THE RIGHT TO DIE

...Will euthanasia be applied not only to the aged but also to the con-genitally deformed...

...Will this awesome prerogative eventually become a matter of convenience for the state, as was the case when the Nazis put to death tens of thousands of mentally ill, mentally defective, and other "unproductive" persons...

...Their basic premise is that it is cruel and immoral to force a person suffering from severe physical pain caused by an incurable disease to have to go on living if he no longer wants to do so...

...Prospects for the enactment of any such legislation in the foreseeable future appear to be extremely dim...

...If so, what dangerous abuses may it lead to...

...How widely various forms of euthanasia are now practiced must remain a matter of conjecture, since the subject is one about which much is said in private but relatively little in public...

...Should people be allowed to give instructions in properly attested and legal instruments, while they are still in good health and sound mind, that their existence be terminated in the case of incurable or severely incapacitating disease...

...In a speech at the annual convention of the National Medical Association in Cincinnati, Dr...

...Should a withdrawal of medication to enable such lives to end painlessly be legally permitted under certain safeguards...

...With a few outstanding exceptions, physicians are reluctant to be quoted for publication on the matter...

...Will it be possible to prevent its abuse by rapacious relatives and subornative physicians...

...Webster's Dictionary now defines euthanasia as an "act or practice of painlessly putting to death persons suffering from incurable and distressing disease...

...When such drugs are administered in ever-increasing doses as the body learns to tolerate them, they can eventually kill the patient...

...Where should the line be drawn between prolonging life and merely prolonging the act of dying...

...Among those favoring euthanasia for hopeless patients were Protestants, 38.5 per cent...

...degenerative diseases that are often incurable and may mean years of lingering illness...

...Indeed, it is precisely because humanitarian concern, medical tradition, and the deepest of human instincts appeal almost irresistibly for the continuation of life that the periodic affirmation of the right to die in peace is so necessary...

...There was a time when life was defined in terms of the beating of the heart and the continuance of breathing," Dr...

...A Belgian doctor, tried for murder in 1963 for complicity with a mother in killing a thalidomide-deformed baby, also was acquitted...

...In the absence of definite legal guidelines or even of a clear social consensus, the question of whether to prolong life and suffering in the face of inevitable death is one of the most painful and tragic the doctor is called upon to answer...

...Catholics, 6.7 per cent...

...Euthanasia is now outlawed in every state...

...Edward H. Rynearson, one of his associates at the Mayo Clinic, who in the past few years has spoken out on a number of occasions against the practice of prolonging life after all medical hope is gone...

...With enough tubes in a person, and surrounded by oxygen, there is hardly any way he can die...

...The breakdown for euthanasia for severely deformed children was Protestants, 40.7 per cent...

...In the first situation, 31.2 per cent of the doctors surveyed said they felt euthanasia was justified, while in the second instance, 32.8 per cent were recorded in favor of euthanasia...

...Various proposals in this field have often been misconstrued because of a loose use of terms...

...He has been at pains to emphasize, as have been other of physicians who hold similar views, that his advice against seeking to prolong life after the struggle obviously becomes hopeless "has nothing to do with euthanasia" but only with "extraordinary measures" which no religious faith, including the Roman Catholic Church, demands...

...Understandably, the proponents of euthanasia by omission of death-delaying devices are far more numerous than those who advocate outright mercy-killing...

...There are too many instances," Dr...

...As a practical matter, this still leaves the decision to the judgment—and conscience—of the individual physician...

...Most relatives involved in mercy-killings have likewise been freed by juries...

...That affirmation of the patient's right to exit from life without prolonged and inhuman suffering will need to be heard again and again as a spur to deeper exploration of a problem which will grow in intensity with the advance of medical science from year to year...

...What is commonly referred to as "the right to die" stands for "voluntary euthanasia," the termination of a person's life upon his own request...

