Euthanasia Articles

Read the following articles. Create a Works Cited for each of the articles using correct MLA format. Refer to the O.W.L. Purdue website if you have questions. APRIL 3, 2012, 2:59 PM Inside a Story About Helping the Elderly to Die By David Jolly For my article on euthanasia in the Netherlands, I interviewed Petra de Jong, the Dutch doctor who is the head of Right to Die-NL. Euthanasia is widely accepted — and, since 2002 legal — in the Netherlands for those whose suffering is ‘‘unbearable,’’ but Dr. de Jong’s group has been courting controversy by seeking to extend help in dying to everyone age 70 and over, even if they aren’t sick. It has also begun offering mobile euthanasia teams to assist people whose doctors refuse to provide them life-ending treatment. For an outsider there is something striking about the Dutch attitude to euthanasia, as well as to marijuana — about which I recently wrote — and prostitution, all of which are legal, but closely regulated. The policies of tolerating these practices grew from experience showing that forcing them into the shadows caused even worse problems: crime and disease, in the case of drugs and prostitution; unrelieved suffering, and murky or deeply troubling cases of supposed mercy killing in euthanasia. Dr. de Jong argues that by insisting on ‘‘unbearable suffering,’’ the law fails old people who have decided that their lives are complete. These people, whom she described as ‘‘suffering from life,’’ may well try to take their own lives anyway, she said. ‘‘Suicide is not illegal, you can always do that,’’ she said. ‘‘But you need a way. Old people are less mobile and there are fewer good ways. And some of the ways we know are really awful.’’ For Dr. de Jong, the questions are deeply personal, I learned. Her parents took their own lives. ‘‘They died together in 2010,’’ she told me. ‘‘They had gathered medication for insurance against when they didn’t want to live anymore, and they didn’t want to depend on their G.P.,’’ their general practitioner or everyday doctor. Her father was suffering from cancer and her mother ‘‘didn’t want to be alone,’’ she said, after a long life together. ‘‘They died in each others’ arms together in their bed. So suddenly my private life and my work here came together. That was a bit strange.’’ Push for the Right to Die Grows in the Netherlands By David Jolly Published: April 2, 2012 AMSTERDAM — It was 1989, and Dr. Petra de Jong, a Dutch pulmonologist, was asked for help by a terminally ill patient, a man in great pain with a large cancerous tumor in his trachea. He wanted to end his life. She gave the man pentobarbital, a powerful barbiturate — but not enough. It took him nine hours to die. “I realize now that I did things wrong,” Dr. de Jong, 58, said in an interview in her office here. “Today you can Google it, but we didn’t know.” Her warm and sincere manner belies, or perhaps attests to, her calling. The man was the first of 16 patients whom Dr. de Jong, now the head of the euthanasia advocacy group Right to Die-NL, has helped to achieve what she calls “a dignified death.” Founded in 1973, Right to Die-NL has been at the forefront of the movement to make euthanasia widely available in the Netherlands, even as the practice remains highly controversial elsewhere. Polls find that an overwhelming majority of the Dutch believe euthanasia should be available to suffering patients who want it, and thousands formally request euthanasia every year. Right to Die-NL, which claims 124,000 members, made worldwide headlines in early March with the news that it was creating mobile euthanasia teams to help patients die at home. The organization has also courted controversy with its call for legislation to make euthanasia available to anyone over age 70, sick or not. Dr. de Jong said more than 100 requests have been made for the mobile service. Several of them are being evaluated, and euthanasia has been performed in one case. Advocates and critics of assisted suicide are watching the organization’s efforts closely. Rick Santorum, the Republican presidential candidate from Pennsylvania, created something of a stir in February when he asserted — wrongly — that euthanasia accounted for 5 percent of all deaths in the Netherlands, and that many elderly Dutch wore wristbands that said “Do not euthanize me.” Dutch officials quickly countered the claims. “Internationally, the Dutch have pushed the conversation on both the wisdom of allowing people to choose how and when they die when they’re in great suffering, and on the nature of compassion in dying,” said Paul Root Wolpe, director of the Center for Ethics at Emory University in Atlanta. Under the Netherlands’ 2002 Termination of Life on Request and Assisted Suicide Act, doctors may grant patients’ requests to die without fear of prosecution as long as they observe certain guidelines. The request must be made voluntarily by an informed patient who is undergoing suffering that is both lasting and unbearable. Doctors must also obtain the written affirmation of a second, independent physician that the case meets the requirements and report all such deaths to the authorities for review. Dr. de Jong said Dutch physicians typically euthanize patients by