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By Julie Grimstad
Are you perplexed about how to make moral medical decisions, particularly in the event of a serious illness or when someone is unable to speak for himself/herself? If so, you are not alone. The distinction between optional medical treatment and ordinary care, between letting a person die naturally and intentionally causing a person's death have become blurred. Confusion abounds. What is right? What is wrong?
This confusion has been deliberately sown by organizations and individuals determined to achieve social and legal acceptance of euthanasia and assisted suicide. Language manipulation has proven to be their most effective weapon in a very real war between the culture of life and the culture of death.
The following questions and answers, hopefully, will help you to clarify your thoughts, develop your "baloney detector"1 , and gain confidence so that you will be prepared to make medical decisions, whether for yourself or someone else, based on sound moral and humanitarian principles.
1. What do the terms "euthanasia" and "assisted suicide" mean?
2. Doesn't everyone have a "right to die?"
3. Shouldn't every adult have the right to make his/her own medical decisions?
4. What are "advance directive" laws?
5. Living Will or DPAHC: which document is preferable?
6. How can you ensure that you are not granting a doctor or health care facility the "right to kill" you
7. Who should sign a Protective Medical Decisions Document?
8. Who should you choose to serve as your health care decision-maker ("agent" or "surrogate")?
9. Are there specific moral guidelines to follow when making medical decisions?
10. Is it ever medically and morally appropriate to refuse food and fluids?
11. How should a conscientious medical professional respond to a patient's or an agent's refusal of ordinary/morally obligatory treatment and care?
1. What do the terms "euthanasia" and "assisted suicide" mean?
Euthanasia is an act or omission intended to cause the death of a person in order to eliminate suffering, allegedly for his/her benefit. Euthanasia can be voluntary (at the request of the person), involuntary (against the person's wishes), or non-voluntary (when the person is unable to refuse or request to be killed).
Assisted suicide means that the person is given assistance to kill himself/herself. The person performs the last act that causes his/her own death. For example, it is assisted suicide if a person swallows an overdose of drugs provided by a doctor for the purpose of causing death. (In the United States, assisted suicide is legal only in the state of Oregon.)
Suffering is not a reason to kill, but rather a reason to care for the sufferer. Suffering is a part of being human. It is not exclusive to people who are sick or dying. Morally, no one may ask for an act of killing, either for himself/herself or for another person, for any reason.
2. Doesn't everyone have a "right to die?"
The simple answer is "no." It is time to engage your "baloney detector." The "right to die" is a term made up by the Euthanasia Society of America (ESA), a group formed in 1938 to work for the legalization of euthanasia. ESA leaders realized that the public was readier to accept the "right to die" than the "right to kill."
Consider this: When police find a guy poised to jump off a bridge, they do not try to ascertain if he has thought this through and has a "good reason" to kill himself. Their job is to prevent him from jumping. Even if a person wants to die, we rescue him. Why? Because, as a society we recognize that life is sacred. So, why are we so confused about the "right to die?" There is no such right. If there were, the police would drive on by and wait for the call to pull the body out of the water.
On the other hand, everyone does have the unalienable "right to life." That precious right is under attack. Most people in the general public have no idea what is being planned for them when they become old or sick or disabled. The "right to kill" certain people (whether they want to die or not) by denying them life-sustaining treatment and care is an idea that has been embraced by many elite practitioners of law and medicine. Also, "right to die" organizations, with the aid of the media, have had much success convincing the public that death is a control issue, a "choice," rather than an unavoidable reality.
3. Shouldn't every adult have the right to make his/her own medical decisions?
That is a complicated question. The simple answer is that people do have the natural right to make their own medical decisions within certain moral parameters. In fact, that right was recognized and respected BEFORE the euthanasia movement stepped in. Nevertheless, many people have been lured into the euthanasia movement's net with the false promise that they would be given control over their own fates.
In 1967, after nearly 30 years of failure, the euthanasia movement hit the jackpot. It developed the Living Will. Deceptively promoted as a means for people to make known their treatment wishes in case they should ever become incompetent, it was actually designed to be a stepping stone to the systematic killing of the very elderly, the disabled, the infirm, and the seriously ill.
