Oncologist Ezekiel Emanuel (1997) addresses the issues of physician-assisted suicide and voluntary euthanasia and explains why Americans ought to think twice before legalizing physician-assisted suicide and voluntary euthanasia. He begins by explaining the difference between the two methods. Physician-assisted suicide is when the doctor gives you the means, such as drugs, which you administer yourself. Voluntary euthanasia, however, is when the doctor actually performs the fatal procedure after the patient has confirmed his/her wish to die. (1) Following this explanation, Ezekiel uses historical references, cites court cases, scientific studies, and case studies from other countries to support his position. He also maintains that there are four myths that have been perpetuated which imply the following: 1) The issue of euthanasia and physician-assisted suicide is relatively new, born from technological advances. 2) There is strong support for physician-assisted suicide and euthanasia. 3) Patients in the most extreme pain are the most interested in physician-assisted suicide or euthanasia. 4) Euthanasia practices in the Netherlands prove that physician-assisted suicide and euthanasia will not get out of control here in America. (2-4)

Emanuel dispels these myths one by one. In response to myth #1, he quotes the Hippocratic oath, which specifically opposes euthanasia. Emanuel claims that euthanasia was often provided at the time that the Oath was written. He dates the beginnings of the euthanasia debate in America back to 1870, and presents historical facts to support his response. (2) Regarding myth #2, Emanuel blames "vague" poll questions for those which show that the majority of Americans support physician-assisted suicide and voluntary euthanasia. Research, which he cites, has shown that support for these practices does decrease when patients aren't described as terminally ill and experiencing constant, intense pain. (3) Studies in both the Netherlands and Washington state are used to refute myth #3. Both report that the minority of people who request euthanasia or physician-assisted suicide are actually requesting it due to severe, unrelenting pain. As a matter of fact, Emanuel states, "No study has ever shown that pain plays a major role in motivating patient requests" (4) Finally, he looks to the Netherlands, a country that has extensive experience with euthanasia and physician-assisted suicide, to help disprove myth #4. Emanuel cites data from two studies which show that the Dutch have violated their guidelines for euthanasia, and nothing would stop us from doing so in our own country. (5-6) It would possibly be worse here in America, due to our lack of a universal health care program. Without such a program, a Netherlands professor has claimed that euthanasia should not be permitted because violations would escalate due to financial pressure. (7) Emanuel concludes the article with warnings about what could happen if legalization occurs.

Dr. Emanuel supports a social policy that keeps these practices illegal to prevent them from becoming, "routine interventions that can be administered without the need for publicly acceptable justification," (9) but also acknowledges that there will be exceptions to the law which should be carefully reviewed on a case-by-case basis.

In a related editorial entitled "Last Rights", the author informs the reader about both sides of the debate over physician-assisted suicide and voluntary euthanasia. Like the first article, this one clearly explains the difference between the two practices, and also discusses the fact that it's a historical controversy. This author (unknown), however, does not state his opinion as Dr. Ezekiel did. Instead, he claims that no matter what, three questions must be answered in order to come to some decision: 1) Do people have the right to choose how and when they will die? 2) If so, do they also have the right to seek assistance after they've made the choice? 3.) If yes, can we draft laws that protect the sick, old, and/or handicapped but who don't want to die. ("Last Rights" 1) The author proceeds to explain arguments that have been made such as "standing or sliding" ("Last Rights" 3) For example, where are the boundaries in terms of what criterion should be used? Also, will people who are terminally ill "slide" into that criterion without having given their consent? These are a sample of the issues the author brings to the reader's attention.

This article leaves the reader with questions, and the idea that this is not a black and white issue. The author of "Last Rights" left the reader to come up with his own solution, rather than suggest a solution as Dr. Emanuel did.

It should be apparent that the legalization of physician-assisted suicide and voluntary euthanasia is not an easy decision. Personally, before I started this research, I was a proponent of these practices. Now, I have some reservations because the issue goes beyond the right to die; it has everything to do with the right to live.

First, I am concerned with the myth that implies that it's the majority of people in pain who are most likely to request one physician-assisted suicide or euthanasia. The 1991 Remmelink Report on euthanasia found that, "in only 32 percent of all cases did pain play any role in requests for euthanasia" (Emanuel 4) Another study done by Washington physicians discovered that depression, loss of dignity, and being a burden/dependent, were the main reasons for considering physician-assisted suicide or euthanasia. (Emanuel 4)

What this could mean is that there is a real possibility that a depressed patient hasn't received all available treatments yet, could possibly get better, but has given up all hope. And legally assisted suicide makes it easier to do this. Herbert Hendin, professor of psychiatry at New York Medical College describes a case study of a 30 year old man who was given a 25 percent chance of surviving acute myelocytic leukemia, with proper medical care. His fears of pain, dying, symptoms, and side effects had him think of suicide before all else. (Hendin 1) While I don't think that this is an unnatural reaction, if physician-assisted suicide and euthanasia were legalized, it would have been easy for this man to choose death over life. And because insurance companies really don't like to pay for expensive treatments, I can envision the offer to pay for drugs that kill rather than other treatment. As a matter of fact, in Oregon, the acting solicitor general, Walter Dellinger, informed the Supreme Court that certain managed-care groups have already offered to pay the costs of dying rather than the costs of long-term care. ("Last Rights 3)

For this reason, I am also worried about involuntary euthanasia occurring with children, the elderly, or the disabled. Though physician-assisted suicide and euthanasia are illegal in the Netherlands, they have been practiced there without repercussions for over 20 years. They follow guidelines, one of which is "the patient must be a mentally competent adult." (Angell 1) The 1991 Remmelink study reported, however, that "1000 of 3300 cases of euthanasia in the Netherlands involved incompetent patients" (Angell 1) Though this is a small percentage, 1000 people is a lot of people to die who weren't capable of making that decision. Also, it illustrates how easy it is to step outside of guidelines. Dr. Emanuel claims that the Dutch are much more law-abiding than we are here in America, and if they break their guidelines, what makes us think that our doctors will adhere to any that we would make. (7)

I don't really think that it's morally wrong to let people decide whether to live or die. And I really don't like to see people have to deal with extreme pain and suffering if they don't have to. I just don't think that our system would ever be healthy enough to support legalization in a fair way for everyone. I just don't trust some doctors and insurance agencies. That is why I agree with Dr. Emanuel. Keep physician-assisted suicide and voluntary euthanasia illegal, always realizing that there are exceptions to the rule.

Works Cited

Angell, Marcia, M.D. "Euthanasia in the Netherlands ­ Good News or Bad?" The New England Journal of Medicine. Vol. 335: 1676-1678. Online. 28 November 1996.<http://www.nejm.org/publicM/1996/0335/0022 /1676/1.htm>

Emanuel, Ezekiel. "Whose Right to Die?" The Atlantic Monthly. Online. March 1997.<http://www.TheAtlantic.com/issues/97mar/emanuel/ emanuel.htm>

Hendin, Herbert. "Scared to Death of Dying." American Suicide Foundation. Reprinted with permission from The New York Times OP-ED. Online. 16 December 1994. <http://www.asfnet.org/research/hendin.html>

"Last Rights." The Economist. Online. 21 June 1997. <http://www.enews .com/magazines/economist/archive/06/970621-002.html>