Tag Archives: Law

Euthanasia: An Introduction

In popular media, the question often posed is: should euthanasia be legal? 

There are several things about the phrasing of this question that are misleading.  First–and this may surprise you–certain forms of euthanasia are in fact legal in the United States.  Second, the question regarding euthanasia and legality, as most popular media refers to it, is actually a question of active/voluntary/physician-assisted euthanasia and its subsequent legality. And lastly, contention with regards to euthanasia is most often connected with the idea or possibility of the occurrence of passive or active/involuntary/physician-assisted euthanasia or as it is more commonly called: a form of homicide. 

It is clear that popular media does little to distinguish between various forms of euthanasia and at best conflates a large number of issues surrounding euthanasia.  This in turn serves to further complicate any discussion regarding it.   With that being said and given that the passing/rejecting of some landmark legislation is in the not too distant past, I want to take this opportunity to consider the topic of euthanasia.  Because the topic is incredibly complex, this will most likely be one of several posts concerning itself with euthanasia.  In this post, I simply intend to present and generally define some terms and provide an overview of euthanasia in the United States*.  In (a) later post(s), I intend to look more closely at the euthanasia debate itself.

*Note: I will only be discussing states that have legislation regarding euthanasia; I am not treating states that have case precedents regarding euthanasia (i.e. Montana, Texas, etc.)

An Introduction

The euthanasia debate spans a large number of fields and theoretical orientations and I believe it can be agreed upon that decisions regarding euthanasia are incredibly complicated due to a confluence of factors encompassing religious, medical and philosophical changes over the centuries.  The complicated nature of this social issue necessitates defining euthanasia as well as utilizing a structure of conceptualization that is categorical in nature.  According to Pfeifer and Brigham (1996), euthanasia, as an overarching concept, refers to any action or inaction by an individual to encourage the death of another who is suffering from a terminal condition.  There are three subcategorical distinctions: active and passive; voluntary,  nonvoluntary, and involuntary; and physician-assisted and nonphysician assisted.  Conceptualizing euthanasia in this manner enables one to concretely and distinctly describe an act of euthanasia (e.g. passive/physician-assisted/ voluntary euthanasia, active/nonphysician assisted/voluntary euthanasia, etc.).  Moreover, it also, according to  Pfeifer and Brigham (1996), enables one to begin to investigate and gain a more concise understanding of current attitudes toward euthanasia.

The terminology and subsequent definitions you encounter below were taken from the introduction written by Pfeifer and Brigham for the Journal of Social Issues: Psychological Perspectives on Euthanasia (1996) unless otherwise stated.

Active and Passive

Active euthanasia is defined as an act of commission in which a person engages in some direct action in order to hasten the death of a terminally-ill individual.

Passive euthanasia is defined as an act of omission such as the issuance of a DNR instruction by a physician that results in the death of a terminally-ill patient.

Voluntary, Involuntary, and Nonvoluntary

Pfeifer and Brigham (1996) do not distinguish between, and actually conflate, involuntary and nonvoluntary euthanasia.  Recently, and in particular among journals concerned with ethics and/or law, a distinction between these two terms is prevalent.

Voluntary euthanasia applies to circumstances in which an individual’s wish to die is known and/or expressed through directives such as verbal statements, living wills, etc.

Harris (2001) and Jackson (2006) are more specific in their language and apply voluntary euthanasia to circumstances in which a patient is able to and does provide informed consent.  This encompasses directives such as verbal statements, living wills, etc.

Nonvoluntary euthanasia applies to circumstances in which the individual is unable to specifically indicate his or her wish regarding death.

Harris (2001) and Jackson (2006) are more specific, stating that nonvoluntary euthanasia applies to circumstances in which the patient is unable to give informed consent, for example when a patient is in a persistent vegetative state, if the patient is a child, etc.  Nonvoluntary contrasts with involuntary, according to Jackson (2006), as follows:

Involuntary euthanasia applies to circumstances in which euthanasia is performed on a person who is able to provide informed consent, but does not either because they do not wish to be euthanized or because they were not asked.

Physician-assisted and Nonphysician assisted

Physician-assisted euthanasia applies to circumstances in which a physician assists an individual.

Nonphysician assisted euthanasia applies to circumstances in which a nonphysician assists an individual.

