Who has the right to end a life?

As the capabilities of medicine and technology grow, society is confronted with new questions about morality and power that were never brought to light in the past. Medical innovations allow people with debilitating and permanent diseases or conditions to live for many years with support. But what if those people do not want to survive any longer? Many court cases and debates have circled around the issues of assisted suicide, euthanasia and taking people off life support.  The debate continues as patients, families, physicians, ethicists, legislators, judges and clergy wrestle with the difficult choices that arise when death nears.

Background

Law in the United States emphasizes the autonomy and dignity of the patient in medical decision-making. The right of patients to refuse medical intervention is well established. The courts have also defined artificial respiration, nutrition and hydration as medical interventions. As of December 2012, the right affirmatively to end one’s own life in the U.S. existed only Oregon, Washington and Montana and could be exercised only under very limited circumstances. Whether physicians should aid in suicide is extremely controversial within the profession, however. Euthanasia, or actively ending someone else’s life without that person taking the step that causes death — as opposed to withdrawing life support from an otherwise dying individual — is not permitted anywhere in the United States. Pain medications, however, may be given in doses that could be potentially lethal if the intention is not ending the patient’s life but controlling otherwise intractable pain. Many conflicts arise when patients are unable to express their views and their wishes are either not clearly known or are disputed by family members.

In November 2009, the nation’s Catholic bishops issued new guidelines on care of terminally ill patients in Catholic hospitals that tightened standards to prevent the actions taken in Schiavo’s case from occurring in institutions under church control. The new policies would make refusal or removal of feeding tubes and some other life-sustaining measures more difficult and, many observers believe, conflict with the desires — and even the legally valid directives — of some patients to have such measures ended or never begun. “In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally,” states the document, Ethical and Religious Directives for Catholic Health Care Services. “This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care.”

Euthanasia.com, an anti-euthanasia site, contains numerous articles on topics such as physician-assisted suicide in Oregon, euthanasia in the Netherlands and statements by religious groups and medical organizations.

Important cases

A 2007 case involved Emilio Gonzalez, a Texas toddler with a fatal neurological disease who died May 19 that year after a legal struggle between his doctors, who wished to end life support under a state law, and his mother, who opposed that action.

In December 2006, the Roman Catholic Church refused to give a religious funeral to a Rome man with muscular dystrophy who had begged the Italian government to allow him to end his life legally. Piergiorgio Welby died after his doctor disconnected him from his respirator. The doctor was arrested, and the Vatican refused to give Welby a religious funeral because he had advocated euthanasia.

The case of Terri Schiavo engaged religious leaders, the public, Congress and the president. Schiavo was a severely brain damaged woman who lived in a persistent vegetative state after experiencing cardiac arrest. Schiavo’s husband wanted to take her off of life support  but Schiavo’s parents opposed that decision and took her husband to the courts to decided. After numerous appeals, cases and legislation based on the case, Schiavo died in 2005 after her water and feeding tubes were removed.

Dr. Jack Kevorkian, also known as “Dr. Death,” served eight years in prison for a second-degree murder conviction for helping a man with Lou Gehrig’s disease die in 1998. Kevorkian, who has admitted participating in more than 130 suicides, was a strong supporter of euthanasia and patients’ rights to doctor-assisted suicides.

Assisted suicide is legal in Oregon via the Oregon Death with Dignity Act, Washington by the Washington Death with Dignity Act), and Vermont by the Patient Choice and Control at End of Life Act. In December 2006, the General Assembly of the United Nations adopted the “Convention on the Rights of Persons with Disabilities,” which prohibits nations that sign on to the convention to deny “food and fluids” to disabled people.

