A few generations ago most people whose death occurred at the end of an illness died at home. Nowadays, 80 percent of people who die following a chronic or terminal illness die in a hospital or nursing home. Institutionalized dying is inevitably accompanied by the apparatuses of technology. The availability of tubes, machines, monitors, and catheters that can be employed to work wonders but, to very sick and dying people, may be perceived
as troublesome nuisances, has also contributed to the euthanasia debate. Although people do not actually face the either-or choice between a technologically burdened dying or “self-deliverance,” a popular misconception is developing that such is the case. It is not surprising, then, in view of this misconception, that there is growing support for euthanasia as a means for avoiding futile, bothersome technology.
Another factor that is contributing to the acceptability of euthanasia is the reality of the dreadfully diminished capacities of people who suffer from such afflictions as AIDS, some forms of cancer, and other debilitating diseases. Both AIDS and cancer can be treated with a vast assortment of medications and other therapeutic interventions, bringing many good days to those who suffer from them. At the end, however, people afflicted by these diseases tend to be very sick, frail, and in pain.
In such circumstances, the issue of fast-forwarding the dying process arises quite predictably, with an increasing inclination to intervene to accomplish this goal. The twentieth century has witnessed the disappearance of one taboo after another. In the past there were things which could not be spoken of, forms of personal appearance which were unacceptable, social and personal relationships which could not be entered into. It seems almost cliche to say that all this has been changed and that there is much more personal freedom and openness today than there was in the past.
In this culture, then, it is not surprising that the widely held and deeply rooted biblical taboo, “Thou shalt not kill,” is losing some of its force for those who believe chronically or terminally ill people should be able to choose to end life’s final phase “with dignity. ” Modern society is secularized and many aspects of life are carried out without regard for a transcendent dimension. In other words, many people acknowledge no connection with a divine higher power so that no obligations to such a power are accepted.
The phenomenon of secularization sets men and women free to act in accordance with their own subjective reason and to choose to live and to die as they choose. To the factors just enumerated I need to add the impact of vocal spokespersons and interest groups whose messages are delivered by the media and who never tire of promoting their pro-euthanasia views. These include Michigan’s Jack Kevorkian, the so-called “Dr. Death” who makes house calls to assist in dying, and Derek Humphrey, President of the Hemlock Society and author of a suicide manual entitled Final Exit.
Recent efforts to legalize physician-assisted suicide, or physician aid in dying, in California and Washington, have also served to make people aware of euthanasia as a possibly acceptable practice. Since 1998 there has been one state in the United States in which it is legal for physicians to prescribe medication to terminally ill patients who choose to end their lives. The Oregon Death with Dignity Act was approved by voters in a 1994 referendum. In November 1997 a second referendum gave voters an opportunity to rescind their decision but, instead, they reaffirmed it.
Following the 1997 vote, the U. S. Drug Enforcement Agency sought to make implementation of the act impossible by threatening sanctions against physicians who prescribe drugs for the purpose of causing a patient’s death. The DEA reasoned that such prescriptions would not constitute legitimate medical use and would violate the federal Controlled Substances Act. On June 6, 1998, Attorney General Janet Reno overruled the DEA, leaving open the option for physician assistance in suicide in Oregon (Lewis, 1998).