In order to gain insight in the concept of death it is useful to examine what is the general consensus regarding the dying process.
Even though literature regarding death and grief abound in society still very few people feel comfortable talking about it.
Death in the Western world is generally taken as a stranger, an intruder.
One does not internalize the idea of dying easily.
(DeSpelder & Strickland 1999)Following Callahan argument, the idea of losing control over one’s life is too challenging.
However, despite such a denial, everybody is going to die and as soon as one realizes this premise one is better prepared to lead a more meaningful life and to take death as the inevitable fact it is.
M.
Scott Peck in his book Denial of the Soul offers an alternative for euthanasia.
He states that the main problem with euthanasia is the lack of education ofpeople concerning death and the lack of spiritual development in society Among Euthanasia:Legal Issue or Personal Choice? The controversial debate about euthanasia is one of the most difficult issues human beings confront in modern times.
Daniel Callahan in his book The Troubled Dream of Life addresses how the development of technology and medicine makes the process of dying more remote and euthanasia more accessible.
He bases his argument on historical and socio-cultural grounds portraying how death in the19th century was accepted as a final stage of one’s life contrasting with the detachment of the actual times.
The effort to extend life is so intense that the line between life and death has become blurred due to the extraordinary means to keep a patient alive.
Callahan argues that physicians are supposed to heal not to prevent death from happening.
At the heart of his argument he agrees in withdrawing the means to keep a terminal or demented patient alive but rebukes extraordinary and futile medical treatment.
His disagreement with voluntary euthanasia or Physician Assisted Suicide (PAS) rests on the fact of allowing somebody else to end one’s life.
Death should follow its natural process.
Furthermore, Callahan argues that human beings are so used to control the events in their lives that when it comes to death, which is a natural event, they want to control it too.
He states human beings must come to the acceptance of their own mortality.
He proposes to reverse the concept of modern death to a “peaceful death,” which consists in coming in terms with one’s self and choosing the life one wants to live in order to have a dignified death Alternatives .
The problem with the health system is trying to fix the problem of dying instead of providing with better means for pain management.
He agrees with Callahan on the issue of the hospice movement, that instead of being a separate entity it should be accessible to everyone for palliative care.
If more people would have access for pain relief the dying process would be more manageable.
It is not a matter of double standard if applying morphine to alleviate the pain of a patienthastens his or her the death.
It is just allowing a patient to have a dignified death.
The problem with euthanasia is also that it is secularized.
It is not only that the First Amendment endorses the freedom of religion, it is the lack of religion and spirituality what promotes the legalization of euthanasia (Peck).
While Callahan does not agree with euthanasia neither, he does not appeal to the issue of religiosity as the basis for rebuking it but it is a plausible alternative.
Recently, the spiritual aspect of a person is becoming more important or at least it is more in the limelight.
Books and articles regarding this issue are everywhere.
The link of praying, meditation or any sort of spiritual activities with physical and emotional well being more and more are being explored.
Would spiritual growth enable one to accept one’s death more easily?According to spiritual leaders most probably but it should be a personal matter not imposed by any organized religion as an alternative to euthanasia.
Should Euthanasia be legalized? Supporters of Euthanasia claim that the right to die movement helps patients to get a dignified death.
In theory, this argument seems plausible but it should not be generalized.
Every case is different and it should be treated individually.
Even the Church and Christian groups evaluate each situation to make the proper judgment.
One of the pioneers of the right-to-die movement is Derek Humphrey who in his bestseller Final Exit provided information about dying with dignity and PAS (1991).
The acceptance to the possibility of voluntary euthanasia was overwhelming.
Additionally, in Freedom to Die, Humphrey in conjunction with Mary Clement proposes the legalization of PAS at the same time that indicates ways to avoid negative outcomes.
One of the reasons for PAS to become legal is financial.
The health system will not be able to deal with an expanding aging society.
A dignified dying process should not be surrounded by immoderate procedures or extended unnecessary care.