Euthanasia in the United States

We have, over the years, witnessed cases and lawsuits arise due to acts involving active/voluntary/physician-assisted euthanasia (i.e. Dr. Kevorkian, etc.); active and passive/voluntary/nonphysician assisted euthanasia (i.e. cases in which someone fulfills the request to die of another); and active and passive/nonvoluntary/physician-assisted euthanasia (i.e. Terri Schiavo, etc.).  Given this and the outcomes of these various cases, it is obvious that euthanasia is both contentious and complicated at best nor entirely legal or illegal.

Death With Dignity Movement

Typically within the United States patients retain rights to refuse medical treatment and elect appropriate management of pain even if it may hasten their death via explicit consent, advanced directives, living wills, etc..  Even though the average American may not conceptualize this as a form of euthanasia, it is. And, more specifically, it is a passive/voluntary/physician-assisted form of euthanasia.  In popular media, I have rarely seen these rights referred to, let alone referred to in the context of euthanasia. However, a lot of media attention is given to active euthanasia, especially cases in which the euthanasia is contested by a party to have been involuntary.  Active euthanasia of any kind is not legal in most states.  However, there are exceptions. According to the Death with Dignity National Center (2012), two states enacted acts legalizing and allowing residents to elect active/voluntary/physician-assisted euthanasia.   These two states are Oregon and Washington.  In Oregon and Washington, these acts allow “mentally competent, terminally-ill adult state residents to voluntarily request and receive a prescription medication to hasten their death” (Death With Dignity National Center, 2012).  The acts passed in both Oregon and Washington have their origins in a movement referred to as the Death with Dignity movement.  This movement’s purpose is to provide options ranging from advance directives to physician-assisted dying so that those facing terminal conditions may take control of their own end-of-life care.

Currently, according to the Death with Dignity National Center (2012), there are six states (Hawaii, New York, Massachusetts, New Jersey, Vermont and Pennsylvania) considering death with dignity-related legislation and two states that have banned death with dignity-related legislation concerning active/voluntary/physician-assisted euthanasia (Georgia and Louisiana).  In Hawaii, legislation was introduced in 2011 and carried over to the 2012 Regular Session, which adjourned May 3; The bills have not moved forward.  In New York, legislation was introduced in February; the legislature enacted clause stricken on May 9th.  On November 7th, Massachusetts voters defeated the bill introduced to their legislature by a narrow margin of 51 percent to 49 percent with 96 percent of precincts counted (Boston Globe, 2012).  In New Jersey as of September 27th, the legislation has been referred to Assembly Health and Senior Services Committee. In Pennsylvania, their bill was referred to Judiciary committee in February of 2011 and is currently active for consideration. And in Vermont, their bill was referred to Senate Committee on Judiciary in March 2011 and the House Committee on Human Services in February 2011. The bill received a hearing in Senate Judiciary Committee on March 2012.  Supporters of the bill worked to give all the Senators an opportunity to vote, and, according to the Death with Dignity National Center (2012), used a Senate rule which allows certain pieces of legislation to be voted on as an amendment instead of as a self-standing bill.  Vermont’s legislative session adjourned on May 5th.*  

Considering the number of states that have/are entertaining death with dignity-related legislation, it is apparent that the death with dignity movement has made considerable advances both in its visibility and its number of proponents since the late 70s/early 80s.  While I am not sure I can agree that euthanasia is “the most pressing social issue of our time” (Pfeifer and Brigham, 1996), I do believe it may be one of the most ethically complicated and contentious.   

*NOTE: For more specific information about these bills or the acts in Oregon and Washington, please visit the Death with Dignity National Center website and follow the links to the appropriate resources.  You may also visit your state legislature’s website.

SOURCES

Boston Globe, The. (7 Nov 2012). Mass. doctor-assisted suicide measure fails. Retrieved 8 Nov 2012 from http://www.boston.com/news/local/massachusetts/2012/11/07/backers-mass-doctor-assisted-suicide-concede/oXZDcgOUbqwhlqzb63FSPO/story.html.

Death with Dignity National Center. (2012). “Research Center: national efforts.” Retrieved 9 Nov 2012 from http://www.deathwithdignity.org/advocates/national

Harris, N.M. (2001). “The euthanasia debate.”J R Army Med Corps 147 (3): 367–70.

