Medicine: Euthanasia

Richard Liu
Euthanasia
Euthanasia - is the intentional killing of patient by a healthcare provider.

Euthanasia - 3 types

1. Homicide/Murder
2. Refusal of life support
a. Competent patients
i. Advanced directives, living wills, DNRs
b. Incompetent patients
i. Underaged
ii. Irreversible coma/unconsciousness
iii. There is a lot of conflict in who takes responsibility for the patients life
3. Assisted Suicide
a. Also known hastened death
b. Usually involves competent patients and doctors
c. Incompetent patients are usually minors
Medical Protocols
Life Support - mechanisms to prevent and prolong life

Resuscitation - revive consciousness, pulse, breathing, CPR

Feeding tubes - provide hydration and nutrition

Respirators - assist in breathing

Right To Die - laws enacted that permit certain clinical conditions met to allow death including irreversible
coma

Assisted Suicide - mechanisms to hasten death

Drugs

Death with Dignity - laws that allow assisted suicide

Documents
Advanced Directives - also known as a living will, orders given in advance before
patients become incompetent and unable to communicate directions for
themselves

Do Not Resuscitate - a type of advance directive that patients consent with in case
to become unconscious to not be given emergency life support (CPR)
History of Euthanasia
Ancient Greeks and Romans - Hippocratic Oath prohibited
euthanasia but few physicians followed it.

12th Century - Rise of Christianity reinforces Hippocratic

Oath and opposes euthanasia.

17th Century - Suicide and assisted suicide prohibited in

American Colonies.

1870s - Morphine is discovered and used as pain reliever.

Samuel Williams proposes to use morphine as a
euthanizing drug.

1885 - American Medical Association denounces Williams

and opposes euthanasia.
History of Euthanasia cont.
1915 to 1917 - Controversy over infant euthanasia

1930s to 1950s - Great Depression spurs support of

euthanasia but Nazis use of involuntary euthanasia during
World War II puts support back down

1950s to 1960s - Euthanasia support reemerges and

Euthanasia Society of America is founded

1967 - First living will/advanced directive created.

1970s - Advocacy for patients rights and right to die

1974 - First American hospice

History of Euthanasia cont.
May 5, 1980 - Pope John Paul II opposes euthanasia.

1984 - American Medical Association allows euthanasia for certain

circumstances

1988 - Unitarian Universalist Association supports assisted euthanasia.

June 4, 1990 - Dr. Jack Kevorkian assists Janet Adkinss suicide

June 25, 1990 - Supreme Court declares Do Not Resuscitate (DNR) legal

1990s to 2010s - several states legalize right to die

November 3, 1992 - Californias Death with Dignity Act fails to pass

June 26, 1997 - Supreme Court declares Right to Die unconstitutional

1998 to 1999 - Kevorkian assists in another suicide and is convicted for

murder.
History of Euthanasia cont.
November 3, 1992 - Californias Death with Dignity Act fails to pass

June 26, 1997 - Supreme Court declares Right to Die unconstitutional

1998 to 1999 - Kevorkian assists in another suicide and is convicted for

murder.

January 17, 2006 - Supreme Court supports Oregons Death with Dignity
Act

June 1, 2007 - Kevorkian released on parole

March 2, 2014 - Belgium legalizes euthanasia for minors under certain

circumstances

October 5, 2015 - California is fifth state to legalize right to die

Euthanasia in the United States
Given the incredible complexity around euthanasia, we will focus on a specific
aspect of euthanasia: supreme court rulings in the united states for sociological
analysis.
Members
Within the Institution:

Patients and Families take responsibility and give consent for medical treatment.

Doctors clinically diagnose and assist in performing medical treatment.

States set laws that regulate medicine. States can set different laws from each
other.

The federal government sets overarching laws, in which states practice.

Outside the Institution:

Under the United States, religious leaders do not give consent, assist, or regulate
medicine.
Pointers
Federal supreme court rulings overrule state supreme court rulings, which in turn
overrule state trial courts.

