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Euthanasia and Suicide (Click to select text)
EUTHANASIA By Brent M. Pergram, Masters of Arts in Sociology The specific sociological problem that is the topic of this research paper is euthanasia. The purpose of this research is to identify the variables associated with euthanasia. It also discusses the variables associated with various types of euthanasia and suicide. I believe that elderly suicide is an example of active euthanasia, and therefore it is important to discuss the issue to have a better understanding of the social problem of euthanasia and suicide. I will also discuss variables that influence whether a person supports euthanasia or not, such as religious belief, gender, age, region, educational level, and marital status that influences how a person views the issue. I will also discuss the definitions of death. I will discuss the ethical and moral aspects of the problem of euthanasia. I will try to use Emile Durkheim’s social integration theory to explain the causes of active euthanasia, and suicide in general. I will also use Charles Tittle’s defiance category of deviance, which represents escape or withdrawal from active participation to social relationships or normative obligations to society. I want to integrate both Durkheim’s egoistic type of suicide, which applies to those that are inadequately integrated into society, and Tittle’s defiance category of deviance. I believe that both show a lack of social integration can increase the likelihood of suicide, and active euthanasia by those that lack coping skills, suffer from depression, have mental problems, and no longer value life. The lack of attachment to society and withdrawal from active participation in social relationships or social positions, which can increase the likelihood of active euthanasia or suicide, includes the following: 1) problems with the family, such as divorce, or the lose of a loved one; 2) interpersonal problems; 3) lack of problem solving; 4) depression; 5) drug and alcohol use; 6) health problems. These problems can influence the thought processes and coping behaviors that can lead to an increased likelihood of suicidal behavior. Euthanasia is the practice of painlessly ending the lives of people who have incurable, painful, or distressing diseases or handicaps. It may occur when incurably ill people ask their physician--or a friend or relative--to put them to death or to allow them to die. It may also occur when ill people ask others to help them commit suicide. Euthanasia is sometimes called mercy killing. Euthanasia is a very controversial issue. Some people believe patients should have an unqualified right to die. Others consider all forms of euthanasia to be murder or suicide and thus immoral. Still others approve of some forms of euthanasia and disapprove of others. Medical ethics is the field of study concerned with moral problems created by the practice of modern medicine. Medical ethics is divided into three branches: (1) public policy medical ethics, (2) biomedical ethics, and (3) clinical ethics. Public policy medical ethics deals with issues related to the regulation of medical practice by governments and by the governing boards of such institutions as hospitals and nursing homes. For example, state and federal governments establish spending limits for public health care. These limits raise ethical questions about the type and extent of medical services available to people who depend on public funds to pay medical bills. Other problems involving public policy include the control of medical research, the question of whether all citizens have a right to health care, and the availability of drugs for severe illnesses, such as AIDS. Biomedical ethics addresses moral questions that arise from the use of medical technology to begin or maintain a life. Many ethical questions focus on medical procedures that affect human reproduction. These include in vitro fertilization (starting human life in a test tube), the cloning (duplication) of human embryos, and abortion. Another important issue is euthanasia, the practice of painlessly putting to death people who are hopelessly injured or terminally ill. Clinical ethics evaluates the morality of decisions about medical care made by or with patients and their families. Problems of clinical ethics include deciding whether or not to remove life-sustaining treatment, making medical decisions for a severely retarded newborn or an unconscious person, and dealing with requests for euthanasia from patients or their families. All three branches of medical ethics relate to one another. For example, patients with AIDS are concerned with the availability of newly developed medications (public policy medical ethics), participate in arguments about whether or not physicians are obligated to treat them (biomedical ethics), and make decisions about their care and death with loved ones and physicians (clinical ethics). Euthanasia means mercy killing to some, and natural death without the aid of life extending, or death prolonging medical devices. It means “good death,” based on the fact that it ends suffering when the quality of life becomes unbearable. The two main perspectives on euthanasia are those who support the sanctity of life, verses those favoring a quality of life viewpoint. The sanctity of life perspective is imbedded in the Western Judeo-Christian tradition that values life as a right given by God, and that man has no right to play God by deciding who lives and who dies. They oppose abortion, suicide, and euthanasia. Those supporting a quality of life perespective believe that when life no longer has a quality or meaning due to a terminal illness, or for some a disease like Downs Syndrome see death as preferable to life (Leming, &Dickenson, p.212-214). Active and passive euthanasia are the two main types of euthanasia that have been debated for decades around the world. Many people oppose active euthanasia, such as the injection of a lethal drug, because it requires one person to deliberately kill another person. Fewer people oppose passive euthanasia-- the withdrawal of life-sustaining medical treatment-- for patients who request it. Passive euthanasia involves a situation where a physician goes by a protocol that no action or medical intervention to allow a natural death to be hastened. This type can involve a physician to not use (CPR) cardiopulmonary resuscitation that was introduced in 1960 and is used to save many lives every year. CPR is used routinely by doctors in hospitals without considering the patients’ chances for survival, or without considering the quality of life the person may live, such as having brain damage. Those favoring the quality of life perspective oppose any medical devices being used to bring a person back from the edge of death. They think that those who do not want to live if they suffer life threatening injuries, are terminally ill, or in need of life sustaining devices, such as the respirator, should have a right to have their death wish accepted. If the person is unconscious and want to die, they must have a living will that expresses their wish that no extraordinary means by way of life extending medical devices will be used to prolong their suffering. But what if the persons family is opposed to the patients living will, to the patients death wish, then what should the doctor do. It is clearly left to the discretion of the doctor whether to accept a living will, or a death wish by a patient. All doctors are expected to use ordinary means to preserve the life of a patient by all medicines, treatments, and operations that offer a reasonable hope of benefit for the patient and that can be used without excessive expense, pain, and other inconveniences. Extraordinary means to preserve life basically means that any treatment, medicines, and operations that cannot be done without excessive expense, pain, or other inconvenience, or that would not offer a reasonable hope of benefit (Leming, & Dickenson. p.216-7). But the problem with this is that what is extraordinary measures in the past may be ordinary now due the ever changing and