Euthanasia: the right to death

What is written below was an article that I wrote that was published in medical journals in Canada, the United States, Australia and Germany in November 1973.

Euthanasia is in effect, the act of permitting or inducing death for merciful reasons. The word itself originated in the seventeenth century when according to the Oxford English Dictionary, it meant simply 'a quiet and easy death'

There are five kinds of situations in which euthanasia is seriously contemplated by the immediate family, the doctors or the victim of a mishap or of a fatal illness. They are; excruciating and endless pain, coma and brain death; severely deformed babies; and a life of mere existence brought about by traumatic injuries, illness or old age.

There are three concerns that face the victims of these unfortunate occurrences in their lives and their loved ones and the medical profession.

The first concern that faces the victims and their families and doctors and even the courts is, 'Is it morally right to let a human being who is suffering the agonies of hell, take his own life or permit it to be taken from him?' Most religions do not advocate any form of euthanasia since it is the belief of the followers of these religions that God will take the victim away in his own sweet time, and not a second before.

The second concern involves the law. For example, in Canada, suicide is not an offence (because you can't prosecute the dead) and neither is attempted suicide (although such a person who attempts it could be hospitalized in a mental facility)

Further, if a person kills another at the request of the latter, the person who does the killing could be convicted of first degree murder and sentenced to a minimum of 25 years in prison. Even if he pleads guilty to second degree murder, he must serve a minimum of ten years in prison. It is mainly for this reason we seldom hear of people in Canada killing their loved ones to relieve them of their pain and suffering.

The doctors and nurses look at another concern which is; 'Is it ethical to let a person die or even assist that person to die? This concern continues to nag the medical profession around the world, especially those doctors who signed the Hippocratic Oath which states that they must save lives, not purposely bring about death.

Before dealing with these concerns, I will go straight to the reasons why so many people around the world are begging for death.

Excruciating pain is probably the most feared thing in the lives of humans, even more so than death itself. And yet, a civilized society that frowns on the use of torture; stands by when hundreds of thousands of victims of advanced cancer and other horrible illnesses pray for a quick and easy death.

Take for example, the case of the seventy-year-old woman who was dying in a hospital from bone cancer. Even before she was brought into the hospital, her legs had fractured. Every day, little bits of bone were splintering off. Her agonizing shaking attacks broke off more pieces of bone. As she screamed in agony, she kept asking her husband why the hospital wouldn't let her die. The hospital staff wasn't prolonging her life--they were prolonging her death.

Then there are those situations where accident victims are trapped in their burning vehicles. One such case involved a truck driver who was pinned in the cab of his overturned truck. As the fire engulfed him and began burning off the flesh of his body, he begged the bystanders to shoot him and put him out of his misery. Several of the bystanders had guns in their possession but were afraid of the legal consequences and had to stand by helplessly as the screaming man burned to death before their eyes.

Brain death is usually brought about by a traumatic accident to the head, a heart attack, an overdose of drugs or the cessation of brain activity that follows a diabetic coma. The human body of the patient merely becomes a vegetable and prolonging the life of the organs of a brain dead patient becomes meaningless. Further, it can bankrupt a small community that must pay for the care of such a person. The community that cared for Karen Quinlan paid a high price to keep the organs of that poor brain dead woman alive year after year.

One of the most difficult decisions that parents of severely deformed babies must decide is whether or not they will consent to let their babies die rather than let them live a life which will serve no purpose for them or anyone else. I am not talking about babies who are born with Down's syndrome and as such, are retarded. Their lives are not meaningless and for the most part, they enjoy life, albeit it is often short. I am talking about children born without brains and whose only continued existence is derived from their brain stems.

I once saw a ten-year-old boy who was born, blind, deaf and totally paralytic. There was no way anyone could communicate with him. During his entire life, he lay in a bed in a coma. For the parents of such babies, and for their doctors, there is no real problem facing them because the death of these unfortunate babies is to them, acceptable. But there have also been births where the babies have been born with two heads and in one recent instance; the baby was born with one head but two distinct faces. This creates a greater problem for their parents since they know that their loved ones will grow up in a society that cannot and will not accept them. For this reason, they are prepared to let their babies die.

In many hospitals, the doctors have in the past, let malformed babies starve to death---an example of euthanasia in it's grotesque form.

Many victims who suffer traumatic injuries often face a life of total paralysis and if that isn't enough, some also become speechless and therefore cannot communicate with anyone other than by the blinking of their eyes. Life for these unfortunates becomes unbearable as boredom sets in and the days drag on into weeks, then months and finally years. Often very old invalids who can walk and talk at the initial stages of senility, slowly vegetate until they are almost like zombies. Life becomes meaningless for them, as life becomes but a blur of light and sound.

