Picture this: The state licenses nonmedical “telostricians” who perform “aid-in-dying” by administering lethal drugs to patients expected to die “within six months, a year, or ten years” or to those who are “technologically dependent.” Under such a plan, parents could request aid-in-dying for children under the age of six. Children older than six could request aid-in-dying on their own, and if their parents disagree, they could go to an “Aid-in-Dying Board” for permission.
An outlandish proposition that will never be accepted in this country? Think again, say euthanasia opponents across the country. The plan is, in fact, a “Model Aid-in-Dying Act,” published in the October 1989 Iowa Law Review. “Euthanasia is not a threat that we might be facing in years to come,” International Anti-Euthanasia Task Force director Rita Marker told CHRISTIANITY TODAY. “It is a threat that is with us right now, and people need to be aware of it.”
When the U.S. Supreme Court decided the highly publicized Cruzan case in late June, it refused to find in the Constitution a “right to die,” a right that euthanasia advocates say should be recognized. However, the Court also refused to deny such a right. “[It] is the [better] part of wisdom not to attempt, by any general statement, to cover every possible phase of the subject,” wrote Chief Justice William Rehnquist, quoting an earlier opinion. But, Rehnquist also noted, previous Supreme Court decisions do indicate that a competent person “has a constitutionally protected liberty interest in refusing unwanted medical treatment.”
In a five-to-four decision, the justices did rule that Missouri could require “clear and convincing evidence” of an incompetent patient’s wishes before the removal of food and water tubes. Thus, the Court denied Joe and Joyce Cruzan’s request that food and water tubes be removed from their 32-year-old daughter, Nancy, who was severely brain damaged as a result of a car accident.
The justices were deeply divided over the issue. “Nancy Cruzan is entitled to choose to die with dignity,” asserted Justice William Brennan. Justice John Paul Stevens agreed. “Medical advances have altered the physiological conditions of death in ways that may be alarming: highly invasive treatment may perpetuate human existence through a merger of body and machine that some might reasonably regard as an insult to life rather than as its continuation,” he wrote. “[For] patients like Nancy Cruzan, who have no consciousness and no chance of recovery, there is a serious question as to whether the mere persistence of their bodies is ‘life’ as that word is commonly understood.”
Living Wills: Problem or Solution?
Nancy Cruzan once told her roommate she wouldn’t want to live “as a vegetable,” but the Supreme Court said that was not “clear and convincing evidence” about her wishes in regard to the withdrawal of food and water in her current brain-damaged condition. In the wake of the Cruzan decision, many lawyers are advising clients to plan for possible future incompetence by writing down explicit medical-treatment guidelines for physicians and families.
While Cruzan’s home state of Missouri has standards that are among the strictest for the removal of life-sustaining treatment, state laws vary. Forty-one states and the District of Columbia recognize a “living will,” which allows a person to put forth his or her medical desires in case of permanent incapacitation.
Strongly pushed by right-to-die advocates, living wills are the source of much controversy—even within the evangelical and prolife communities. Rita Marker, director of the Anti-Euthanasia Task Force, is a staunch opponent. “When a person signs a living will, that signer … is in effect handing a blank check to an unknown physician to interpret however he or she thinks, with total civil and criminal immunity.”
The Christian Action Council’s Tom Glessner agrees, saying the documents are not needed. “Standard medical practice has always been that extraordinary treatment to preserve life when a person is in the dying process is not necessary.”
But Paul Linton, counsel for Americans United for Life, said his organization “doesn’t have a problem with the typical living wills in most states” because they are “only operative when a patient is terminally ill and unable to direct his own medical treatment.”
Burke Balch of the National Right to Life Committee urges people to write down clearly if they do want to receive food and water in case of incapacitation. “It used to be the case that the presumption was for life, but nowadays, if you … were going to be unconscious for a long time, probably the assumption would be that you would prefer to starve to death,” he said.
Back To The States
Prolife advocates, who oppose most right-to-die legislation, were pleased by the decision, but saw it as far from a total victory. “It is just plugging a hole in the dike,” said Christian Action Council executive director Tom Glessner. “The Court did not say that Nancy Cruzan had a right to food and water, but simply that there was not convincing evidence of her wishes to starve to death.”
The Anti-Euthanasia Task Force’s Marker believes the decision has opened the way for more controversy. “This whole heated area has been tossed back to each state,” she said. “And so, state by state, there will be laws passed that could vary a great deal. Unfortunately, it could be that some very dangerous laws will be passed.”
Many state battles are already beginning. In Washington State, citizens have launched a referendum petition drive to get a “death with dignity” measure on the November 1991 ballot. If the proeuthanasia group is successful in getting more than 150,000 signatures on petitions, then the state will be forced either in its legislature or through a referendum to consider allowing physician-assisted suicides for terminally ill patients.
A similar attempt failed in 1988 in California, although right-to-die groups are planning to try again. Foundations for euthanasia initiatives are also being laid in Arizona, Florida, and Illinois. And in Oregon, at least four state senators have promised to sponsor a physician-assisted-euthanasia bill.
Death By Omission
To date, all efforts to advance active euthanasia, such as lethal injections, have failed decisively. However, advocates and opponents of euthanasia alike believe the tide may already be turning. Although Missouri chose to prohibit Cruzan’s death by starvation, many states currently allow the withdrawal of artificial nutrition and hydration on a regular basis.
“Once a society accepts the principle of passive euthanasia, that you can cause someone’s death by omission, it doesn’t take much to cross the barrier to the proposition that you can cause someone’s death by commission,” said Americans United for Life counsel Paul Linton. He points to the lack of public outrage about Michigan doctor Jack Kevorkian and his suicide machine (see “The Suicide Machine,” editorial, p. 14) as evidence of a changing environment surrounding the issue. “That would have been unthinkable 20, or even 10, years ago,” Linton said.
Most prolife groups do not believe “extraordinary and heroic” life-support systems to be required if a patient is terminally ill and already in the dying process. However, as Justice Stevens pointed out, medical advances are rendering the definitions less clear. And, as more states take up the battle over euthanasia, medical, legal, and theological issues are expected to become increasingly complex.
By Kim A. Lawton.