advancing technology of the medical profession. Who decides what the definitions mean, such as reasonable hope, or excessive pain, because persons can disagree on their meaning, with some seeing CPR as an ordinary, cheap, and very effective way to save lives, while others may view it as an excessive, painful, life prolonging technique that is not needed if the quality of the persons life would be unbearable. One problem is that of cultural lag, which results in static definitions of biological life and death being applied to new medical technological advances that change require new definitions to define when a person dies, such as the issue of brain death. The definition of death will determine if a person is pronounced dead before death has actually occurred. Doctor Paul A. Bryne says that “no one should be pronounced dead unless and until there is destruction of at least the major vital systems of the body, i.e. the circulatory and respiratory systems, and the entire brain.” He says that that the Uniform Determination of Death Act calls for “irreversible cessation of all functions of the entire brain, including the brain stem,” but that this is not what is occurring in practice. He says that the Annals of the New York Academy of Science (ANYAS 9, 313, pg.65, 1978) found that only 4 percent of the patients in a Collaborative Study would have met the criteria of a dying brain stem, which means that 96% of the patients did not and do not have a dying brain stem. This means that 96% of so-called brain dead patients still have a functioning brain, and this leads to the removal of life support (i.e. passive euthanasia) such as removal of a respirator that causes the heart to stop beating, which leads the patient to become dead. But once again who defines quality of life, and who does it apply to. Does it only apply to rational adults that consent to euthanasia due to pain and suffering and not due to personal considerations like being a financial burden, depression, or loneliness. Or does it apply to anyone those in power say is unfit to live, such as the mentally ill, the disabled, or children with diseases. The most common method of mercy killing today is withholding food and fluids to those that are usually in a coma or persistent vegetative state, who usually need assistance in feeding. The person may be on a feeding tube, that when removed will lead to death. It can take several days for a person to die after the removal of fluids. The person suffers cramps, vomiting, emotional disorders, depression and confusion if not in a coma, or if not brain dead. This method is very painful and it should not be called a mercy killing, when the person suffers such great pain to their bodily organs that eventually lead to their death (ORL-Withholding Food and Fluid FAQ). Active euthanasia requires the direct action of a person, such as a doctor, family member or any person to bring about the death of another person. The two kinds of active euthanasia are suicide, which I discuss later in this article, and mercy killing. The supporters of active euthanasia favor the term self-deliverance when a life of a terminally ill patient is terminated, but can include the mercy killing of a fetus that is know n to have a genetic disease. They do not favor suicide for those that are clinically depressed or that suffer from psychological pain, and not physical pain. As I will show in this article the research literature shows that most who commit suicide are acting irrational based on psychological problems and an inability to cope with negative stimuli in the persons present environment. Self deliverance is justified as an act of a rational person that seeks a solution to the long term pain and suffering for the individual and their loved ones suffering from a terminal illness. Self deliverance is said to be a voluntary act by a patient, while mercy killing involves the attitudes and behavior of others and may not be supported by the patient. Derek Humphry’s book FINAL EXIT , and the Hemlock society, which is a United states based organization that assist terminally ill persons in the act of self-deliverance favors the rights of individuals to active, rational, and voluntary euthanasia when the dying process offers nothing but pain and a life devoid of dignity or meaning. They support Oregon’s Death with Dignity Act that allows lets a terminally ill person that consents to euthanasia to have their wishes carried out by a doctor. The words used in the euthanasia debate, such as extraordinary, hopelessly ill, futile and virtually futile treatment are not legal terms, and are vague, meaningless, and thus dangerous terms that can be used to commit euthanasia against anyone that is ill, or has an accident, or a disease that is viewed negatively by society. For example some favor prenatal euthanasia, due to the fact that some parents and doctors believe that recognized disabilities of the fetus based on genetic tests is a justifiable reason to commit euthanasia or abortion to end suffering. But a Down syndrome child can still find a loving home and can still live a productive life, even if some may view it negatively based on prejudices against those with disabilities and the view that their life’s must be nothing but suffering and pain. But in reality many diseases can be treated, and many with disabilities can live productive life’s that have meaning and value. ) I will discuss the research literature on euthanasia and suicide to look at the various factors that increase the chances of suicide, such as family history, depression, lack of problem solving ability, drug and alcohol use, interpersonal problems, loss of a loved one, and the role of the media. Nicholas Dixon (1998) article says that those who support physician assisted suicide often seek to distinguish it from active euthanasia, but that the two face similar objections. Nicholas says that both do the following: 1) can lead to abuse; 2) implicate the physician in the death of a patient; 3) violate whatever objection there are to killing. Nicholas says that “the case for legalizing active euthanasia is morally indistinguishable from the case for legalizing physician-assisted suicide”(p.25). Active euthanasia is technically illegal throughout the world, except in Australia\\\'s Northern Territory and in Oregon, USA. In practice, however, it is also permitted in the Netherlands under certain conditions. In the United States, the Supreme Court ruled in 1990 that patients who have clearly made their wishes known have a right to passive euthanasia. People can express their wishes in documents called living wills and by granting durable powers of attorney. In living wills, people state what kind of care they would prefer if, due to injury or disease, they could not express their wishes. In the granting of durable powers of attorney, people name one or more persons whom they wish to make decisions about their medical care if they should ever lose the ability to communicate such decisions themselves. Mercy killing is performed by doctors in the Netherlands, but doctors are expected to follow strict guidelines established by the Dutch medical profession and sanctioned by the courts. In order for euthanasia to occur, the following criteria must be met: 1) the choice to die must be a free will decision of the individual and not made under pressure by others; 2) the wish to die can be an enduring one; 3) the person is experiencing unbearable physical and / or emotional pain, and the chance for improvement is not reasonably expected; 4) the individual is not mentally disturbed at the time of the decision to commit suicide; 5) it is carried out in a way that does not cause harm to others; 6) the person assisting in the suicide is a qualified health professional, and only medical doctors can administer the lethal drug; 7) the assisted suicide must be fully documented, and the documents should be made available to the appropriate authorities (Leming & Dickenson, p.221-2) This procedure is not technically legal, but the courts in the Netherlands have enacted legal precedents that have made physician assisted suicide some what common since 