A recent study by the Pew Research Center indicates changing trends in how Americans view end-of-life medical treatment. Down 7 percent from a 1990 survey, 66 percent of Americans now say there are circumstances in which medical professionals should allow their patients to die.
The study also showed an increase in recent years of people who said, for their own medical care, they would prefer to end medical treatment, depending on the exact circumstances. This group stands at 57 percent, as opposed to the 35 percent who said they would do everything possible to stay alive.
The study also signifies Americans’ overwhelming belief that individuals have a moral right to end their own lives. On a case-by-case basis, 62 percent say that if a person is suffering and shows no sign of improvement, it is that person’s moral prerogative to commit suicide. This is a 7 percent uptick from 1990.
But Americans have consistently disapproved of physician-assisted suicide. In 2013, 49 percent of respondents said they did not believe physicians have the right to end a person’s life, up from 45 percent in 2005.
Options for end-of-life careElon University sophomore Tom Riley spent the last few months at the Hospice and Palliative Care Center of Alamance-Caswell County helping patients work through their advance care directives. Advance directives specify a patient’s wishes and instructions in the event of a medical emergency during which he or she can’t make decisions.
Patients at the hospice center are required to be in the final six months of their lives. Many have decided to discontinue medical treatment for serious illnesses.
Riley said people in hospice haven’t always completed their advance directives, especially if they’ve never been ill before.
“So many people don’t have them,” he said. “People above 60 who have had previous illnesses or a near-death experience are the people who have it.”
The Pew study specified that 26 percent of adults 18-49 had written down their preferences for end-of-life care, while 61 percent of adults older than 75 had made a record of their wishes.
Riley said that it’s not just the elderly or people who suffer from illnesses who need to consider decisions like these.
“It should be discussed more because it’s a topic that people usually ignore,” he said. “People don’t like talking about death, but it’s a topic that’s very real.”
Because of his time at hospice, Riley said he is a staunch believer in individuals having the right to die on their own terms. A specific cancer patient who survived multiple rounds of chemotherapy and numerous surgeries whom Riley spent time with at the center solidified this conviction.
“He survived his illness but filled out an advance directive because there was a pretty good chance he could have a stroke or the cancer could come back,” Riley said.
Patients at hospice are largely aware that death is approaching. Providing comfort and pain management is a main concern to ensure that patients can die with dignity, he said.
“Spending time in a hospice center, you realize how grim it is. Seeing the misery and walking through the hallways — there’s just silence. Everyone is just dying or waiting to die,” Riley said.
Increasing options for illThere are a growing number of end-of-life care options for terminally ill patients, including hospice care. Elon junior Kaitlyn Saal-Ridpath has seen it first hand.
Her mother was diagnosed with stage four rectal cancer in 2009. Five years later, she chose to discontinue treatments.
“Everything that could go wrong did go wrong,” Saal-Ridpath said. “It finally got to the point where there were no more treatment options available.”
In May 2012, her mother chose to stop treatments altogether, and she was placed in hospice care.
For the duration of her illness, Saal-Ridpath’s mother was treated at the University of Pennsylvania. She was admitted into a program called CLAIM (Constitutional Longitudinal Advanced Illness Management), which focuses on palliative care.
“They’re all about pain management,” she said. “My mom chose that because she wanted to be at home, in her own house, with her own things and with her family.”
The program provided Saal-Ridpath’s family with a nurse who came to their house every day to manage her mother’s pain and administer medications. CLAIM also offers counseling for up to a year after a patient passes away.
“It made it easier towards the end,” Saal-Ridpath said. “When I was home for the summer, if I wanted to talk to her, I didn’t have to go anywhere. If she needed a nurse, she could call in the middle of the night, and they would come to the house.”
When her mother’s condition took a turn for the worst in Nov. 2013, Saal-Ridpath took a leave of absence from Elon. The oldest of her three siblings, she said it was important for her to be there.
“I really value that time together because it gave us time as a family in her last couple of months,” she said.
Saal-Ridpath’s mother passed away in Nov. 2013.
Delaying deathWhile the Pew study shows Americans generally support ending medical treatment when a patient is suffering instead of keeping them alive, there is little support for physician assisted suicide and euthanasia, which is prohibited by federal law under general homicide laws.
Philosophy professor Yoram Lubling takes issue with the illegality of euthanasia on philosophical grounds.
“Philosophy thinks about it differently than a politician,” he said. “There is something sinister in the U.S. about prolonging a life.”
Lubling lost his father to congestive heart failure a few months ago. After watching him suffer extensively, he said his father did not have any life to speak of. He was miserable.
“I have seen my father begging me to help him end his life,” Lubling said. “In kindness and passion, I wanted him to be able to not suffer.”
