I. INTRODUCTION: Euthanasia is a social issue in today’s world because not only does it affect the lives of those who are terminally ill and/or comatose, and the physicians who have been entrusted with their care, but it also affects the patient’s ability to have control over their own life, whether they are aware of this decision or not, which is one of the reasons why euthanasia has become such a controversial issue around the globe.
Caddell and Newton (1995) define euthanasia as “any treatment initiated by a physician with the intent of hastening the death of another human being who is terminally ill and in severe pain or distress with the motive of relieving that person from great suffering” (p. 1,672). Even though the concept of great suffering may lead to one’s desire to have their death happen sooner than later, there are many factors that contribute to the euthanasia debate including: the physicians role, religion, race, and death. In this paper, I will explore how euthanasia is perceived in the United States, Sweden, and India through the eyes of society. I will also demonstrate how some these factors play a role in the social issue and how they contribute to the euthanasia debate.
II. EUTHANASIA AND THE PHYSICIAN’S ROLE: A. The physician’s role Caddell and Newton (1995) state that “it is not difficult to imagine moral dilemmas dealt with by physicians when faced with the choice between vague directives in the law, professional ethics and the wishes of a suffering terminal patient and his or her family” (p. 1,672). A huge theme that society has seen in regards to euthanasia is the physician’s role. Physicians have been seen as murderers for assisting the death of their patients and they have been referred to as mercy-killers. However, many people tend to disregard the fact that even the physician, who is usually the one being blamed, can actually be the victim as well.
According to the American Medical Association’s Council on Ethical and Judicial Affairs, it was stated that “although life-prolonging medical treatment may be withheld, the physician should not intentionally cause death” (as cited in Dickinson, Clark, Winslow & Marples, 2005, p. 44). In a study mentioned by Dickinson et al. (2005) it was found that when physicians were asked about whether or not active voluntary euthanasia (AVE) should be legalized, the percentage of those who were in favor of was between 35% and 71% (p. 45).
The physician’s role toward euthanasia in regards to Sweden is quite similar to that of the United States in the sense that many people prefer a professional doctor (or physician) to be assist in hastening a patient’s death. According to the survey responses by Swedish medical students, Karlsson, Milberg and Strang (2007), it was demonstrated that “some thought that the patient should make the decision all on their own (35%), together with their family (2%), whereas others wanted a medical doctor to participate in the decision (63%)” (p. 618). India also has the same perception when it comes to the physician’s (or doctor’s) role in euthanasia. Kamath, Bhate, Mathew, Sashidharan, and Daniel (2011) conducted a study in which they sent out a questionnaire to 230 doctors and received responses from 213 of them. According to these responses, it was suggested that “many of the respondents were of the opinion that either the family members; or the treating doctor were most suited to make the final decision regarding euthanasia if the patient was not competent to do so” (p. 198).
Although many people have represented that they would rather have a physician make the final decision when it comes to the wishes of a patient, many people still see this as a conflict, as well as a debatable issue, in today’s society. Karlsson, Milberg and Strang (2011) suggest that some individuals “perceived that the legalization of euthanasia would bring about a situation where society has the legal right to take patients’ lives in certain situations, and that individuals would lose the protection of and power over their own lives” (pp. 37-38). In a sociological perspective, this can relate to the conflict theory because regarding euthanasia, there is a strong sense of coercion and power when it comes to handling the lives of individuals who are terminally ill, or incapacitated individuals who don’t have the capability to make their own decisions.
In addition to this, “those who feel like they are not in control of their over their own lives…are more likely to fear the potential abuse of euthanasia” (Verbakel & Jaspers, 2010, p. 113). When the concept of losing one’s own power becomes a prominent reality for these individuals, it can not only result in a larger conflict, but it could also further ignite the euthanasia debate. The reason why the physician’s role may contribute to the euthanasia debate is because a lot of the time many family members of the patients assume that the patient’s health will eventually improve. Also, some physicians may become worrisome and begin to hesitate with the decision in fear that maybe the patient doesn’t really want their life to end. Based on some research studies conducted in Sweden, “it was found that “physicians stressed the possibility of the patient changing their mind, whereas the general public focused on the chances of improvement through the development of medical treatment” (Lindblad, Juth, Fürst & Lynöe, 2010, p. 286).
In addition to the physician’s role, sometimes nurses may play a part in euthanasia as well. In a questionnaire that was sent to registered nurses in India, it was found that “although 39.7% agreed that patients without hope shouldn’t suffer, 66.4% disagreed that patients with an incurable disease should be allowed to die and only 42.5% agreed that patients with an incurable disease should not live half dead because of suffering” (Poreddi, Nagarajaiah, Konduru & Math, 2013, p. 188). The fact that people do not want to see someone suffer greatly is what encourages many people to be favorable of life-sustaining treatment, but the fact that people do not want to see a loved one die is what creates the opposing views, resulting in the euthanasia debate.