1972. It is estimated that over 6000 people in Holland commit suicide with medical assistance from doctors. The majority of Holland’s AIDS patients end their lives by assisted suicide. Mercy killing has clearly become socially sanctioned in modern industrial societies. The living will is a document that states the kind of medical care an individual would prefer if, due to injury or disease, the person could not communicate his or her wishes. It also may name treatments the person would not want. Such treatments include restarting the heart, and feeding- -by artificial means-- patients who can no longer eat normally. Living wills may come into force when patients are near death or in a coma from which they can never recover. Living wills are useful because, unless told otherwise, many physicians assume their patients want to be kept alive as long as possible. To be legally valid in the United States, a living will must be written, signed, and witnessed in a manner determined by state law. The document is called a living will because, unlike a regular will, it becomes effective while the person is still alive. Self-induced euthanasia occurs when people end their own lives painlessly. In some cases, physicians provide lethal drugs that their patients then take to kill themselves. This type of euthanasia is called physician-assisted suicide. Only Australia\\\'s Northern Territory and Oregon in the United States have a law that clearly allows physician-assisted suicide, though the practice is also permitted in the Netherlands. The Netherlands law sanctions euthanasia, but it has been openly practiced since 1991. In Oregon, USA, physician assisted suicide was first enacted on December 8, 1994, but was deferred through appeals, until it was confirmed by a second referendum on November 22, 1997. On May 25, 1995, the Northern Territory Parliament in Australia passed the Rights of the Terminally Ill Act. It became law on July 1, 1996, making it the first place on the planet to have legalized euthanasia. It was appealed to the Supreme Court in Australia, and was ruled valid, but on September 9, 1996 the Commonwealth Parliament of Australia the Euthanasia Laws Bill 1996, designed to repeal the assisted suicide laws of the regional territories of Australia. The bill passed and took effect on March 25, 1997 giving the Federal Parliament the power to over rule the laws of its Territories, although it cannot over rule state laws. In the United States in the 1990\\\'s, Jack Kevorkian, a Michigan doctor, focused national attention on physician-assisted suicide by helping gravely ill people kill themselves. The state or Oregon permits physician assisted suicide. But Kevorkian himself violated the bounds of law when he committed active euthanasia on national television. He was found guilty of second degree murder in March of 1999. However, the issues he raised will continue to be debated for years to come. As of July 1998, assisted suicide is only legal under Oregon state’s statute. It is criminalized under state common law in Alabama, Idaho, Maryland, Massachusetts, Michigan, Nevada, Ohio, South Carolina, Vermont, and West Virginia. It is criminalized under state statute in Alaska, Arizona, Arkansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Virginia, Washington, Wisconsin, and the district of Columbia (7.6.98, USA Today).. Many people support the concept of physician-assisted suicide. Many of those who oppose the practice argue that doctors should not help people kill themselves, because their job is to preserve life. The US Supreme Court in June of 1997 rejected the right to assisted suicide. They said that their is no protection for euthanasia under the due process clause of the Constitution. In the decision the court upheld laws in Washington and New York that makes it a crime for doctors to give life ending drugs to mentally competent but terminally ill patients who no longer want to live. The Federal Government opposes funding assisted suicide, as can be seen by the fact that Congress passed and President Clinton signed into law on April 30, 1997 the Assisted Suicide Funding Restriction Act of 1997, that bans the use of Federal funds to pay for assisted suicide, euthanasia, or mercy killing, which would end it as a threat to those on Medicare. This means that Oregon state must pay for any assisted suicide and that Medicare will not cover it. Dixon Nicholas (1998) article raises the slippery slope issue, that either of the two main types of euthanasia, including active and passive euthanasia both create too great of a danger of abuse due to coercion from doctors, family members, institutions, or other social forces to end ones life. However Quill, Cassel, and Meier say that assisted suicide is solely the final act of the patient and the risk of coercion from others is therefore reduced. Christopher James Ryan (1998) article says that based on the evidence of two studies on physician assisted suicide and euthanasia in the Netherlands and Australia, shows that the fears of a slippery slope have not materialized. In fact he says that the evidence suggests that the legislation of physician assisted suicide may decrease the prevalence of non-voluntary and involuntary euthanasia (p.341). Kissane et al. (1998) article about the first seven deaths in Darwin, under the Rights of the Terminally Ill Act in the Northern Teritory of Australia found that all seven of the patients had cancer, most at advanced stages. They found that three of the patients were socially isolated, and symptoms of depression were common. This shows that mental problems is a problem that must be evaluated before euthanasia is committed. In April 1997, the Oregon Medical Association’s House of Delegates voted 121 to 1 to condemn implementation of Measure 16 (O’Keefe, p.1). The American Medical Association also opposes the legalization of euthanasia in America. Some people believe that the only reason that assisted suicide became legal in Oregon was because the supporters of euthanasia was deceptive by passing the bill the Death with Dignity Act. Death with dignity was a term used by those that believe in the sanctity of life, it was also the term coined by the Nazi’s to get support for their euthanasia program. Similar bills had been rejected that proposed the same assisted suicide provisions, but had the title Aid in Dying Bill. The critics of the Oregon assisted suicide measure is that it does not provide adequate controls to avoid abuse, and that privacy issues leads to an inability to determine whether the patient was rational or done it for personal reasons. The wording of the act does not state that the deadly dose must be self-administered, which means that the doctor can practice active euthanasia. Also those in support of the act, such as Jack Kevorkian, Derek Humphry, co-founder of the Hemlock Society and John Pridonoff, executive director of the Oregon based Hemlock Society all say that more than just terminally ill patients should be covered by euthanasia laws, such as those with disabilities, or who are incapacitated. Disability rights advocates say that allowing assisted suicide based on fear of needing help going to the toilet, bathing, and performing other daily life activities will involve far more disabled and elderly people than terminally ill ones. In 1998 15 people in Oregon, was said to have been legally committed suicide with the assistance of their doctor. The information shows that not one of them was forced into the act by intractable pain or suffering, but those who died had a strong personal belief in individua autonomy, and chose suicide based mainly on fears of future dependence. This shows that such laws will be used by more than just those with terminal illnesses suffering from pain. Likewise in the Netherlands the definition of euthanasia is that it is an action that is aimed at taking the life of another at the latter’s expressed request. Yet the Remmelink Report on September 10, 1991 found that 2,300 patients died as a result of doctors killing them upon request, which is active, voluntary euthanasia, but 1,040 patients died from involuntary euthanasia, meaning that