Euthanasia And The Right Not To Die

Cutting Edge Magazine
January 1991
Tom Terry & Bill Wayne

Euthanasia, which is often confused with the right to die concept means, “Painless death,” or “Mercy killing.” The popular concept of euthanasia is “Death with dignity.” There are different forms of euthanasia that fall under three categories.

  • Voluntary Euthanasia
  • Involuntary Euthanasia, and what is known in Holland as
  • Crypthanasia

While each type of euthanasia is different, they bear striking similarities in the reasons for being performed.

The first and most popular form of Euthanasia is “Voluntary.” Voluntary Euthanasia is assisted death for the terminally ill or suffering. In New Mexico voluntary euthanasia is allowed through a Living Will.” Living Wills permit individuals to let their wishes for specific types of medical care be known in advance of a fatal accident or terminal illness. Living Wills are used to inform doctors of the patient’s wishes for treatment when the patient is not able and can designate a “guardian” or “agent” to make treatment decisions for them. Patients, for instance, who do not wish to be connected to respirators or feeding tubes may say so in a Living Will. Problems with Living Wills are found in definitions. Current state law does not define “terminally ill” nor give a time clause as to when a patient with a terminal disease might be classified as “imminently” terminal.”

In the much-publicized Kevorkian case, Michigan doctor Jack Kevorkian provided a homemade suicide device so Janet Adkins could kill herself. He cited her diagnosis as terminal and reason enough to allow her to use his machine.

Another point of concern in the Living Will is the defining of food and water as medical treatment. Normally, “nutrients and hydration” are not classified as medical treatment. But according to Professor Rob Schwartz of the University of New Mexico, food and water “Can be medical treatment when given through a medical device.” However, unless someone executing a Living Will understands the implications of that definition, further suffering could result from removing food and water to fulfill the requirements of the Living Will. Dauneen Dolce from the New Mexico chapter of Right To Lifebelieves that definition could cause problems for patients and their families if used wrongly by an unscrupulous doctor. “Twelve states already have laws stating that food and water is medical treatment which can be prescribed or removed as the doctor deems necessary for the patient.” She asks the rhetorical question, “Does the family (of a vegetative patient) have to give consent to every treatment the doctor uses?”

While ill-intentioned doctors may perform euthanasia on the basis of the lack of definition in current law, another amendment will be proposed to the current “Right to Die Act” that would take the move to voluntary euthanasia one step further. In a Cutting Edge interview, Joanna Robinson of the Santa Fe chapter of the Hemlock society plans on privately proposing with a team of medical professionals a new amendment to the act. Part of that amendment repeats the “Terminally ill by two physicians” requirement and adds, “Repeatedly requests assistance in self delivery.” In layman’s language, “Repeatedly requests the doctor to take the life of the patient.” The new language would take euthanasia in New Mexico past the Living will stage with doctors taking the life of a patient upon his or her request. Robinson is soliciting the testimony of physicians in the attempt to change the current law because “If it looks like amedical movement, more legislators will take note.”

Beyond Voluntary

Concern among those opposed to euthanasia is focused on the future. Euthanasia opponents argue that once the dam is cracked, it won’t be long before it bursts open. Any move to free doctors and patients to perform euthanasia upon request could result in “Involuntary euthanasia,” when a patient’s life is removed with their knowledge against their will. Such actions might be unthinkable for many Americans, but the idea is by no means foreign. Former Governor of Colorado Richard Lamm, once proposed that the elderly have a “Duty to die.” Rita Marker, Director of the International Anti-Euthanasia Task Force in a November 1989 interview with Citizen Magazine told of Dr. Helga Kuhse, a philosopher from Australia, and her position to the World Federation of Right To Die Societies that people can be encouraged to accept lethal injections by first starving a few patients and showing how painful it is.”

Involuntary euthanasia is common in Holland where euthanasia is popular among physicians and the public. Richard Fenigsen, in his report, Euthanasia, How It Works, reports that “More people die in [Holland] by involuntary than voluntary euthanasia.”

