Legislative Process
In April 2019, New Jersey became the 7th U.S. state to allow assisted dying after the Governor of New Jersey signed the bill into law, and the bill went into effect on August 1, 2019. In view of the extreme ethical controversy of the topic of euthanasia, it seems interesting to consider this bill from the point of view of legal and biosocial ethics. New Jersey’s Medical Aid in Dying for the Terminally Ill Act (A1504) took effect on August 1, 2019, and is in pending litigation. The law is known as the “Medical Aid in Dying for the Terminally Ill Act,” permitting terminally ill, adult patients-residents of New Jersey, to receive and carry out self-administration of medication to end life in a peaceful and humane way. Democratic Governor Phil Murphy signed the bill on April 12 after the Democratic Assembly and the Senate voted in favor of the bill.
The regulatory document has gone through many stages of review since 2014. The state version conceptualized terminal illness being a condition when death is expected in the term of six months with or without providing treatment for life-sustaining. The assembly version removed mentioning of treatment (Patients rights council, n.d.). Hefler notes that the original bill, similar to the approved version, passed in the Assembly in 2014 but was not approved in voting in the Senate (Hefler, para. 4-5). The issue received new attention when Brittany Maynard, a 29-year-old California woman with aggressive terminal brain cancer, moved to Oregon to take advantage of that state’s “death with dignity” law (Hefler, 2019, para. 6). Now, when the bill is already passed voting and signed by the Governor, in order to be eligible for euthanasia, a patient over the age of 18 or more must go through two waiting periods, submit one written and two oral requests for lethal drugs and receive a conclusion from two doctors that he really needs a lethal dose of the drug (i.e., that his illness is fatal and incurable) (Medical Aid in Dying for the Terminally Ill Act). The bill defines a deadly disease as an incurable one that, according to doctors, will end in death within six months (Medical Aid in Dying for the Terminally Ill Act). Thus, the bill provides a detailed mechanism of the implementation of the ‘right to die.’
The rationale for Choosing the Legislation. Impact, Benefits, and Limitations
The rationale for Choosing the Legislation
For several decades, few questions in medicine have remained as debatable as the ethical aspects of euthanasia. For several decades, few questions in medicine have remained as debatable as the ethical aspects of euthanasia. Medical experts and the general public do not find it possible to reach a consensus that would balance the idea of a “death with dignity” from the point of view of the interests of the individual and society as a whole. Lawyers and philosophers offer arguments for and against euthanasia, revealing the shortcomings of both positions. At the same time, an absolutely atypical situation is observed: unsolved theoretically, continuing to be the subject of discussion as a problem, euthanasia is already being introduced into life, in medical practice, in-laws. Practice drives the theory ahead of it, leaves no time for a long discussion; it refutes the theory, corrects it, and is in a hurry to test all the results. Such a “running ahead” leads to a large number of errors and abuses. The law has both supporters and opponents, which is not surprising and which, in fact, determined our choice of this particular legislative act for consideration.
Benefits and Limitations
Human life is the highest social value of every society. Euthanasia is a violation of the human right to life and brings to naught the achievements of political and legal thought of the 20th century, due to which human life was recognized as the highest value at the international level. A giant breakthrough occurred in the mid-20th century, when, after two bloody world wars, the adoption of the Universal Declaration of Human Rights took place. It embodied religious doctrines and the political, economic, ethical, and legal teachings of many peoples, recognizing human life as the highest value of world civilization. While presenting ‘benefit’ in the form of aeriform’ right to die,’ never earlier included in the list of inalienable rights, the bill has evident limitations. The legalization of euthanasia, albeit in latent form, discourages the development of modern palliative care achievements. On the contrary, it returns humanity in times of barbarism (when a nomadic tribe, leaving for a new camp, left the elderly to die of hunger alone) and antiquity (with traditions like dropping children with congenital diseases or malformations from the cliff).
Impact on the Public
We should not forget that the Hippocratic oath reads: “I will not give anyone the lethal remedy I am asking for and will not show the way for such a plan.” Thus, euthanasia is a direct violation of the Hippocratic oath by a doctor, even in countries where it is legalized. Accordingly, this distorts the very essence of medicine, its foundations. The legalization of euthanasia can harm the medical profession in particular and society as a whole.
Author’s View and Position on the Legislation
In medical terms, it is always possible to control pain. The development of analgesic pharmacology, a better understanding of the effects of analgesia, and the optimal conditions for its use contribute to the fact that the doctor today is more equipped with drugs and has a wide range of working methods in this area. Often, pain, which is considered “resistant to analgesia,” occurs due to initially improper pain relief and inadequate dosage. It is possible to alleviate or eliminate the pain with the pharmacological method, but this alone is not enough. The drama of most patients in a terminal state is mainly of a socio-psychological nature: they feel abandoned not only by a doctor but often by relatives. Just at such a moment, the thought of euthanasia comes, a request for which, in essence, is a cry for help.
Obviously, after legalizing euthanasia, older people may experience psychological pressure to commit suicide. Such pressure may be exerted by relatives in order to receive the inheritance as soon as possible. Moreover, researchers note that there are cases (however, they are still rare) when doctors form the opinion in a patient being in a terminal state about euthanasia as the only right decision (Nunes & Rego, 2016, p. 5). They exert psychological pressure, using their authority and the fact that, often, the doctor is the only one who can be trusted at the moment.