...This point of view was aptly summed up by an editorial comment in The Lancet, the leading British medical publication, that "a clinician who persistently seeks to sustain a parody of life may end in serving nobody and nothing except pride in his own technical competence...

...and Jews, 38.8 per cent...

...But what, precisely, is the distinction between "ordinary" and "extraordinary" means, and what are the exact circumstances under which withholding of the latter may be justified...

...A bill introduced some years ago in the New York legislature would have permitted a patient, certified by his physician to be suffering from severe pain caused by an incurable disease, to apply to a court for authorization for painless ending of his life, subject to approval by a special committee...

...Euthanasia in this sense is forbidden by law, religious codes, and medical ethics...

...With the consent of the dying person," he said, "it is permissible to use narcotics with moderation to alleviate suffering, even if the narcotics hasten his death...

...The basic difference between this and euthanasia in the sense in which it is now commonly used is that in the latter case the physician himself may decide to end the patient's life without the patient's explicit consent, or he may do so upon the request of relatives...

...How long should doctors attempt to defer death when ebbing life can be maintained only by artificial means...

...Commenting on the feeling of many physicians that they are obliged to keep on fighting for the last faint heart flutter, several other medical authorities have emphasized that the mere maintenance of pulse and respiration in the dying patient is no longer a valid aim...

...Basically, their argument is that it is senseless to prolong suffering when, as Dr...

...Dr...

...In the process of seeking to come to terms with the inexorable truth that man is only mortal, the concept is gradually evolving that, to a degree at least, we can control the style of our dying...

...Proposals for legalizing voluntary euthanasia have been sponsored by the Euthanasia Society of America in several states but have gotten nowhere...

...Otherwise, he has said, treatment should be limited to the use of such natural means of preserving life as food and drink, "good nursing care, appropriate measures to relieve physical and mental pain, and the opportunity of preparing for death...

...Are doctors always in a position to make the arbitrary judgment of when to stop fighting death...

...The scene of death is shifting more and more to the hospital with its superior facilities for alleviating pain and its varied apparatus for unmercifully stretching out the act of dying...

...How can doctors decide when mercy justifies the ending of life, when a life is no longer "worthy" to be lived...

...The American Medical Association, or any other leading professional organization, can hardly be expected to embroil itself in an issue so controversial and full of pitfalls...

...The upshot appears to be that the decision on whether to grant a patient the relief of death will continue to remain in the hands of individual physicians, where it has always been...

...The opponents of euthanasia base their case primarily on one of the most fundamental principles of the Judaeo-Christian ethic—that it is wrong to take human life...

...How valid, legally, can such consent be considered when the patient is heavily drugged or racked with pain in the absence of drugs...

...Charles S. Cameron, dean of Hahnemann Medical College in Philadelphia and former medical and scientific director of the American Cancer Society, has said that "the difference between euthanasia and letting the patient die by omitting life-sustaining treatment is a moral quibble...

...The proponents of voluntary euthanasia contend that man should have the right to determine, in advance, the time of his own death, as long as the rights of others are not infringed upon, much as he has the right to determine the form and content of his life...

...The magazine sent out questionnaires to a wide cross-section of physicians in all parts of the country, asking them to comment on what they believed should be done in two situations—the case of patients in great pain and without hope of relief or recovery, and the case of infants born with serious abnormalities and with no chance of a normal life...

...In this case, death is not directly desired but is inevitable, and proportionate motives sanction measures which may hasten its advent...

...The measure failed of passage despite its endorsement in petitions signed by 1,776 physicians and 379 Protestant and Jewish clergymen...

...His only punishment was temporary suspension of his license...

...Catholics, 6.2 per cent...

...It is precisely because of the boon of greater average longevity and medicine's vastly expanded armamentarium, they point out, that many old people now arrive at the stage where they are kept for months only technically among the living, barely breathing in oxygen tents, their wasted bodies nourished through nasal tubes, their bladders drained by catheters, their faltering hearts and waning consciousness stimulated by drugs...