The euthanasia movement achieved success in 1976 with the passage of the California Natural Death Act (Living Will law), but only after the Euthanasia Society of America changed its name to the Society for the Right to Die. (The word "euthanasia" had an unsavory association with the Nazi killing program.) Since then, every state has enacted "advance directive" laws.
4. What are "advance directive" laws?
There are two types of "advance directive" laws: Living Will and Durable Power of Attorney for Health Care. While these laws vary in their particulars from state to state, they basically regulate legal documents which people use to express their wishes regarding medical treatment in the event they become incapable of making their own medical decisions.
5. Living Will or DPAHC: which document is preferable?
By signing a Living Will directive, you give authority to an "attending physician" to withhold or withdraw life-sustaining procedures for some future illness or injury. The attending physician may be a stranger, unfamiliar with your moral principles and wishes, who may interpret your directive in ways you did not intend. A Living Will's ambiguous and confusing language is one of its most dangerous flaws. Another flaw is that it is impossible to make sound medical decisions based on guesswork about the future. A Living Will is a legally binding document which must be followed, potentially tying the hands of medical professionals whose skills could restore you to health or save your life.
It seems more prudent to adopt, as your advance directive, a Durable Power of Attorney for Health Care (DPAHC), which is less flawed than a Living Will. A DPAHC allows you to appoint a trusted family member or friend (your "agent" or "surrogate") to make health care decisions for you should you become either temporarily or permanently unable to do so. Your agent will make decisions based on knowledge of your actual condition and treatment options, in light of your personal wishes and moral principles.
By way of "advance directive" laws, euthanasia by omission (withholding or withdrawal of life-sustaining treatment and care, including food and fluids) has been legalized in every state. It is up to you to ensure that your advance directive does not permit euthanasia.
6. How can you ensure that you are not granting a doctor or health care facility the "right to kill" you?
Euthanasia by omission is already commonly practiced, and there is a movement underway to add euthanasia by lethal injection and assisted suicide to end-of-life choices in every state. The most important thing you can do to protect your "right to life" is to sign a DPAHC that specifically prohibits euthanasia and assisted suicide.
Fully aware that in an ideal world such a document would be unnecessary, Human Life Alliance endorses one specific life-protective DPAHC, the Protective Medical Decisions Document (PMDD) prepared by the International Task Force on Euthanasia and Assisted Suicide (ITF).2
Every patient being admitted to a health care facility is asked, "Have you signed a Living Will or Durable Power of Attorney for Health Care?" This is because the federal Patient Self-Determination Act of 1990 forces health care facilities, under threat of losing federal funds, to educate patients about their right to refuse treatment (in other words, to promote advance directives). Consequently, you will most likely be given a Living Will or DPAHC form to sign at the time of admission, a time when you are under stress and distracted by other paperwork and questions. Be prepared. Always bring along your signed and witnessed PMDD.
7. Who should sign a Protective Medical Decisions Document?
Everyone who is 18 years old or older needs a PMDD. Anyone of any age may suddenly become incapacitated due to illness or injury. Appointing in writing someone you trust to make health care decisions for you could mean the difference between life and death.
8. Who should you choose to serve as your health care decision-maker ("agent" or "surrogate")?
Any DPAHC is only as good as your health care agent. Therefore, it is of utmost importance that you appoint a trusted family member or friend who:
You may also name an alternate agent in case your agent is unavailable or unable to act on your behalf. Discuss your wishes and moral principles with your agent(s) when you sign your PMDD and periodically thereafter.
The "right to die" movement has tried to convince us that the main question is "Who decides?" in order to distract us from the moral question, which is "What is being decided?"
9. Are there specific moral guidelines to follow when making medical decisions?
Yes. First, examine intent. When making a decision to withhold or withdraw a particular form of treatment or care, ask if the intention is to hasten or cause the person's death? If so, the decision is wrong, or at least made for the wrong reason.
Next, understand the difference between what is moral and what is legal. The words"ordinary" and "extraordinary" are not legal terms. They are used here to differentiate between those medical means which are morally obligatory and those which are morally optional. Legally, you can refuse any or all medical means, but morally you are obliged to protect and preserve your own life and may not refuse ordinary means for doing so.