Moreover neither The Roman Catholic Church other religious groups should interfere with the legalization of voluntary euthanasia.
Decisions about one’s life and death are to be taken based on personal moral values.
Society should not be governed by Judeo-Christian principles.
In addition, the American Medical Association with its conservative rules that reject voluntary euthanasia and PAS are pushing away members who believe in more realistic parameters.
With a decline of 42 percent of all physicians, many doctors are implementing their own ethical values in helping patients carry on their wish to end unnecessary suffering (Humphrey & Clement, 1998).
Additionally, in advocacy for legal euthanasia, “The Oregon Health Division’s 2nd year report on the Oregon Death With Dignity Act” demonstrates how responsible and empathetic the law is.
It has worked in an unbiased and legal way.
It has followed guidelines and no abuse has been reported.
Most of the patients were men and had received hospice care.
Oregon provides its patients with excellent “end-of-life care”(New England Journal of Medicine 2001).
Is Euthanasia Unethical and Immoral? Opponents also try to base their arguments on moral, ethical or religious grounds.
As stated above many religious activists claim that euthanasia is abolished by the Christian faith.
Others object that Judaism also sanctions euthanasia.
These religious traditions are based on the respect of human life and morality.
People against euthanasia or PAS believe that there is not a justified situation for a doctor to perform either one.
Both actions violate the innate human right of a natural death.
Even though opponents recognize the need sometimes of passive euthanasia, as Callahan says, there is a difference on allowing to die and helping to die.
In addition, the American Medical Association is also against the legalization of euthanasia and PAS.
What they advocate is the Pain Relief Promotion Act or HR 2260.
The purpose is to promote the palliative care of the patient (AMA 2000).
Although AMA does not endorse PAS it recommends to physicians to inquire about the motives a patient has to request it (AMA 1994).
The emotional state of the person must be evaluated because in some cases depression and fear make the illness intolerable.
It is important for the patient not to feel abandoned by the physician even when they do not share the same opinion.
Sometimes after an evaluation the patient can be referred to psychological or palliative care making the illness more bearable for the person.
Moreover, the legalization of euthanasia is problematic in two significant aspects.
First, any human being that claims a right to assisted suicide is imposing that duty on someone.
Most likely on the physician assisting the patient.
Given this situation, what is the limit of a physician?Should the moral values of the physician be taken into consideration or not?Whose rights are being respected?Secondly, with the legalization of euthanasia problems with abuse can arise, especially in the case of the elderly and mentally dysfunctional individuals.
Callahan argues that the life of a ninety years old is valuable, but due to the medical costs and availability of means, one should place priority on a younger person.
Whereas his argument sounds logical one encounters the controversy of placing subjective values on a patient.
Who would determine the value and significance of another human being? Furthermore, euthanasia has an impact on society.
It does not limit itself in respecting the autonomy of each individual.
There are parameters in society to which a person must adhere.
If one’s actions are based on the inability to sustain suffering the bases of the social order could collapse.
Restrictions should always be enforced, if not anarchy would be the outcome.
PAS and euthanasia should always have guidelines and limitations, because there is the danger that what started as an empathetic action could develop into an in discriminatory act.
Besides, in the Netherlands, where euthanasia and PAS were legalized on November 2000, for over twenty years some physicians have performed these acts and not in every case they have followed the expected guidelines (Christianity Today 2001).
Likewise, there is a report which shows that 75 percent of Dr.
Kevorkian’s patients were not terminally ill (The New England Journal of Medicine 2000).
Taking into consideration all these facts the danger of generalizing euthanasia is real and people should be educated in order to make the best choice.
The popular opinion is valuable in determining policies in this country.
Legal decisions should be made based on the desire for a better society.
A better death is a main component of society; therefore palliative care and passive euthanasia should be enforced in managed care.
At the end, the matter for euthanasia to be legalized rests on the hands of the citizens.
