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Alex Kollar
Mike Joyce
Diane Hernandez
9/18/16/
Case Study 1
Our Issues with the California End of Life Option

On October 5, 2015, California Governor, Jerry Brown signed the California End of Life

Option Act that allows certain terminally ill adults to request and obtain a prescription for

medication to end their lives in a peaceful manner. This new death with dignity law went into

effect on June 9, 2016 and has since been the basis of numerous physician assisted suicides.

However, if you were to read through the official Death With Dignity website, the word suicide

will not appear once. This term omission is the basis of our argument against the passing of this

bill.

While the bill describes that giving patients the option of prescribed medication to end

their life is a peaceful and dignified alternative to other forms of treatment, we do not believe

that this act is can be defined in any other way besides as a suicide. If the bill protects the

physicians from having to claim any personal responsibility for taking someones life, then the

patient takes complete control of ending his/her life. According to the Merriam Webster

dictionary, the definition of suicide is as follows: the act or an instance of taking one's own

life voluntarily and intentionally especially by a person of years of discretion and of sound

mind. With this definition in mind, and pulling from thoughts provided by James Rachels in his

article Euthanasia, we argue that although the End of Life Option Act is in legal effect in

multiple states around the country, the act of physician assisted suicide is still, by definition,

suicide and is not morally sound.

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We believe that while James Rachels was not able to point out any apparent moral

contrasts between active and passive euthanasia, we contend that there are some severe

implications to legalizing active euthanasia. One of the primary reasons why we oppose this

legislation is due to the fact that active euthanasia resembles a very slippery slope. To further

clarify, we mean that legalizing active euthanasia can lead to some very dire circumstances for

society.

For example, if Person A loses his job and, as a result, his prospects for the future do not

look as bright as they once did, and Person A becomes clinically depressed and suffers daily from

emotional wounds that will not heal. As his life begins to spiral out of control he considers

physician-assisted suicide as an option. It is these people we fear for if active euthanasia is

legalized. Obviously the law will probably exclude people like Person A at the beginning, but we

worry that the law will begin to degenerate over time. As these constraints gradually loosen, the

possibility of abuse begins to rear its head.

In the world today, the Netherlands is the perfect example of what is wrong with

euthanasia. The Netherlands legalized active euthanasia in 1981 with strict guidelines. One of the

most stringent guidelines put in place by the Dutch government was regarding physical pain. In

Dutch Penal Code 294 it states, The patient must be experiencing unbearable pain (to be

euthanized). Initially this meant physical pain, but several decades later Dutch courts have

broadened this definition to include emotional/psychological pain and the potential

disfigurement of personality (Background about Euthanasia in The Netherlands, Patients

Rights Council). This is the perfect example of slippery slope, people who are not terminally ill

are being euthanized because of their state of depression. This does not set a good precedent for

any government. Instead of choosing to rehabilitate our citizens, governments are choosing to
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abide by their wishes when they are not in a right state of mind. In this scenario, Person A does

not make it.

Another side of the argument one needs to consider is the problem of pressure. For

example, Person B has a terminal illness of some kind and is expected to live only to the age 25,

but in the meantime he will require constant medical attention and the support of family. Person

Bs family is really struggling to pay the medical bills and whether intentionally or not, Person B

is starting to feel pressured by his family. Is it right for Person B to be pressured into taking part

in physician- assisted suicide? It is for reasons like this that we oppose legalizing physician-

assisted suicide. This in addition to the pressure felt by the doctor who performs the act. Can the

doctor be held accountable for possible malpractice? The Netherlands is the perfect case study

for this debate. The third tenant of liability for Dutch doctors, The death request must be

voluntary has reportedly been abused the past few years. Originally the idea to legalize active

euthanasia was one based of self-autonomy, but as the interpretation of the law has become more

broad, it has trended the opposite way. Doctors have more power in these decisions now more

than they have ever had before. In 1991, the Dutch government released The Remmelink Report,

which revealed the grisly details of malpractice in the Netherlands. According to this report,