Religious positions

To find out how religious groups weigh in, read a 2000 essay, “Euthanasia and Religion” by Courtney Campbell, Oregon State University philosophy professor. Campbell says there continue to be five basic denominational positions in regard to physician-assisted suicide and euthanasia:

Physician-assisted suicide is immoral and should be illegal: Roman Catholics, Southern Baptists, Latter-day Saints

Physician-assisted suicide is immoral, but its legality is not a “religious” issue per se: most mainstream Protestants, Conservative and Orthodox Judaism, Islam

No denominational position has been formulated on physician-assisted suicide because it is a political/medical issue: many Protestant groups

Physician-assisted suicide is moral in limited circumstances as a matter of respecting individual choice: United Church of Christ, Reformed Judaism

Physician-assisted suicide is moral in limited circumstances and it is a religious responsibility to advocate for passage of laws securing this right: Unitarian Universalist

End of life issues

Physician-assisted suicide and euthanasia – The state of Oregon permits physicians, under strictly limited circumstances, to provide terminally ill patients with the means of ending their own lives.  Belgium and the Netherlands permit both physician-assisted suicide and, under strictly limited circumstances, euthanasia, or causing the death of the patient. In both countries, physicians may comply with requests to end the lives of patients undergoing intolerable suffering if specific legal requirements are met.  Both of these procedures are very controversial in the United States, both among health-care professionals and the public.

Advance care planning – Two years after the vast publicity and intense interest surrounding the 2005 Schiavo case, 80 percent of Americans still had not made an advance care document for themselves. Such documents serve the purpose of indicating who will serve as agent or surrogate if an individual is unable to make decisions concerning his or her own care. They also express the values that a person holds about the end of life.

Curing vs. relieving – The bright line that formerly existed between curative and palliative care, between curing a condition or relieving its symptoms, is becoming more blurred.

Resource allocation – In a time of intense competition for funding, how can the health-care system allocate sufficient resources to provide the staffing and staff time needed for adequate end-of-life care?

Pain – How can the health-care system deal with both the physical pain and the existential and spiritual suffering of dying individuals?

Care for families and caregivers – How can institutions be organized to aid both the dying and those involved in their care?

Potential conflicts between the desires of the dying – How can the wish to be an organ donor be reconciled with expressed desires to avoid artificial extension of life, which may be needed to preserve organs?

Definition of death – Most states in the United States define death as either the cessation of breathing and blood circulation or the cessation of all electrical activity in every part of the brain. Some people argue, however, that irreversible cessation of electrical activity in the cerebral cortex, which controls consciousness and cognition, constitutes death because the individual then has no possibility of regaining any capacity for thinking, awareness or other higher brain functions.

Definitions

The terms are tricky to define and often used interchangeably. But it is clear that many people support physician-assisted suicide while rejecting active euthanasia.

Death – Most states in the United States define death as either the cessation of breathing and blood circulation or the cessation of all electrical activity in every part of the brain. Some people argue, however, that irreversible cessation of electrical activity in the cerebral cortex, which controls consciousness and cognition, constitutes death because the individual then has no possibility of regaining any capacity for thinking, awareness or other higher brain functions.

Euthanasia – The act or practice of killing or permitting the death of hopelessly sick or injured individuals in a relatively painless way for reasons of mercy; also known as mercy killing.

Active euthanasia – The delivery of a lethal dose of medication to a terminally ill person.

Passive euthanasia – The withholding of potentially life-saving medical treatment.

Physician-assisted suicide – When a physician facilitates a patient’s death by providing the means and information to enable the patient to take his or her own life.

Euthanasia with no “free will” – When a physician decides whether or not to end the life of a person who suffers from a serious illness or medical condition.

Why it matters

Euthanasia raises the most profound questions about who has the right to die, who has the right to help them — and who has the right to choose who lives and dies. Not a day goes by when a country, state, doctor, hospice worker, theologian, ethicist or family member doesn’t wrestle with whether to allow passive or active euthanasia and whether to challenge doctors or patients who take the law into their own hands.

Questions for reporters

Covering end-of-life issues and cases is complicated because much depends on the particular circumstances, including the precise medical condition and prognosis; the patient’s and family members’ religious, spiritual or moral beliefs; and the legal situation, which varies among states. Changes in any of these can alter the ethical calculus of the cases and raise additional, or different, bioethical questions. For example, the drive in a number of states to revise laws on organ donation, in order to increase the supply of organs available from deceased individuals, has raised the issue of potential conflict between a dying person’s expressed desire both to donate organs after death and to avoid artificial extension of life, which may be necessary to preserve the organs in a condition suitable for donation.