Religion and Euthanasia Even though the diverse cases of passive euthanasia are individually evaluated the position of the Roman Catholic Church is to avoid euthanasia due to the right to life.
The idea is to preserve all lives equally based on dignity and respect.
Life is considered sacred and “the basis of all values.
”The Church is against new medical modalities where physicians are engaging in supposedly compassionate acts towards their patients.
God is the one who gave life to humans and He is the only one who can take it away (John Paul II 1980).
Supposedly Church and state are two different entities.
The First Amendment makes this distinction clear, but the intromission of the Roman Catholic Church with its opposition against PAS is trespassing this limit.
The majority of Christian and Jewish groups approve withholding and withdrawing life-sustaining treatments.
In his 1995 encyclical, Evangelium Vitae, Pope John Paul II stated the difference between stopping “aggressive medical treatment” and suicide or euthanasia.
He makes it clear that the Church accepts the former and rejects the latter.
Most of the religious people who agree with the Pope’s position are the traditional Catholics, Protestants, Jewish and Muslims.
The more liberal Reformed Jews and Protestants in general based their decision on personal belief.
(Humphrey & Clement 1998).
The issue of death is not easy to handle because it has always been one of the unanswered questions of humankind.
Throughout history men have tried to deal and wrestle with it, but still death prevails.
The debate over euthanasia can be objectively approached in a positive o negative way, but one does not know until one has to deal with death in a personal way if those values would prevail or if one would incurred in a change of heart.
The issue with the debate on euthanasia deals with the power of men over life.
As Callahan states, there is a limit on what medicine can do.
The emotional and economic implications on unnecessary extending a patient’s life are enormous.
If presently the health system is not prepared to maintain indefinitely patients in this situation how will the situation with the Baby Boomers be?In 2006 the first Baby Boomers generation turns 65 years old.
The life span is expected to increase as well.
Therefore, the need for more availability in hospitals for extraordinary treatments will also increase (Hooyman & H.
Asuman Kiyak 1999).
The idea of doing everything that is possible to keep a patient alive even when it implies harming the person is not the answer for a peaceful death.
Having acknowledged valid arguments on both sides of this controversy one can arrive to the conclusion that if euthanasia is to be legalized it should dissuade abuse and base itself on personal choices.
The decision should not rest only on policies but on families taking into account the wish of the patient.
Personal, empathetic care is also necessary for a dignified death.
Moreover, physicians must get involved with their patients in talking about death and the management of physical discomfort.
Death should be approached as a reality not as an accident of nature.
References Callahan Daniel.
The Troubled Dream of Life.
In Search of a Peaceful Death.
Washington:Georgetown University Press, 2000.
Christianity Today.
“Death by Default.
”Available online at htpp://www.
christianitytoday.
com/ct/2001/002/31.
26.
html.
Accessed May 10, 2001.
Council on Ethical and Judicial Affairs, American Medical Association.
Code of Medical Ethics.
Report 59.
Chicago, Ill:American Medical Association; 1994.
DeSpelder Lynne Ann & Albert Lee Strickland.
The Last Dance.
Encountering Death and Dying.
Mountain View, California:Mayfield Publishing company, 1999.
Hooyman Nacy &H.
Asuman Kiyak.
Social Gerontology.
Needham Heights, MA:Allyn & Bacon, 1999.
Humphry Derek & Mary Clement.
Freedom to Die.
New York:St.
Martin Press, 1998.
Peck, M.
Scott.
Denial of the Soul.
New York:Harmony Press, 1997.
Pope John Paul II.
“Declaration of the Sacred Congregation for the Doctrine of the Faith.
”Pastoral Constitution on the Church in the World of Today, no.
27.
May 5, 1980.
“The Complexities of Assisted Suicide”Available online at [http://pc.
pdr.
net/pc/public.
ht?path=content/journals/p/data/2000/1130/11a00suicide.
html].
Accessed May 10,2001.
“The Oregon Health Division’s 2nd year report on the Oregon Death With Dignity Act” (2001,Feb.