Physicians supporting euthanasia against state law is considered homicide.

Removal of feeding tubes and respirators is different from giving drugs or

assisted suicide.

States can draft different constitutions from each other as long as it adheres to
the federal constitution.
History of Supreme Court Cases
Analysis:
Karen Ann Quinlan 1976
Under functional theory, parents acted under their
21 year old Karen was clinically diagnosed with religious belief against hospital officials and Morris
an irreversible coma. Her Roman Catholic county. Hospital officials did not support the parents
parents requested that Karens respirator be because they feared homicide charges from the state.
removed to relieve discomfort, but the hospital
Even though functional theory applies to both parties to
officials did not give consent in response to
some extent, there is a clash in social structures
threats by Morris county prosecutor for
between Roman Catholicism and New Jersey Law.
homicide charges under New Jersey law.
Under conflict theory, this resulted in changes to
Eventually, New Jersey Supreme Court allowed
euthanasia starting with extraordinary means.
the removal of the respirator because Karens
parents argued that the respirator was
Members of the institution include Karen, her parents,
extraordinary means, citing Pope Pius XII.
doctors, hospital officials, Morris County, and New
Extraordinary means was support that
Jersey Supreme Court.
prolonged life but difficult to endure.
Outside members include Pope Pius XII.
Cruzan v. Director, Missouri Department of Health 1990
Cruzans parents requested doctors to remove
permanently unconscious Cruzans feeding tube,
but doctors refused due to Missouris homicide
law. The parents went against Missouris
department of Health under the federal supreme
court. The court ruled in favor of Missouri such
that without evidence that Cruzan refused life
support, the state would have authority over
Cruzans right to die. It ruled that even though
the right to die is under the constitution, it is not
guaranteed. Eventually, there was evidence for
Cruzans preferences. The ruling also stressed
the need for living wills and advanced directives.
Analysis:
Under functional theory, doctors obeyed
Missouri state and its homicide law. In order to
prevent homicide charges, doctors maintained
their role and status. The federal government
ruled in favor of Missouri state to preserve
functionalism.
Under conflict theory, parents went against
Missouri state, but lost. However, because of
this conflict, living wills and advanced directives
became increasingly important for incompetent
patients.
All parties are participants within the institution.
There were not any external members.
Doctors vs State: Assisted Suicide
Washington v. Glucksberg 1997
Analysis:
Dr. Glucksberg, representing doctors and
Under conflict theory, doctors and terminally ill
terminally ill patients, went against
patients went against state law.
Washingtons state on a ban on assisted
suicide. Assisted suicide is the intentional usage
Under functional theory, the supreme court ruled
of drugs to hasten death. The federal supreme
in favor of states and social order was
court ruled in favor of Washington state. It ruled
maintained.
that the right to die is not constitutionally
guaranteed. This resulted in that the right to die is allowed
but not guaranteed in the constitution. States
Vacco v. Quill 1997 can allow or not allow the right to die.

Doctors went against New Yorks ban on All parties are members of the institution.
assisted suicide. The federal supreme court
ruled in favor of New York state. It ruled that the
Terri schiavo 2005
Analysis:

Without a living will, Terris husband with
consent from doctors went against Terris
parents to remove Terris feeding tube. The
husband and doctor Terri was permanently
comatose whereas her Catholic parents
believed she would be able to awaken from her
coma. During a seven year span, Florida
Supreme and other courts mainly ruled in favor
of Terris husband. President George W. Bush
and Governor Jeb Bush tried to convince the
courts in favor of the parents. The Vatican also
intervened in favor of Terris parents. Eventually,
a second CT autopsy was performed on Terri
during her last years, revealing permanent,
irreversible severe brain atrophy that permitted
the removal of her feeding tube.
Under functional theory, Terris parents conformed to
religion and the Vatican. George W. Bush and Jeb Bush
also conformed to their conservative perspectives.
Also under functionalism, due to the CT autopsy, the
conclusion was euthanasia for irreversible coma. The
husband and doctors won against the parents.
Under conflict theory, the living will became
increasingly important.
Terri, her husband, parents, doctors, Florida states and
courts were members of the institution.
President George W. Bush, Governor Jeb Bush, and the
Vatican were not members.

