Research Paper

Euthanasia:
It Should Be Legally Accepted

Ayako Teramoto

Lewis & Clark College
AES220-01 Advanced Writing
December 14, 2006

Abstract
Today, TV programs sometimes show that a physician has practiced euthanasia or assisted in patients’ suicides. Why are people against euthanasia? What is wrong with it or with physician-assisted suicide (PAS)? What is Euthanasia? Euthanasia is “the practice of ending life in order to give release from incurable suffering.” There five arguments for and against euthanasia, which include the following: autonomy, essential wrongness of killing, the integrity of the profession, potential abuse, and relief of pain and suffering.
There is a cross-cultural, historical, and religious background of the issue of suicide in many countries or societies all over the world and many religions prohibit suicide and euthanasia. These must be considered when making public policy.
In the United States, Oregon is the only state where PAS is legal. This has seen the core since 1997 when Oregon adopted The Death with Dignity Act (the Act).
The Oregon would be a good one because the Act respects the will and right of both patients and physicians. There should be similar laws adopted in other states in the U.S. and in other countries.


Today, TV programs sometimes show a physician practicing euthanasia or assisting patients’ suicides. In Japan, physicians who practice euthanasia are arrested because in many cases, it is difficult to confirm that it is the will of a patient and it is illegal. In the United States, many people object to euthanasia itself. BBC also reported that physicians sometimes practice euthanasia even if it is illegal and most countries prohibit euthanasia (2006 b). Why are people against euthanasia? What is wrong with it or with physician assisted suicide?

First of all, what is euthanasia? Carl E. Wasmuth, MD of Cleveland Clinic and Cleveland-Marshall Law School stated that euthanasia can be classified into voluntary and involuntary. Voluntary euthanasia occurs when patients ask for it of their own free will while involuntary euthanasia does not need patients’ consent. He also classifies euthanasia into active and passive. Active euthanasia occurs when physicians directly induce patients’ death while passive euthanasia occurs when physicians withdraw or withhold life-sustaining treatment and give natural death to patients. Assisted suicide is a type of active euthanasia in which patients use drugs or other means given by physicians to end their life (2004).

Battin, Professor of Philosophy and Internal Medicine, Division of Medical Ethics, at the University of Utah, in her book Ending Life: Ethics And The Way We Die writes that the debate about euthanasia and physician-assisted suicide (PAS) caught public attention in the mid-1970s and many people got involved in the debate. Liberals tend to think that PAS and voluntary euthanasia could be accepted and should be legally allowed. On the other hand, many conservatives think euthanasia and suicide are morally wrong. The debate became important as a philosophical and international public issue in the twentieth and twenty-first centuries because the epidemiology of human mortality basically changed and death from degenerative diseases such as heart disease and cancer had been increasing.

When the following argument, a background of the issue of suicide and an example of practicing PAS are considered, PAS should be legal.

Battin (2005) showed five arguments for and against euthanasia, which were triggered by the civil rights movement in the 1960s and 1970s.
The first argument was about autonomy. Supporters of euthanasia said patients have the right to decide how to die as well as live. Opposed to this idea, a patient who is terminally ill or dying has great difficulty deciding euthanasia by himself or herself. The advocates insisted that patients’ choices must be respected even if they are “socially shaped” and most patients can make choices without negative influences such as depression. Opponents argued that people must not obligate anyone to practice suicide even if a patient rationally makes a decision of her or his own free will and suicide is morally wrong. The advocates argued against the opponents that they were just assuming that suicide is wrong, which is not proved and the physician can choose to assist the patient’s suicide only if he or she asks (Battin, 2005, p20).

The second argument opposed to euthanasia, insisted on the essential wrongness of killing. One of the Ten Commandment told people that “Thou shalt not kill,” so opponents argued that killing is wrong and suicide is killing, so suicide is wrong. The advocates insisted that societies and law allow killing if it occurred in self-defense, war, capital punishment and other situations. Against this idea, opponents said that in those cases, the guilty person is killed, but in this case, the person who is killed in not guilty (Battin, 2005, p21).