24).
New England Journal of Medicine.
Even though literature regarding death and grief abound in society still very few people feel comfortable talking about it.
Death in the Western world is generally taken as a stranger, an intruder.
One does not internalize the idea of dying easily.
(DeSpelder & Strickland 1999)Following Callahan argument, the idea of losing control over one’s life is too challenging.
However, despite such a denial, everybody is going to die and as soon as one realizes this premise one is better prepared to lead a more meaningful life and to take death as the inevitable fact it is.
M.
Scott Peck in his book Denial of the Soul offers an alternative for euthanasia.
He states that the main problem with euthanasia is the lack of education ofpeople concerning death and the lack of spiritual development in society Among Euthanasia:Legal Issue or Personal Choice? The controversial debate about euthanasia is one of the most difficult issues human beings confront in modern times.
Daniel Callahan in his book The Troubled Dream of Life addresses how the development of technology and medicine makes the process of dying more remote and euthanasia more accessible.
He bases his argument on historical and socio-cultural grounds portraying how death in the19th century was accepted as a final stage of one’s life contrasting with the detachment of the actual times.
The effort to extend life is so intense that the line between life and death has become blurred due to the extraordinary means to keep a patient alive.
Callahan argues that physicians are supposed to heal not to prevent death from happening.
At the heart of his argument he agrees in withdrawing the means to keep a terminal or demented patient alive but rebukes extraordinary and futile medical treatment.
His disagreement with voluntary euthanasia or Physician Assisted Suicide (PAS) rests on the fact of allowing somebody else to end one’s life.
Death should follow its natural process.
Furthermore, Callahan argues that human beings are so used to control the events in their lives that when it comes to death, which is a natural event, they want to control it too.
He states human beings must come to the acceptance of their own mortality.
He proposes to reverse the concept of modern death to a “peaceful death,” which consists in coming in terms with one’s self and choosing the life one wants to live in order to have a dignified death Alternatives .
The problem with the health system is trying to fix the problem of dying instead of providing with better means for pain management.
He agrees with Callahan on the issue of the hospice movement, that instead of being a separate entity it should be accessible to everyone for palliative care.
If more people would have access for pain relief the dying process would be more manageable.
It is not a matter of double standard if applying morphine to alleviate the pain of a patienthastens his or her the death.
It is just allowing a patient to have a dignified death.
The problem with euthanasia is also that it is secularized.
It is not only that the First Amendment endorses the freedom of religion, it is the lack of religion and spirituality what promotes the legalization of euthanasia (Peck).
While Callahan does not agree with euthanasia neither, he does not appeal to the issue of religiosity as the basis for rebuking it but it is a plausible alternative.
Recently, the spiritual aspect of a person is becoming more important or at least it is more in the limelight.
Books and articles regarding this issue are everywhere.
The link of praying, meditation or any sort of spiritual activities with physical and emotional well being more and more are being explored.
Would spiritual growth enable one to accept one’s death more easily?According to spiritual leaders most probably but it should be a personal matter not imposed by any organized religion as an alternative to euthanasia.
Should Euthanasia be legalized? Supporters of Euthanasia claim that the right to die movement helps patients to get a dignified death.
In theory, this argument seems plausible but it should not be generalized.
Every case is different and it should be treated individually.
Even the Church and Christian groups evaluate each situation to make the proper judgment.
One of the pioneers of the right-to-die movement is Derek Humphrey who in his bestseller Final Exit provided information about dying with dignity and PAS (1991).
The acceptance to the possibility of voluntary euthanasia was overwhelming.
Additionally, in Freedom to Die, Humphrey in conjunction with Mary Clement proposes the legalization of PAS at the same time that indicates ways to avoid negative outcomes.
One of the reasons for PAS to become legal is financial.
The health system will not be able to deal with an expanding aging society.
A dignified dying process should not be surrounded by immoderate procedures or extended unnecessary care.