...The debate over some of these issues—all of them beset by thorny moral, theological, and legal problems— was not long ago given renewed impetus by Dr...

...Mayo asserted that adult individuals have a right to decide, in advance, whether they want to go on living when their outlook becomes hopeless...

...Literally translated, the word "euthanasia"—derived from the Greek eu, meaning "well" or "good," and thana-tos, "death"—means painless death...

...One of the few available samplings ? professional opinion on the subject was conducted in 1962 by New Medical Materia, a monthly publication on medical and socio-economic problems...

...Rynearson believes that "artificial life-sustainers" should be used only when they offer hope of some real benefit to the patient or when they are specifically requested by his relatives or spiritual adviser...

...A New Hampshire physician who in 1949 injected air into the veins of a patient, who died within a matter of minutes, was found innocent after a lengthy trial on a murder charge...

...People have as much the right to die as the right to live," he said...

...In addition to acts of omission through the withdrawal of life-prolonging agents, the area in which euthanasia is probably most widely practiced is in the administration of pain-relieving narcotics...

...In his statement on euthanasia, Pope Pius XII mentioned this specifically as a permissible procedure...

...Even in advanced cancer, there have been cases of so-called "spontaneous remission...

...Small wonder, then, that one medical authority has commented that "the deeper one goes into these problems, the more one is inclined to favor both sides instead of assuming a definite pro or con attitude for one specific side...

...Rynearson has put it, "every process of the body is bent toward extinction," and that the dying ought to be allowed to depart in peace...

...This crucial and prickly question, which has long agitated many thoughtful physicians, theologians, and laymen, is increasingly being propelled into the arena of public discussion for a variety of reasons...

...But this, too, seems highly unlikely...

...that while man cannot live as long as he might choose, there may be justification for allowing him to stop living whenever he wants to...

...Interesting is a breakdown of these figures by religious affiliation of the doctors...

...Leland Chris-tenson, another Minnesota physician, has written...

...Mayo said that all too often these days we are keeping alive in a "vegetable state" those "who should not be kept alive...

...Mayo thus lined up with Dr...

...Are they not dedicated to the proposition that they must continue to battle in the face of what appear to be insurmountable odds...

...He wrote the recently published book, "The Troubled Calling: Crisis in the Medical Establishment...

...In such cases, he has argued, it is pointless to keep on trying to maintain life, and physicians should confine themselves to doing all they can to alleviate suffering and let nature take its course...

...It is wrong for doctors to see how long we can keep 'vegetables' alive...

...Historically, the tradition has developed that the shortening of life is under any circumstances undesirable and illegal...

...What should be done about progressively deteriorating patients who are kept alive for months, and sometimes even years, in comatose incontinence...

...According to published opinion and private comments by physicians, the practice of euthanasia is presently not uncommon, particularly in its "passive" form, which means the administration of sedatives and the withhhold-ing of stimulants when the outlook is clearly hopeless...

...Those who favor expediting death to end the agony of the hopelessly ill in terminal cases emphasize that they are not advocating positive action to terminate life but only the withholding of medications which would artificially prolong it...

...They therefore propose that individuals be permitted to make a sort of one-before-the-last will and testament, to be opened if and when they are stricken with incurable disease, stating whether they wish to be killed painlessly, or allowed to die without preventive measures...

...It is therefore advisable, before going any further, to define these terms...

...With all the fluids, vitamins, electrolytes, protein supplements, antibiotics, hormones, and other agents available to us now, we can keep people suffering for an indeterminate number of months...

...Mayo suggested that the medical profession make a "group decision" on when to stop efforts to prolong life instead of leaving it to individual judgment...

...Rynearson has said, "in which patients are kept alive indefinitely by means of tubes inserted into their stomachs, or into their veins, or into their bladders, or into their rectums ¦—and the whole sad scene thus created is encompassed within a cocoon of oxygen which is the next thing to a shroud...