The third argument is about the integrity of the profession. The opponents said physicians should not kill patients because the Hippocratic Oath prohibits euthanasia. The Hippocratic Oath is the standard of professional ethics and tells that physicians have to relieve suffering and prolong and protect life (Wasmuth, 2004, p711). The advocates of euthanasia rejoined that assistance in suicide should be accepted because the Oath can be “modified to permit surgery, abortifacients and taking fee for teaching medicine that are originally prohibited.” The opponents answered, “To permit physicians to kill patients would undermine the patient’s trust in the physician.” The advocates said, “Patients trust their physicians more when they know that their physicians will help them, not desert them as they die” (Battin, 2005, p24).

The fourth argument was about potential abuse. The opponents insisted that patients may be killed by their physicians against their will. The advocates argued that society should be allowed to predict what will happen to protect patients’ choices and individual rights. The opponents persisted, “the bases for these predictions are increasing cost pressures” (Battin, 2005, p26). The advocates argued again that their rights and choices can effectively be protected if the cases are carefully designed. Moreover, the opponents urged that people and society around the patients may make them think that they are not valuable to live and may persuade others into choosing death. The advocates insisted that only documented-terminally ill patients may choose to have PAS, which was opposed by the opponents who persisted, “Pressures to die would spread beyond the terminally ill” (Battin, 2005, p26). The advocates said, “Where these practices are legal, there is no evidence of disparate impact on patients in vulnerable groups” (Battin, 2005, p26).

The last argument was about relief of pain and suffering. People supported euthanasia and insisted that patients do not have to suffer pointless pain and only death can save them. People opposed it because they think techniques of pain management can treat virtually all pain and relieve virtually all suffering. The advocates insisted that “virtually all” means that it is impossible to treat some pain or suffering. Then, the opponents argued again that physicians can use complete sedation to control pain. The advocates rejoined that complete sedation means patients cannot feel anything and that is equal to causing death and if that is allowed, the direct way or assisted suicide should be permitted. Furthermore, some people opposed euthanasia because they think they dying process can be important for “a positive, transformative experience of new intimacy and spiritual growth” (Battin, 2005, p29). According to a BBC report, Pope John Paul II stated in 1984 that suffering gives people the power to feel close to Christ (2006 a). The advocates argued that there can be no guarantee of that experience (Battin, 2005, p29).

Battin (2005) thought it is essential to know a cross-cultural, historical, and religious background of the issue of suicide in order to understand the issue of euthanasia. He said that in the Western world, the record of discussion of suicide began in the First Intermediate Period of ancient Egypt 3000 year ago. The writing about suicide was written in Hebrew text. In the ancient Greeks, there were acceptable and unacceptable suicides. Surprisingly, according to Battin, “the Greek and Roman Stoics came to celebrate suicide as the act of the wise man, while the Christian church, from the time of Augustine through the time of Thomas Aquinas, increasingly vigorously condemned suicide as sin” (p165). In addition, Roman Catholicism had most heated debate over PAS in the western world (Battin, 2005, p22) and made some statements opposed to the idea of suicide and euthanasia in the seventh and thirteenth centuries (Wasmuth, 2004, p711) because killing and self-killing mean abandonment or refusal of the gift of life from God (Battin, 2005, p22). BBC also reported that still today killing others or self-killing is thought by some to mean denying God (2006 a). On the other hand, the Catholic Church also cared about the issue of pain and in 1958 Pope Pius XII issued a statement “The Prolongation of Life,” in which he said that physicians may be allowed to use drugs to reduce pain, even though the act causes the earlier death if is not intended (Battin, 2005, p22). As for Judaism, its view of suicide became similar to that of Christianity in the first and second centuries AD and during the Middle Ages that suicide should be prohibited. In the Islamic view, suicide is clearly and always wrong (Battin, 2005, p167).

In the Eastern world, ancient Hinduism, Buddhism and Confucianism in India, Southeast Asia, early China and Japan also had ideas about suicide, which developed differently in each culture, but they retained a unique fundamental ethical stance (Battin, 2005, p166). There was a custom of sati in which a wife whose husband is dead is burned to death in Hindu culture. Ideas about suicide in Confucian China and Bushido and hara-kiri in medieval Japan and kamikaze pilots in World War II were affected by Hindu spirituality and Buddhist views the illusoriness of life. In other words, suicide was considered positive, at least not negative, in those countries (Battin, 2005, p167). On the other hand, BBC report said, “Several Eastern religions believe that we live many lives and the quality of each life is set by the way we lived our previous lives. Those who believe this think that suffering is part of the moral force of the universe, and that by cutting it short a person interferes with their progress towards ultimate liberation” (2006 a). In other words, several Eastern religions opposed stopping suffering and were, therefore, against euthanasia.

