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After all, why did we Americans need this ruling in the first place?
In New York State, where this case was brought, not a single
physician has been penalized for aiding a suicide since 1919. For 77
years, one can assume, some doctors have been quietly helping
patients die. Why then the need for a legal ruling to make that official,
a ruling that erases a fundamental ethical line and opens medical
practice to unconscionable abuse?
The need comes from the modern American craving for
“authenticity.” If you are going to do it, do it openly, proudly,
unashamedly. But as a society, do we not want this most fearful act —
killing — to be done fearfully? If it must be done at all — and in the
most extreme and pitiable circumstances it will — let it be done with
trembling, in shadow, in whispered acknowledgment that some
fundamental norm is being violated, even if for the most
compassionate of reasons.
No more. These judges have now liberated us from the hypocrisy
of the unenforced law. Damn them. Lack of enforcement is an
expression of compassion, but the law is the last barrier to arrogance.
And God knows that in this age of all-powerful medicine, arrogance is
the greater danger. Every grandparent will soon know that, too.
DISCUSSION
I. Explain the meaning of the following quotations from the
text:
1. “Did you ask for your hemlock?”
2. “Others are letting go; others are giving way; should not you
too?”
3. “The absolute ethical norm established since the time of
Hippocrates — that doctors must not kill — was removed in the name
of compassion.”
4. “Once given power heretofore reserved to God, some exceeded
their narrow mandate and acted like God.”
5. “Pulling the plug for the dying is permitted. Prescribing death-
dealing drugs to those who are quite self-sustaining is not.”
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6. “…as a society, do we not want this most fearful act —
killing — to be done fearfully?”
II. Express your opinion about the following:
1. “…legalization has resulted in so much abuse — not just
psychological pressure but a shocking number of cases of out-and-out
involuntary euthanasia, inconvenient and defenseless patients simply
put to death without their consent.”
2. “There is a great difference between, say, not resuscitating a
stopped heart — allowing nature to take its course — and actively
killing someone.”
3. “Killing is hard to do. The whole purpose of this case is to make
it easier. How? By giving doctors who actively assist in suicide the
blessing of the law and society.”
TEXT 4
EUTHANASIA AND AID IN DYING
BACKGROUND: Current law allows competent adults to instruct
their physicians in writing to withhold or withdraw “life sustaining
treatment” in instances of terminal illness or permanent
unconsciousness. State law, however, does not allow adults to
authorize “aid in dying” or euthanasia, which is the use of medical
procedures, such as lethal injections, to end the life of terminally ill
patient. It is presently illegal to assist someone in suicide in
California. The most recent attempt to change this is AD 1592, the
Death with Dignity Act, introduced by Assembly member Dion
Aroner. This bill intended to legalize and protect euthanasia in
California. Specifically, this bill would have authorized a competent
adult who has been diagnosed as terminally ill by at least two doctors
with less than six month to live to make an oral and written request
that would end his or her life. Other procedural requirements include
that there be a 15 day period between the initial oral request and the
prescription, the patient must be mentally competent, and the doctor
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must offer upon a second request the opportunity for the patient to
change his or her mind. Finally, a written request must be filed in
addition to the oral request and this must happen to less than 48 hours
before the prescription is written.
SUPPORT: Supporters argue that legalizing euthanasia could
result in savings to the state because terminally ill patients would have
the right to receive aid-in-dying. The patients would then be able to
spare the state the expense cost of constant long term care. Even more
important than this expense, is the burden that is put on the patient and
on the family of someone who is terminally ill. Dr. Warren Bostick,
the former president of the California Medical Association, argues that
modern medicine can strip away a terminally ill patient’s dignity, as
well as prolong his suffering. Many terminally ill patients are forced
to make the decision to kill themselves, often in a brutal manner,
because there is no other option such as euthanasia available to them.
The basic premise of supporters of euthanasia is that everyone has the
right to control their own destiny, and part of this includes the right to
die with dignity whenever one is suffering from an illness or a disease
that has no cure.
OPPOSITION: Opponents fear that legalized euthanasia has the
potential to be abused. For example, Dr. Kevorkian, known as the
“suicide doctor” because he has frequently helped people commit
suicide, assisted a woman who allegedly had breast cancer. However,
the autopsy revealed no signs of breast cancer. Opponents such as
Right to Life groups suggest that patients who are diagnosed as
terminally ill often experience serious depression, which could cause
them to make the decision to die without thinking it through over a
reasonable period of time. If euthanasia remains illegal, a terminally
ill patient might be more likely to put serious thought into making
such an irreversible decision because they would not want their loved
ones to bear the burden of having broken the law. Opponents also fear
that patients might even receive pressure from others to make such a
decision. Furthermore, opponents argue that doctors sign the
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Hippocratic Oath swearing to save lives, and assisting patients with
suicide violates that oath.
DISCUSSION QUESTIONS
6. What kind of abuses are possible if euthanasia is legalized and
how can they be prevented?
