Physician Assisted Suicide and Voluntary Active Euthanasia
The case of Grace Lee
The case of Brittany Maynard
Findings and interpretation of Opinion Questionnaire Results
Media Portrayal of Terminally Ill Patients Right-To-Die Stories: Case Studies of Brittany Maynard and Grace Sung Eun Lee.
For many people, it is of paramount importance that life is preserved in every sense of the word. But for terminally ill patients, life seems hopeless to the point where death becomes their only way out of suffering and excruciating pain. This paper identifies two terminally ill patients’ cases and their pursuit to fight for their right-to-die. To identify their cases, this paper examines literature on physician assisted suicide and active euthanasia coupled with the news articles. This examination indicates that there are vast distinctions between the two methods terminally patients can use to die. These methods, arguments for and against, and the media representation of both patients’ cases are the central platforms of this paper. I hypothesized that the media portrayal of terminally ill patients’ right to physician assisted suicide or voluntary active euthanasia is positive and this portrayal is geared towards support for those patients’ right-to-die. This hypothesis hinges on media articles on Brittany Maynard and Grace Sung Eun Lee cases as portrayed in online news sources.
Keywords: Terminally ill patient, physician assisted suicide, voluntary active euthanasia, media representation
Terminally ill patients’ legal right-to-die issue has become a favorite topic for discussion and debate in many parts of the world. A terminally ill patient’s legal right to die is a highly debated, ethical, and moral issue widely discussed, particularly in the media. Although considerable media coverage has been devoted to physician assisted suicide (hereinafter referred to as PAS) and voluntary active euthanasia (hereinafter referred to as VAE), rather less attention has been paid to the role of the media in setting the tone for proposition or opposition for this issue. This paper analyzes media articles by four online news sources to examine how they represent the cases of two of the most recent terminally ill patients’ right-to-die stories. This paper also includes findings from a social survey in the form of an online questionnaire to gain insights into people’s opinion on the issue of PAS and VAE.
Darrel Montero (2001) quoted Kirk & Sullivan (1996) as saying “public attention to end-of life issues occurred throughout the 1990s with the controversy surrounding Jack Kevorkian, the Michigan doctor who assisted terminally ill patients in taking their own lives” (Kirk & Sullivan (1996) cited in Montero (2001)). As a result of this, Doctor Jack Kevorkian rose to controversial fame and reports indicate that he was referred to as Dr. Death.
A terminally ill patient is referred to by a physician as “a person who is suffering from a serious illness and whose life is not expected to go beyond 24 months at the maximum” (USLegal, 2015). Terminally ill patients endure excruciating pain and suffering and they are dependent on a wide spectrum of medical care and attention. For some patients, this unfortunate condition is sudden and there is no time to decide how their last few months would be spent as in the case of Grace Lee. She moved from being a healthy young woman to a paralyzed patient suddenly. Contrary to that of Brittany Maynard who decided how she wanted to live her last few months on earth; she did all fun things she ever wanted to do (visit Yellowstone National Park and the Grand Canyon) and spent valuable time with friends and family.
What is the role of the media in all of this? The media’s role is to sensitize the public of health issues but more importantly the way in which the media represents terminally ill patients’ right-to-die stories plays a role in shaping views of support or opposition for the use of PAS and VAE (Montero, 2011). Although viewers and readers have their own views on the issue featured in this paper, the media portrayal of this issue can be considered powerful in determining what certain issues mean. The media circulates meanings and the question arises “who has the power, in what channels, to circulate which meanings to whom?” (Hall, 1997)
Physician Assisted Suicide and Voluntary Active Euthanasia
Assisted death is the general term which includes PAS and VAE, “the most commonly discussed types” or methods (Montero, 2011). The World Federation of Right to Die Societies notes that there is “a difference in degree of involvement and behavior” among the two methods and concludes that “Physician-assisted suicide entails making lethal means available to the patient to be used at a time of the patient’s own choosing. By contrast, voluntary active euthanasia entails the physician taking an active role in carrying out the patient’s request, and usually involves intravenous delivery of a lethal substance” (The World Federation of Right to Die Societies, n.d.). PAS and the right-to-die movement are controversial topics which have carpeted “American society for decades” (Park, 1998). Similarly, Darrel Montero (2011) notes that the “controversy over euthanasia and end-of-life decision has been prevalent since the beginning of the 20th century” (Montero, 2011).
This controversy led to the emergence of The Patient Self-Determination Act (1990) which according to American Cancer Society “encourages everyone to decide now about the types and extent of medical care they want to accept or refuse if they become unable to make those decisions due to illness. The PSDA requires all health care agencies to recognize the living will and durable power of attorney for health care” (American Cancer Society, Inc, 2015). Terminally ill patients are not always mentally or physically conscious to make an informed voluntary decision about PAS or VAE, hence the reason The Patient Self Determination act emphasizes the need for all Americans to make those decisions before they become ill. And for the patients who do not but are terminally ill and are capable of making such a decision, there is the ‘ Oregon Measure 16 ’ also called the Death with Dignity Act (1994). According to Park (1998) the Death with Dignity Act is “the first law in the United States to authorize assisted suicide” (Park, 1998, p. 281). Park asserts that “The Act established a statutory regime under which mentally competent adults who were diagnosed with a terminally illness, and who voluntarily expressed a desire to die, could request medication from a physician for the purpose of ending their lives” Park, 1998, p. 281-282). Patients have taken advantage of this Act as shown in figure 1.
