Public opinion polls conducted from 1936 to 2002 found that Americans support both euthanasia and physician-assisted suicide. Although public opinion regarding end-of-life decisions appears to have been influenced by the events of the times, Americans have consistently favored the freedom to end one's life when the perceived quality of life has significantly diminished, either by one's own hand or with the assistance of a physician. This paper indicates that existing policy regarding euthanasia and physician-assisted suicide conflicts with the American public's attitudes regarding the matter, as well as examines implications for social workers who serve clients facing end-of-life decisions.
Keywords: euthanasia, end-of-life decisions, physician-assisted suicide, death and dying issues
The concept of euthanasia inevitably provokes a moral dilemma for many Americans, because euthanasia gives individuals the freedom to choose whether to live or die. This article examines the opinions of a cross-section of the American public concerning the ethics of death and dying, attitudes toward euthanasia and physician-assisted suicide, and a patient's right to forego life-sustaining treatment. Before we interpret the results of studies on these issues, we briefly present definitions, discuss religious perspectives, and examine the history of euthanasia.
Euthanasia has been debated for many centuries. Two factors that have contributed to euthanasia's prominence in modern culture are both an increasing sense of self-determinism and medical innovations that have the potential of substantially prolonging human life (Loewy & Loewy, 2000). Our findings indicate that existing policy regarding euthanasia and physician-assisted suicide unquestionably contradict the American public's attitudes regarding the matter.
To clarify essential terms, "passive euthanasia" is the withholding or withdrawal of artificial life support or other medical treatment and allowing a patient to die. "Physician-assisted suicide" refers to a physician's provision of the means (such as medication or other interventions) of suicide to a competent patient who is capable of carrying out the chosen intervention. With "active voluntary euthanasia," a physician administers a lethal dose of medication to a competent person who explicitly requests it. "Involuntary euthanasia" involves the intentional administration of medication or other interventions to cause a competent person's death, without informed consent or an explicit request. "Non-voluntary euthanasia" involves ending the life of an unwilling individual (i.e., a death sentence) or mentally incompetent person who is unaware of what is happening (Csikai, 1999). The decision to end life in the ways that the first two terms imply is often based on the judgment of disproportionate burden, that is, the judgment that treatment will be useless, cause the patient more pain and suffering, or not restore the patient to an acceptable quality of life (Vose & Nelson, 1999).
Religion and Culture
As Miller, Hedlund, and Murphy (1998) note, euthanasia is a significant factor in the religious beliefs and spiritual values of people worldwide. However, various cultures and religions view euthanasia and assisted suicide differently. The ancient Greeks believed it was morally acceptable to end one's life if one no longer considered one's life to be worthwhile (Snyder, 2001). This belief is similar to that of the Irish culture, in which death is often the most celebrated experience of the life cycle (Miller et al., 1998).
Christians also have a wide range of perspectives on euthanasia. Some believe that it is acceptable to advocate for euthanasia, whereas others oppose the idea that individuals can choose to die (Darr, 2002). According to traditional Christian philosophy, euthanasia was considered immoral until recently and was universally condemned in all societies with Christian traditions. …