Some questions to consider:

How are religious leaders, theologians, hospital chaplains and bioethicists in your area weighing in on right-to-die issues, from passive euthanasia to active assistance in terminating life?

What kind of end-of-life decisions are families making every day in your area, and to whom do they turn for guidance?

What kinds of moral issues do health-care workers face when administering pain medication or withholding food or hydration from a dying patient?

What issues do families and health-care workers face when dealing with people with dementia and Alzheimer’s?

Should depressed people be allowed to end their lives?

Should cost of medical treatment be a factor in deciding whether to terminate a life?

What religious and secular groups are leading the opposition to euthanasia and physician-assisted suicide in your region?

What groups are actively supporting legislation to allow physician-assisted suicide?

News articles and research

National Sources

Law

  • Bill Colby

    Bill Colby was the attorney for the Nancy Cruzan family in the first right-to-die case heard by the U.S. Supreme Court. He is the author of Unplugged: Reclaiming Our Right to Die in America (AMACON, 2006) and Long Goodbye: The Deaths of Nancy Cruzan (Hay House, 2002).

  • Carl H. Coleman

    Carl H. Coleman is director of the Health Law and Policy Program at Seton Hall Law School in Newark, N.J. Professor Coleman served as Bioethics and Law Adviser at the World Health Organization (WHO) in Geneva, Switzerland from 2006-2007. He has written on assisted suicide and was a member of the New York State Attorney General’s Commission on Quality of Care at the End of Life. He co-wrote The Ethics and Regulation of Research With Human Subjects (Lexis, 2005).

  • Jon B. Eisenberg

    Jon B. Eisenberg is an appellate lawyer who was part of the legal team of Schiavo’s husband, Michael Schiavo. He also teaches appellate procedure at University of California Hastings College of the Law. Eisenberg wrote Using Terri: The Religious Right’s Conspiracy to Take Away Our Rights (HarperSanFrancisco, 2005).

  • Susan M. Wolf

    Susan M. Wolf is McKnight Presidential Professor of Law, Medicine and Public Policy, as well as Faegre & Benson Professor of Law at the University of Minnesota law school. She is also a professor of medicine at the University of Minnesota Medical School and a faculty member in the university’s Center for Bioethics in Minneapolis. She previously directed the Hastings Center project that produced the influential book Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying in 1987.

  • Carl E. Schneider

    Carl E. Schneider is Chauncey Stillman Professor for Ethics, Morality and the Practice of Law at the University of Michigan Law School. He served on the President’s Council on Bioethics and edited Law at the End of Life: The Supreme Court and Assisted Suicide.

Medicine

  • Ira Byock

    Dr. Ira Byock is the executive director and chief medical officer for the Providence Institute for Human Caring. He was formerly the director of the palliative care program at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. His books include Dying Well: Peace and Possibilities at the End of Life. A past president of the American Academy of Hospice and Palliative Medicine, he maintains information and resources about end-of-life care at the website DyingWell.org.

     

    Contact Yvonne Corbeil, the press and media contact.

  • Dr. Ezekiel J. Emanuel

    Dr. Ezekiel J. Emanuel is the Diane Levy and Robert M. Levy University Professor in the department of medical ethics and health policy at the University of Pennsylvania.

  • Dr. Joanne Lynn

    Dr. Joanne Lynn is a pioneer in palliative care and care of the dying, a geriatrician, a health services researcher and an ethicist. She has served as chairwoman for various efforts to improve end-of-life care, is past president of Americans for Better Care of the Dying and is the author or editor of numerous books, including Sick to Death and Not Going to Take It Anymore: Reforming Health Care for the Last Years of Life (University of California Press, 2004). She works in the Office of Clinical Standards and Quality within the federal Centers for Medicare and Medicaid Services in Baltimore; contact her through the centers’ office of external affairs in Washington, D.C.