Jackson, J. (2006). Ethics in medicine. Polity. ISBN 0-7456-2569-X.

Pfeifer, J.E., Brigham, J.C. (1996). Psychological Perspectives on Euthanasia. Journal of Social Issues 52 (2): 1-11.

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Prohibitions on Death: YOU SHALL NOT PASS.

Last updated Nov. 15, 2012

“It is forbidden to die in the Arctic town of Longyearbyen.  Should you have the misfortune to fall gravely ill, you can expect to be despatched by aeroplane or ship to another part of Norway to end your days.  And if you are terminally unlucky and succumb to misfortune or disease, no-one will bury you here.  The town’s small graveyard stopped accepting newcomers 70 years ago.” Duncan Bartlett, of the BBC News,  wrote in his article on this little Arctic town in July of 2008.

Longyearbyen is the largest settlement and administrative center of Svalbard with roughly 1,500 inhabitants (as of 2008) and is

Image Credit: Spitsbergen Travel

located on the Western coast of Spitsbergen, the largest island of the Svalbard archipelago.  This group of islands lies between Norway’s Northern coast and the North Pole. Thus, it should come as no surprise that Longyearbyen’s prohibition on death was a necessity, as it was discovered bodies were not decomposing.  Rather, these permafrost preserved remains were becoming a morbid curiosity.  Scientists even removed tissue from a man who died there and were able to extract intact traces of the influenza virus he died from during an epidemic in 1917 (Duncan 2008; Sumitra 2012).

But Longyearbyen is not the only town with a prohibition on death! Itsukushima, Japan; Falciano del Massico, Italy; and Sarpourenx, Cugnaux, and La Lavandou France; and Lanjarón, Spain also have prohibitions on death.

Click to enlarge; Image credit: Wikipedia

The Japanese island of Itsukushima is considered a sacred place according to Shinto belief.  And thus, in an attempt to maintain the sanctity of the island according to Sumitra,  “no deaths or births have been permitted near the shrine [since 1878.  Furthermore,] [p]regnant women nearing the date of delivery aren’t allowed there, nor are the elderly or the terminally ill” (2012).  This may seem strange but this concept is not an entirely unfamiliar one.   The island of Delos, birth place of the twins Apollo and Artemis, was considered a sacred and holy place by the ancient Greeks and various measures were taken to “purify” the island. In the 6th century BC, Peisistratus ordered that all graves within sight of the island’s temple be dug up and the bodies removed to locations on or beyond the perimeter (Whitaker, 2012).  In addition, in the 6th century and under instruction from the Delphi Oracle, the island was purged of all dead bodies and it was decreed that no one shall be allowed to give birth or die there (Whitaker, 2012).

On the other hand, the reasons for prohibitions in France and Italy are not, shall we say, so lofty or practical in nature considering the issue they seek to address.  Since March of 2012, according to Craggs,  it has been illegal to die in Falciano del Massico, Italy.  The reason: the village has no cemetery and has been feuding with the near by town that has one since 1964 when local boundaries were redrawn.   Luckily for the residents of this village, the mayor is now seeking land to build a cemetery.

Meanwhile in France, in an ordinance posted in Sarpourenx (2008), residents were also forbidden to die.  The mayor even threatened harsh consequences should any of the residents deliberately disobey and die.  In addition to Sarpourenx, there are two other settlements in France that have created similar bylaws and/or ordinances, La Lavandou (2000) and Cugnaux (2007), for similar reasons.  All three towns were denied permission to annex land and/or build on certain proposed areas (i.e. requests to expand their town cemeteries were denied). The Mayors’ claimed their responses were proportional to the absurdities of the laws and/or regulations obstructing the requests for land.  As far as I could find, nothing has been resolved in these French towns with the exception of Cugnaux.  And so it seems the residents of La Lavandou and  Sarpourenx will not be as fortunate as their Italian counterparts.

And lastly, we have Lanjarón, Spain.  It seems to have been the first town to outlaw death due to lack of space in the local cemetery back in 1999.  Mayor Rubio blamed “inertia by his predecessors for the tight quarters at the cemetery” and he further insisted that the edict banning death was not about hubris, but, rather, a “response to politicians pestering him for a quick fix to the problem that dogged them for years” (Stiffs, 1999).  