III. RELIGION AND EUTHANASIA: A. Religion Religion appears to be one of the most common factors when it comes to society’s attitudes and views toward euthanasia. Based on their findings, Hamil-Luker and Smith (1998) suggest that “the non-religious had the highest percentage of approval for allowing incurable patients to choose to die, nearly 90%. Liberal Protestants, Catholics, and mainland Protestants followed closely behind with 79.1%, 73.3%, and 71.3%” (p. 382). Even though the majority of Protestants seem to be accepting of euthanasia, there are certain levels of Protestants that tend to oppose it. Ruth and McKinney (1987), and Wuthnow (1988) demonstrate that “there is reason to expect moderate Protestants to be generally accepting of physician-assisted suicide and terminal palliative care.
Compared with conservative Protestants, moderate Protestants are less likely to view the Bible as the literal word of God…which may render biblical appeals to submission less persuasive (as cited in Burdette, Hill & Moulton, 2005, p. 82). Even though some religions are accepting of euthanasia, one of the reasons that others are debating it is because in their opinions, religious or not, they don’t believe that it is right to take away another person’s right to their life and they see it as not just a sin, but they may also see it as murder to some extent. Boone (1989) and Ellison et al. (1986) claim that “those who embrace this perspective see the Bible as the ultimate authority. Passages such as ‘Thou shall not kill’ and ‘do not slay the innocent and righteous’ often serve as ideological beacons for conservative Protestants on issues pertaining to life and death” (as cited in Moulton, Hill & Burdette, 2006, p. 254).
According to one of Sweden’s official websites, Sweden.se, 64% of the Swedish population attends church but only 29% claim to have any sort of religious affiliation, which may provide a reason as to why their society doesn’t see euthanasia as big of a controversy as that of the United States. Religion was also a contributing factor regarding attitudes toward euthanasia in India as well. Abbas, Abbas, and Macaden (2008) conducted a study in which they sent out questionnaires to 100 doctors. Out of these 100 doctors, 60 responded: 23 of them were Christian, 26 were believers of Hinduism, and 10 were Muslim. When it came to their responses, it was demonstrated that “four Christian, 16 Hindu, eight male and female doctors, supported the concept of euthanasia” (p. 72).
Based off of the research and studies that have been conducted, it appears that religion really does play a role in how euthanasia is perceived and that based on other research, it was suggest that many individuals “in different countries and regions have different religious or cultural backgrounds influencing their moral views” (Hagelin, Nilstun, Hau & Carlsson, 2004, p. 521). The symbolic interaction theory poses this notion that people create their own social worlds through interacting with symbolically and socially within society. Not only does religion contribute to one’s interactions and developments with their social world, but it can also be a double-concept in the sense that religion and culture can be intertwined.
Another reason why the symbolic interaction theory can be explored is because race can be a factor in regards to attitudes toward euthanasia. Religion and race can be intertwined based on a cultural foundation. Early and Akers (1993) insinuate that “the idea that suicide is wrong and unthinkable is embodied in the religious norms and values of black culture” (as cited in MacDonald, 1998, p. 413). In addition to this, it was found that “Blacks who reported moderate levels of confidence in medical science were 1.20 times more opposed to euthanasia thank Blacks who reported high levels of trust in medical science. Blacks who reported no confidence…showed 1.45 times greater opposition to euthanasia…” (Jennings & Talley, 2003, p. 55).
IV. ILLNESS, DEATH, AND EUTHANASIA A. Patients’ illnesses and perceptions of death In many cases, the excruciating pain and suffering that patients are enduring will most likely lead them to believe that dying is the best way to relieve their pain, especially if they are suffering from a terrible disease or mental illness. However, Battin (1994) has insinuated that “by the time death becomes imminent for a person suffering from Alzheimer’s disease, dementia may prevent the person from competently whether or not to seek voluntary euthanasia” (as cited in MacDonald, 1998, p. 75). This can hinder some patients’ decisions because even though they are suffering greatly, sometimes they may believe that there is still hope for their mental or physical health to improve. The patient’s views and possible decision may also rely on their “personal beliefs, health, illnesses, depressive symptoms, recent hospitalizations, and demographic characteristics” (Carr & Moorman, 2009, p. 758).
Some people put in their living will that if for any reason it is believed that they will never recover mentally or physically from an illness, their wish is to have their death hastened. In Sweden, a questionnaire demonstrated that when patients were asked about their wishes regarding euthanasia and assisted suicide, it was shown that “the palliative care physicians reported the highest proportions of patients asking for withholding or withdrawing of treatment” (Valverius, Nilstun & Nilsson, 2000, p. 144). One of the reasons why people view euthanasia and physician-assisted death as a debatable issue is because in a lot of cases, the patient may have a mental illness that leave them incapable of consenting to this life-ending decision, as well as deciding it for themselves.
“Cognitive symptoms such as memory loss, inability to remember details, and decreased intellectual and language skills make it difficult for the patients to communicate their desires accurately” (Shekhar & Goel, 2012, p. 628). According to the Constitution of India, “the ‘right to life’ is a natural right embodied in Article 21 but suicide is an unnatural termination or extinction of life and, therefore, incompatible and inconsistent with the concept of ‘right to life’…it is the duty of the State to protect life and the physician’s duty to provide care and not to harm patients” (Math & Chaturvedi, 2012, p. 899). This is an example of the fuel that feeds the euthanasia debate, especially when it comes to physicians because they are the ones who are supposed to help save lives, not end them. However, many people also have the opinion that nobody deserves to suffer great pain, especially when there is truly no hope of any mental or physical improvements.