Moreover neither The Roman Catholic Church other religious groups should interfere with the legalization of voluntary euthanasia.
Decisions about one’s life and death are to be taken based on personal moral values.
Society should not be governed by Judeo-Christian principles.
In addition, the American Medical Association with its conservative rules that reject voluntary euthanasia and PAS are pushing away members who believe in more realistic parameters.
With a decline of 42 percent of all physicians, many doctors are implementing their own ethical values in helping patients carry on their wish to end unnecessary suffering (Humphrey & Clement, 1998).
Additionally, in advocacy for legal euthanasia, “The Oregon Health Division’s 2nd year report on the Oregon Death With Dignity Act” demonstrates how responsible and empathetic the law is.
It has worked in an unbiased and legal way.
It has followed guidelines and no abuse has been reported.
Most of the patients were men and had received hospice care.
Oregon provides its patients with excellent “end-of-life care”(New England Journal of Medicine 2001).
Is Euthanasia Unethical and Immoral? Opponents also try to base their arguments on moral, ethical or religious grounds.
As stated above many religious activists claim that euthanasia is abolished by the Christian faith.
Others object that Judaism also sanctions euthanasia.
These religious traditions are based on the respect of human life and morality.
People against euthanasia or PAS believe that there is not a justified situation for a doctor to perform either one.
Both actions violate the innate human right of a natural death.
Even though opponents recognize the need sometimes of passive euthanasia, as Callahan says, there is a difference on allowing to die and helping to die.
In addition, the American Medical Association is also against the legalization of euthanasia and PAS.
What they advocate is the Pain Relief Promotion Act or HR 2260.
The purpose is to promote the palliative care of the patient (AMA 2000).
Although AMA does not endorse PAS it recommends to physicians to inquire about the motives a patient has to request it (AMA 1994).
The emotional state of the person must be evaluated because in some cases depression and fear make the illness intolerable.
It is important for the patient not to feel abandoned by the physician even when they do not share the same opinion.
Sometimes after an evaluation the patient can be referred to psychological or palliative care making the illness more bearable for the person.
Moreover, the legalization of euthanasia is problematic in two significant aspects.
First, any human being that claims a right to assisted suicide is imposing that duty on someone.
Most likely on the physician assisting the patient.
Given this situation, what is the limit of a physician?Should the moral values of the physician be taken into consideration or not?Whose rights are being respected?Secondly, with the legalization of euthanasia problems with abuse can arise, especially in the case of the elderly and mentally dysfunctional individuals.
Callahan argues that the life of a ninety years old is valuable, but due to the medical costs and availability of means, one should place priority on a younger person.
Whereas his argument sounds logical one encounters the controversy of placing subjective values on a patient.
Who would determine the value and significance of another human being? Furthermore, euthanasia has an impact on society.
It does not limit itself in respecting the autonomy of each individual.
There are parameters in society to which a person must adhere.
If one’s actions are based on the inability to sustain suffering the bases of the social order could collapse.
Restrictions should always be enforced, if not anarchy would be the outcome.
PAS and euthanasia should always have guidelines and limitations, because there is the danger that what started as an empathetic action could develop into an in discriminatory act.
Besides, in the Netherlands, where euthanasia and PAS were legalized on November 2000, for over twenty years some physicians have performed these acts and not in every case they have followed the expected guidelines (Christianity Today 2001).
Likewise, there is a report which shows that 75 percent of Dr.
Kevorkian’s patients were not terminally ill (The New England Journal of Medicine 2000).
Taking into consideration all these facts the danger of generalizing euthanasia is real and people should be educated in order to make the best choice.
The popular opinion is valuable in determining policies in this country.
Legal decisions should be made based on the desire for a better society.
A better death is a main component of society; therefore palliative care and passive euthanasia should be enforced in managed care.
At the end, the matter for euthanasia to be legalized rests on the hands of the citizens.
Religion and Euthanasia Even though the diverse cases of passive euthanasia are individually evaluated the position of the Roman Catholic Church is to avoid euthanasia due to the right to life.