    Contact: Director of Communications, Ken Schwartz

  • Dr. R. Sean Morrison

    Dr. R. Sean Morrison is a professor of palliative careat Mount Sinai School of Medicine in New York. He co-edited a book on geriatric palliative care and is director of the National Palliative Care Research Center.

  • Richard Payne

    Richard Payne is dean of the Institute of Buddhist Studies and professor of Buddhist studies at the Graduate Theological Union in Berkeley, Calif. He can speak about Tantric rituals and Buddhist spiritual practices.

  • Dr. Daniel Sulmasy

    Dr. Daniel Sulmasy is a professor of medicine and ethics at the University of Chicago. Sulmasy is a Franciscan friar and a physician. He also holds a doctorate in philosophy and has expertise in end-of-life decision-making. His writings include “Are Feeding Tubes Morally Obligatory?” in the January 2006 St. Anthony Messenger, examining Catholic teachings about extraordinary medical treatments.

Theology

  • Lucy Bregman

    Lucy Bregman is a religion professor at Temple University in Philadelphia. She researches religion and death and has taught a course on death and dying since 1979.

  • John J. Paris

    The Rev. John J. Paris is a Jesuit priest who teaches in the theology department of Boston College. He has been a consultant to the President’s Commission for the Study of Ethics in Medicine and the United States Senate Committee on Aging and presented to Gregorian University in Rome on Catholic approaches to end-of-life care.

  • Kenneth L. Vaux

    Kenneth L. Vaux is a professor of theological ethics at Garrett Evangelical Theological Seminary of Northwestern University in Evanston, Ill. He has written about theology and medicine and is the co-author of Dying Well (Abingdon Press, 1996).

Ethics

  • W. Maurice Young Centre for Applied Ethics

    The W. Maurice Young Centre for Applied Ethics is located at the University of British Columbia, Vancouver, B.C. It focuses on the research on and teaching of applied ethics in fields such as science and technology, health, research, and animal welfare.

  • Emory Center for Ethics

    Center for Ethics at Emory University in Atlanta focuses on the study of ethics in decision-making. The Center focuses on four pillars: health, science, and ethics; citizenship and the public good; organizational and corporate ethics; and ethics and the arts. Paul Root Wolpe is director.

    Contact: 404-727-3150.
  • Edmond J. Safra Center for Ethics

    The Edmond J. Safra Center for Ethics at Harvard University studies and researches ethics in professional and private life. Eric Beerbohm is director.

  • Consortium Ethics Program

    The Consortium Ethics Program at the University of Pittsburgh is a regional health care ethics network. It educates health care professional and institutions in clinical health care ethics. Rosa Lynn Pinkus is director.

  • Ethics Resource Center

    The Ethics Resource Center is a nonprofit, nonpartisan educational organization whose vision is a world where individuals and organizations act with integrity. Its focus is organizational ethics. It is based in Arlington, Va. Contact through the website.

    Contact: 703-647-2185.
  • Dartmouth College Ethics Institute

    The Dartmouth College Ethics Institute at Dartmouth College in Hanover, NH focuses on applied and professional ethics, ranging from medical and business ethics to teaching and research ethics. Aine Donovan is director.

Organizations

Supporters of physician-assisted suicide and/or euthanasia

Opponents of physician-assisted suicide and/or euthanasia

  • Wesley J. Smith

    Wesley J. Smith is a San Francisco-based attorney, columnist and anti-euthanasia activist. He is the author of Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (Times Books/Random House, 1997).

  • Diane Coleman

    Diane Coleman, an attorney, is the founder of Not Dead Yet, a Forest Park, Ill.-based organization of people with disabilities who actively oppose euthanasia and physician-assisted suicide.

  • F. Michael Gloth

    F. Michael Gloth is associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore. Gloth has written extensively about pain management in the elderly.

  • Richard Doerflinger

    Richard Doerflinger, deputy director of the Secretariat for Pro-Life Activities of the United States Conference of Catholic Bishops, is a bioethicist who writes frequently on euthanasia. He has written extensively on Roman Catholic teachings on bioethics and testified before Congress. Many of his articles are posted on the Pro-Life Activities bioethics web page.

