Euthanasia.

“Euthanasia” is a broad term for mercy killing—taking the life of a hopelessly ill or injured individual in order to end his or her suffering. Mercy killing represents a serious ethical dilemma. People do not always die well. Some afflictions cause people to suffer through extreme physical pain in their last days, and euthanasia may seem like a compassionate way of ending this pain. Other patients may request euthanasia to avoid the weakness and loss of mental faculties that some diseases cause, and many feel these wishes should be respected.

But euthanasia also seems to contradict one of the most basic principles of morality, which is that killing is wrong. Viewed from a traditional Judeo-Christian point of view, euthanasia is murder and a blatant violation of the biblical commandment “Thou shalt not kill.” From a secular perspective, one of the principal purposes of law is to uphold the sanctity of human life. Euthanasia is so controversial because it pits the plight of suffering, dying individuals against religious beliefs, legal tradition, and, in the case of physician-assisted death, medical ethics.

This moral dilemma is not new. The term “euthanasia” is derived from ancient Greek, and means “good death.” But while the debate over mercy killing has ancient origins, many observers believe that it is harder today to achieve a good death than ever before. Advances in medicine have increased people’s health and life span, but they have also greatly affected the dying process. For example, in the early twentieth century the majority of Americans died at home, usually victims of pneumonia or influenza. Today most people die in the hospital, often from degenerative diseases like cancer that may cause a painful, lingering death.

Most observers trace the modern euthanasia debate back to the court case of Karen Ann Quinlan, and her story is a poignant example of medical technology’s ability to prolong life. In 1975, after consuming alcohol and tranquilizers at a party, Quinlan collapsed into an irreversible coma that left her unable to breathe without a respirator or eat without a feeding tube. Her parents asked that she be removed from the respirator, but her doctors objected. The New Jersey Supreme Court case that followed was the first to bring the issue of euthanasia into the public eye. In 1976 the court allowed Quinlan’s parents to have the respirator removed. Although Quinlan lived for another nine years (her parents did not want her feeding tube removed), the case set a precedent for a patient’s right to refuse unwanted medical treatment.

In 1990, this right was further expanded in the case of Nancy Cruzan. Cruzan had gone into an irreversible coma in 1983 after a severe car crash, and her parents wanted the machine that was keeping her alive removed. However, in this case the machine consisted of intravenous feeding tubes that provided Cruzan with hydration and nutrition. Her parents viewed the removal of the machine as the termination of unwanted treatment. However, the state of Missouri argued that to remove the feeding tubes would be to intentionally kill Cruzan through starvation. In a controversial vote, the U.S. Supreme Court ruled that the provision of artificially delivered food and water is a treatment which patients may legally refuse, even if doing so will result in death.

The cases of Quinlan and Cruzan helped develop a social policy that recognizes that some lifesaving treatments are not always appropriate, and permits the removal of these treatments as a form of “passive” euthanasia. But shortly after the Cruzan case more active forms of euthanasia became the focus of public attention. One of the persons most responsible for this is Timothy E. Quill, a physician who in 1991 described in the New England Journal of Medicine the case of “Diane,” a longtime patient of his who was suffering from acute leukemia. She asked Quill for the means to end her life should she find it intolerable, and, unable to dissuade her, he prescribed sleeping pills, telling her how many were necessary to cure insomnia and how many were necessary to commit suicide. Four months later Diane killed herself.

Quill’s article provoked immediate and heated discussion over the legality of physicians’ assisting in suicide. Quill’s selfproclaimed goal is to improve the care dying people receive rather than to legalize any form of euthanasia. Nevertheless, he became a central figure in a court case that challenged the constitutionality of state bans on assisted suicide—Quill and other right-to-die advocates essentially argued that terminally ill patients have a constitutional right to assisted suicide. In 1997, however, the Supreme Court disagreed, ruling that states may legislate for or against physician-assisted suicide as they see fit. (Currently, over 35 states have laws against assisted suicide; only Oregon has legalized the practice.)

Ironically, however, the person most responsible for bringing euthanasia into the public eye is one from whom most right-todie activists have tried to distance themselves: former pathologist Jack Kevorkian, who has admitted helping over 130 people die since 1990. Whereas Quill is regarded as a reasoned, thoughtful spokesman for the terminally ill, Kevorkian is seen as a renegade. Many of the people he has helped to die were not terminally ill, and he did not know them before they requested his assistance in suicide. He holds some bizarre opinions: In his book Prescription: Medicide, Kevorkian advocates experimentation on patients before they die and nonvoluntary euthanasia for anyone whom physicians deem to have an extremely low quality of life. Many of his views and methods have been condemned by right-to-die leaders, yet Kevorkian is the name people most associate with euthanasia.

Prior to 1998, Kevorkian only assisted in suicides. He rigged so-called suicide machines that allowed patients to self-administer a lethal dose of drugs. However, on November 23, 1998, 60 Minutes aired a videotape of Kevorkian participating in a more active form of euthanasia. For the first time, he administered the fatal injection himself, ending the life of Thomas Youk, a fifty-twoyear- old who suffered from Lou Gehrig’s disease. On March 26, 1999, a Michigan jury, faced with this videotape evidence, found Kevorkian guilty of murder. The judge in the case did not allow the defense to present testimony about Youk’s pain and suffering, and emphasized that whether the victim consents is legally irrelevant in murder cases. Kevorkian plans to appeal the verdict.

Kevorkian’s is the latest in a series of contentious euthanasia cases that have challenged and, in some cases, changed Americans’ beliefs about death, mercy, and killing. Less than three decades ago, many people considered the removal of a comatose patient’s respirator a shocking act of passive euthanasia. Today, the most divisive euthanasia cases concern physician-assisted suicide and Kevorkian’s direct mercy killing. The authors in Euthanasia: Opposing Viewpoints debate these increasingly complex topics in the following chapters: Is Euthanasia Ethical? Should Voluntary Euthanasia Be Legalized? Would Legalizing Euthanasia Lead to Involuntary Killing? Should Physicians Assist in Suicide? The viewpoints in this book help shed light on the legal and ethical problems that Americans continue to face in their quest for a “good death.”