The idea is to preserve all lives equally based on dignity and respect.
Life is considered sacred and “the basis of all values.
”The Church is against new medical modalities where physicians are engaging in supposedly compassionate acts towards their patients.
God is the one who gave life to humans and He is the only one who can take it away (John Paul II 1980).
Supposedly Church and state are two different entities.
The First Amendment makes this distinction clear, but the intromission of the Roman Catholic Church with its opposition against PAS is trespassing this limit.
The majority of Christian and Jewish groups approve withholding and withdrawing life-sustaining treatments.
In his 1995 encyclical, Evangelium Vitae, Pope John Paul II stated the difference between stopping “aggressive medical treatment” and suicide or euthanasia.
He makes it clear that the Church accepts the former and rejects the latter.
Most of the religious people who agree with the Pope’s position are the traditional Catholics, Protestants, Jewish and Muslims.
The more liberal Reformed Jews and Protestants in general based their decision on personal belief.
(Humphrey & Clement 1998).
The issue of death is not easy to handle because it has always been one of the unanswered questions of humankind.
Throughout history men have tried to deal and wrestle with it, but still death prevails.
The debate over euthanasia can be objectively approached in a positive o negative way, but one does not know until one has to deal with death in a personal way if those values would prevail or if one would incurred in a change of heart.
The issue with the debate on euthanasia deals with the power of men over life.
As Callahan states, there is a limit on what medicine can do.
The emotional and economic implications on unnecessary extending a patient’s life are enormous.
If presently the health system is not prepared to maintain indefinitely patients in this situation how will the situation with the Baby Boomers be?In 2006 the first Baby Boomers generation turns 65 years old.
The life span is expected to increase as well.
Therefore, the need for more availability in hospitals for extraordinary treatments will also increase (Hooyman & H.
Asuman Kiyak 1999).
The idea of doing everything that is possible to keep a patient alive even when it implies harming the person is not the answer for a peaceful death.
Having acknowledged valid arguments on both sides of this controversy one can arrive to the conclusion that if euthanasia is to be legalized it should dissuade abuse and base itself on personal choices.
The decision should not rest only on policies but on families taking into account the wish of the patient.
Personal, empathetic care is also necessary for a dignified death.
Moreover, physicians must get involved with their patients in talking about death and the management of physical discomfort.
Death should be approached as a reality not as an accident of nature.
References Callahan Daniel.
The Troubled Dream of Life.
In Search of a Peaceful Death.
Washington:Georgetown University Press, 2000.
Christianity Today.
“Death by Default.
”Available online at htpp://www.
christianitytoday.
com/ct/2001/002/31.
26.
html.
Accessed May 10, 2001.
Council on Ethical and Judicial Affairs, American Medical Association.
Code of Medical Ethics.
Report 59.
Chicago, Ill:American Medical Association; 1994.
DeSpelder Lynne Ann & Albert Lee Strickland.
The Last Dance.
Encountering Death and Dying.
Mountain View, California:Mayfield Publishing company, 1999.
Hooyman Nacy &H.
Asuman Kiyak.
Social Gerontology.
Needham Heights, MA:Allyn & Bacon, 1999.
Humphry Derek & Mary Clement.
Freedom to Die.
New York:St.
Martin Press, 1998.
Peck, M.
Scott.
Denial of the Soul.
New York:Harmony Press, 1997.
Pope John Paul II.
“Declaration of the Sacred Congregation for the Doctrine of the Faith.
”Pastoral Constitution on the Church in the World of Today, no.
27.
May 5, 1980.
“The Complexities of Assisted Suicide”Available online at [http://pc.
pdr.
net/pc/public.
ht?path=content/journals/p/data/2000/1130/11a00suicide.
html].
Accessed May 10,2001.
“The Oregon Health Division’s 2nd year report on the Oregon Death With Dignity Act” (2001,Feb.
24).
New England Journal of Medicine.
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