An example of involuntary euthanasia was related to Cutting Edge when Susan Bowuwmeester was in Albuquerque visiting family. Susan’s grand-mother in-law, J.J. Gyzmieter living in Rotterdam Holland, was 90 when she was struck ill. The illness was not terminal, but she required constant medication and assistance since she was confined to bed for over two months. Because her family did not wish to take care of her daily needs, and because she was in pain, her sons asked the doctor to give her an injection that would “Put her to sleep.” Under Gyzmieter’s protests of, “I will not die, you will not kill me,” the arrangements were made, and she was injected with the necessary solution at her home. J.J. Gyzmieter died in February of 1989.

When reflecting upon the story of euthanasia in America, Susan Bowuwmeester said, “I hope the people in the United States won’t let it come to this, it’s putting people to sleep like animals.”

Farmington Physician Wilbur Tso feels that the current trends in the right to die movement are pointing us in that direction. “Just because someone’s sick we decide to put them to sleep? I think that’s where we’re headed.” Dr. Tso was asked to answer questions in a survey sent to him and other New Mexico doctors by the Hemlock Society. The purpose of the survey was to ascertain doctor’s feelings on euthanasia. At press time, the national Hemlock office had not responded to our request for the survey results.

Involuntary euthanasia can also take place through a Durable Power of Attorney. According to Albuquerque Attorney Tom McBride, “The D.P.A. gives sweeping authority to the holder to make health care decisions. If a person is in a vegetative state or a coma the holder can withdraw food and water.” Such cases may almost be described as involuntary euthanasia by default. Unless the person filling out a Durable Power of Attorney is clear as to the document’s meaning, their wishes, which could change with time, could be easily violated. The same can be said of a Living Will.

Most euthanasia proponents argue that no one wants to see a person killed against their wishes, and that sounds logical. What must be remembered, however, is that euthanasia itself means “Mercy killing.” Even Joanna Robinson of Santa Fe’s Hemlock chapter agrees. When speaking on who should be the one to actually perform euthanasia, she said, “It’s not that easy to kill somebody, people aren’t prepared for what death looks like. Spouses should not be allowed to perform euthanasia.” According to Robinson and most pro-euthanasia advocates, only licensed physicians are qualified. Wilbur Tso is adamant in his feeling that he “Would vote against any legislation that would make doctors killers, whether the patient is going to die anyway or not.” But are these fears of the dam breaking legitimate? Apparently so. The basis for these concerns is wrought from the experiences in Holland where euthanasia, even involuntary, is common, and from what current New Mexico legislation does not define for the patient’s protection. Examples? The following terms have no legal definitions in the current “Right to Die Act” that patients can count on as limits set for their doctors and family members:

Terminally ill. At what time between diagnosis and imminent death is a patient terminal? Competent. On what legal basis are families and doctors to make the decision on a patient’s competency? One UNM source told Cutting Edge that there is currently no procedure involving mental health officials for determining the competency of a patient requesting death. If the paragraph quoted earlier in this report is to be added to the “Right to Die Act,” then another phrase will be without definition. Repeatedly requests. What constitutes repeated requests for self-delivery (Death)? Several times in one day, a week, a month? Should such requests be honored if the patient is in pain since pain often affects an individual’s judgment?

Living Wills often define food and water as Medical maintenance when it is delivered by means of a feeding tube surgically placed. However, dying or not, the patient’s need for food and water to live and remain in relative comfort is an essential. What exceptions, therefore, should be included as sustenance apart from medical maintenance? These are all aspects of the euthanasia question that have not been fully considered before drawing up legislation.