the doctors actively killed these people without the patients knowledge or consent. Of those who suffered involuntary euthanasia, 72% had never expressed any interest in having their lives terminated. Also 8,100 patients were intentionally given overdoses of pain medication to hasten the patients death, and in 61% of these cases the intentional overdose was given without the patient’s consent. It does not include the thousands of people that had treatment withheld or withdrawn without the patients consent. The most cited reason for ending the lives of patients without their consent was low quality of life, and the family couldn’t take it anymore. Doctors in Holland have also been found to provide inadequate pain control and comfort care that could reduce the need for euthanasia, and they falsify death records to avoid paperwork or scrutiny from local authorities (Medical Decisions About the End of Life). The legalization of euthanasia also fails to consider the problem doctors may face after performing such procedures, such as one study showed that many doctors that performed euthanasia or assisted suicide felt regret and 39.5 percent feared prosecution (http://www.euthanasia.com/doctors.html). A anonymous (1997) article says that the Academy of Hospice Physicians represents more than 1,600 U.S. doctors who focus on providing specialized care for patients diagnosed as terminally ill. The Academy based in Florida, is opposed to euthanasia just like its counter part in the United Kingdom, the Association for Palliative Medicine of Great Britain and Ireland, who oppose legalizing doctor assisted suicide. These organizations believe that improving the quality of life for dying patients and their families should be the goal of all doctors by way of pain relieving medicines, counseling, and group support in both the hospital and home settings to help the patient and their family. Hospice is a family-centered concept of health care for people dying of an incurable illness. The hospice concept aims at easing the physical and psychological pain of the patient\\\'s illness, so that the person can appreciate his or her remaining life. It relies on a team approach to achieve this aim. The team includes the patient and his or her family, as well as physicians, nurses, social workers, members of the clergy, and volunteers. The modern system of hospice care began with the founding of St. Christopher\\\'s Hospice in London in 1967 by Cicely Saunders, an English physician. The hospice concept emphasizes home care. Family members are encouraged to participate in caring for the patient when they desire to do so. The hospice staff works with the family and with community agencies to help the patient remain at home. Staff members visit the family regularly and are available at all times for emergencies. They try to provide what the patient and family need. Such hospice services may include nursing care and pain control, meal preparation, laundry, or shopping. Hospice staff members are also available to sit with the patient while family members rest. After the death of the patient, emotional support is provided for the family. Hospice care is also available to inpatients--that is, patients who cannot remain at home. This care may be provided in a separate hospice medical center or in a hospice unit of a hospital. In some cases, a hospice team cares for patients throughout the wards of a general hospital. Inpatient hospice programs provide health care with a friendly attitude in a relaxed setting. Contrary to appearances, no organism dies all at once not plants or animals, including human beings. Major vital organs, such as heart, lungs, or brain, may fail extremely rapidly in the case of animals; however, lesser noticed signs of life can continue for some time after an individual has been pronounced dead. Hair and fingernails can continue to grow, and individual cells continue to function. Because the heart has long been considered the central organ of the body, its failure once indicated with certainty an impending death. Failure of the breathing mechanism was known to bring about cessation of heartbeat, thereby inducing death. But now there are techniques of resuscitation, or revival, for both the heart and lungs, including life-sustaining machines. The operation of the heart and lungs may be stopped and their functions taken over by a heart-lung machine during heart transplants and other major surgery, for instance. The use of these new medical techniques has raised the question: When is a person really dead? If only a machine is keeping a person\\\'s vital functions going, is that individual really alive? Such machines can support an undamaged brain, but once the brain fails no machine can yet revive and support it. Such complexities have confronted modern medical scientists with the need to define exactly when the moment of death occurs. This need is influenced by legal, moral, and religious issues as well. If the heart and lungs cease to operate, the brain will die for lack of oxygen. Conversely, if the brain dies, the heart and lungs will soon fail to function unless they are regulated by a respirator. It only takes about six or eight minutes for the brain to expire for lack of oxygen. Failure of heart and lungs is fairly easy to determine, but determining brain death is more difficult. It is done by examining a combination of life signs. Is there a total lack of response to any kind of stimulation? Can the person breathe without artificial aid? Is there any eye movement, swallowing, or coughing? Does an electroencephalogram, or tracing of brain waves, show any evidence of electrical activity coming from the brain? Is there any blood flow through the brain? A negative answer to all of these questions would indicate brain death, but no single sign is enough to warrant such an assumption. Even if the brain has been determined to be dead, it is possible to keep the heart and lungs operating by machine. Other bodily functions will continue. Yet a physician would say that the person is dead. Who has the right to \\\"pull the plug\\\"? In the absence of the ability of a person to respond, only family members can authorize turning off the machine. Sometimes a patient may stipulate that no special measures be taken to prolong life. Some states have passed statutes recognizing the legality of living wills. An individual signing such a document asks that life not be prolonged under specified circumstances. When a person has been declared dead by a physician, this fact must normally be reported to a governmental agency charged with keeping records of births and deaths. Specific laws relating to the presumption of death and the disposition of property vary widely. Dying is something everyone endures essentially alone. Nothing, therefore, so engages the mind and the emotions as does the ending of one\\\'s life. Except in the case of sudden death, an individual who is ill centers hope on medical treatment and possible cure. People often go through a series of stages in accepting the reality of their own mortality. Diagnosis of a terminal illness brings shock, which soon gives way to denial. This denial may take the form of searching for any possible cure for the disease. From denial the patient may go on to anger at himself, at everyone around him, and even at a God who seems not to hear his pleas for recovery. Anger eventually gives way either to hope for a temporary respite or to deep depression over the impending loss of everyone and everything. This grief over oneself then turns to resignation and acceptance in the face of the inevitable. How an individual responds depends, of course, on the quality of one\\\'s personal life. For most people it is probably true, as Sir Thomas Browne said, that \\\"The long habit of living indisposes us for dying.\\\" For those to whom life has been an ordeal, death may come, in Hamlet\\\'s words, as \\\"a consummation devoutly to be wished.\\\" In the face of such an unknown quantity, however, death often becomes a matter of fear: Aristotle asserted that it \\\"is the most terrible of all things, for it is the end.