What's Wrong With Involuntary Euthanasia?

by David N. O'Steen, Ph.D., and Burke J. Balch, J.D.

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A massive push is now underway to ensure that many people with a supposed poor "quality of life" -- not only people with disabilities that are congenital, but also with disabilities caused by illness or injury -- are "allowed" to die against their will.

This campaign for involuntary euthanasia demonstrates that pro-lifers were correct when we said that euthanasia proponents would never stop at "voluntary" euthanasia.

For many years euthanasia advocates, for public consumption at least, have marched under the banner of "autonomy" and "respect for family decisions." They pushed for living will laws, and later for durable power of attorney laws, that would enable people to say they didn't want life-saving treatment or to authorize others to refuse it if the authors should become incompetent. Any opposition to these measures was dismissed as an effort to "impose morality" on the free choice of patients to decide for themselves.

At the same time, euthanasia advocates masked their true intentions by appealing to the sanctity of the family. If a patient had left no word about whether she wanted her life preserved, they argued, the decision should be made exclusively by her nearest and dearest -- her family. They inveighed against any governmental "interference" through the courts or even those agencies established to protect the rights of vulnerable people.

Now, having "succeeded" in achieving widespread legalization and acceptance of both of these positions, euthanasia proponents are dramatically changing their rhetoric.

As the pro-life movement has warned all along, the true motive of many leaders of the euthanasia movement is to eliminate those with a poor "quality of life." Individual rights, autonomy, and deference to farnilies were all convenient slogans with which they successfully assaulted what twenty-five years ago was the prevailing ethic of respect for all life.

Today, however, the culture has changed, so that the quality of life ethic arguably has become predominant. And in this context, euthanasia advocates are now discarding the principles of individual and family autonomy they once so extolled. For them, there is no room for respect for the autonomy of those who want to live.

We used to hear denounciations of the "paternalism" of doctors who, citing the Hippocratic Oath, expressed reluctance to starve their patients at their family's request. Now, some of those who used to be most vociferous in attacking physician paternalism argue that patients and families have no right to obtain lifesaving treatment whenever doctors believe the life it will preserve lacks adequate "quality."

We in the pro-life movement must now educate ourselves to take part in a great debate about whether people who want to live should be allowed to live. What are the facts and the arguments?

Q: What Is the Evidence That Doctors Are Really Denying Treatment So People Die Against Their Will?
A: Even a cursory look at the medical literature reveals that a rising number of health care providers are insisting that when they believe a patient's life is not worth living because of the person's disabilities or poor "quality of life," this means they should be able to deny lifesaving treatment, even if the patient and patient's family disagree:

A nursing home study reported in the March 1991 New England Journal of Medicine found that 25 percent of the time advance directives were not followed by the nursing home and medical staff. (An "advance directive," such as a Will to Live, contains instructions about medical treatment left by patients to guide health care decisions in which they are no longer able to participate.) The popular myth is that patients are "overtreated." But this study found that in 18 percent of the cases the patients were denied treatment they had requested, compared to only 7 percent of cases in which treatment they had rejected was provided.

In September 1990, the Journal of the American Medical Association published an article arguing that when family members who direct that their relative bc resuscitated have "views about suffering and quality of life [that] differ substantially from those of most reasonable people ... then physicians should not be forced ... to adhere to family preference."

In December l990, the Society of Critical Care Medicine issued a "consensus report" asserting that health care providers have the right to refuse therapy requested by a patient if they think it "burdensome." This includes treatment for which they think "loss of function [is] ... disproportionate to benefit" -- even though the patient whom they are sentencing to death thinks the "benefit" of continued life is worth the "loss of function."

In January l99l a Minnesota hospital went to court to try to cut off medical treatment for Helga Wanglie, an 87-year-old patient with brain damage. Prior to her incapacity, she had many times made it clear that she would want lifesaving medical treatment, food, and fluids if she became disabled. Her family unanimously supported her. The hospital eventually lost the court battle. But numerous doctors and ethicists writing about the case made clear it was only a pioneering first attempt to establish the principle that doctors can deny treatment against the paticnt's wishes when they consider the patient's quality of life to be too poor. Indeed, similar cases have reached the courts of Georgia, Massachusetts, and New Jersey.

Dr. Donald Murphy of George Washington University Medical Center believes "lucid individuals probably cannot anticipate what aggressive measures they would want for themselves should they become demented." Therefore, he argued in the October 1988 Journal of the American Medical Association, we "should allow the health care team to make a unilateral decision to withhold CPR [cardio-pulmonary resuscitation] from severely demented patients. " The reason? Their "poor quality of life."

