Euthanasia

I. THE RIGHT-TO-DIE

On the night of April 15, 1975, for reasons still unclear, Karen Ann Quinlan ceased breathing for at least two 15 minute periods. Karen was 21 years old when she lapsed into a coma after a fatal drug overdose. Experts testified that she was in a persistent vegetative state. This condition means that although reflex actions may be present, the patient regains neither awareness nor purposeful behavior of any kind. Karen was placed on a respirator and never recovered consciousness. After 7 months, her father requested that the respirator be turned off but the hospital refused. The case reached the New Jersey Supreme Court and in 1976 it rendered the landmark decision that Karen Ann Quinlan had a constitutional right to die. The decision became the pivotal point for the reemergence of the debate on Euthanasia and the birth of Right-to-Die movements.

The right to life is recognized in virtually every society in the world. From the earliest civilizations to modern penal codes, there is a prohibition against murder. Catholic teaching tells us that Direct and Intentional Killing is considered gravely sinful. Human life is sacred and is a basic good. But it is not absolute. If it is necessary for the realization of a preferable value, after consideration of all circumstances, one may be allowed to cause death, a relative disvalue. Richard McCormick argues that "in a situation where taking of human life is truly life saving and life serving in the circumstances, death cannot be regarded as turning against a basic good of life." The value of life may be sacrificed if there is an equal or greater value that has to be protected, if there is no less harmful way of protecting this value, and if in causing death, the value chosen will not be undermined in the long run. The core question that would have to be answered is whether the recognition of the right to die is justified by proportionate reason.

The initial advocacy of right-to-die movements contemplated the right to die as the right to refuse treatment. The recent advances in medical science and technology brought about changes in the health care system. It is now possible to keep a patient alive indefinitely through artificial respiration. In cases of severe brain injury, the increasing refinements of treatment have made it possible for patients who formerly would have died to now survive for indefinite periods without regaining any meaningful mental function. The advances in medicine has also considerably increased the life span of man. Through technology and science, diseases that would have been fatal in the past are now cured. Tuberculosis for example was considered incurable before vaccination and antibiotics for TB became available. This also means, however, an increase in malignancies, and chronic and degenerative diseases which usually afflict the elderly. People began to see that the benefits of technology came with a price. Today, more than sustaining life, medicine has the capacity to prolong death. In addition, the reality of exploding health care costs become a heavy financial burden on patients, families and societies. In a case decided by the Philippine Supreme Court, a patient who suffered brain injuries due to medical negligence became comatose, was living on mechanical means, and remained in that condition for over a decade. The family incurred a monthly expense ranging from P8,000 to P10,000. It is against this backdrop that the right to die was initially claimed.

McCormick tells us that "love is always controlled by the possible." There is proportionate reason in a situation where causing or permitting an evil is the only alternative to the causing of a greater evil. It was argued that sickness may be avoided, "but not at the cost of sending the whole family into the most dire straits." It is submitted that death may be avoided but not when further medical intervention would be futile and where the costs of such treatment would bring to the whole family a heavy burden. To the Christian, suffering is a fact of human life that gives one the opportunity to share in Christ's redemptive suffering. One may relieve suffering as long as one does not intentionally cause death or interfere with other moral and religious duties. If death is inevitable and imminent, in spite of the means used, then the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life is permitted in conscience. This limited context of the exercise of the right to die has been generally accepted by the public.

The decision in the case of Quinlan also raised the questions on who would have the right to refuse treatment in case the patient is incompetent or is otherwise unable to decide for himself or herself and on what type of medical treatments could be refused. Since the Quinlan case, several laws and court decisions established the legal framework in which the right to die could be exercised. Competent persons could refuse medical treatment; if they were incompetent, the courts or the law addressed the question of how such decision could be reached. The Judiciary decided on who could exercise substitute judgment. The legislative in various US states enacted statutes that dealt with living wills, durable powers of attorney for health care and other statutory surrogates.

The major disagreement arose on the issue of tube feedings. In the recent case of Terri Schiavo, who experienced cardiac arrest and massive brain damage, the court allowed the removal of the gastric feeding tube that kept her alive upon finding that she had made previous credible statements that she would not wish to be kept alive on a machine. The Catholic teaching is that one is morally obliged to use all ordinary means of treatment but that extraordinary means are optional. In 1992, the US Catholic Bishops' Committee for Pro-Life Activities said that nutrition and hydration may be withheld if intention is not to cause death. The removal of feeding tubes would have to be assessed based on circumstances. In some cases, feeding tubes may be considered extraordinary means. For example, a patient with end-stage lung cancer where neck nodes have grown to a size that impeded feeding, the patient is permitted to refuse an operation to insert a tube to his stomach. In cases like this, the operation is burdensome, carries with it risks, and is disproportionate to the expected outcome, since whether or not the feeding tube is inserted, the prognosis of the patient is already poor.

In this limited context of the right to die, it is submitted that the right to refuse treatment does not undermine the sanctity of life, is not direct and intentional killing, and may be justified by proportionate reason. Today, however,