The Arctic, Africa, North, Central and South America, and Oceania had oral cultures where practices of suicide and related forms of suicide developed. Their views and practices are very different from those of the literate cultures in the East and West.
As for non-religious people, according to BBC report, they also think suffering givens them a chance to grow mentally and reach “the highest and noblest points of what they really are” (2006 a). Therefore, many people who do not believe any organized religion believe euthanasia is wrong.

Battin showed some examples of the United States and the Netherlands where euthanasia is partly allowed under a law. According to a 1989 study, 85-90% of physicians in the United States were withdrawing or withholding life-sustaining treatment. According to the NY times, a 1994/95 study showed it is estimated that 1.3 million of 2 million American deaths per year were caused by withholding life-sustaining treatment (cited in Battin, 2005, p49).

Oregon is the only state in the U.S. where PAS is legal. It has been legal since 1997. In other states, “allowing to die” is legally accepted (Battin, 2005, p49). The Death with Dignity Act (the Act) was enacted in 1997 and it enabled “terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose” (Department of Human Services, 2006 a). If people want to participate in the Act, they must be a patient who is: “1) 18 years of age or older, 2) a resident of Oregon, 3) capable of making and communicating health care decisions for him/herself, and 4) diagnosed with a terminal illness that will lead to death within six (6) months” (Department of Human Services, 2006 a). No one living in other states can take part in the Act. The physician who practices PAS must be chosen from “a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) licensed to practice medicine by the Board of Medical Examiners for the State of Oregon. The Physician must also be willing to participate in the Act” (Department of Human Services, 2006 a) To get a prescription from a participating physician, “1) the patient must make two oral requests to the attending physician, separated by at least 15 days; 2) the patient must provide a written request to the attending physician, signed in the presence of tow witnesses, at least on of whom is not related to the patient; 3) the attending physician and a consulting physician must confirm the patient’s diagnosis and prognosis; 4) the attending physician and a consulting physician must determine whether the patient is capable of making and communicating health care decisions for him/herself; 5) if either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination; 6) the attending physician must inform the patient of feasible alternatives to the Act including comfort care, hospice care, and pain control; 7) the attending physician must request, but many not require, the patient to notify their next-of-kin of the prescription request” (Department of Human Services, 2006 a). According to Eighth Annual Report on Oregon’s Death with Dignity Act (the Report), there were only 24 prescriptions for PAS written in 1998 which was the second year. In next year, there were 33 prescriptions, 39 in 2000, 44 in 2001, 58 in 2002, 68 in 2003, 60 in 2004 and 64 in 2005. The number of prescriptions has been increasing year by year. 16 patients carried out PAS in 1998, 27 in each of 1999 and 2000, 21 in 2001 and around 40 in each from 2002-05 (Department of Human Services, 2006 b).

As mentioned above, there are many ideas and views about euthanasia in the world and most of them influenced by religion. However, there are many kinds of people: Christians, Jews, Muslims, Hindus, Buddhists, etc. and others are non-religious. All people should not be controlled by one thought. In other words, they should have the freedom to choose the way they live and die. If someone thinks he or she opposed to euthanasia, he/she does not have to practice it. However, there are many people who need the option of assisted suicide. For those who ask for euthanasia, it should be legally allowed. Oregon as model is a good one because the Death with Dignity Act respects the will and tight of both patients and physicians. The Act does not invade anyone’s right and the will. There should be laws like the Act in other countries and states.


