COMMITTEE: UTOPIA (Special Committee) ISSUE: Assisted Death STUDENT OFFICER: Elif KURTAY POSITION: Co-chair I- Introduction Assisted death has been a controversial debate topic for a very long time. However, a consensus hasn’t been reached for years. The end of life is a very crucial and critical topic to make a decision on. There are many conditions that affect whether a life can be taken away from a person with their request. The patients’ condition, the physician, whether the disease can be cured or not in the future, mental illness, religion, laws, etc. Euthanasia was a softer, maybe more rightful way to die than suicide. And recently assisted death (physician assisted suicide) become a more justifiable way to end one’s own life than euthanasia. However, some people have neither accepted nor agreed any of the aforementioned forms of suicide due to some understandable and important reasons. By both sides, for and against, having their reasons that cannot get disregarded, a decision seems impossible to be made. Besides having different point of views, it is always possible to reach a joint resolution regarding any topic and in order to succeed this goal, all sides, discussions and factors of should be studied and well understood. Therefore, hoping that this report will help with the comprehension of the issue, it is expected that assisted death will be granted great concern and attention to conclude this ever ending debate. II- Overview 2.1) Definition of Key Terms Suicide: is the act of causing one's own death commonly because of a mental illness like depression, bipolar disorder, schizophrenia, personality disorders, alcoholism, or drug abuse. Physician: is who is educated, clinically experienced, and licensed to practice medicine but will not perform surgery; a medical doctor who is not a surgeon. Euthanasia: is the Greek term meaning “good death”, normally implies an intentional termination of life by another at the request of the person who wishes to die. It is generally implemented as the act of killing an incurably ill person out of concern and compassion for that person's suffering; also called as “mercy killing”. Assisted suicide: is suicide committed by someone with the help from another person; also known as physician-assisted suicide (PAS), physician aid-in-dying (PAD), assisted death or voluntary passive euthanasia. In this situation, a physician supplies information and/or the means of committing suicide, such as a prescription for lethal dose of sleeping pills, or a supply of carbon monoxide gas, to a person, so that the individual can successfully terminate his or her own life. 2.2) Background Information Physician-assisted suicide (PAS) received a worldwide public attention after Dr. Kevorkian, a retired pathologist from Michigan, participated in his first such procedure in 1990. Kevorkian set up a machine that allowed a 54-year-old woman suffering from Alzheimer's disease (a degenerative neurological condition) to press a button that delivered a lethal poison into her veins. Kevorkian went on to assist in the suicides of dozens of individuals suffering from terminal, debilitating, or chronic illnesses. In 1992, Michigan passed an “assisted-suicide bill” that was specifically designed to stop Kevorkian's activities, but technicalities and questions as to its constitutionality delayed its implementation, thus allowing Kevorkian to continue assisting suicides, often in direct opposition to court injunctions. Observers disagree about the humanity of Kevorkian's activities. Some see him as a hero who sought to give suffering people greater choice and dignity in dying. Others point to his lack of procedural precautions and fear that the widespread practice of assisted suicide will lead to the unnecessary death of people who could have been helped by other means, including treatment for depression. Many opponents of assisted suicide find the same faults in the practice that they see in other forms of euthanasia. They envision its’ leading to a devaluation of human life and even to a genocidal killing of vulnerable or so-called “undesirable individuals”. 2.3) Discussions on Related Issues Religious Ethics Religion is one of the main actors to consider for a patient, but particularly for ones that are terminally ill. So the patient might put his/her hopes in his/her religion believing that it will bring him/her happiness after death. The meaning and the beauty of life has always been questioned in many different religions. Every religion has their own practice when it comes to new life and the end of life. However, the most common belief is that life itself is sacred and it shouldn’t be taken away by another or oneself. Examples include Islam, Buddhism, Catholicism and Mormonism. About any form of suicide, Quran is very clear: "Do not kill yourselves as God has been to you very merciful". In Islam, it is believed that even though there is pain and suffering especially at the terminal end of an illness, there will be reward from God for those who patiently persevere in suffering. The sacredness of