OH, but wait! Of course, there is at least one more.  Mayor of Biritiba Mirim, Brazil, following in the footsteps of the French, filed a public bill to prohibit his some 28,000 residents from dying back in December of 2005 in response to federal regulations restricting new or expanding cemeteries in preservation areas (BBC News, 2005).   The bill was not passed nor denied as far as I could find.  Thus, this issue is still in suspense to my knowledge, but the government has agreed to a vertical cemetery from what I understand.

So, it seems banning death is becoming the trending political response to what has been called, by several of these mayors, absurd politics/law.  Well, isn’t that just– oh, how shall I put it–productive.  Religious beliefs and practical responses to environment and climate change aside, these prohibitions (France, Italy and Brazil) are laughable.  Maybe I find it utterly ridiculous because I do not understand the nuances of French law or peculiarities of Italian pride.  Or maybe I am missing an important environmental factor wrapped in these nuanced laws.  Or maybe I am just missing the political and satirical brilliance that is the purpose of these bans. My question at the moment–to the mayors threatening harsh penalties on those who disobey their decrees– is just how exactly will those that break the prohibition be punished,  that is if you do intend to directly punish those that break the prohibition and not indirectly punish them by fining their bereaved families? Will you not put a pillow beneath the poor souls’ heads?  Will you remove stuffing from their pillows or their casket liners? Will you take their shoes and socks so they are forced to face the afterlife with an chronic case of cold feet all in an attempt to ensure that they duly pay for and regret their decision to disobey the law and die?

It makes me think of the Fellowship of The Rings when Gandolf tells the balrog that he shall not pass…

…Except in this case YOU SHALL NOT PASS takes on an entirely new meaning.

Image Credit: Oddity Central

Sources:

Bartlett, Duncan. (2008, Jul 12). “Why dying is forbidden in the arctic.”  BBC News. Retrieved 14 Sept 2012 from <http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/7501691.stm&gt;

(2005, Dec). “Brazil City proposes ban on death.” BBC News. Retrieved 14 Sept 2012 from <http://news.bbc.co.uk/2/hi/americas/4527868.stm&gt;

Craggs, Ryan. (2012, 13 Mar). “Death made illegal in Italy town Falciano del Massico.”  The Huffington Post. Retrieved 14 Sept 2012 from  <http://www.huffingtonpost.com/2012/03/13/deaths-illegal-italy_n_1341120.html&gt;

Dobbie, Andrew. (2008, Mar 5). “Cemetery full, mayor tells locals not to die.” Reuters. Retrieved 14 Sept 2012 from <http://web.archive.org/web/20110604150100/http://www.reuters.com/article/2008/03/05/us-election-cemetery-idUSL0552076620080305&gt;

Henley, Jon. (2000, Sept 22). “Citizens live under law’s dead hand.” The Guardian. Retrieved 14 Sept 2012 fro <http://www.guardian.co.uk/world/2000/sep/23/jonhenley&gt;

Ionox. (2007, Nov 25).  “Forbidden to die because lack of room.” Weird Globe News. Retrieved 14 Sept 2012 from <http://web.archive.org/web/20080528204947/http://weirdglobenews.com/forbidden_to_die_because_of_lack_of_room.html&gt;

Johansen, B.F., et al. (2008, Jul). Longyearbyen – The Cruise Handbook for Svalbard.  Norwegian Polar Institute. Retrieved 14 Sept 2012 from <http://cruise-handbook.npolar.no/en/isfjorden/longyearbyen.html&gt;

Stiffs.com. (1999, Oct 2).  Spanish mayor outlaws death. Retrieved 15 Nov 2012 from <http://web.archive.org/web/20080709215313/http://www.stiffs.com/backoct99.html&gt;

Sumitra. “4 places where dying is not allowed.” (2012, Mar 16). Oddity Central: Collection Oddities. Retrieved 14 Sept 2012 from <http://www.odditycentral.com/pics/4-places-where-dying-is-not-allowed.html&gt;

Whitaker, Alex. (2012). “Delos.”  Retrieved 14 Sept 2012 from <http://www.ancient-wisdom.co.uk/greecedelos.htm&gt;

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