Euthanasia is practiced in two ways---actively and passively and death is brought about in one of four ways.

First, there is the direct way such as actively disconnecting a life support machine. It also involves shooting loved ones to death, smothering them with their pillows or injecting fatal drugs into them.

Some doctors and nurses, with the permission of the immediate family will pull the plug so to speak but only if the patient is in a coma or is brain dead. This practice has increased steadily and it is indeed rare that such medical practitioners are criminally charged or professionally disciplined for their actions.

The strangling or shooting of a loved one is indeed the saddest scenario that can take place where euthanasia is involved. And in some cases, the persons who do the shootings, turn the guns on themselves.

Some doctors have injected overdoses of morphine and in some cases, air bubbles into the veins of terminal patients suffering from agonizing pain. When they inject overdoses of morphine into their patients, it is done gradually over a period of days. The overdose breaks through the immunity that has built up until one more dose depresses the respiratory system of his patient and causes death directly or through the intervention of bronchial pneumonia. But in cases like this, it is always with the patient's permission, expressed or implied.

In the aforementioned ways, the act of euthanasia is done actively and in its strictest sense, is first degree murder because the act is done with deliberation, albeit for a noble reason. First degree murder is punishable automatically by life imprisonment without eligibility for parole until 25 years has been served. Probably the person charged would face a second degree murder charge, punishable by life with a ten year minimum. It is also conceivable that the Solicitor General of Canada might exercise his prerogative of mercy and recommend that the person convicted be conditionally pardoned.

The second manner in which euthanasia is committed is when the doctor doesn't take extraordinary measures to save his patient. Examples of this is when he doesn't order oxygen when it's needed, or alternatively, orders that no resuscitation of his
patient is to be undertaken.

This method of euthanasia is called passive euthanasia and in it's strictest sense, is criminal negligence causing death. That crime is contrary to section 202(1) of the Criminal Code of Canada which says that every one is criminally negligent who in omitting to do something that is his duty to do, shows reckless disregard for the lives of other persons. The operative word here is 'reckless' and it may be difficult to prove that a doctor who acts on the wishes of his patient is reckless. That crime nevertheless is punishable by life imprisonment.

The third method of euthanasia is brought about by the deliberate action of leaving about fatal overdoses of morphine in the form of pills. For example, a patient who has expressed a desire to die, will be told by his doctor that the three pain killer pills he's left with the patient are not to be taken all at once. The doctor knows that his patient will take them all at once and that when he returns to the bedside of his patient an hour later, his patient will be dead. This is passive euthanasia.

The fourth method, often performed by family members, is to leave poison, a gun or a knife within easy reach of the dying patient. This form of euthanasia is passive euthanasia and in its strictest sense, is contrary to section 224 of the Criminal Code that prohibits every one from aiding a suicide. It is punishable by fourteen years in prison.

It would appear that the strongest religious objections to the practice of active euthanasia stems from the interpretation of the Sixth Commandment which states that "Thou shall not kill.' The more scholarly have interpreted that Commandment to mean, 'Thou shall not commit murder' and that would mean that there is justification in killing in defence of one's country, or in self defence. If that is so, it is but a small leap to kill as an act of mercy.

We are forced to ask ourselves, "Why must patients who are dying in excruciating agony or whose continued existence is brought about by having tubes inserted into their bladders, their lungs kept going by breathing machines and nourishment given to them intravenously, be forced to suffer the indignity of the living dead? Is it so that the medical profession can improve on techniques that bring them closer to the powers of God?

We are at an era where matters of life and death should be decided in a court of law. If a patient expresses a will to die, his or her doctor should be able to have the matter brought before a court, as was done in the Karen Quinlan case. Anyone who is immediate kin to the patient or represents the hospital can play the devil's advocate but the decision of the court should be final where pain is involved. To subject a terminal patient to unnecessary and prolonged pain while waiting years for the matter to go to the Supreme Court of the land would bring the entire exercise into disrepute.

When anyone considers the arguments of the pros and cons of euthanasia,perhaps they should look to the United States case in 1927 where a father was charged with murdering his young daughter. For months, he listened to the screams of his eight-year-old daughter begging for death. She was slowly dying of incurable tuberculosis and gangrene of the face. Finally he could take no more and he picked up that pitiful creature and drowned her in the bathtub. The jury returned a verdict of not guilty knowing that he acted out of remorse and as an act of mercy. They knew that he would suffer from the image of his dying girl looking up at him as he placed her under the water, a girl who made no effort to fight the death he was bringing to her.

When Justice Branson addressed the jury just before they began their deliberations, he said; "It is a matter which gives food for thought when one considers that, had this poor child been an animal instead of a human being, so far from there being anything blameworthy in the man's action in putting an end to its suffering, he would actually have been liable to punishment if he had not done so."