References
Battin, M.P. (2005). Ending life: Ethics and the way we die. New York: Oxford University Press.
BBC. (2006 a). Against the will of God. In Religion & Ethics – Ethical Issues. Retrieved November 21, 2006, from http://www.bbc.co.uk/religion/ethics/euthanasia/against/against_2.shtml
BBC. (2006 b). Ethical problems of euthanasia. . In Religion & Ethics – Ethical Issues. Retrieved November 21, 2006, from http://www.bbc.co.uk/religion/ethics/euthanasia/overview/problems.shtml
Department of Human Services. (2006 a). FAQ about the death with dignity act. Retrieved October 25, 2006, from http://www.oregon.gov/DHS/ph/pas/fags.shtml
Department of Human Services Office of Disease Prevention and Epidemiology. (2006 b). Eighth annual report on Oregon’s death with dignity act. Retrieved November 17, 2006, from http://www.oregon.gov/DHS/ph/pas/docs/year8.pdf
Wasmuth, Carl.E. (2004). Encyclopedia americana (Vols. 10). Danbury, CT: Scholastic Library Publishing, Inc.

thanksgiving break

I'm very late to write something about thanksgiving break.

On thanksgiving day, I went to my American friend, Lindsey's cousins' house with her, Asami and Takako. Her cousin took us to their house by car. The house was very big (for Japanese...) and beautiful. We took off our shoes at the entrance. That was like a Japanese style. Besides us, father's co-woker's family also joined them for the party.
On this day, I had seen such a big turkey for the first time! It was really big! And, I tried a glass of Oregon wine! Well, it was a little different from Japanese one though I didn't know well about Japanese wine. Japanese wine is a little bitter, but Oregon one was not bitter and easier to drink.
The food was wonderful!! I tried everything and all of them were very delicious! I had never eaten such good dishes in the US. The desserts were very good too. There were four kinds of pies: pampkin, chocolate, pecan, and apple. I ate a piece of chocolate pie and apple pie.
We watched two moview: Marry Popins and Aradin. It was very difficult to memorize the very famous phrase, "Supercalifragilisticexpialidocious."

The next day, I went to Washington Square with Ariko. That was troublesome...We knew how to get there, but we had never been there. We finally managed to go to Washington Square. It was really bigger than I expected. We stopped by every shop one by one. Unfortunately, we couldn't find any good clothes for us. Instead, we bought some jewlry. I got tired because we walked around, but I was happy at last.
We went back to Pioneer Square because we heard there was an even there. There was a big Christmas tree at the center of Pioneer Square. We waited there until the tree was lit up. I took two pictures before and after the tree was lit up.
Can you see the pictures well? They are very good pictures, aren't they?

Teenagers Should Not Go Out at Night

There have recently been many accidents and cases of mischief involving teenagers in Japan. Some of them were caught up in a crime in the daytime, but most of them were involved at night. In addition, according to news reports, the achievement of students in elementary school, junior high school and high school has been becoming worse in Japan. This is because they have been spending less time on studying. Moreover, young children have had less communication with their family members, especially with their parents. To solve these problems, there should be a curfew that prohibits teenagers going out after ten o’clock p.m. in Japan.
Some people may say that teenagers have the right to go out even at night and the curfew infringes on their right. Though this argument has some merits, going out at night has a bad influence on teenagers now and in the future. It cannot be helped that people’s rights are invaded in order to protect the citizens; that is the nature of law. A curfew would be beneficial to teenagers and other people for a number of reasons.
First, a curfew prevents teenagers from being involved in mischief. Many people get into trouble after it gets dark and late at night. If someone gets involved in some trouble in the daytime, they can call somebody for help. However, if it happens late at night, there are fewer people who walk outside and can help them. In fact, a TV program showed that police officers told young children to go home at night because it is dangerous for them to stay out in the dark.
Another positive point is that a curfew helps teenagers spend more time on studying. Students have many things to study, but if they go out late at night, they do not have time enough to do homework or study. Actually, students have been spending less time on studying and their achievement has been becoming worse. In Japan, students had classes on Saturday until five years ago, but there is no class in public school on Saturday today. Examination results of all subjects in elementary school, junior high school and high school showed that achievement has been worse than when classes were held on Saturday. Therefore, it is clear that Japanese students do need more time on studying instead of going out at night so that they can become well-educated and intelligent people who can make their society better.
A final and important benefit of a curfew is that it encourages young people to spend more time with their family members. If they do not go out at night, they can stay and talk with their family. Recently, some TV programs have shown that little communication among family members has a negative influence on children in their future because they can not learn how they should communicate with them and what family should be like. In that case, they may not have strong family relationships in the future and sometimes some sad incidents happen as a result. A conflict among family members may occur and they may live separately. In Japan, a son killed his father and mother a few years ago because they did not understand each other and often quarreled.
A curfew does more than just infringe on teenagers’ rights. It will also protect them from what is likely to be dangerous for them: crimes or accidents. It will also enable them to use more time for studying. In addition, it will help them have good family relationships now and in the future. A curfew will help teenagers and their families live in a better environment, so it should be constituted as soon as possible for the safety and welfare of society.