Even in countries that support euthanasia, it is recognized that in most cases, patients’ requests for death are caused by pain and depression, and, often, alleviation of the patient’s moral and physical suffering is a task that is quite feasible for the doctor. It is worth considering what a person really wants when he/she says that he/she wants to die because doctors of any hospital hear requests for death every day. Is the patient afraid of the unknown, pain, loneliness, does not want to be a burden for loved ones? Maybe, a suffering person will be able to use the disease as an excuse to take stock of his life, draw some conclusions, forgive, reconcile. Not to miss this moment is the task of those who are close to him.
Respect for human dignity is always associated with the recognition of individual freedom to make choices in accordance with own spiritual values. Bioethics, as a social institution, recognizes not only the subjective-personal but also the objective-social dimension of emerging problems. It is about the social consequences of a policy that will allow medical actions, obviously leading to the death of the patient. The question remains whether the consent to euthanasia is ethical for the doctor. Permitting euthanasia is incompatible with the long-standing prohibition for doctors on killing their patients. Society’s trust in doctors is based on the fact that medicine is designed to heal, and its capabilities should not be used to bring death closer. The prohibition of murder is an attempt to protect the doctor from evil and has not only practical but also symbolic significance – to preserve the social status of medicine. In certain cases, suicide or euthanasia supported by a doctor may look merciful from his subjective and personal positions, but from an objective social point of view, this activity can harm the medical profession in particular and society as a whole, and, therefore,,, cannot be justified.
The use of euthanasia will inevitably lead to the criminalization of medicine and the loss of social trust in the institute of healthcare, to the scolding of the priceless gift of human life, to belittling the doctor’s dignity and perverting the meaning of his professional duty, to slowing down the development of medical knowledge, in particular, the development of methods of resuscitation and pain medication.
Stakeholders’ Concerns
Supporters of the law welcome its adoption based on the concept of ‘right to death.’ Oppositionists claim the decision could harm the most vulnerable members of society, and they want the state to do more to improve its healthcare system and palliative care. Lawmakers insist that the law be adopted in 2021, but opponents of this controversial law have led it to a dead end. Mike Catalini notes that if proponents of the law say that it allows patients to choose how to die while preserving their dignity, opponents of the law argue that suicide promotion laws target the most vulnerable sectors of society, such as people with disabilities, the elderly, and the poor (Catalini, 2019). Opponents of the law believe that such a policy can be dangerous and can lead to abuses. Thus, while proponents base their argumentation in a philosophical manner, claiming about the supposedly inalienable right to “death with dignity,” opponents see the situation more in practical terms
“Death with dignity” represents the most often used argument in favor of the case when a terminally ill person ingests prescribed medication anticipates death. At the same time, proponents of death with dignity claim about the inapplicability of the term “suicide” to terminally ill people who decide to die with the aim to terminate suffering. However, there is another definition of dignity, which has much more consequences and refers to the very structure of a civilized society. It is a dignity that upholds the constant, immeasurable, inviolable, and equal value of all members of society.
Therefore, through the prism of such ideas, the legalization of euthanasia can mean that the whole society agrees that the individuals’ lives may not have their original meaning. Such actions can implicitly message society that the very value and significance of an individual human life is based only on subjective choices and decisions, as well as on the compliance of this life with certain ‘quality standards.’ As a result, such an understanding can affect the whole society, and not just its representatives involved in euthanasia, albeit for the benefit of an individual. Thus, undoubtedly, “aid in dying,” or, in fact, euthanasia affects all members of the medical community – administrators, doctors, and nurses. In this regard, it seems necessary to conduct public hearings and consultations with the participation of the American Nurses Association, New Jersey Nurses Association, New Jersey Hospital Association regarding the conditions and aspects of the use of “aid in dying.”
Impact on Nurses and the Nursing Profession
For nurses, this question is especially crucial since their position assumes the execution of a doctor’s order. A nurse whose personal ethics does not allow euthanasia may appear in a situation similar to that of German soldiers in World War II, who, disagreeing with the ideology of Nazism and understanding the impending consequences of the war, were nevertheless drafted into the army and forced to fight under the Nazi banners. Nurses’ opinions are rarely considered in the decision-making process concerning euthanasia. However, the nurse-patient relationship can play a crucial role in the patient’s decision whether he/she wants to pass away voluntarily. The nurse’s empathy to the patient, as well as her skills in pain management, can contribute to the prevention of many potential causes of “aid in dying.” It can be recommended that Senator Nellie Pou, Assembly district members Democrats Shavonda E. Sumter and Benjie E. Wimberly, as well as congressman Jefferson Van, Drew organize appropriate hearings and consultations on the issue.
References
Catalini, M. (2019). New Jersey’s medically assisted suicide law takes effect.Federal News Network. Web.
Hefler, J. (2019). N.J.’s Aid in Dying bill: Terminally ill patients say it stops suffering, critics worry about abuse.The Philadelphia Inquirer. Web.
Medical Aid in Dying for the Terminally Ill Act A1504. 218th Legislature (NJ 2019). Web.
Nunes, R., & Rego, G. (2016). Euthanasia: A Challenge to Medical Ethics. Journal of Clinical Research and Bioethics, 7(4), 1-5.
Patients rights council (n.d.).New Jersey. Web.