Figure 1: Death with Dignity By the Numbers
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The Acts mentioned above are both enacted in the United States, however other Acts like the Rights of the Terminally Ill Act (1995) which according to Fraser & Walters (2000) became “effective July 1, 1996 in northern Territory, Australia.” Those scholars note that “the first person to choose a statutory sanctioned death with physician assistance was Bob Dent of Darwin, Northern Territory, Australia, who died September 22, 1996” (Fraser & Walters, 2000, p.121). As of 1997, this Act has since been overturned and Australia now adopts an anti-euthanasia bill (Christian Action Research and Education, 2010).
There is also the Suicide Act of 1961 established by the Mr Keir Starmer QC of England. This Act “decriminalized suicide but explicitly did not decriminalized assisting suicide” (Scolding, 2010, p. 318). Figure 1 depicts the number of assisted suicides per country where it is or was legal to do either PAS or VAE. Germany, United Kingdom, Switzerland, and France are the countries with the highest numbers of assisted suicides. Figure 2 shows all the countries and states throughout the world where PAS and VAE can be legal administered to terminally ill patients.
Figure 2: shows the Countries & States where PAS and or VAE is legally permitted
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The debate for advocacy which engulfs terminally ill patients right-to-die is generally based on two main arguments; Elimination of Suffering and Individual Autonomy. Existing literature on the topic shows that these arguments are most prevalent for the use of PAS and or VAE.
In the United States citizens right to choose or decide is of absolute importance, this autonomy or right is assured by the Fourteenth Amendment of the US Constitution (Fraser & Walters, 2000). The autonomy argument which supports PAS or VAE corresponds to the Self Determination Act mentioned earlier, this Act permits patients the right to accept or reject medical care. There is a twist however, as “those who favor assisted suicide claim that autonomy extends to the right of a patient to decide when, where, how and why to die” (Marker, 2013). On the idea of autonomy, one can ask questions like: why should it matter who is affected by a patient wish to use PAS or VAE? Shouldn’t the patient’s decision be paramount to that of any other? In a book review Scolding (2011) notes that on the notion of autonomy “it is the patient alone to decide whether his or her life is worthwhile, and not for others to override this judgment” (Scolding, 2011, p. 319). Advocates stress the need for everyone to respect and regard terminally ill patients autonomy when it comes to the decision of how, where, and by what means they should die. In the case of Grace Lee, according to a Daily Mail report by Beth Stebner (2012) her autonomy was clear; Grace Sung Eun Lee even managed to vocalize her wishes, telling her parents and the doctors tending to her: ‘I want to die.’”
It is the argument of elimination of suffering that place family members, doctors and nurses in a testing situation. They are tested on values, ethics, and morals. The dilemma is whether they should assist the patient to relive the suffering or do nothing and watch that patient suffer. In situations where the first is chosen over the latter, assisting a terminally ill patient to relieve intolerable pain and suffering even if the act results in the death of that patient, the act is justified (Marker, 2013; Fraser & Walters; Park 1998). Fraser & Walters (2000) in their journal paper titled ‘Death-whose decision? Euthanasia and the terminally ill’ quote a statement by The American Medical Association in their discussion of the “double effect” euphemism: “The intent of palliative treatment is to relieve pain and suffering but the patient’s death is a possible side effect of the treatment” (The American Medical Association (2003) cited in Fraser & Walters (2000)). The intent of administering the drug is not to kill but to put the patient’s pain to an end. The idea of eliminating suffering is link with death with dignity. To die with dignity is what Brittany Maynard championed for before she passed. In A CBS interview with Jan Crawford, Brittany said “cancer is ending my life, not suicide so I’m choosing to end it a little sooner and in a lot less pain and suffering.”
Figure 3: Views on PAS Abbildung in dieser Leseprobe nicht enthalten
The proposing arguments above are often challenged with two opposing arguments; assisted suicide is exclusive to the terminally ill and sanctity of life based on faith or religion. If the central arguments proposing PAS and VAE are autonomy and elimination of suffering then other questions must be posed (Marker, 2013). Two of the questions put forward by Rita Marker (2013) are “if the reason for permitting assisted suicide is autonomy, why should assisted suicide be limited to the terminally ill?” And “if assisted suicide is a good and acceptable medical treatment for the purpose of ending suffering, why should it be limited to adults who are capable of decision-making?” These two questions signal the need for proponents to explain why terminally ill patients have this choice to end their suffering and others who are not terminally but are suffering do not. There are millions of people around the world who suffer from diseases as a result of extreme hunger, thirst, lack of medical supplies, they are impoverish and their suffering is unbearable ( Scolding, 2011). Neil Scolding (2011) wonders if those people “could or should be relieved of their undoubted suffering” through the use of PAS or VAS (Scolding, 2011, p. 319).
Human life should be preserved and there are laws which originates in “Juedo-Christian values” that upholds the principle of the sanctity of life (Park, 1998). There is also the Declaration of Geneva, Article 2 of the European Convention which upholds ‘everyone’s right to life shall be protected by law; no one shall be deprived of life intentionally’ (Scolding, 2011). It was noted by Fraser & Walters (2000) that “in Michigan, the most important personal characteristics defining physicians views against assisted suicide was strong religious affiliation” (Fraser & Walters, 2000). Human beings are believed to have come from a sacred place and that life is nothing but sacred. As such, it is believed by Christians that God is the maker and creator of life and only He should decide when and how humans depart from earth. The supporters of this idea seem less interested in the quality of life one make have if that person considers the sanctity of life while suffering excruciating pain. What is life if it cannot be enjoyed to the fullest?
There are numerous arguments for and against PAS and VAE but this paper has limited the discussion to two arguments respectively. Figure 3 depicts the split in numbers in terms of views that favor and oppose the use of PAS and VAE.
Although both patients were diagnosed with terminally illness by physicians their stories are vastly different as the media reports indicate. These two cases were selectively chosen because they are the most recent cases to have attracted intense media attention and coverage.