Movie

I went to see a movie with my friendship family on last Saturday.
Joann checked and selected a good movie which was not hard and a kids so that Rachel and I could understand it.
The title was "FLICA." It was the name of a hourse that the heroine loved.
It was a ranch in America and the heroine named Katy really liked the life with hourses. However, her father actually wanted her to go to college. One day, she found a black hourse in a forest and tried to ride on the hourse, Flicka. But, Flicka did not like to be kept and tred to be free. This was a story about Katy and Flicka.
I could understand almost all parts and liked it very much. As Joann told me and there were many children seeing the movie, it was for kids. However, I think everyone at every age can enjoy it. It was very good movie.

After movie, we went to a restaurant for dinner. I had been to restaurants in Portland only a few times. The atmosphere of American restaurants were very different from that of Japanese ones, so it was interesting to have dinner there.

Megumi's Birth Day

November 3rd was my classmate, Megumi's Happy Happy Birthday!!
Other classmates, Chiaki & Maiko prepared a birthday cake and other food for the party without leting her know! But actually, before the party started, Megumi knew it.
There were many Japanese, some Saudi Arabian and some American friends. First, we sang the birthday song. Then we ate cake and some snacks. The candles on the cake were very cute!! She is now 20 years old, so the candle's shape was 20 too.
After that, we played some games too. I don't know the name, but it was fun. I'll introducd that game. First, we chose who will be "god" and a girl named Lindsay who is sitting on a chair in the left picture became "god." Then, the "god" chose an "angel" and a "Mafia." When there were many players, the "god" chose two Mafia. When the "god" chose an angel and a or two Mafia, everyone had to close their eyes and sleep. While everyone was sleeping, the "Mafia" chose who would be killed and pointed him/her. Then, after the "Mafia" went back to sleep, the "angel" woke up and chose who she/he would save from the "Mafia." If the "angel" chose the same person as who the "Mafia" killed, the person could be saved. But, if not, the person would died. After that, everyone woke up, guessed who was the Mafia and chose it. A person who was chosen most times would die. People who died could not come back the game. Then, the cycle was continuted. If the real Mafia was chosen, he/she would die.
The game was childish, but it was very fun!! I had very good time with them!!

Halloween Party

My friendship family invited me for Halloween party at their house today.
Mother, Joanne, picked me up in front of my dorm at five o'clock and took me to the house by car.Joanne is living with her daughter Rachel where it's 15 minutes away from L&C by car. Their house is very big for two people even though they have two dogs, two cats and hamster.
Her daughter, Rachel, who is eleven years old, invited her friends for the party. There were seven children at the party and all of them were in some costumes. There were three wiches, a cat, a vampire, a movie star and a Micky Mouse. All of them were very cute, except for the vampire who was scary!
We made Halloween bracelets soon after arriving there. Joann bought bracelet sets for us. There were very pretty.
After that, we made our own pizza! There were cheese, ham, sausage and mushroom for topping. And we made caramel apples. There were paper-shaped caramel, and we put one on an apple and baked them in the oven for five minutes.
It was the first time for me to try caramel apples. It was a little hard to eat it because caramel adhered to inside my mouse, but it was delicious.
After eating them, children played in a room and their parents and I talked in another room.
One of Joann's friend talked to me about the history of Halloween and it was interesting. We talked about many things; American and Japanese traditional celebrations.
I had really fun and very good experience!

My Birthday

Today is my birthday.
I got many e-mails from my friends in Japan. And my frinds at L&C held a birthday party for me! I was very surprised that many people celebrated my birthday and I was very HAPPY!
My frind and my roomy cooked 21 small cute cakes because I became 21 years old. They were very good!
Now I can drink and buy alcohol by myself! Yay!
Anyway, I really thank many frinds for celebrating my birthday.