human life is appreciated in the Quran. "Do not take life which God has made sacred except in the course of Justice" (Quran 6:151). According to Buddhism, assisted suicide is an uncompassionate act as it causes grief to others and is believed to deprive them of spiritual development. Also, according to Buddhist belief, death will not relieve the killed person of suffering, but postpone the suffering to the next life. The Catholic Church opposes euthanasia and assisted suicide. In Pope John Paul II's words, medical killings such as those caused by assisted suicide are "crimes which no human law can claim to legitimize." Basing its arguments on passages from the Bible, Catholic theology has for many centuries opposed all forms of suicide. Catholicism argues that innocent human life cannot be destroyed for any reason. Furthermore, during the thirteenth century, the traditional Christian belief condemned any type of suicide, whether it was assisted or not, on the theory that it violated one’s natural desire and right to live. In Mormonism, anyone who takes part in 'assisted suicide' is regarded as having violated the commandments of God. However, the Church recognizes that when a person is in the final stages of terminal illness there may be difficult decisions to be taken. The Church states that 'When dying becomes inevitable, death should be looked upon as a blessing and a purposeful part of an eternal existence. Members should not feel obligated to extend mortal life by means that are unreasonable.’ Euthanasia vs. Assisted Death Physician-assisted suicide is often confused with euthanasia (sometimes called "mercy killing"). In cases of euthanasia the physician administers the means of death, usually a lethal drug. In physician-assisted suicide (PAS) the patient self-administers the means of death, the physician only assists to patient to get to the materials (drugs, machines) which will take their own life. Euthanasia is separated into two categories: passive euthanasia and active euthanasia. Passive euthanasia is the death of a person by altering some form of support and letting nature take its course. Examples include such things as turning off respirators, halting medications, discontinuing food and water so as to allowing a person to dehydrate or starve to death, or failure to resuscitate. In many jurisdictions, active euthanasia can be considered murder or manslaughter, whereas passive euthanasia is accepted by professional medical societies, and by the law under certain circumstances. Therefore, physician assisted death also goes by the name “voluntary passive euthanasia”. Countries’ Views on Physician-Assisted Suicide The debate surrounding physician-assisted suicide in the United States has been influenced by medical practices in other countries, particularly the Netherlands, which legalized both active euthanasia and physician-assisted suicide, in April 2001. Physician-assisted suicide in the Netherlands is conducted within strict guidelines that include the following requirements: the patient's request for assisted suicide must be voluntary, the patient must be experiencing intolerable suffering, all other alternatives for treatment must have been explored, the physician must consult another independent physician before proceeding. A study commissioned by the Dutch government indicated that, in 2001, about 3,500 deaths, or 2.5 percent of the 140,000 death cases that were reported in the Netherlands that year, occurred by active euthanasia. The study, known as the Remmelink Report, defined euthanasia as the termination of life at the patient's request. Figures also indicated that 300 deaths, or 0.2 percent, were caused by physician-assisted suicide. In the United States, the debate on legalizing assisted suicide began in earnest in the 1970s. On one side of the debate have been Patients' Rights groups who have lobbied for the right to die, or the right to choose to die, of terminally ill patients. The strongest opposition to the legalization of physician-assisted suicide has come from physicians' groups such as the American Medical Association (AMA) and from religious groups that are morally opposed to the practice. The debate over physician-assisted suicide eventually reached the Supreme Court. Starting with 1994, an advocacy group known as Compassion in Dying filed two lawsuits challenging the constitutionality of state laws banning assisted dying in Washington and New York. Debates on PAS took a long time until June 26, 1997 when The Court ruled that state laws against assisting a suicide are not unconstitutional, but also stated that patients have a right to aggressive treatment of pain and other symptoms, even if the treatment hastens death. The Court wrote; "Throughout the Nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician assisted suicide. Our holding permits this debate to continue, as it should in a democratic society." Ultimately then, the voters and representatives of the states and the legal system itself have to decide whether or not physician-assisted suicide will be legalized.