1,040 people (an average of 3 per day) died from involuntary euthanasia in 1990, meaning that

doctors actively killed these patients without the patient's knowledge or consent. While we are

not saying widespread abuse like this will occur if the United States legalized physician-assisted

suicide, it worth noting how poorly things have transpired in another country in the developed

world. This coupled with the possibility of misdiagnosis on the part of the doctor really raises

some red flags. For these enumerated reasons, we chose not to pass the active euthanasia bill into

law.
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While our stance was against this bill, we also recognize that there are very strong

arguments for this bill. We mentioned the problem with pressure and misusing the procedure,

but a recent article in Medscape proves that in fact the one state Oregon in which this Death with

Dignity (DWD) is legal there has been little evidence of abuse. "Users are predominantly

elderly, white, and well educated, - Almost all patients are in hospice, and almost all take the

medications at home after telling loved ones of their decision," said Dr Blanke (professor of

medicine). The rules in Oregon as far as DWD are very strict, but also must be followed so

there is no evidence in the past 20 years that this procedure has been abused. Rules such as

patients must have a life expectancy of 6 months or less; the prescriber must be a physician with

an MD or DO degree licensed in Oregon; patients must be capable of making health decisions

for themselves; patients must be able to self-administer the drugs; and physicians must inform

the patients of alternatives, including comfort care, pain control, and hospice; the patient must

make three separate requests for lethal medication (Nelson). In Oregon, it was also made clear

that the common reason for patients who want to go through with the DWD procedure, do it

mainly because they are less able to engage in things that make life enjoyable. Along with this

evidence that there is no misuse, the doctors commented that if patients had more access to

palliative care then there would not be a need to seek this procedure.

Another counterargument would be the one that is most talked about and the reason

Brittany Maynard desired approval to be able to go forth with DWD. After she found out about

her cancer, she was aware of what would come with palliative medication (morphine resistant

pain, personality changes, and verbal, cognitive and motor loss), she would have had to go

through the physical pain for weeks or even months and her family would have to watch that.

The last thing a person wants is to have their loved ones to suffer through so much pain before
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their death. Brittanys statement is one that is a valid point in this argument, Who has the right

to tell me that I don't deserve this choice? That I deserve to suffer for weeks or months in

tremendous amounts of physical and emotional pain? Why should anyone have the right to make

that choice for me? Brittanys desire was to die on her own terms, be surrounded by her family

and most importantly with little to no pain to pass peacefully. This idea that DWD is a way to

alleviate pain and suffering is supported by the Hippocratic Oath, often times it is

misinterpreted to being against euthanasia. The key element to this oath, is that the physician

must protect the wellbeing of the patient, do no harm - harm could be interpreted as literally

the life of the patient. But in this situation the physician could potentially be doing more harm by

not allowing the patient to die, but rather endure the intense suffering.

Though the cases made by supporters of the End of Life Option Act frame their argument

in a compelling way, based on our philosophical perspective we still do not support the bill.

Rachels had a difficult time discerning the moral difference between active and passive

euthanasia, and thus argued that we should consider legalizing physician assisted suicide.

Though we understand why one would see this act as fair and just, we oppose this idea based

on the possibility of abuse within the system and the moral standpoint that ending your own life

is, by definition, suicide, whether it is approved by a doctor or not.

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Journaled Meetings

30 minutes on September 14th in Stupe

15 minutes on September 15th in Blanchard

Works Cited

Maynard, Brittany. "My Right to Death with Dignity at 29." CNN. Cable News Network, 02 Nov.

2014. Web. 20 Sept. 2016.

Netherlands. Commissie Onderzoek Medische Praktijk Inzake Euthanasie. Outlines Report

Commission Inquiry into Medical Practice with Regard to Euthanasia. By Jan Remmelink. 's-

Gravenhage: Ministerie Van Justitie, 1991. Print.

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Nelson, Roxanne. "Death with Dignity in Oregon: No Evidence of Abuse or Misuse." Medscape.

N.p., 20 Sept. 2016. Web. 20 Sept. 2016.

"Background about Euthanasia in The Netherlands." Patients Rights Council. N.p., n.d. Web. 18

Sept. 2016.