Q: How Can You Force a Doctor to a Give Treatment He or She Thinks Is Medically Inappropnate?
A: There is a world of difference between a legitimate medical judgment about whether a treatment can save a life and a non-medical value judgment that a life should not be saved.
The proper role of a physician includes diagnosis, making judgments about the probable effect of providing alternative medical treatments, and administering medical treatment It does not include judging that a life that can be preserved is not worth preserving, overriding the opinion of the person whose life it is.
Q: What About Doctors Who Believe It Is Unethical to Treat Patients With a Poor Quality of Life? Should They Be Forced to Treat Against Their Conscience?
A: Most living will and durable power of attorney laws currently allow doctors unwilling to abide by patient directives to transfer care to another doctor. This was the solution euthanasia advocates successfully argued should apply to doctors who, for example, feel morally obliged to give food and fluids a patient or surrogate rejects.
Why shouldn't the same approach be followed when the situation is the other way around? All a doctor whose "ethics" forbid preserving the life of a person with a disability has to do is preserve the status quo by maintaining lifesaving treatment until the transfer is completed.
Any doctor who enters into a physician-patient relationship assumes certain duties, which are enforced by medical malpractice suits. Among them is a duty to give adequate medical care, and not to abandon the patient. Providing treatment or food and fluids until the transfer is completed seems a small imposition when the patient's very life is at stake.

Posted 6 Sep 2000.

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Copyright 1995 by David O'Steen and Burke Balch
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Q:	What Is the Evidence That Doctors Are Really Denying Treatment So People Die Against Their Will?
A:	Even a cursory look at the medical literature reveals that a rising number of health care providers are insisting that when they believe a patient's life is not worth living because of the person's disabilities or poor "quality of life," this means they should be able to deny lifesaving treatment, even if the patient and patient's family disagree: A nursing home study reported in the March 1991 New England Journal of Medicine found that 25 percent of the time advance directives were not followed by the nursing home and medical staff. (An "advance directive," such as a Will to Live, contains instructions about medical treatment left by patients to guide health care decisions in which they are no longer able to participate.) The popular myth is that patients are "overtreated." But this study found that in 18 percent of the cases the patients were denied treatment they had requested, compared to only 7 percent of cases in which treatment they had rejected was provided. In September 1990, the Journal of the American Medical Association published an article arguing that when family members who direct that their relative bc resuscitated have "views about suffering and quality of life [that] differ substantially from those of most reasonable people ... then physicians should not be forced ... to adhere to family preference." In December l990, the Society of Critical Care Medicine issued a "consensus report" asserting that health care providers have the right to refuse therapy requested by a patient if they think it "burdensome." This includes treatment for which they think "loss of function [is] ... disproportionate to benefit" -- even though the patient whom they are sentencing to death thinks the "benefit" of continued life is worth the "loss of function." In January l99l a Minnesota hospital went to court to try to cut off medical treatment for Helga Wanglie, an 87-year-old patient with brain damage. Prior to her incapacity, she had many times made it clear that she would want lifesaving medical treatment, food, and fluids if she became disabled. Her family unanimously supported her. The hospital eventually lost the court battle. But numerous doctors and ethicists writing about the case made clear it was only a pioneering first attempt to establish the principle that doctors can deny treatment against the paticnt's wishes when they consider the patient's quality of life to be too poor. Indeed, similar cases have reached the courts of Georgia, Massachusetts, and New Jersey. Dr. Donald Murphy of George Washington University Medical Center believes "lucid individuals probably cannot anticipate what aggressive measures they would want for themselves should they become demented." Therefore, he argued in the October 1988 Journal of the American Medical Association, we "should allow the health care team to make a unilateral decision to withhold CPR [cardio-pulmonary resuscitation] from severely demented patients. " The reason? Their "poor quality of life."
Q:	How Can You Force a Doctor to a Give Treatment He or She Thinks Is Medically Inappropnate?
A:	There is a world of difference between a legitimate medical judgment about whether a treatment can save a life and a non-medical value judgment that a life should not be saved. The proper role of a physician includes diagnosis, making judgments about the probable effect of providing alternative medical treatments, and administering medical treatment It does not include judging that a life that can be preserved is not worth preserving, overriding the opinion of the person whose life it is.
Q:	What About Doctors Who Believe It Is Unethical to Treat Patients With a Poor Quality of Life? Should They Be Forced to Treat Against Their Conscience?
A:	Most living will and durable power of attorney laws currently allow doctors unwilling to abide by patient directives to transfer care to another doctor. This was the solution euthanasia advocates successfully argued should apply to doctors who, for example, feel morally obliged to give food and fluids a patient or surrogate rejects. Why shouldn't the same approach be followed when the situation is the other way around? All a doctor whose "ethics" forbid preserving the life of a person with a disability has to do is preserve the status quo by maintaining lifesaving treatment until the transfer is completed. Any doctor who enters into a physician-patient relationship assumes certain duties, which are enforced by medical malpractice suits. Among them is a duty to give adequate medical care, and not to abandon the patient. Providing treatment or food and fluids until the transfer is completed seems a small imposition when the patient's very life is at stake.