7. Who should determine if a patient is “mentally competent”
enough to decide to end their life? Should anyone?
8. What are the ethical implications of euthanasia?
9. What limits should be placed on how euthanasia may be
committed? Should the patient be responsible for administration of the
lethal dose with doctors only allowed to prescribe the drugs and tell
the patient how to use them effectively? What do you think?
10. The Ballot results of the survey carried out in California in
2002 show that 35% of people answered yes, 65% — no when asked
the question: Should terminally ill patients be allowed to request their
doctor to provide them with medication that would end their life? If
the same survey were carried out in Volgograd, what results would
you predict?
TEXT 5
LIVING WILLS AND TREATMENT REFUSALS
by R. Higgs
Patients often express fears of death but also of life unnecessarily
prolonged — an undignified, lingering existence as a “vegetable.”
However difficult professionals may find this, these anxieties are not
irrational. To the rising numbers of the elderly who are no longer in
control of their destiny must be added the smaller numbers of those
permanently incapacitated by stroke, road traffic accidents, or failed
resuscitation procedures.
Society does not yet agree within itself or with its doctors on what
should be done. One answer for the future may be for patients to
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anticipate some of these decisions while still capable and competent
and to make a formal statement about how they would want to be
treated were this no longer the case. These declarations have come to
be known as “advanced directives” or “living wills.'” Since the term
living will was coined in 1967 by Luis Kutner, a Chicago lawyer, over
10 million Americans are estimated to have prepared such statements:
“If I should have an incurable or irreversible condition that will
cause my death within a relatively short time, and am no longer able
to make decisions regarding my medical treatment, I direct my
attending physician… to withhold or withdraw treatment that only
prolongs the process of dying and is not necessary to my comfort or to
alleviate the pain.”
Knowing that the patient’s wishes will be respected powerfully
reassures both patients and relatives when curative medicine may have
little else to offer. That people might “change their minds” after
becoming mentally incompetent seems to make little sense both
logically and psychologically, but wills may be changed by the
competent at any time. A more worrying objection to living wills is
that patients might be (or feel themselves to be) under pressure from
friends, relatives, or health workers to show their willingness to stop
treatment because they have come to think of themselves as burdens
that nobody wishes (or can afford) to carry. An appropriate procedure
and a carefully worded document should relieve such fears rather than
create them.
Although living wills offer freedom of choice to the patient, some
worry that they might compromise the autonomy of the professional.
Those doctors who believe that their duty is to preserve life might feel
particularly uneasy. But where the ethical views of patient and doctor
conflict a second opinion is always an option. If the doctors knew the
patient’s view, they might be able to give more effective symptomatic
relief and be more assured when making difficult decisions about
altering plans for care.
Nobody could claim that living wills will ever be a real substitute
for empathic communication between health workers, patients, and
relatives. A living will may best be seen as an advisory device and
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need not become a legal weapon. But if our care is to anticipate and to
prevent, it makes sense to know what the patient wanted. Where there
is a will there may be a better way.
ASSIGNMENTS
I. Summarize the main ideas of the text in five sentences.
II. Comment on the final sentence of the text. What proverb
does it allude to?
III. Read the following court case about a medical and human
dilemma. Be the judge — “May I die?” If you were on the jury,
what would you say — is Dr. Kevorkian guilty of murder? Write
two or three reasons for your decision.
Dr. Jack Kevorkian gained fame, or notoriety, depending on your
opinion, for helping the terminally ill to end their lives. Dr.
Kevorkian, who practiced medicine in the state of Michigan, attended
“medicides,” a term Kevorkian used for doctor-assisted suicides. In
these medicides, which he had been attending since 1990, Dr.
Kevorkian provided patients with the means to commit suicide.
On October 22, 1993, Dr. Kevorkian set up an apparatus that
allowed Merian Frederick, a 72-year-old woman suffering from a
debilitating nerve disease, to inhale carbon monoxide. About a month
later, Dr. Kevorkian helped another doctor, All Khalili, die by a
similar method.
Dr. Kevorkian helped a 30-year-old man with a degenerative nerve
disease which had left the man paralyzed and in extreme pain. The
doctor put a mask over the patient’s face and connected it to a
container of carbon monoxide. The patient then turned a knob to start
the flow of the poisonous gas to himself. The man made a videotape a
month before the actual medicide. The tape shows the man with one
arm dangling, completely useless, while the man had difficulty
moving his other arm. He was almost unable to swallow and took
several minutes to get out these words: “I want to end it. I want to
die.”
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Many of the patients that Dr. Kevorkian assisted with medicides
were terminally ill. Many were in extreme pain. For example, Dr.
Khalili had progressed to the point that his bones were fracturing and
he had to use a morphine pump to control his pain. These patients
chose to die rather than live.
In early 1992, the state of Michigan passed a law forbidding
assisted suicides. This law was aimed specifically at Dr. Kevorkian.