\\\" Those that have had a healthy and good life, with a good education, and a high income but little faith in religion is more likely to favor euthanasia as a solution to their problems. They may not be able to cope with negative situations like a terminal illness and so they apply their attitudes to the issue, which makes them support it more than those that have not had an easy life, such as those with less education, a lower income, and more faith in religion can better cope with life’s problems and are therefore less likely to favor euthanasia. Clearly, people of great religious faith are often able to face dying with composure: They know it as the final part of life, but they also view it as a transition, not a termination. Religious belief reduces the fear of dying, and survey data indicates that the more religious a person is the less likely they are to favor suicide, abortion, or euthanasia. Yeuh-Ting Lee et al. (1996) hypothesized based on cross cultural studies of euthanasia and abortion that attitudes toward euthanasia and abortion were the effect of culture ( America and China) and type of death (infanticide and geronticide). Yeuh-Ting Lee et al. (1996) found that students from the American culture were less likely to favor infanticide than those from Chinese culture, and that Chinese students believed that infanticide was more common than geronticide in Chinese society. They found that education, judgment of population density, and traditional family values were related to attitudes toward euthanasia, abortion, and female infanticide in Chinese, but not in the American culture. Those in China believe in filial piety, which is a deep respect for the elderly, but do not value female infants. In the U.S. most don’t value the elderly because of the myth that to be old is to be in pain and suffering, which is false for most. The elderly in America are discriminated against and experience ageism that leads to the elderly being valued less by most in society. This lack of value for old age and the elderly, can increase the likelihood that the young and middle aged populations would support euthanasia to end the perceived suffering of the old. The Lee Yueh-Ting et al. (1996) article found that attitudes toward euthanasia were culturally based, but that density of population, such as Chinese are more likely to favor abortion or euthanasia as a way to control population growth. The Nisha Shah et al. (1998) authors done a national survey to find out the attitudes toward euthanasia of United Kingdom psychiatrists’. They say that the belief in the so-called rational suicide is interesting since most suicides are said to occur in the context of mental illness. They say that most psychiatrists believe that suicide may be a rational act, and accept passive euthanasia. But, many are not willing to use their skills to exclude mental illness in people who request assisted suicide. Russel D. Ogden and Michael G. Young (1998) article explored the attitudes and experiences concerning voluntary euthanasia and assisted suicide held by professionally registered members of the British Columbia Association of Social Workers, using an anonymous postal survey. They found that social workers had only a small moral distinction between voluntary euthanasia and assisted suicide, and a large majority believed that both should be legal, in certain circumstances, with over 75% support for both. Most social workers feel they should be involved in the decision making process of euthanasia and assisted suicide. Kitchener (1998) article found that attitudes toward active voluntary euthanasia are more favorable in people that have less contact with the terminally ill. He found that palliative care nurses are the only subgroup without a majority in favor of active voluntary euthanasia, with only 33% supporting it. Sullivan et al. (1998) article found that population surveys have showed an increasing public support for euthanasia and assisted suicide, but have not dealt with chronically ill older person populations. Sullivan et al. (1998) article seeks to show the views of functionally-impaired Dutch elders on death, dying, and hastening death and to relate these to sociocultural and health issues. The community dwelling participants in the longitudinal part of the Groningen Longitudinal Aging Study were assessed at home by interview and questionnaire in 1994, and again in 1995. They measured the following independent variables, age, sex, income, education, religious affiliation, strength of religious belief, physical health status (number of chronic medical conditions, functional impairments), and mental health status (life satisfaction, self-efficacy, anxiety, depression, and neuroticism). The dependent variables were preoccupation with and fear of death, fears of the dying process, and attitudes toward hastened death. Sullivan et al. (1998) article found that low and stable rates of preoccupation with death and fear of death were found. Also occasional but not persistent fears about the dying process were common. But fears of death and dying were most closely related to health status, especially mental health. The participants views concerning hastening death were most strongly related to sociocultural variables, especially religious belief and affiliation. They conclude that beliefs about death, dying, and hastening death are stable over the 1 year follow up. They show that fear of death and dying are most strongly related to mental health in this participant sample. Also mental health factors may determine the distress associated with the prospect of death and dying, while religion may dictate the actions considered proper when dying. For examples the more religious a person is the less likely they are to favor hastening death by way of suicide or euthanasia. Combing responses from the NORC General Social Survey between the years 1977 and 1994 (n=16,000+), found that Americans are more likely to approve of euthanasia (64%) than suicide (49%). The moral issue with the greatest change in approval was suicide of the terminally ill, which Americans were nearly two-thirds more likely to approve of in 1994 (61%) than in 1977 (38%). Among those approving of the right to commit suicide, the percentage approving of both abortion and euthanasia increased from 48 to 55 percent. Among those disapproving of the right to commit suicide, the percentage disapproving of both abortion and euthanasia increased from 47 to 60 percent. While in 1977-78 period those favoring suicide were four times more likely to approve of both euthanasia and abortion than those disapproving of suicide, by 1993-94 there was nearly a five fold difference. Based on this data it is clear that there is a great moral polarization in American on the matters of euthanasia, suicide of the terminally ill, and abortion that is increasing over time (Kearl’s Guide to the Soc. of Death: Moral Debates-Euthanasia, p.3). Using Student Explorit for Dos and data file for: Discovering Sociology: An Introduction Using Explorit, with data from the 1996 General Social Survey (NORC) defines euthanasia as a person having a disease that cannot be cured, and asks if the respondent thinks the doctor should be allowed to end the patients life by some painless means if the patient and his family requests it, shows that out of a total of 1877 respondents 70.8 percent favor it. In terms of gender, males approve of euthanasia by 75.1%, while females support it by 67.4%. The difference was statistically significant with a Chi Square of 13.241, DF= 1, and a probability of 0.001. In terms of race, 74.4% of whites aprove of it, while only 48.5% of African Americans favor it. It was statistically significant, with a Chi Square of 73.758, DF= 1, and a probability level of 0.001. In terms of marital status, those that are divorced and seperated are most likely to favor euthanasia 74.9%, and widowed persons were the least 59.8%. It has a Chi Square of 13.843, DF= 3, and a probability of 0.003. It shows that those that have lost a loved one are more likely to oppose euthanasia than those that have not. Those that are divorced and seperated are more likely, which could be due to anger at the