...The argument of those favoring this course is that there now is considerable illegal or bootleg euthanasia, which properly should be regulated by law, and that medical progress has made the legalization of mercy-killing more imperative than ever...

...The questionnaire made no reference to any specific form of euthanasia...

...Rynearson's disavowal of the advocacy of euthanasia underscores the semantic confusion which has led to frequent misapprehension in the debate on the subject...

...Once we begin to arrogate to ourselves the prerogative of destroying life, or permitting it to lapse, those opposing euthanasia argue, where do we draw the line...

...Charles Mayo, director of the famed Mayo Clinic and Foundation of Rochester, Minnesota...

...The most obvious are the lengthening of the average life span and the resulting rising tide of the aged with their high incidence of SELIG GREENBERG, a prize-winning reporter on medical and related problems for The Providence Journal and Evening Bulletin, has twice been honored by the Lasker Foundation for his writing...

...It should be noted that while Hippocrates pledged doctors never to use a drug to produce death, he also forbade the administration of remedies to those beyond hope...

...Should the Sixth Commandment, "Thou shalt not kill," be modified...

...In his Cincinnati talk, Dr...

...And how about the quality of the patient's continued consent to the end of his life, which is basic to the proposals for voluntary euthanasia...

...But our society's ambivalent position on the issue is amply demonstrated by the fact that rarely is there any penalty imposed in such cases and, if there is a penalty, it is seldom drastic...

...At the same time, the erosion of religious beliefs, with their emphasis on the promise of the hereafter, and the growing secularization of our culture are bringing about some significant changes in our attitudes toward death...

...The practice of euthanasia, in the sense of relieving pain in the final stage of life, has always been regarded as one of the highest missions of the medical profession and is universally accepted...

...But now, with cardiac pacemakers, extrinsic temperature control, respirators, intravenous nutrition, vasopressors, and artificial kidneys, a body can be kept functioning long after the natural course of events would have resulted in 'death.' This is functioning on a mere cellular level, no higher than can be achieved in a tissue culture...

...But even if it were conceded that acceleration of the death of the incurably ill is sometimes justified, they say, the legalization of euthanasia would raise many difficult problems and open the way for possible grave abuses...

...There is no record that any doctor has ever been indicted for failure to use every means at his disposal to keep a patient alive...

...The major religions have taken the position that doctors may restrict their ministrations to dying patients to the employment of "ordinary" measures and are not called upon to resort to "extraordinary" action...

...and Jews, 48.8 per cent...

...But over the years the originally benign word "euthanasia" has come to be applied to mercy-killing or any other form of acceleration of death to liberate incurable patients from intractable pain...

...He made it clear that he was talking not only about the incurably ill among the aged but also about children born with severe physical malformation or brain damage who are being kept alive at the cost of untold heartbreak to their parents and many millions of dollars...

...The late Pope Pius XII said, in 1957, that in the case of serious illness "normally one is held to use only ordinary means . . . that is to say, means that do not involve any great burden for oneself or another...

...Moreover, there is always the chance of the discovery of an effective treatment for some kinds of cancer or other incurable disease afflicting the patient...

...One of the pledges in their Hippocratic Oath states flatly that "I will give no deadly medicine to anyone if asked, nor suggest any such counsel...

...No longer do most people receive death in the privacy of their homes, with whatever comfort they can derive from the presence of their loved ones and with a minimum of medications and other measures for sustaining life when all hope of recovery is gone...

...But the distinction between acts of omission and commission is often murky, requiring far-reaching value judgments of both a professional and moral nature...

...The public," the Canadian Medical Association Journal said in a recent editorial, "can rest assured that the average physician, impelled as he is by instinct, by training, and by the weight of peer opinion, will continue in his attempts to maintain life as long as reasonable hope of recovery exists...

...Another important factor is medicine's success in prolonging not only life but, frequently, also the agony of dying...

...By our religious and moral precepts and their own code of ethics, physicians are committed to prolong life in all persons as long as they can by whatever means are at hand...