  • David Callahan

    David Callahan is author of The Cheating Culture: Why More American are Doing Wrong to Get Ahead (Harcourt, 2004) and co-founder of the public policy center Demos.

    He opposes physician-assisted suicide and has written that, “the application of mercy killing has no logical boundaries.”

Regional Sources

In the Northeast

  • Arthur Dyck

    Arthur Dyck is a Harvard University professor of population ethics.. His main concentration is in ethical theory, with special application to questions of moral knowledge, human rights, and bioethics.

  • Lisa Sowle Cahill

    Lisa Sowle Cahill is a professor of theology at Boston College who has written about genetics from a Christian perspective. Her books include Theological Bioethics: Participation, Justice and Change and Bioethics and the Common Good.

  • George Annas

    George Annas is professor and chairman of the health law department at the Boston University School of Public Health and an expert on abortion policy, embryo research, stem cells and end-of-life research.

  • Arthur Caplan

    Arthur Caplan is a professor of bioethics and director of the division of medical ethics at New York University’s school of medicine. He co-edited Assisted Suicide: Finding Common Ground.

  • Sylvia A. Law

    Sylvia A. Law is Elizabeth K. Dollard Professor of Law, Medicine and Psychiatry and co-director of the Arthur Garfield Hays Civil Liberties Program at New York University Law School.

  • Rita Simon

    Rita Simon is university professor emerita of justice, law and society for the School of Public Affairs at American University in Washington, D.C. She wrote the book Abortion: Statutes, Policies and Public Attitudes the World Over (Praeger Publishers, 1998).

  • James Hoefler

    James Hoefler is a professor and the coordinator of the political science department at Dickinson College.

    He has written about terminal dehydration as an alternative to physician-assisted suicide and moral decisions about tube feeding for severely demented patients at the end of life. He hosts a web site on the topic.

In the South

  • D. Dixon Sutherland

    Dixon Sutherland is the Stetson University professor of religion and ethics and has also served as director of the Christian Ethics Institute.

  • Stella Capek

    Stella Capek, Hendrix College sociology professor, has studied the right-to-die movement in the United States.

In the Midwest

  • Kathryn Rettig

    Kathryn Rettig is a professor of family social science at the University of Minnesota who has looked at marriage issues, child support systems and the values underlying end-of-life decisions.

  • M. Cathleen Kaveny

    M. Cathleen Kaveny is the John P. Murphy Foundation Professor of Law at the University of Notre Dame. She focuses on the relationship of law and morality.

  • Gerald McKenny

    Gerald McKenny is a professor of Christian ethics and moral theology at the University of Notre Dame. He studies and writes about the ethics of biotechnology and the philosophy of medicine.

  • John F. Kavanaugh

    The Rev. John F. Kavanaugh is a philosophy professor at St. Louis University. He wrote the book Who Counts as Persons? Human Identity and the Ethics of Killing.

     

In the West

  • Courtney Campbell

    Courtney Campbell, Oregon State University philosophy professor, has focused on the Latter-day Saints and medical ethics, as well as hospice and assisted suicide. He has authored numerous articles on the controversial Oregon Death with Dignity Act and on the Oregon Health Plan.

  • Darien Fenn

    Darien Fenn, professor in the psychiatry department at Oregon Health Sciences University, has studied the attitude of Oregon psychologists toward physician-assisted suicide and the Oregon Death with Dignity Act. He can be emailed through a website contact form.

  • Linda Ganzini

    Linda Ganzini, professor of psychiatry and medicine at Oregon Health Sciences University, surveyed 2,500 Oregon physicians and 500 hospice workers about patients’ experience of assisted suicide.

  • Joel Zimbelman

    Joel Zimbelman, a California State University-Chico, religious studies professor, has written on legal decisions and public opinion informing the debate over the removal of life-sustaining treatment, assisted suicide and euthanasia.

  • Elliot Dorff

    Rabbi Elliot Dorff is a professor of philosophy and university rector at American Jewish University in Bel-Air, Calif. He is an expert in Jewish family issues, including adoption. He has studied the Jewish perspective on assisted death, transhumanism and ethics in general.

Related source guides