other spouse. In terms of religion those that report no religion are the most likely 88.8% to favor euthanasia, and conservative protestants 55.3% are the least likely. The difference is statistical significance, and has a Chi Square of 19.401, DF= 2, and a probability of 0.001. Clearly the more religious the person is the less likely they are to favor euthanasia. The less religious, or more liberal in their religious beliefs are more likely to favor euthanasia. In terms of region, Westerners are most likely 80.4% to favor euthanasia, Southerners 65% are the least likely. The difference is statistically significant, with a Chi Square of 31.812, DF= 3, and a probability of 0.001. This shows that the region a person is from influences their views on the issue of euthanasia, with those in the west favoring it more, and those in the south favoring in the least. In terms of age, the higher the age, the less likely the individual is to approve of euthanasia. The most significant difference comes between those age 50-64, and those over 64. The difference is statistically significant, and it has a Gamma of .14, a DYX of .089, and a probability of 0.001. The higher the education, the more likely the person is to approve of euthanasia. Those least likely to support euthanasia have no High School degree 58.9%, while those with the most education favors it the most 75.5%. The higher the income the more likely the person is to approve of euthanasia. Those with low income have 65.8% approval and those with the highest incomes have a 75.5% approval of euthanasia. The most significant difference comes between those with income lower than the median and those with income close to the median. In terms of number of kids, the more children one has the less likely they are to favor euthanasia. Those with no kids favor it by 77.1%, those with 1-2 kids 71.5%, and those with 3 or more 64.2%. In terms of those who support abortion for any reasons, 84.7% also supports euthanasia, which is significant at the probability level of 0.001. In terms of those that do not feel close to their neighborhood favor euthanasia more than those who are close. Those close to town favor euthanasia less than those not close. In terms of urban vs. rural, those in urban areas favor euthanasia by 70.7%, while those in rural areas are less likely to support it 64%. This like the persons region shows that were a person lives can influence their view of this issue. In terms of political views, those that are liberal favor euthanasia by 74.5%, moderate 74.7%, and conservatives the least with 64% support. The Chi Square is 32.372, DF= 2, and a probability of .001. It is clearly statistically significant. Those that are least confident in the Supreme Court of the US are least likely to favor it with those saying hardly any favoring it by 67.3%, and those that have a great deal of confidence in it favoring it by 77.7% The difference is statistically significant. Those that pray daily favor euthanasia by 60.2%, while those less than weekly favor it by 92.4%, which shows that the less religous the more one will favor it. In terms of the bible those that believe the bible to be the actual truth only favor euthanasia by 54.3%, while those that see it as an ancient book of myth that they do not believe is real favor euthanasia by 85.8%. The difference is significant at a Chi Square level of 0.001. Those that favor both suicide if a person has an incurable disease, and euthanasia by a doctor to end a patients life by some painless means if the patient and family ask for it shows that 90.7% supported both. They clearly favor a persons right to die at their own hand, or assisted suicide if needed. But the data shows that they trust government and democracy more, are of a higher income, higher education level, and younger age, and never widowed, meaning that they do not really know the problems of the poor minorities, and elderly. They are applying their middle class perspective to a problem that mainly affects depressed poor elderly. Clearly there is many variables that are significantly related to euthanasia. The National Right to Life Council Suicide Fact sheets says that the following is a summary of points worth making in rebutting arguments for legalizing active euthanasia. They say that a request for assisted suicide is typically a cry for help, and is a call for counseling, assistance, and positive alternatives as solutions for very real problems. They say that suicidal intent is typically tempory, with data showing that of those who attempt suicide but are stopped, less than 4 percent go on to kill themselves in the next five years, less than 11 percent will commit suicide over the next 35 years. They say that terminally ill patients who desire death are depressed and depression is treatable in those with terminal illness, will one study showing that 24 percent of terminally ill patients who desired death, all had clinical depression. They say that pain is controllable and that modern medicine can control pain that ends the main justification for the need of euthanasia, which is that avoiding pain is why they want euthanasia. Therefore legalized assisted suicide is not needed, but a doctor better trained in alleviating pain. They say that in the Netherlands, legalizing voluntary assisted suicide for those with terminal illness has spread to include nonvoluntary euthanasia for many who have no terminal illnesses. Half the killings in the Netherlands are now nonvoluntary, and the problem for which death is now the legal solution include such things as mental illness, permanent disability, and even simple old age. They finish by saying that you do not solve problems by getting rid of the people to whom the problems happen, but that the humane solution to human suffering is to address the problems. Depression is a serious mental disorder in which a person suffers long periods of sadness and other negative feelings. The term depression also describes a normal mood involving the sadness, grief, disappointment, or loneliness that everyone experiences at times. This article discusses depression as a mental disorder. About 10 million to 14 million people in the United States suffer depression. Depressed people may feel fearful, guilty, or helpless. They often cry, and many lose interest in work and social life. Many cases of depression also involve aches, fatigue, loss of appetite, or other physical symptoms. Some depressed patients try to harm or kill themselves. Periods of depression may occur alone, or they may alternate with periods of mania (extreme joy and overactivity) in a disorder called bipolar disorder. This condition is also known as manic-depressive disorder. Psychiatrists do not fully understand the causes of depression, but they have several theories. Some psychiatrists believe that depression follows the loss of a relative, a friend, a job, or a valued goal. Many psychiatrists believe that experiences that occur during early childhood may make some people especially subject to depression later in life. According to another theory, disturbances in the chemistry of the brain occur during depression. Brain cells communicate with one another by releasing chemicals called neurotransmitters. Some experts think that certain neurotransmitters become underactive during depression and overactive during mania. These changes in brain chemistry may be related to disturbances in the body\\\'s internal rhythms. Treatments for depression include hospitalization, psychotherapy, drugs, and electroconvulsive (electroshock) therapy. Hospitalization is an essential treatment for depressed patients who are suicidal. In psychotherapy, the psychiatrist tries to understand (1) the childhood events that make a person subject to depression and (2) the events that preceded the patient\\\'s current depression. The most prescribed antidepressant in the United States is a drug called fluoxetine. Fluoxetine is marketed under the name Prozac. Lithium carbonate is a drug used in treating bipolar disorder. Electroconvulsive therapy is generally used as a treatment only for patients who fail to respond to other treatment. Cathryn Devons article (1996) says “The rate of suicide among persons age 65 and older has steadily increased since 1980, according to a study released in January by the Centers for Disease Control and Prevention (CDC).” Suicide rates increase with age and are the highest among those persons age 65 and older.