Introduction
Filene asks an important question that several philosophers are yet to offer an adequate explanation, which relates to the worthiness of life. A debate is ongoing as to whether an individual has the right to withdraw his or her life whenever it is felt that it no longer makes sense.
Some of the concerned parties to the debate include bioethicists, social workers, families of the affected individual, as well as the entire society. The book discusses the historical and cultural aspects of life and death by putting it into the context of the modern society. Some historians view his works as an account of the right to die.
For instance, he presents the views of individuals who have wished to die because of one reason or the other. First, he discusses the role of technology in saving lives. Moreover, he evaluates whether the use of technology would be sustainable in the future because life-support machines are gaining relevancy in many societies, but they are not effective in safeguarding life.
In particular, he gives the case of Karen Ann Quinlan, which served an important purpose of shaping the public opinion as regards to the use of technology in supporting life. Apart from the case, he proves that several individuals have moved to court to determine whether they have the right of terminating their own lives, as well as those of their loved ones.
In his conclusion, he sums up that the issue of life and death is an ethical one, and self-determinism should not be applied in resolving this important issue. He notes that, “as we think about how we hope to die, we need to take into account the perspectives of history and culture[1].” To him, consideration of cultural and historical events in making ethical decisions helps in understanding the ambiguities that awaits an individual, as well as the options that people take.
Case Studies
The first court case to have emerged in the country regarding the right to die was presented in New Jersey when the parents of Karen Ann Quinlan sought an interpretation from the judiciary on whether their daughter would continue to suffer.
Her physical condition was not improving after being kept alive in a respirator for some months, something that made her parents to ask the hospital administration to terminate her life without further delay. The hospital refused, citing several reasons, one of them being the provision in the constitution declaring that life is sacred and should be protected at all times. The court determined that the parents had the right of terminating the life of their daughter.
The decision sparked a heated debate, with one group supporting the court’s decision while the other was highly opposed. Each side presented valid reasons as to why their positions had to be adopted. The practice of medicine was particularly affected since the ruling lead to the subsequent amendment of the law to incorporate divergent views. Through the case, each hospital was required to develop an ethics committee whose role would be to analyze each case and offer professional advice.
Ann’s parents defended their position by claiming that they were not pessimistic about the health of their child, but instead they wanted her to be returned to the natural state since they were against the technology employed in keeping her alive. The hospital was concerned with the response from the Morris Country prosecutor since they would be charged with homicide in case they withdraw the ventilator without state approval hence it decided to seek further clarification from courts.
The hospital was granted a court order stopping Quinlan’s family from terminating Ann’s life, but a successful appeal was made in 1976, granting the family its wish. It was surprising to note that Ann did not die as soon as the ventilator was removed because she survived for nine more years, even though the mode of feeding was artificial.
The ruling changed the perception of many, with the Catholic Church being drawn into the debate. The Supreme Court identified that Ann’s father was acting out of good faith. Moreover, the judges relied on letter received from the Pope requesting all doctors to exercise morality whenever dispensing their services. On the issue of withdrawing the life-support machines, the Pope responded by giving five important reasons as to why the family has the right.
The Catholic Church clarified that the doctor has the right to withdraw life support machines, but in extreme cases when it is felt that it is the only remaining option of fulfilling the ethical duty. However, the doctor cannot take this decision without receiving instructions from the patient directly, obliquely, utterly, or openly meaning that the family can represent the patient in making the decision.
The technique is considered an extra-ordinary means of saving life hence the family should never think of using it or instructing the doctor to do so. If it is confirmed that the patient has no hope of recovering and is unconscious, the Catholic Church allows the family to apply any available technique, including removal of life-support machine since it would turn out to be the only solution.
However, it should never be tried because it might end up affecting the condition of the patient. Finally, the Catholic Church is simply against euthanasia and the case of Ann was different because only the ventilator was disconnected and it turned out to be effective because she survived for an additional nine years.
From the case, it is noted that the Church was simply against the overreliance on technology to save life since the Pope was of the view that God might provide a natural healing and in this case, the patient has to be allowed to survive through the natural means. In order to save life, all available options have to be tried out and withdrawal of machines is just one of the options. The church refers to this as the principle of double effect whereby the outcome might be either positive or negative.
The court supported Ann’s father proposal by considering his faith and the intention of the act since he was optimistic that his child would survive through natural means. The decision and the overturning of events surprised many people because Ann was able to survive for additional days, even though the majority expected her to be pronounced dead upon the withdrawal of the ventilator.