Ashcroft (Gonzales) v Oregon 2006
Oregons passage of assisted suicide and
doctors went against federal U.S. attorney
general Ashcroft. Ashcroft claimed control due
to authority under Controlled Substances Act.
The federal supreme court ruled that attorney
generals have no say in assisted suicide.
(The case was renamed to Gonzales because
Gonzales replaced Ashcroft as attorney general)
Under functional theory, doctors obeyed state
law that allowed assisted suicide. Oregon state
did not go against federal law since federal law
allowed states to act based off their own
discretion.
Under function theory, Ashcroft believe he had
control due the Controlled Substances Act that
was also permitted by federal government.
Under conflict theory, the federal government
mistakenly allowed two parties to conflict with
each other. The conflict was resolved by the
supreme court.
Oregon state, doctors, and federal government
were members of the institution
Ashcroft assumed membership, but was not
part of the institution.
Conclusion
Patients and families expressed more freedom to go against functional structuralism.
However, families also conformed to functional structuralism if they followed religious
belief.

Doctors generally conformed to functional structuralism out of fear for consequences

imposed by state governments. As further legalization of euthanasia continued with time,
doctors became more outspoken against state governments.

State and federal governments generally conformed to functional structuralism set by

constitution. The U.S. Supreme court tried to avoid constitutionalizing euthanasia to appease
state government. State governments were free to enact their own laws.

Some individuals tried to go against the functional structuralism of a society/institution they

were not members of.
Additional Questions
1. How has the institution changed over time?
People generally have become more accepting of euthanasia. More states have begun legalizing parts of euthanasia.
2. What has caused various institutions to change?
People battle over patients rights and morality.
3. Discuss any stable features of the institution, that is, features that have not changed.
Because federal government has not constitutionalized euthanasia, state governments are free to enact laws.
4. As a way to better accommodate members of society, how would you improve your institution?
Because legalization of euthanasia is not complete, I encouraged expansion of euthanasia to minors. Some minors above a certain age are
competent enough to take responsibility over the right to die.
If the conflict between states and other parties worsen, which I do not believe will happen, the issue of euthanasia needs to be
constitutionalized.
5. Does your institution work better for some members of society (as opposed to others)?
The institution generally works better for physicians because their roles are founded within the institution of medicine. They generally
conform to functional structuralism regardless of change to the institution itself. This institution does not work well with those who follow
religious belief because of the separation of church and state in the United States.
Works Cited
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Magnay, Diana. Parents plead to be able to help terminally ill children die. CNN. 27 November 2013. Web.

Martin, Laura J. Do-not-resuscitate order. MedlinePlus. 2 June 2016. Web.

McGreevey, Patrick. After struggling, Jerry Brown makes assisted suicide legal in California. Los Angeles Times. 5 October 2015. Web.

Mills, Ben. Morphine-from-xtal-3D-balls. Wikimedia. 10 September 2008. Digital Image.

Nordqvist, Christian. Euthanasia and Assisted Suicide. MedicalNewsToday. 8 April 2016. Web.
Works Cited Cont.
Peitranglo, Ann. What Do You Do When A Child Wants to Die?. HuffPost. 6 July 2017. Web.

SWNS Reporter. Cancer sufferer who raised 40,000 from his hospice bed for a new nurse finally meets the angel who will care for him in his dying days. SWNS.
27 January 2016. Digital Image.

Westside Today Staff. Current CA Governor Jerry Brown will be running for a fourth term against GOP Candidate Neel Kashkari. Westsidetoday. 4 June 2014. Digital
Image.