Ordinary medical treatment and care are routine, available, and beneficial. They are necessary to sustain life, maintain health, provide comfort, cure or improve your condition. Ordinary means may be stopped when they cease to be effective, but never in order to hurry death.
Extraordinary medical treatment is non-obligatory, that is, you may accept or refuse it. Extraordinary treatment is unduly burdensome or risky; it may impose on the patient strain or suffering out of proportion with the benefits. The physician should discuss the risks and burdens as well as the benefits of a particular treatment with you/your agent. However, when a potentially effective extraordinary treatment is available, it must always be you/your agent who decides whether or not to try it. If you want to fight for every last moment of life, that is your right.
When death is truly inevitable and close at hand (expected within hours or a few days, not weeks or months) in spite of the means used, it is only necessary to provide normal care and thus to permit a natural death. The challenge is not how to be killed, but how to let go of life.
In some cases, the situation may be so complex as to cause doubts about the way moral principles should be applied. When in doubt, err on the side of life.
10. Is it ever medically and morally appropriate to refuse food and fluids?
One glaring example of language manipulation is the assertion by euthanasia promoters that food and water are medical treatment. On the contrary, food and water are basic human needs and therefore basic human rights. In a medical setting, their provision is ordinary care, not treatment. Food and fluids do not become "treatment" simply because they are taken by tube any more than penicillin or Pepto-Bismol becomes "food" when taken by mouth.
Certainly, feeding tubes are artificial devices, but the food and water that they deliver to the patient's digestive system are real. Feeding tubes are sometimes necessary to sustain life, but often they are used because they are simpler and less costly than spoon-feeding or they are necessary to provide comfort.
It is important to distinguish different circumstances under which food and fluids are withheld:
Dehydration is an ugly word. It is a cruel way to die.
Living Wills and DPAHCs list food and fluids as things that can be taken away from patients diagnosed to be either "terminally ill" (a very broadly defined term) or in a "persistent vegetative state" (an ill-defined and dehumanizing term). Euthanasia by dehydration is now legal in every state. Those who favor removing feeding tubes from otherwise non-dying patients have impressive credentials. They are judges, lawyers, physicians, bioethicists, philosophers, et al. How did we come to this?
In 1984, at a World Federation of Right to Die Societies meeting, bioethicist Helga Kuhse explained the strategy of the world-wide "right to die" movement:
If we can get people to accept the removal of all treatment and care, especially the removal of food and fluids, they will see what a painful way this is to die, and then, in the patient's best interest, they will accept the lethal injection.
Can legalization of the lethal injection be far off?
11. How should a conscientious medical professional respond to a patient's or an agent's refusal of ordinary/morally obligatory treatment and care?
If a patient or agent decides to refuse ordinary treatment or care in order to bring about the patientŐs death, in some instances there may be little that a medical professional can do to prevent this. However, there remains the duty to attempt to persuade the patient/agent otherwise or, failing that, for the physician or other care provider to remove himself/herself from the case in order not to be guilty of complicity in euthanasia.
"Always to care, never to kill," has been the constant motto of medical professionals throughout the ages. Nothing and no one can make killing their patients right or a "right."
Julie Grimstad is the primary writer and editor of Euthanasia: Imposed Death. She is the executive director of Life is Worth Living, Inc., whose members are dedicated to the authentic restoration of respect for human life. Julie co-founded and served as the director of the Center for the Rights of the Terminally Ill from 1985 to 2003. A patient advocate, public speaker and writer, she is recognized for her long-standing focus on end-of-life issues. She resides in Stevens Point, WI. Julie may be contacted by email at lifeisworthliving@sbcglobal.net.
1. "Baloney detector" is an acquired ability to detect language manipulation/clever lies disguised as truth (usually authoritatively pronounced by intimidating "experts.")
2. To order your PMDD, call the International Task Force at 1-800-958-5678 between 8:30am and 4:30pm (Eastern Time). Note: Some states require that a DPAHC must have a specific printed "notice" or "warning." The ITF distributes state-specific PMDDs for those states as well as a Multi-State PMDD for use in other states.
3. Even though both food and water are taken away, it is being deprived of fluids and the resulting dehydration that kills the patient, not starvation.