Because of his disease, Lubling’s father lost his ability to eat. His heart and kidneys failed, and he lost half of his body weight. Every month and a half, he would go to a hospital where a doctor emptied the liquid from his lungs.
But Lubling said he was rational. He knew what he was saying when he asked for his life to be over.
“If people are rational, society should allow them the freedom to make choices,” he said.
Religious lawLubling said he doesn’t foresee the political stance on euthanasia changing anytime soon. Politicians create laws based on how they feel religiously, he said, and in Judaism, Protestantism and Catholicism, suicide is a sin.
Based on the study, 47 percent of Catholics and 37 percent of Protestants believe a person has a moral right to suicide when they are ready to die or when life becomes a burden. While this number is higher in circumstances where the patient is suffering or has an incurable disease, more than one-half of religiously unaffiliated people said people do have a moral right to suicide.
Lubling said that, since America has a separation of church and state, religious views should not infiltrate the legislative system.
“With all due respect to people who have strong religious views, I feel it’s just personal,” he said. “Modern societies like America should not use religious guidelines or beliefs when creating laws.”
According to the Pew Report on Religious Affiliation, 83.1 percent of adults consider themselves religious.
“We saw how much Obama had to go through to prove that he was a Christian in the 2008 election,” Lubling said. “I can’t see it happening politically. You can’t get elected without proclaiming your faith in God.”
Lubling compares the issue of euthanasia to abortion. He said those who are pro-choice don’t force people to have abortions. But they would like their beliefs to be considered as well.
“People are free. Life belongs to them — not to the state,” he said.
Lubling said Elon is guilty of confusing knowledge with spirituality. He said the presence of religion in the lives of students often infiltrates reason and paralyzes rationality.
“Many people at Elon are very religious,” he said. “I respect their right to have whatever beliefs they want, but I’m not sure what religion has to do with knowledge.”
Lubling said he wonders what role personal faith has in the pursuit of knowledge. From his perspective, the placement of the Numen Lumen Pavilion directly across from the philosophy department is ideologically confusing for students.
“Education is about reason, logic, accountability and ending superstition. I would like to see a university committed to inquiry, not confusing our beliefs with knowledge,” he said.
A slippery slopeCatholic Campus Ministry business Manager Trung Huynh-Duc said his religious affiliation plays a substantial role in his political decisions.
“Your religious beliefs should guide how you approach certain situations,” he said. “As a Catholic, my religious views do play into my political choices. You can’t separate the way a person with religious convictions would act politically.”
Huynh-Duc said, in the Catholic faith, all human life has an inherent dignity that should be respected at all times: from fetuses in the womb to the elderly and those at the end of their lives.
But Huynh-Duc recognizes a difference between ending a life and choosing not to fight an illness.
“I think if a person is suffering, and there’s no opportunity for recovering, then ending treatments is another thing,” he said. “But there’s a difference between taking a life and ending medical treatments.”
Huynh-Duc also said legalizing euthanasia could open the door to some other issues, especially when the patient in question is not suffering from a disease.
According to the Journal of Medical Ethics, arguments for euthanasia are countered by “slippery-slope” arguments that warn about the dangers of committing genocide, similar to the Holocaust.
As a person of Jewish heritage and the son of Holocaust survivors, Lubling takes issue with this argument against euthanasia.
“As a child of Holocaust survivors, I would like people to not use the Holocaust to justify their views,” he said.
But, Huynh-Duc said, the issue of euthanasia is complex, with many a gray area. He said that respecting the person in question is paramount.
“Above all else, part of how we should act is to make sure that those who are suffering, those who are on the deathbed, are cared for and given love,” he said.
End-of-life legislationPhysician aid in dying (PAD), or assisted suicide, is legal in the states of Washington, Oregon, Montana and Vermont. Oregon passed the Death with Dignity Act in 1997, which allows terminally ill adults in Oregon to acquire prescriptions from doctors for self-administered, lethal doses of medication, according to the Oregon Division of Public Health.
Since the law was passed, in 1997, 1,173 people have received prescriptions for lethal medications. In 2013, of the 122 patients who were administered these medications, only 51.6 percent of them died from them. Others chose to see their illnesses through until the end of life came naturally.
Patterned from Oregon’s initiative, Washington passed a law that permits PAD in 2008. The Washington law requires physicians to list the underlying causes of the patient’s terminal illness as the cause of death on the death certificate, after determining if a terminally ill patient is competent and has made the request voluntarily. Since the law’s enactment in March 2009, 376 people were prescribed lethal medication, and 353 consumed and died from it.
Montana became the third state to legalize PAD in December 2009. One of the justices who ruled on the case said in a statement following the verdict, “The right to physician aid in dying quintessentially involves the inviolable right to human dignity — our most fragile right.”
Vermont is the most recent state to allow PAD in May 2013.