Euthanasia Essay
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Euthanasia is a controversial subject, not only because there are many different moral dilemmas associated with it, but also in what constitutes its definition. At the extreme ends of disagreement, advocates say euthanasia (which in Greek means "easy death") is a good, or merciful, death. Opponents of euthanasia say it is a fancy word for murder.
Between the two extremes, there are various positions for and against euthanasia. One position opposes cases of "active" euthanasia, where an active, or overt, effort is made to bring about death, such as in administering a lethal injection, but accept "passive" euthanasia, which is generally described as declining to initiate extraordinary or even ordinary medical treatment, as moral.
Another position advocates that passive euthanasia is acceptable when the person to die has consented. Other positions include situations where a terminally ill patient is unable to consent as justifiable, because it resolves a hopeless situation. Conversely, even with this gradation, some opponents to euthanasia believe that voluntary, passive euthanasia is the same as suicide; involuntary euthanasia is considered to be murder.
Because euthanasia poses classic dilemmas as to its morality, it is not surprising that many issues arise in the legal and medical arenas. In law, the resolution of a particular case cannot always be applied to resolve another. In the medical realm, interpretation of medical doctrine concerning treatment of terminally-ill patients can result in entirely different applications.
In two relatively recent cases, the Supreme Court had to decide the future of patients that were considered to be in chronically persistent vegetative states. The courts had to decide whether to continue with the prevailing treatment, as advocated by the medical community, or discontinue treatment at the request of the patients' guardians. The courts considered several factors in making a determination: What are the state's interests in terms of human life? When does the patient's right to refuse treatment override the state's interest? What does the right to refuse treatment entail, and is it included in the patient's right to privacy? Do a patient's guardians have the right to refuse treatment on behalf of a patient? What constitutes ordinary and extraordinary medical treatment?
The court indicated that a patient's right to refuse treatment was an extension of the constitutionally-derived "right to privacy" and, more importantly, permitted the assignment of those rights to Quinlan's guardians.
With the Matter of Quinlan decision, the Supreme Court attempted to set forth a process to balance the state's interests, which were seen as preserving human life and the physician's right to administer medical treatment according to her best judgment, with that of the individual. The court reasoned that the state's interest weakens and the patient's right to refuse treatment increases as the "degree of bodily invasion increases and the prognosis dims." In this case, because it was agreed that the patient was incurable, the treatment, a respirator, was seen as being extraordinary treatment, so the Supreme Court indicated that no civil or criminal liability would be levied if the treatment was withheld.
With the Matter of Quinlan decision, the Supreme Court extended a person's constitutionally-derived "right to privacy" to include the right to refuse treatment. Perhaps more importantly, the Supreme Court permitted the assignment of determining the right to refuse treatment to Quinlan's guardians.
These two landmark findings in Matter of Quinlan clearly raised the legal and moral hackles of the Supreme Court in Cruzan v. Harmon (1984). In this case, the Supreme Court found that the right to refuse treatment plainly did not exist, either in the context of constitutional law, or in common law. The court determined that the common-law right to refuse treatment means that the patient must be informed, and so the conditions of that right did not exist in Cruzan. Further, the Cruzan court did not find the situation of a woman's decision to terminate a pregnancy as being analogous of a decision to terminate a comatose patient, as the Quinlan court had. The Cruzan court also found that the "penumbra" of privacy rights that the Quinlan court relied on to develop the right to refuse treatment was not absolute (Roe v. Wade and Bowers v. Hardwick), nor was it transferable.
Finally, even if the right to privacy included the right to refuse treatment, the Cruzan court reasoned, that right had its limitations. The Cruzan patient, unlike Quinlan, breathed on her own, but relied on a gastrostomy tube for nourishment. Essentially then, the refusal of treatment was really a refusal of food and water. The Cruzan court did not see that the right of privacy or the right to refuse treatment included the right to refuse food and water.
The court's determination of what individual interests did and did not consist of substantially weakened the balance between individual rights and state's rights in favor of the state. The Cruzan court further shifted the balance towards the state when it stated that the State's interest is in the unqualified preservation of life, an interest that does not weaken in light of the patient's rights.
These findings led the Cruzan court to deny the patient's guardians the ability to refuse food and water. Supplying food and water, the court reasoned, met the state's interest in life, and there was no undue hardship placed on the patient.
The Cruzan reasoning avoids some of the difficulties presented in the Quinlan case. First of all, it avoids a slippery slope of problems which could be encountered in enabling the assignment of individual rights to a guardian. Even though a guardian may act in the best interest another, it does not replace the actual intentions of the individual. The Cruzan decision also avoids at least two moral dilemmas that Quinlan decision tends to create....
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