By Tove I.S. Gerhardsen
Euthanasia is a moral dilemma that may not be seen in terms of black and white -- a mistake people tend to make when failing to recognize the differences between active and passive, voluntary and involuntary euthanasia.
'This is a real moral dilemma,' said Richard R. Tolman, chair of the Zoology Department at BYU. Tolman teaches Zoology 338, biology ethics, in which students discuss, among other topics, the ethical implications of euthanasia.
The issue of euthanasia is not as clean and sterile as the debate might appear to be in the media, said Sandra Rogers in the BYU Nursing Department. It involves people and pain.
'It is not 100 percent reality until experienced,' she said. 'Most students think the world is black and white.'
However, when it comes to euthanasia, there is a huge gray area when all the methods of euthanasia are considered, he said.
'I think (students) are often unable to comprehend how difficult the situation is,' Rogers said.
'I think there is a high level of possible abuse with euthanasia -- it could be seen as kind of a noble thing,' said Lara Canen, a student from Denver majoring in social work. Canen said euthanasia would be a hard decision to make.
Although all forms of euthanasia are usually referred to as being in the same category, there are major differences between active voluntary, passive voluntary, passive involuntary and active involuntary euthanasia.
Active voluntary euthanasia is defined as feeding sleeping pills or other medication to patients who are too ill to take care of themselves. Passive voluntary euthanasia means providing but not feeding sleeping pills or other medication to patients to use for overdose.
Passive involuntary euthanasia means not initiating life support procedures. Active involuntary euthanasia means injecting air into veins. The gray area in involuntary and voluntary cases is the act of disconnecting life support equipment.
'I am personally against active euthanasia. We are taking over a role we are not supposed to have,' Tolman said.
However, Tolman said that in the case of passive euthanasia, family members and competent physicians should decide the outcome. Facilitators can decide with family members. When they abide by the decision of the patient's family, it is passive euthanasia.
Passive euthanasia cases, especially quiet practices only known to the doctor and the family, are often practiced when there is no hope for the patient.
'Should you legislate what really belongs between the physician and the patient?' Tolman said.
Passive euthanasia is when issue of death is nearby; active is when death is not eminent per se, yet there is terrible suffering and pain, Rogers said.
The nature of health care in general is to keep people alive, Rogers said. The question is not whether to use active euthanasia, but whether to use passive euthanasia or treatment.
Rogers said we should get guidance from the prophet in this ethical problem.
'Life is sacred and we don't take it,' she said. She said people should ease the suffering of others if they can.
Rogers said all of the parties talking together early is preferable. The parties should work out an agreement.
According to the New England Journal of Medicine, one in five intensive-care nurses responding to a survey admitted to hastening the deaths of terminally ill people, sometimes without the knowledge of doctors, families or the patients themselves.
According to the survey, the nurses invariably said they acted out of compassion -- a strong desire to end the patients' misery.
A physician might see the patient for five minutes; the nurse sees the human emotion and can't stand to see this person suffer anymore, which might be a motivator, Rogers said.
'Nurses are taught to be advocates for the patient,' Rogers said. She also said nurses understand the sanctity of life, but they also have to understand people whose loved ones are in pain.
One of the roles of nurses is to be with families who have to make the decision regarding euthanasia, and to help them see what their options are, Rogers said.
'(Euthanasia is a) combination of prayerful decision making and respect for people and their choices,' she said. 'It is not the physician who pulls the plug ... withholds the food ... it is the nurse.'
According to the Chicago Tribune, polls indicate that only 2 to 13 percent of doctors say they have assisted patients in dying, either by providing prescriptions or by administering lethal injections.
The American Medical Association is against any form of euthanasia, Tolman said. '(AMA thinks) doctors have a dual role: relieving suffering and prolonging life,' he said. AMA seeks to do a better job to find pain-relievers and does not think doctors should be in the business of killing.
Most doctors and nurses support the AMA and its stand in the case of euthanasia since it is the governing organization with a widely-read journal, Tolman said.
Dr. Linda L. Emmanuel, AMA vice president for ethical standards, said she opposes physician-assisted suicide, but views its popularity as a growing awareness of society's need to cope with the end of life, according to the Chicago Tribune.
The Kevorkian method of euthanasia has been widely criticized, Tolman said. This method has been named after Dr. Jack Kevorkian, who is the only one who practices it.
The patients activate a gas mask as they breathe and fall asleep. Thus, they die from lack of oxygen, Tolman said. The Kevorkian method is passive on the doctor's part and voluntary on the patient's part.
According to Hastings Center Report, families deliver more than 80 percent of the long-term care in this country, almost always at great personal cost.
In his article 'Is there a duty to die?' published in Hastings Center Report, John Hardwig argues that it may be that technological sophistication coupled with a commitment to loved ones that generates a fairly widespread duty to die.
It is a question about technology. How long can we keep someone breathing artificially, Tolman said.
'We fear death too much ... but we will not conquer death by one day developing a technology so magnificent that no one will have to die ... we can conquer death only by finding meaning in it,' Hardwig said.