Beyond Involuntary

The most extreme form of euthanasia is known as “Crypthanasia.” Richard Fenigsen in his report, Euthanasia How It Works, defines crypthanasia as “Active euthanasia on sick people without their knowledge.” This is the ultimate form of euthanasia and best describes what euthanasia is all about. The handicapped, the elderly and the terminally ill are done away with since their value is lessened by their infirmities. There is the feeling that a Living Will, will bring about involuntary euthanasia and possibly, crypthanasia. Right to Life Director Dauneen Dolce recalls “The whole approach of the Living Will when it was introduced in the thirties [and rejected by this nation) was to introduce the idea of euthanasia.” Joanna Robinson, Santa Fe’s Hemlock President disagrees. “I don’t think these laws will set a precedent for broader sweeping laws.” But laws and their full implications are not always laid out by a legislative body. Courts have, since the 1950’s, been in the practice of reinterpreting laws to take on broader meaning. Indeed, that is where the test of what euthanasia is for New Mexico will be determined. When asked why certain phrases in the current “Right To Die Act” are not defined specifically, Robinson responded, “I don’t want the statutes to be too specific. The courts will interpret the statutes.”

Court definitions can change, however. In the much-publicized Cruzan ease, Nancy Cruzan was said to be in a vegetative state because of severe brain damage. But was Nancy aware of her surroundings? In the Citizen interview, Rita Marker cited transcripts showing that “Those who cared for her testified under oath that she did respond. When they told her funny stories, she smiled. Rita also cited Nancy’s discomfort during her menstrual cycle and attempts to form words.

Crypthanasia, if actually done, takes away the patient’s right to know their fate. It places the one performing the task in the role of judge. Patients admitted to hospitals are examined by a doctor and without their knowledge, are judged to be without hope of recovery or the ability to lead a “normal” life if recovery occurs, thus, the patient would be injected with a lethal solution. The implications are broad. Who decides who dies and for what reason? Is it solely the doctor’s decision, the family, or a consensus of both? Would euthanasia or crypthanasia be performed on the basis of insurance coverage or the lack of it? Such pictures stir the mind to recall the Nazi atrocities of the forties when Jews and other disagreeable groups were put to death because imperfections. If a patient is put to sleep because it in their “Best interest,” when does that application stop? Euthanasia and crypthanasia could be used as solutions of a sort to many of society’s ills. The elderly population is increasing and medical and financial resources for their care are severely limited. Let them die. AIDS carriers are multiplying themselves through illicit sexual behavior, why not kill off AIDS carriers in an effort to preserve the human race? Each rational could be justified by a “civil” society concerned with food shortages, disease spread and the potential for human demise.

Justifying an Early Death

As decisions are made whether or not to shorten the life of a patient or family member, the rational for the coming death must be explained in a manner acceptable on three fronts: compassion for the patient, compassion for the family, and ability of all to care for the patient.

Compassion is the most widely accepted reason to kill off a terminally ill or deficient person. Euthanasia proponents argue that it is not reasonable to let someone suffer through the pain of a terminal illness or have their dignity stripped by remaining hooked up to machinery such as a
feeding tube. Similar logic is used to justify abortion when the unborn child is discovered to have Downs Syndrome or some birth defect. It is considered cruel to force a child to live with such handicaps. Such reasoning often assumes that all pain is unbearable and devalues life. But
that is not true according to Dauneen Dolce, “There’s a lot of people who are fearful of pain and are in depression, and then out of depression would make a wrong decision.” Compassion for family members is also used to justify ending life early. Families don’t want to see their loved ones suffer. Death, then becomes better than life.

The problem associated with such reasoning is found in the family’s right to make the decision when a loved one should die. Apart from the legal ramifications of the Living Will, what gives a family member the right to decide when their loved one’s life must come to an end because they are suffering too much? At what point does “Too much suffering” take place and then justify prematurely ending life? What if, as in the case of J.J. Gyzmieter, though you are suffering, you still wish to live though family members disagree?

The ability to care for a patient is the most frightening aspect of euthanasia. When resources are low, who gets treatment and who doesn’t? This is known as Health Care Rationing. Rob Schwartz says, “Once we realize there’s only so many health resources, we may look at getting the most for our health care dollar.” For some, the “Most of our health care dollar” may mean depriving certain groups of their right to be treated, regardless of their age or social status.