989, February 24). 3, col. A sense of personal failure and responsibility for the deathmay accompany such decisions. Harmon (1988). Inthe case of such conflicts, it would be advisable for an impartial party,such as the courts, to become involved in order to protect the rights ofthe patient who cannot speak for himself. Where an incompetent person is concerned, thestate's responsibility rests in again determining what the individual'sdecision would have been if they had been capable of reaching such adecision on their own. As it becomes more medically certain thatthe patient will not recover normal functioning, however, a decision willbe required to be made. Second, in the absence of clear evidence, is there ameasure of trustworthy evidence that the patient would have refusedtreatment. 565). It is difficult even to think ofa case where another person would be harmed by the patient's dying soonerrather than later. True, a child might be left an orphan and penniless,but would that not also be the case if the patient were to die monthslater. In this instanceas well as with passive competent euthanasia, there is no activeintroduction of a death-producing agent but rather a non-treatment withlife-sustaining medical tactics. Shaw, ed.In Re Quinlan, 7 N.J. 4 7). Treatment Plans Hang on Decision, American Medical News, pp. The casesdetermined whether her guardian could order that all nutrition andhydration provided by a gastrostomy tube could be withdrawn. "People understand their own business and their own interestsbetter, and care for them more, than the government does, or can beexpected to" (Dworkin, 1984, p. Harmon, 76 S.W.2d 4 8, 416 n.11 (Mo. Often the patient's family and the physicianattending the patient will be in agreement that the patient would haverefused further life-sustaining treatment. Therefore, the issues of suicide and ofthe state's obligation to preserve life are no more at issue than incompetent situations. A living will is an advanced written directive instructingphysicians to withhold or withdraw life-sustaining procedures in the eventof a terminal illness (Meyers, 1981, p. Patients often do ignore adoctor's recommended treatment in lesser matters and no one would suggestthat the state interfere in those instances. Similarly to the case with passive competenteuthanasia, any conflicts with medical integrity and protecting thirdparties may be also disregarded by the same arguments as stated above. The paternalistic aspect of the state which might beinclined to interfere should be restricted solely to determining that thepatient has the capacity and maturity to reach such decisions rationallyand in a reasoned manner. Mill's argument could be carried further to say that if anindividual is acting against his own good, or what is generally agreed bysociety to be good for him, then that is his right to do so. 922 (1976).Webster's New Twentieth Century Dictionary, Unabridged. Dworkin suggeststhat perhaps a "cooling off" period (Dworkin, 1984, p. Incompetency, of course, involves cases where the patient isunable, because of his mental or physical condition, to make such adecision on his own behalf. p. In cases where clearwritten instructions are not available, it often falls to the patient'sfamily and physicians to make the determination. The opposite side of this coin would be passiveeuthanasia, by which the withholding or termination of life-sustainingmedical treatment allows a disease to run its natural course--presumablyending in death. 598) might be thebest approach in that it would allow the patient time to consider andreflect on his decision, which might have been made under the extremeemotional or physical distress brought on by his condition. His own good,either physical or moral, is not a sufficient warrant" (Mill, in Arthur,1984, p. In summary, in the case of passive competent euthanasia, thepatient's wishes should always prevail. One instance of such a conflict was the case of Karen Ann Quinlan.In April, 1975, Karen Ann Quinlan went into an irreversible come with nohope that she would revive. In this case, the decision of Ms.Quinlan's parents was seen by the court to be in accordance with what thepatient's own wishes would have been if she had been able to decide forherself. In the case of Nancy Cruzan, none of these three tests werefound to be true and the court ordered that her treatment be continued. denied, 429 U.S. The state has no case forinterfering in a case where a mature, informed individual has made asincere decision to refuse life-sustaining medical treatment. (1984). Often suchsituations arise in the case of a person who is succumbed to anirreversible coma or in the case of a mentally deficient person who isunable to make a reasoned decision. ReferencesAbraham. In most cases, the court will rightly accord substantial weight tothe judgment of the patient's family in determining what the patient'swishes would have been, but in cases where there is a conflict betweenphysician and family, a review of the situation should still be made bysome agency of the state in order to protect the patient's rights andinterest. And yet, euthanasia doesnot have only one single, simple aspect. In cases where amature individual is competent to determine his own fate, his wishes shouldbe respected and not interfered with by the state. (1984). Euthanasia The word euthanasia comes from the Greek which means "a good death".Black's Law Dictionary defines euthanasia as "the act or practice ofpainlessly putting to death persons suffering from incurable anddistressing disease as an act of mercy" (Black, 1979, p. Thegovernment of the United States was formed on the basis of each man's rightto life, liberty and the pursuit of happiness. One method of making such a determination isthe evidence of his desire regarding medical treatment may be documented ina living will. The question thenbecomes whether the patient should be hindered from choosing the timing andcircumstance of his dying according to his own interests. A situation where a patientsuffering from a painful, ongoing illness has chosen to refuse life-sustaining medical treatment is one where the government, then, has noright to interfere. 497.Cruzan v. Indeed,the definition of suicide is "the act of killing oneself intentionally"(Webster's, 1979), implies that suicide cannot be done without an actionbeing taken--non-action, or refusal of treatment cannot therefore beconsidered suicide. 