In a different case involving Cruzan and the Director of Missouri Department of Health in 1990, the Supreme Court failed to grant the family its wish of withdrawing the life-support machine because the reason was not convincing. The case was brought to the judges at the time when the health sector had developed laws to deal with issues of medical morality.
The Cruzan family requested the court to instruct the hospital to remove their child from the life support machine. However, the judges failed to pursue a similar path as the New Jersey Supreme Court because it followed the advice of the medics and stated clearly that a competent person has the right to object to the issue of machine withdrawal because he or she has adequate experience and understanding of the case.
Since Nancy Cruzan, the patient, was a minor and did not understand what was fit for her, it was against the law for the family to come up with a unanimous decision without consulting experts. The family appealed the decision and went back to collect enough evidence to prove that withdrawal of the machine was the best option for Nancy. The court heeded to the family’s plea and ruled in its favor leading to the stoppage of the life-support services.
Nancy survived for an additional seven days meaning that life can still go on without the machines. The decision and the preceding events had a greater impact on people’s perceptions on technology because they expected an instant death upon the stoppage of machine services. Even though many people are still of the view that machines have a role to play in preserving life, a majority of individuals have to appreciate the natural process that human beings go through in their lives.
Debate
The withdrawal of life support services to allow the patient to use natural means of survival is considered homicide in the United States and it might be punishable by law, but the case is different when the individual or the family requests for the abandonment of the machines.
Filene suggests that those in support of the withdrawal of the machines base their arguments on the principle of self-determination, something he highly contests since life is not an individual affair, but instead a communal concern. For instance, the death of a family member might bring trauma, something that increases suffering instead of solving the problem.
Additionally, supporters of mercy killing note that it would be better to allow a subject to die peacefully instead of allowing him or her to go through a lot of pain. Advocates of mercy killing suggest that the use of the term doubt of effect is hypocritical and unrealistic because placing a patient under a life support machine means he or she is unable to use natural means. There would be no any other alternative to improve the situation.
The opponents present strong points as to why the act should never be allowed in the country. One of the arguments is that not all deaths are painful meaning that there is no need of rushing to withdraw the machine without establishing whether the patient is really suffering.
Apart from inducing euthanasia or withdrawing life support machines, other options exist, including cessation of active treatment and inducing pain relievers. In fact, this would be the best option of reducing pain, as the situation is monitored. It is always believed that the patient might be allowed to die today, yet the cure for his or her condition is invented the following day. Some individuals believe that everything is possible in the world of science and technology because inventions are made every minute.
If life support services are to be withdrawn, the status of the patient should be taken into consideration because some patients might be opposed to the idea while the family is concerned with the escalating hospital bills. This would definitely amount to murder because the life of the individual would have been terminated without his or her knowledge[2]. In fact, this should always be investigated and those found guilty must be arraigned in court to face murder charges.
From a legal standpoint, mercy killing, which entails the withdrawal of the life-support machine, is a criminal homicide meaning the intention is always to terminate life, irrespective of the intention. However, the law is clear on homicide because not all of them are illegal. Any homicide that does not attract a criminal punishment is permissible and pardonable. However, withdrawal of life-support machine does not fall under the category that is excusable because it is active euthanasia.
If the physician injects the patient to facilitate death, the law designates this as suicide. The same applies with withdrawing life support machine, even though the practice is allowed in the United States. From the works of Filene, it is observed that several courts have upheld the decision to terminate life through switching off the machines. In the case of Ann, her parents had to make a decision for her, but she survived for nine years, something considered an extra-ordinary case.
For the case of Nancy, she did not survive beyond the eleventh day meaning that machines could be utilized effectively to enhance life. Even though the church is opposed to mercy killing, it permits the family to explore other options believed to be effective in preserving life, including the withdrawal of machines. This means that euthanasia and mercy killing are controversial concepts that cannot be addressed effectively by evaluating the views of one side.
Bibliography
Filene, Peter. In the Arms of Others: A Cultural History of the Right-to-Die in America. New York: Diane Publishing, 2003.
Oluyemisi, Bamgbose (2004). “Euthanasia: Another Face of Murder”. International Journal of Offender Therapy and Comparative Criminology 48.1 (2004): 111–121.
Footnotes
- Peter Filene, In the Arms of Others: A Cultural History of the Right-to-Die in America (New York: Diane Publishing, 2003), p. 65.
- Oluyemisi, Bamgbose, “Euthanasia: Another Face of Murder”, International Journal of Offender Therapy and Comparative Criminology 48.1 (2004), p 119.