A century ago, it all seemed so simple. Physicians, guided by
the Hippocratic oath, sought to treat and cure patients and extend
lives. The decision to save someone's life was a simple one.
While there obviously remains room for improvement, the
healthcare industry has become increasingly successful at saving
lives. Advancements in science and technology have done much to
increase Americans' average life expectancy and to improve most
health indicators, such as self-rated health status, infant
mortality and cancer rates.
But ironically, there are ways in which making such great
strides has been like opening Pandora's box. Today the healthcare
system is asked to balance the ability to extend life against the
quality of life experienced. In 1997, Gallup's "Spiritual Beliefs
and the Dying Process" survey* found that 73% of U.S. adults fear
"the possibility of being vegetable-like for some period of time"
before their deaths, and 67% fear "the possibility of great
physical pain" before death. Such concerns have introduced a gray
ethical area regarding what the medical community should and should
not do to promote the continuation of life, and how to ensure
patients' rights to maintain dignity in death. It's an area that
will only grow thornier as researchers develop new ways to extend
life using stem cells and cloned organs.
Recent Events in the "Right-to-Death" Debate
In October 1997, the Oregon Death with Dignity Act, a law that
legalized physician-assisted suicide for terminally ill patients,
went into effect. Oregon is thus far the only state to pass such a
law. After its passage, 67% of the state's physicians said they
would refuse to participate in assisted suicide, according to an
Oregon Health Division survey. The Bush administration has also
weighed in: The Justice Department announced last month that it
would appeal a federal judge's ruling that it does not have the
authority to overturn the Oregon law using the Controlled
Substances Act.
Last April, the Netherlands became the first country to legalize
voluntary euthanasia, though it had already been a common practice
in the Dutch medical community for more than 20 years.
Support for Physician-Assisted Suicide Is Growing in the
United States
Since 1947, the Gallup Poll has been asking Americans whether
they feel doctors should be legally permitted to help patients end
their lives.
As the graph shows, Americans have become much more likely to
accept the idea of euthanasia over the past 55 years. In 1947, only
37% of respondents answered yes to this question, while 72% did so
in May 2002**.
Two Paths for End-of-Life Care
Yet though the majority of Americans now believe that
physician-assisted suicide should be legal, euthanasia is still
against the law in almost every U.S. state, not to mention almost
every other country in the world. The tension between current
policy and the climate of public opinion will soon force the
question: Which is the correct path -- to provide the most
compassionate care possible short of offering physician-assisted
suicide -- or to offer compassionate care with the option of
physician-assisted suicide as a last resort?
There will be no easy answers, but Arthur Caplan, PhD, director
of the University of Pennsylvania Center for Bioethics, gives
advice in the American Medical News on how we may bring
these two divergent paths closer. "Even if you're for assisted
suicide, you certainly don't want to say that it's the option of
the first resort," Caplan notes. "And even if you're against
assisted suicide, you definitely want to see people get as much
pain control, palliation, and relief of suffering as possible."
*Results are based on telephone interviews with 1,200 adults,
aged 18 and older, conducted May 1997. For results based on the
total sample of national adults, one can say with 95% confidence
that the maximum margin of sampling error is ±2.9%.
**Results are based on telephone interviews with 475 adults,
aged 18 and older, conducted May 6-9, 2002. For results based on
the total sample of national adults, one can say with 95%
confidence that the maximum margin of sampling error is
±5%.
