CALIFORNIA ELECTIONS : PROPOSITION 161 : Initiative Fuels Debate Over Morality of Euthanasia

Proposition 161, the ballot initiative that would allow the terminally ill to choose doctor-assisted suicide, has energized a growing national debate among ethicists and religious leaders over the morality of euthanasia.

Those who favor voluntary euthanasia for the terminally ill say it is an extension of individual rights--the right to choose a painless and peaceful death.

“People ought to be able to be architects of their own death,” said University of Utah philosophy professor Margaret P. Battin, who describes the choice as “a new civil right.”

But ethicists on the other side contend that legalization of active euthanasia devalues life.

University of Washington bioethicist Albert R. Jonsen fears that laws such as Proposition 161 could make it too easy to end a life without agonizing about the significance of the act.

“To put (the pro-euthanasia argument) in a harsh way, people want to be put to sleep just like we do with our beloved dog who is too old and has arthritis,” he said.

Recently, Jonsen has written that “if we abolish terminal misery from our experience, we will foolishly hide an essential measure of our humanity.”

For Cardinal Roger M. Mahony of Los Angeles, opposition to the forms of voluntary euthanasia and suicide allowed under Proposition 161 is rooted in centuries of Roman Catholic teachings as well as societal values.

“We as a human society have always through the years tried to limit the circumstances in which one person may take the life of another person,” he said. “Euthanasia in this proposition runs right in the face of the commonly held societal trend to enhance human life and not take it away.”

Mahony argued that there is a significant difference between actively taking the life of a dying patient and doing what is permitted under state law--removing life-support from a dying patient.

“From a Christian perspective, we are bound to preserve and protect our life but not bound to take extraordinary means to do that,” Mahony said.

In a letter to be read at all masses in Los Angeles, Ventura and Santa Barbara counties this weekend, Mahony called on Catholics to pray and do penance for the defeat of Proposition 161, condemning the measure as “unnecessary and dangerous.”

The Rev. John Brooke, a United Church of Christ minister, takes the opposing view, and like Mahony quoted Scripture to support his case.

“When suffering is unbearable and life intolerable, the compassionate God in whom I believe does not require life to the very last breath,” said Brooke, who has taken leave from his Belmont church to coordinate the Yes on Proposition 161 campaign in Northern California.

The two sides of the moral debate generally agree that the argument over euthanasia has shifted since 1976, when California became the first state in the nation to pass legislation permitting so-called passive euthanasia--”pulling the plug” on life-support systems that keep hopelessly ill, unconscious patients alive.

With the agreement of family or those given a patient’s power of attorney, doctors are able to shut off dialysis machines, respirators, and food and nutrition, in effect killing the patient.

Now the ethicists are debating whether these acts, which allow a patient to die, are morally different from active euthanasia--the administration of a fatal injection or deadly gas.

That is one of the questions that Californians will decide Tuesday when they vote on Proposition 161, which would make the state the first place in the world to enact a law permitting voluntary active euthanasia.

The initiative, sponsored by a Los Angeles attorney whose wife died of cancer, would allow doctors to comply with a terminal patient’s request for help in dying. Opponents say the measure lacks safeguards needed to prevent abuse, but backers say it is designed to let the terminally ill die with dignity.

Both camps point to the experience in Holland, where physician-assisted suicide and euthanasia remain illegal but are tolerated under guidelines developed over two decades by Dutch courts.

The rules generally permit Dutch physicians to perform euthanasia for patients experiencing intolerable suffering with no prospect for improvement, but only after consultation with an independent physician who has experience with the disease.

Like the California initiative, the Dutch require that a patient’s request be persistent and entirely voluntary. But unlike Proposition 161, the Dutch do not require that the patient be likely to die within six months, only that there be no prospect for improvement.

One court-sponsored study of the Netherlands’ experience found that fewer than 3% of all deaths in that country involved physician-assisted suicide or euthanasia--still a substantial 3,000 cases a year. The number is far less than earlier estimates, some of which were seven times that high.

The Dutch government has stressed that doctors are asked by patients for help in dying much more often than they provide that aid--proof that physicians in Holland do not see euthanasia as “a convenient alternative to good terminal care,” according to a brochure published by the Ministry of Welfare, Health and Cultural Affairs.

However, critics point to disturbing findings amid the statistics.

Although the Dutch court guidelines require that a patient’s request for euthanasia must be “well considered, durable and persistent,” the 1991 studies found that physicians failed to meet all the established standards in one-third of the cases.

The University of Utah’s Battin, who has visited Holland to study the system, said that many of those cases involved patients who made their feelings about euthanasia known to their doctors before becoming ill.

She conceded that there were some troubling cases in the recent findings.

But for the most part euthanasia has worked well, she said. “Many cases of euthanasia are performed at home, typically with the family present. It is understood that the physician will be there, really through the entire time, in a side room or present in the room.”

Opponents of euthanasia argue that the Dutch experience proves that once physician aid in dying is permitted it quickly runs out of control.

Doctors in the Netherlands have extended euthanasia to “to a woman who only had a disability, a quadriplegic,” said Richard Doerflinger, associate director of the National Conference of Catholic Bishops’ Secretariat for Pro-Life Activities.

With Proposition 161 on the ballot here, university bioethicists are in high demand to speak on the issue.

Dan W. Brock, director of the Center for Biomedical Ethics at Brown University, said he has given three talks on the subject in the past week. Brock said that morally there is no significant difference between active and passive voluntary euthanasia.

“While there are certainly differences between refusing life support and voluntary euthanasia, nevertheless the underlying values that provide the moral support for one also support the other,” Brock said.

Alexander Capron, co-director of the Pacific Center for Health Policy and Ethics at USC argues that there is a clear distinction.

Active euthanasia “is a statement of medical power, a clean medical solution to a problem, a statement of medical omnipotence and omniscience,” Capron said. “Withdrawal of treatment is a recognition of the limits to medicine.”

With the election just days away, Capron said he worries that Californians are making the decision without adequate reflection.

“This is one of the most significant things possibly to be on any ballot in the United States in any time,” Capron said. “It would be singular in the whole world if we did this. But I just don’t have any sense that people are thinking about this.”