(Devons) The CDC released figures that “Older persons account for 13% of the population, but they committed 19% of all suicides between 1980 and 1992.”(CDC) The article “Skyrocketing suicides,” says that “New government statistics show a stunning increase in suicide rates among both young and elderly Americans.”(p.18) The overall average rate of suicide has remained relatively constant, while suicides among children ages 10 to 14 have soared 127% from 1980 to 1995, and suicides among adults 75 years and older have risen 42%.(Ibid) In contrast, suicides fell 17% in adults ages 24 to 75. They say that these numbers are based on a government review of Washington state death statistics from 1980 to 1995 and reflect national trends, according to the Center for disease Control and Prevention (CDC).(Ibid) In terms of physician assisted suicide, even without legal sanction, it is practiced in the United States. There is limited anecdotal reportage on actual physician assisted suicides, a recent study conducted in the state of Washington of 1,443 physicians (Back, Wallace, Sparks, & Perlman, 1996) reported that the practice is not rare and that as many as 25% of all patients who make such a request have received help from their doctor. The American Hospital Association said that many of the approximately 6,000 hospital deaths per day are planned in some way by their families or physicians. Another source reported that as many as 70% of all deaths in hospitals are preceded by primarily ad hoc decisions to withdraw life support (Markson, 1995). Also a survey of 852 nurses found that 16% claimed that they had participated in active euthanasia or assisted suicide at least once in their career, with 8% having done so in the preceding 12 month period (Asch, 1996). Jan C. Heller\\\'s article \\\"Suicide, assisted suicide, & voluntary euthanasia: unsettled questions, unsettled responses,\\\" is used to define suicide. Heller says that suicide is defined as \\\"the act of intentionally taking one\\\'s own life.\\\" She says where there is no intention to end one\\\'s life, there is no suicide. In terms of adolescent suicide Nancy Merritt says that in 1993 an estimated 276,000 people between the ages of 14 and 17 try to kill themselves every year, and over 5,000 succeed. The Center for Disease Control 1992 data on deaths shows that suicide was the third leading cause of death for those between the ages of 15 to 24.(Gardner) The reasons why elderly and adolescent individuals commit suicide will be compared and contrasted. I looked at several articles that dealt with the issue of family background as a cause of suicide. Katz (1997) article says that “The current state of knowledge about suicide in the elderly and about its associations with depression is well documented in the chapter “Suicide in the Elderly” by Yeates Conwell (1994) in the Proceedings of the NIH Consensus Development Conference on the Diagnosis and Treatment of Late Life Depression,” and so on.(p.269) Katz says that “In the United States, the demographic group with the highest rates is elderly white males, and it is white men who show the steepest age-related increase in the risk of suicide.”(Ibid) In African American men, the rates in late life are lower and suicide rates across the life span shows two peaks, one from the ages of 20 t 35, and one in late life, at age 80-85.(Katz, pp.269-70) Katz says “these lower suicide rates are consistent with the modestly lower rates of depression among frail older African-Americans”.... and “they may be due to either better coping and more effective supports, or to selective mortality.”(Ibid) William MacDonald (1998) article says that researchers have consistently found that blacks are more opposed to legalizing voluntary euthanasia than are Whites. They say that the reasons attributed to these differences are either the levels of fundamentalism, or due to the level of fear regarding the giving of others the power to end one’s life. Data from the General Social Survey (GSS) and the Ohio Death and Dying Survey (DANDS) were used to examine the extent that those two variables along with socioeconomic status and political conservatism, account for Blacks’ greater opposition toward the legalization of voluntary euthanasia. They found that fear regarding the giving of others the power to end one’s life, being more religious, and being poorer were less likely to favor assisted suicide than those with higher incomes, less religious, and more liberal in political beliefs. Allberg and Chu\\\'s article shows that families of adolescents who have attempted suicide are different than families of non-attempters, having frequent conflict in communication styles, impaired problem-solving ability, and negative language. Research indicate that the loss of meaningful relationships can lead to suicide, such as the loss of a parent through divorce, death, or breakup with a loved one have been found to be precursors of suicide. The authors say the adolescents who attempt suicide have not yet learned ways to cope sufficiently with losses or anticipated losses. They often seek out quick cures for their problems, such as drug abuse and suicide. The elderly are more likely to commit suicide based on depression, hopelessness, complicated grief, and anxiety, as well as lower levels of perceived social support, than non suicide ideation.(Szanto, et al.) Szanto et al (1997) article says that “57% of the patients with high complicated grief scores were found to be ideators during the follow-up versus 24% of the patients with low complicated grief scores.”(p.194) The study showed that most of the depression was a result of the loss of a spouse, or loved one. The study lasted for 17 months, and studied 130 elderly participants who had lost their spouse within the past 2 years. They found that “having high levels of complicated grief symptoms and depressive symptoms appears to make bereaved individuals vulnerable to suicidal ideation.”(Szanto) Grabbe et al (1997) article found that “a history of cancer should be considered as a risk for suicide in the elderly. They used data from the 1986 National Mortality Followback Survey.(Grabbe et al, 1997: 434-437) Deborah O’Connor (1998) article says that “Depression is prevalent in elderly patients but frequently missed or undertreated”... and that a “systematic approach can help you improve quality of life for the depressed elderly and reduce disability, suicide rates, and unnecessary health care costs in the process.”(p.73) The elderly are vulnerable to depression, not only because of the biological effects of aging, but because they may be more likely than younger age groups to have been widowed, to like alone, and to have physical and mental illness.(Ibid) Depression is not a natural part of growing old, although it is a chronic illness affecting mood, behavior, and physical health.(Ibid) O’Connor says that “Major depression is most pervasive in the institutionalized elderly, while the incidence of less debilitating forms of depression, which increases with age, is most prevalent in the community.”(Ibid) If depression is left untreated it can lead to substantial morbidity, contribute to existing medical illness, and increase the likelihood of suicide. But effective treatments can help the majority of those affected by depression to recover, and improve their quality of life and decrease health care costs. O’Connor says that “The more debilitating and severe the depression, the more important it is to use an antidepressant medication, whether the patient is elderly or not. Martin Graham\\\'s article \\\"Adolescent Suicide,\\\" shows that a bad family background can increase the chances of depression and suicidal thought. He says that in most cases there is clear evidence that a troubled home life with a particular crisis (personal, home, or school) can trigger the act of suicide.