Dr. Kevorkian challenged the law, saying that it is an invasion of a
person’s privacy, that a person has the right to die however and
whenever he or she sees fit.
Under the current law, Dr. Kevorkian could be convicted of
murder. The court must decide whether the law as it is written now is
correct.
Opponents of medicides would like you to consider the following
information.
It is true that Thomas Hyde deliberately tried to find Dr. Kevorkian
in order to end his own life. Hyde hated the disease that had weakened
his arms to the point that he couldn’t even lift his own daughter. The
illness had happened very quickly; within a year, Hyde could no
longer walk or speak clearly, and he knew he was going to die.
However, the choice of suicide for such terminally ill people is
much rarer than most people know. In a survey of 86 others with the
same disease as Hyde, only 2 said they were sorry they were alive or
dependent on a respirator. Medicide opponents say that we have
underestimated the will or desire of people to live and should not use
Hyde’s decision to say that suicides with help from doctors are OK.
IV. Search the Internet to find more information about Dr.
Kevorkian known as “Dr. Death.”
WRITING
Write an essay on the topic “Ethical Implications of
Euthanasia.” Among others, consider the opinions given below.
Yours essay should be approximately 500—800 words in length.
1. A person has the right to die with dignity.
2. God gave us life and only God can take it.
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3. In an age of crushing health-care costs, you don’t want to be a
burden to your loved ones, to say nothing of society.
4. Legalizing euthanasia weakens our commitment to provide care
for the dying.
5. We know too little about what a person in a coma feels or ‘what
is out there’ after death.
MOVIE
A Million Dollar Baby
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Unit 9
PEOPLE WITH DISABILITIES
PREREADING
1. If you were given an opportunity to be or experience anything in
the world, what would it be?
2. What experience have you had with illness or disabilities (your
own or friends’)?
3. How do disabled people want to be treated?
4. What kind of problems might they face?
TEXT 1
THE QUIET HEART
by Norman Rosten
Of all the people who moved into our house, I guess I remember
Philip the best. He was older than I, about fourteen, sad-eyed, skinny,
and had to spend most of the time in a wheelchair. He had something
we’d never heard of before on our block: an enlarged heart. Pretty
soon we called him Jumpy because his heart could be seen jumping
right under his skin when his shirt was open. The spot on his chest
would go poom-boom poom-boom (without a sound) up and down, no
bigger than a dime. It was weird. Yet after a while we got used to it.
Watching it was like a game.
When Jumpy was wheeled out in his chair on the sidewalk to sit in
the morning sun, he’d wave his arm and call, “It’s me, fellas.” And
we’d crowd around, joshing him, spinning his chair, until someone
would say, “Let’s see it jump, how about it, Jumpy!” And grinning
shyly, he opened his shirt, as we stared at the pulsing circle of flesh ―
his real alive heart!
Jumpy smiled feebly. “The doctor says I’ll get better. I might even
go back to school after summer vacation.” We said nothing; we didn’t
know much about hearts, but it didn’t look as though he would be in
school for a long time.
I would stop into his room almost every day. He sat up in bed,
reading or listening to the radio, or just leaning back looking into
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space. I would sometimes come in and he wouldn’t see me, and the
room so silent I’d think he was dead. I’d call out, “Jumpy?” And he
would turn slowly, his eyes brightening. “Hi, sit down.”
We talked about all kinds of things. Baseball and horses and
radios. He had a small crystal set. We wondered how music came
from an inch of wire probing a piece of crystal — with no electricity!
We talked about school, science, and the tutor who came to the house.
That was before he got too sick and stopped studying altogether. We
played cards a lot.
His mother was nice, but sad, as if she knew something was going
to happen. She brought us cakes and ice-cream while we played our
games. They had to be quiet games because he couldn’t get excited;
that made it worse, his mother explained.
Sometimes my sister would visit. She was shy, and she usually
brought him some little gift, like a jelly apple or a small bag of
cherries. He loved cherries.
“You look better, Philip,” my sister said on these visits. (She never
called him Jumpy, she used his real name).
“Thank you,” Jumpy replied.
“You look much better than last week, honest, Philip,” she said.
And he smiled his thin but intense smile. He never said much to her.
She, as well, was embarrassed. She was skinny in her bathing suit and
shy all the time. I was conscious of her growing up, and it made me
feel a little strange at first. I found myself watching her more after
that. Anyway, her growing up and Jumpy’s growing up made them
shy with each other. I thought he liked her, but I wasn’t sure about
what she felt.
Once, when we were talking about girls, Jumpy said he thought my
sister was a nice kid.
“Did you ever kiss a girl?” I asked him.
“No. Did you?”
“Yes,” I said.
“I don’t mean sisters,” he said.
I had, in fact, earlier this summer, kissed a slender light-haired girl
good-night. It wasn’t much of a kiss, but I recalled the warmth of her
lips with a shiver. It was quick; in the movies they were long kisses,
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