injecting a barbiturate to induce sleep, followed by a powerful muscle relaxant like curare. For assisted suicide, the doctor prescribes a drug to prevent vomiting, followed by a lethal dose of barbiturates. Almost 80 percent of all such deaths take place in patients’ homes, according to the Royal Dutch Medical Association. In 2010, the latest year for which data are available, doctors reported 3,136 notifications cases of “termination of life on request.” Serious illnesses — late-stage cancer, typically — lie behind a vast majority. Euthanasia is responsible for about 2 percent of all deaths annually in the Netherlands, according to Eric van Wijlick, a policy adviser for the association. Euthanasia is typically carried out by the general practitioners who serve as the backbone of the country’s universal health care system, doctors who often have enjoyed long relationships with their patients and know their feelings well. Mr. van Wijlick said the euthanasia law was possible because of “the moderate and open climate we have in the Netherlands, with respect for other points of view,” and acknowledged that it would be difficult to carry out elsewhere, because everyone in the Netherlands has access to health care, an income and housing. “There are no economic reasons to ask for euthanasia,” he said, something that might not be true in the United States, with its for-profit health care system. The mobile teams were needed, Dr. de Jong said, because many general practitioners, either for moral reasons or perhaps because of uncertainty about the law, refused to help suffering patients to die after it had become too late to find another doctor. The mobile teams will work to help them do so, she said. Say a hypothetical 82-year-old man with metastasizing prostate cancer and poor prospects is told by his doctor that does not qualify for euthanasia. The man could contact the Right to Die-NL’s new “life-ending clinic,” and if he appeared to meet the criteria, a doctor and a nurse would go to his home to make an assessment. If all the conditions were met, he would be euthanized, ideally with his family beside him. Dr. de Jong emphasized that a patient could never be euthanized on the initial visit, because the law requires that a second physician be consulted. Even in the Netherlands, some think Right to Die-NL may now be going too far. In addition to the mobile teams, the organization is among those pushing to give all people 70 years old and over the right to assisted death, even when they are not suffering from terminal illness. (The conservative government of Prime Minister Mark Rutte has said there will be no changes to the law under its tenure.) “We think old people can suffer from life,” Dr. de Jong said. “Medical technology is so advanced that people live longer and longer, and sometimes they say ‘enough is enough.’ ” Mr. Wijlick said the Royal Dutch Medical Association was “uneasy” with the mobile teams because “the question of euthanasia can’t be taken out of isolation of the care of the patient,” which should be in the hands of the primary caregiver, the general practitioner. Most of the time, he added, there is a good reason that a doctor refuses euthanasia. Often, it is because the doctor believes the patient’s case does not meet the criteria set out by law. The association also opposes euthanasia for those “suffering from life.” “There must always be a medical condition,” Mr. van Wijlick said. Still, in such cases a doctor could explain to patients how to deny themselves food and drink, he noted, and could assist with any suffering that entailed. The Dutch patients’ organization N.P.V., a Christian group with 66,000 members, strongly criticizes the current application of the law, saying the practice of euthanasia has been extended to encompass patients with dementia and other conditions who may not by definition be competent to request help in dying. Elise van Hoek-Burgerhart, a spokeswoman for the N.P.V., said in an e-mail that the idea of mobile euthanasia teams was “absurd,” and that there was no way the mobile-team doctors could get to know a patient in just a few days. Moreover, she added, research shows that 10 percent of requests for euthanasia from the elderly would disappear if palliative care were better. She also noted that the law requires review committees to sign off on every reported case of euthanasia, but that 469 cases from 2010 had still not been reviewed, meaning it was not clear how well doctors were adhering to the official guidelines. Dr. Wolpe, the Emory University bioethicist, said he was “generally supportive” of people’s right to choose their own death, but that he was troubled by some trends in the Netherlands, including the extension of euthanasia to people who were not suffering physically. “When you switch from purely physiological criteria to a set of psychological criteria, you are opening the door to abuse and error,” he said. A Polarizing Figure in End-of-Life Debate A version of this news analysis appeared in print on June 5, 2011, on page A21 of the New York edition with the headline: A Polarizing Figure in End-of-Life Debates. Associated Press By JOHN SCHWARTZ In reports of Dr. Jack Kevorkian’s death on Friday at the age of 83, the general