352-353). J. If a person suffers from andincurable disease or condition which is not terminal, the simple refusal oflife-sustaining treatment will not result in an end to the patient'ssuffering. "Paternalism," in Readings in Philosophy of Law J. Each of us wishes to be accorded respect and to beallowed to function autonomously - to engage in personal freedom of action(Abraham, 1989. One type is active euthanasiawhere active administration of a death-producing agent is used toaccelerate death. There should also be distinctions made between competentand incompetent decisions to undertake euthanasia. "Over himself, over his own body andmind, the individual is sovereign" (Mill, in Arthur, 1984, p. Care must be taken, however, to ascertain that the individual hasindeed made a rational, informed decision in such cases. Let us first consider the case of competent passive euthanasia. (1979), p. In cases where no conflict exists, the wishes of the family andthe physician should be considered to be in accord with the patient'sdesires and the state has no right to interfere. First, when clear and convincingevidence exists that the patient would refuse treatment under thecircumstances. Arthur and W.H. The state's interest in preventing suicide is not threatened in acase where the patient had not set the death-producing agent in motion withthe intent to cause his own death, and where the patient's decision torefuse treatment was not an irrational act of self-destruction. It should be assumed that, initially, medical decisions are based onthe premise that everything can and should be done to preserve the life ofthe patient. Alive? As Millstates, "Neither one person, or any number of persons, is warranted insaying to another human being of ripe years, that he shall not do with hislife for his own benefit what he chooses to do with it" (Dworkin, 1984, p.589). An entirely new set of issues becomes involved in cases of activeeuthanasia, whether competent or incompetent. It is generally agreed thatthere are, and should be, limitations on each man's right to liberty whereit might infringe on the rights and liberties of other individuals.Determining the extent of liberty that should be allowed, and at what pointan infringement occurs on a third party's rights has been the topic ofdebate. One area of concern here is that the family members may insome situations act in accordance with their own best interests rather thanthose of the patient. Many varied ethical and legal considerations come into play whendifferent forms of euthanasia are concerned. Thirdly, a more purely objective test is whether the effect ofadministering life-sustaining treatment would be inhumane due to severe,recurring and unavoidable pain, treatment could be withdrawn (Cruzan v.Harmon, 1988). Thecritical question that comes into play in the case of passive incompetenteuthanasia is to determine the wishes of the patient. What would the wishes of the patient have been if they were to makesuch a decision themselves? In such cases, the interests of the state in preserving lifeand preventing suicide again come into view. "On Liberty," in Readings in Philosophy of Law. 1988).Dworkin, G. It is not easy for physicians and nurses to terminatetreatment. That person must be presumedto have considered the options and to have made the wisest choice forthemselves. It might bean occasion for attempting to dissuade the person from a course of action,but nevertheless there is no justification for compelling the person toaccept another option if his choice will harm no one except himself. A competent decisionwould be that made by a patient who is in full possession of his facultiesof reason and also in possession of the facts of his medical situation.This is often known as "informed consent", whereby the patient makes aninformed, rational decision regarding the course his life and treatmentshould take. 3.Black's Law Dictionary, 5th ed. Shaw, ed.Meyers, D. In most cases, it is the patient's family that will determine thedecision finally. "Ethicists Try to Define Status of Vegetative Patient: Dead? Three testswere formulated to make a determination as to the withdrawal of life-sustaining procedures such as this. 1 ,4 , 355 A.2d 647, 663 (1976), cert. Medico-Legal Implications of Death and Dying.Mill, J.S. The medical profession has performed it'sethical duty once a full explanation of treatments, recommendations andconsequences have been given to the patient. Finally, the issue of causing harm to an innocent third party can beall but disregarded in the case of a terminally ill patient wishing torefuse life-sustaining medical treatment. In cases ofincompetency, if there is a clear determination of what the patient'swishes would be, then again those wishes should be respected. The basis for this is that the family would be theclosest to the patient and therefore best able to determine what thepatient's wishes would have been if they had been able to decide forthemselves. As stated by John Stuart Mill in On Liberty, "the only purpose forwhich power can be rightfully exercised over any member of a civilizedcommunity, against his will, is to prevent harm to others. These rights are inviolate and nojustification can be made for the removal of the individual's rights todetermine his fate. 565). Arthur and W.H. Even the state's interest in allowing the medical profession tomaintain ethical integrity cannot interfere with the patient's right tochoose what is in their own best interest. Clearly the legal decision in this case upholds Mill's doctrine ofthe individual's sovereignty over his own body and mind. The statehas no right or power to interfere with the individual's decisionsregarding their own health and body. Mill's concept of assuming the individual to be "master of his fate"would seem to have no more perfect application than in the situation ofpassive competent euthanasia. 594). In such cases, the family andthe physician, when in agreement, should be presumed to have the interestof the patient at heart and the state should not interfere. A mature, rational person has chosen todecline acceptance of medical treatment which would prolong his life, andthat decision harms no one except themselves. An example of the issues at hand in cases such as this are reviewedin the case of Cruzan v. Her parents attempted to get her removed fromlife support systems, but the physician and hospital authorities opposed.In 1976, the New Jersey Supreme Court rules that comatose Karen AnnQuinlan's constitutional right to privacy protected her right to refusemedical treatment and allowed her physicians to disconnect the respiratorkeeping her alive (In Re Quinlan, 1976). In the case of a terminally ill patient, the questionof sustaining life would seem not to apply since the patient is determinedto be dying regardless of any action or inaction. 1). In summary, an individual is entitled to the right to die, the rightto refuse life-sustaining treatment, the right to end their life in adignified way of their own choosing. The staggering costs of prolonged life-sustainingtreatment may be one reason for a family to choose to refuse treatmentrather than to truly consider the patient's desires. An individual's decision, orthe family's decision in the case of an incompetent person, to activelytake a patient's life requires much more careful review in the light of thestate's interest. (1979).----------------------- 11 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.