(Graham, 1992) The psychologist Calvin Frederick says that \\\"The primary underlying cause of the rising suicide rate among American youth seems to be a breakdown in the nuclear family unit,\\\" and he says \\\"there is evidence that at a developmental stage when they are most in need of it, adolescents have been receiving less support.\\\"(Colt, 1990.) I believe that it is not the breakdown of the family itself, but the resulting consequences of it that increases the likelihood of suicide. For example the depression that can result from divorce or loss of a loved one can increase the likelihood of suicide. McCall (1991) article found that “family dissolution and white children living in poverty are associated with white male adolescent suicide trends and that societal affluence is associated with white male elderly suicide trends.” The article showed that a child being in a poor social class with a broken home, and the older persons loss of societal affluence within their social class increases the likelihood of suicide. Joseph M Chandy\\\'s article shows that a history of sexual abuse and parental alcohol misuse of teens within such families have higher rates of suicide, and eating disorders. Leah Wallach\\\'s article shows that a family history with poor communication skills with the parents that was a consequence of social withdrawal associated with depressed moods. He says that poor social adjustment (poor relations with others) increased the risk of suicide among teens about four times in a study by Dr. Shaffer at the New York Psychiatric Institute of 170 teenagers who committed suicide. The study found that 60% of boys and 68% of girls that committed suicide were depressed showing that girls are more suicidal than boys. Those factors can also contribute to an increased likelihood of suicide among the elderly, because lack of communication skills could lead to isolation and loneliness that can increase the likelihood of suicide. The frequency of suicidal thoughts and attempts is lower in late life.(Blazer et al 1986) Since elderly persons make fewer attempts per completed suicide than younger adults, suicide completers are less likely to have made a previous suicide attempt, making it more difficult to identify them as at higher risk for suicidal behavior.(Szanto) Skoog et al (1996) article found that “Mild suicidal feelings are common in elderly subjects with mental disorders but infrequent in the mentally healthy.”(p.1015) The study was of a population of 85 year olds, and showed that those that did not have mental disorders, such as depression, had fewer death wishes, or thoughts of taking ones life, than those with mental disorders.(Skoog et al.) The role of television and suicide is discussed in the article \\\"Television and teen suicide: More than a coincidence?.\\\" The article says that for every 100,000 Americans, the number of households with televisions, and the number of families with more than one television set all correlated very highly with the rise in yearly suicide rates among 15 to 24 year olds between 1950 and 1988. The main reason he gives for the strong correlation between television and suicide is one of many factors that could separate a person from his family, but also includes the rise in two-parent\\\'s working, and rising divorce rates. It also says that other studies have shown that television news stories about suicide have led to a temporary rise in suicide rates. In one article John Ashton says \\\"Although some have sought to deny the link with media reportage, that there is such a link, especially for young people, seems to me to be beyond reasonable doubt. I believe that the media should be required to adopt a strict code of practice in suicide reporting until they can prove there is no causal link.\\\" (Ashton, 1994) Clearly the media- newspapers, television, radio, and movies have added to the confusion surrounding the euthanasia issue by neglecting to carefully examine legitimate objections to death related legislation and court decisions. In addition, by focusing on the sensational hard cases and by disseminating inaccurate and biased information, the media contributes to public support of the pro-euthanasia philosophy. In terms of the elderly Derek Humphry’s Final Exit in 1991 caused a large uproar because it was basically a manual on how a person could commit suicide.(Lerner) The book was more than just a pro right to die book, but also a detailed manual on how to end ones own life, such as the use of prescription drugs, aided by a plastic bag.(Lerner, p.508) It stressed the right of the terminal ill to end their suffering. The strong role of affective illness in suicides late in life has been shown repeatedly.(Waern, et al.) Waern et al (1996) article shows that there is high rates of antidepressant treatment in elderly people who commit suicide. Their study of Scandinavian born elderly 65 and over who committed suicide and were examined by the Goteborg Institute of Forensic Medicine. The data revealed that 90% of all reported cases of suicide among elderly people in the catchment area (includes Goteborg, Sweden’s second largest city) underwent necropsy at the institute in 1994 and 1995.(Waern et al) They showed that a majority of those studied had a history of treatment for affective illness, and that antidepressants were prescribed in a large percent of the cases. They say that antidepressant sales have more than doubled in the catchment area during the past 10 years. which increases the availability of prescription drugs that can be used to attempt suicide.(Waern et al) David Lester, and Tulin Icli, in the article, \\\"Beliefs about suicide in American and Turkish students,\\\" used the Mcintosh, Hubbard, and Santos (1985) devised inventory of myths about suicide and exploring the extent to which they are held by people in the U.S. The myths that they described can be appropriately viewed as beliefs about suicide that may or may not be held in a given society or different cultures. Their study looked at the extent to which American and Turkish students held these beliefs. They say that the American suicide rate from 1979 to 1981 was 12 per 100,000 people per year, while the Turkish suicide rate was officially 0.02. They say that American students are heterogeneous in religious preference, but primarily Christian, and Turkish students are mainly Islamic. Since suicide is rarer in Turkey than in the US, it was expected that people in Turkey would be less familiar with suicidal behavior in friends and family and would read about it less in the newspapers. Their knowledge about suicide should be less accurate. The authors gave the Mcintosh (1985) inventory of beliefs about suicide to 80 American undergraduates ages 17 to 24 enrolled in social science classes at an American college (55 females & 25 males, mean age=20.4) and to 98 Turkish undergraduates ages 17 to 24, enrolled in social science classes at a Turkish university (63 females and 35 men, mean age=20.3). They used chi-square tests with 1 df, and a critical value of significance at 3.84. Here are some of the questions that were asked and the results: \\\"People who talk about suicide rarely commit suicide\\\" (50% vs. 22.5%; chi-square= 13.04). \\\"The suicidal person wants to die and feels there is no turning back,\\\" (89.8% vs. 53.7%; chi-square= 27.62). American students agreed more with two beliefs: that the tendency toward suicide is inherited and passed on from one generation to another (24.1% vs. 4.1%; chi= 13.71) and that oppressive weather, such as rain, humidity, etc. has been found to be related to suicidal behavior (71.2% vs. 54.1%; chi= 4.80). But no major differences were found for the beliefs that an individual who commits suicide is mentally ill, suicide is more common among lower socio-economic groups, nothing can be done to stop a person attempting suicide once he or she decided to, and suicide usually occurs at night. The overall results show that American students agreed with a mean of 4.5 beliefs, while Turkish students agreed with a mean of 7.3, t(172)= 10.22, p
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