rule of obituaries held: Do not speak ill of the dead. Dr. Kevorkian was generally described as a difficult man who helped advance the cause of assisted suicide for those with terminal illness. Within the movement known generally as death with dignity, however, the evaluation of his contribution might seem surprisingly qualified, and the praise decidedly muted. “He raised the profile of the issue, but he put the wrong face on it,” said Eli D. Stutsman, a lawyer in Portland, Ore., who helped draft his state’s trailblazing Death With Dignity Act, which allows terminal patients to end their own lives with the help of a doctor. The 1997 Oregon law was built with compromise and careful consideration of policy, Mr. Stutsman said. It includes requirements that the patient be at the end stage of terminal disease and not have psychiatric disorders like depression, and that the patient take the drugs used in the procedure without help, to ensure that the act is voluntary from start to finish. It is a very different system from that of Dr. Kevorkian, who seemed to make up his methods as he went along. He did not appear to screen patients to determine whether they were actually close to death, and he seemed to make no efforts to get counseling for those who might have wanted to live longer. He devised “suicide machines” that could deliver drugs or carbon monoxide gas and could be set off by the patients. He carted the equipment to patients in his battered Volkswagen van and left many of the resulting 130 or more bodies at emergency rooms or even in hotel rooms. Death, certainly — but death with dignity, no. “Under the Oregon Death with Dignity Act, we would have put him in jail,” Mr. Stutsman said. “We ended up using him as an example of how not to do it.” Since the act was passed, 525 people have ended their lives under its auspices, according to the state’s 2010 annual report. In 2010, 96 prescriptions were written for the barbiturates used, and 65 people ended their lives. Mr. Stutsman went on to be a founding board member of the Death With Dignity National Center, which promotes similar legislative efforts around the country. They face serious opposition by groups that reject physician-assisted suicide for reasons that include religious belief and concern that such laws would open the door to forced euthanasia. Mr. Stutsman said successful campaigns in Oregon and Washington State showed the value of a strategy of compromise and coalition building. “He was advocating from the margins of the political debate,” Mr. Stutsman said of Dr. Kevorkian. “I was working from the middle of the political continuum — it’s very hard to change public policy from the margins of the debate.” The movement won a major victory in 2006 when the United States Supreme Court ruled that the federal government could not prosecute Oregon doctors who participated in the assisted-suicide law. Peg Sandeen, the executive director of the Death With Dignity National Center, said the ruling helped convince states that their own efforts would be respected — and was, she said, a major factor in the 2008 passage of the Washington State bill. The Montana Supreme Court held in 2009 that no state law restricts the right of its citizens to end their lives with the help of physicians, though the court did not go so far as to say that physician-assisted suicide is a right under the State Constitution. Efforts so far in California, Hawaii, Maine and Vermont have not been successful, though a new bill is before the Vermont Legislature. Barbara Coombs Lee, the president of Compassion and Choices, a group that promotes what it refers to as “end-of-life choice” in legislatures and the courts and was a co-plaintiff in the Montana case, said Dr. Kevorkian “was quite scornful of any effort to change the law.” She called his death “the end of an era.” Noting that he was a polarizing figure — “people either thought he was a saint and martyred or the devil incarnate” — she explained, “To us, he was neither, but certainly pivotal to our movement.” Even at the extremes, she said, he “raised everyone’s consciousness about the problem of end-of-life suffering” and spurred others to look for ways for those with terminal illness to end their lives on their own terms. An “ignominious” death at the hands of Dr. Kevorkian “was a dramatic display of just how desperate people were who are seeking a peaceful end of their terminal disease,” she said. The policy-oriented groups worked to distinguish themselves from the Kevorkian spectacle. One Washington briefing in 1999 was titled “Jack Kevorkian and Physician-Assisted Dying: Not One and the Same.” Still, disagreement has its uses, said Scott Blaine Swenson, who was the executive director of the Death With Dignity National Center from 2001 to 2005. “He was the perfect foil” for the centrist movement that was promoting policy change, Mr. Swenson said. “You need somebody to play against,” he said. Dr. Kevorkian — erratic, loud and playing by his own rules — helped the movement establish rules that voters could live with, Mr. Swenson said. “The truth, I think, is that had a Kevorkian not existed, that folks in Oregon and other proponents of assisted dying would have needed to invent him,” he said.