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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 states interests in terms of human life? When does the patients right to refuse treatment override the states interest? What does the right to refuse treatment entail, and is it included in the patients right to privacy?
Do a patients guardians have the right to refuse treatment on behalf of a patient? What constitutes ordinary and extraordinary medical treatment? The court indicated that a patients 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 states interests, which were seen as preserving human life and the physicians right to administer medical treatment according to her best judgment, with that of the individual. The court reasoned that the states interest weakens and the patients 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 persons 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 womans 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 courts determination of what individual interests did and did not consist of substantially weakened the balance between individual rights and states rights in favor of the state. The Cruzan court further shifted the balance towards the state when it stated that the States interest is in the unqualified preservation of life, an interest that does not weaken in light of the patients rights. These findings led the Cruzan court to deny the patients guardians the ability to refuse food and water.
Supplying food and water, the court reasoned, met the states 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. First, while the Quinlan case indicates that no civil or criminal liability is assigned to the act of removing treatment, there is no direction as to how to resolve any moral liability for the person who will physically remove treatment. Second, the Quinlan case places the judicial branch in the delicate position of having to qualify what medical conditions warrant treatment, a position they do not have the expertise for. The Quinlan and Cruzan cases, insofar as they offer important guidelines for the treatment of terminally-ill patients, pose some problems for the reasoning of J. Gay-Williams. In Gay-Williams view, these cases would likely constitute passive euthanasia, where treatment is withheld from terminally-ill patients.
According to Gay-Williams, failure to continue treatment after it is realized that the patient has little chance of benefiting from it is perfectly acceptable, and the medical community must make these kind of decisions all the time. In fact, says Gay-Williams, passive euthanasia does not really constitute euthanasia at all. However, in his arguments against the benevolence of active euthanasia, Gay-Williams cites as a slippery slope giving others the authorization to decide on behalf of a patient, especially members of the medical community. Euthanasia may have a corrupting effect, Gay-Williams indicates; doctors may not try as hard to save a critically ill person, and this may transfer over to their treatment of less-ill patients. But it is not clear how it is acceptable, on one hand, for the medical community to discontinue treatment of terminally-ill patients when there is no hope, yet it is not acceptable to give them the authorization to decide on behalf of a patient. Gay-Williams argues against the purported benevolence of euthanasia in two others ways; he provides an argument from nature and another from self-interest.
First, he argues, every human has a natural inclination to continue living. Euthanasia is therefore wrong, even without an appeal to religion and morality, because it destroys this natural tendency, and sets us up against our own nature. Second, Gay-Williams indicates, there is always a possibility that we will work against our own interest if we practice euthanasia. Not only are we prone to error in diagnosis, there might be an experimental procedure that we are not aware of that will hasten our improvement. In addition, because we make often make decisions impulsively, especially when we are in pain, we may give up too easily. Unlike Gay-Williams, James Rachel's sees the differentiation between passive and active euthanasia, where it is generally seen as permissible to withhold treatment and allow a patient to die, as making no moral sense.
In particular, he criticizes the American Medical Association (AMA) doctrine regarding terminally-ill patients as making this distinction, and says that this causes extreme confusion for the medical community. Rachel's, points out a case which would cause this sort of confusion is where allowing to die by withholding treatment might be more painful than a quick intentional lethal injection. Additionally, allowing a passive doctrine of euthanasia allows for decisions to be made regarding life and death that are made on irrelevant grounds. Rachel's cites the example of not operating on a infant with an intestinal blockage because the infant has Downs Syndrome as a prime example. Finally, the distinction made regarding intent is questionable, according to Rachel's, because having the intent to kill and letting someone die can result in the same end death so it ultimately makes no difference what the original intent was. According to Rachel, then, the differentiation between passive and active euthanasia is incorrectly based on the rationale that there is a significant moral difference between intentionally killing and intentionally doing nothing.
Bonnie Steinbock criticizes Rachel's position against the AMA doctrine. She says that contrary to what Rachel indicates, the AMA doctrine does not draw a distinction between active and passive euthanasia. Rather, it draws a distinction between 1. intentional termination of life, and the cessation of extraordinary efforts to prolong life, and 2. the difference between ordinary and extraordinary care. She sees Rachel's example of starving infants to death as a misinterpretation of the doctrine.
According to Steinbock, discontinuing care of a patient can result from the caregivers intention to termination life, but there are other reasons for care discontinuance. Such reasons include discontinuance at the patients directive (which is seen as a right to be protected from the unwanted inference of others), stopping treatment if it is no longer doing any good, or when the treatment is doing more harm than good. It can be seen that the right to refuse treatment can quickly lead to a patients death given the circumstances, especially if that care is the last known element of preserving the patients life. But none of these reasons, say Steinbock, equate withdrawing care to the right to kill, as she believes Rachel's implies. Steinbock's argument against identifying cessation of treatment with intentional termination seems to be once of imprudence given a historical viewpoint that surgical treatment is seen as intrusive battery on a person requiring their assent. Not having read the AMA doctrine personally, it is difficult to support either claim as to what the doctrine spells out, and what applications can arise from its interpretation.
But what is clear is that the doctrine is subject to misinterpretation in terms of what can be considered extraordinary and ordinary care. And just like in the Cruzan and Quinlan decisions, it seems to be a matter of interpretation as to precisely where patients rights come into play. There is a gray area as to where a treatment, applied during a time where there is hope for a patients recovery, fades into a condition where the treatment is insufficient to bring the patient back.
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Research essay sample on Terminally Ill Patients Food And Water