Professor Gabriela Rios
19 November 2012
Euthanasia: Ethically Analyzing the Stakeholders
“Performing a stakeholder analysis during the planning stage can greatly influence the development of an effective project strategy.” When discussing a topic as heated as Euthanasia, it all comes down to identifying and involving the right stakeholders in the appropriate ways, so that the focus remains on the people that affect or can affect the achievement of the project’s goals (influenzatraining.org). Because of Euthanasia’s overwhelming controversy, taking stakeholder’s needs and concerns into account by rhetorically listening is crucial to solving the problem ethically and efficiently. I’ve identified some of the stakeholders in the debate as Doctors, Politicians, the Public (religious, dismissive and supportive), the families of those who are in hospice care, and the small percentage of potential Euthanasia users themselves.
For my field research, I wanted to share the viewpoint of the stakeholder with the most at stake, and from which the whole issue truly surrounds… the potential Euthanasia user and family. This could be anyone from the severely disabled to those with fatal diseases. Although they are the smallest stakeholder, they have the most interest because this issue directly affects them. I chose a person who has been active in changing the law to allow assisted-suicide without penalty or charge of murder. “Tony Nicklinson, 58, from Melksham, Wiltshire, communicates by blinking and has described his life as a “living nightmare” since a stroke in 2005.” He has locked-in syndrome, which immobilizes him from the neck down. His paralysis is so severe that he would have to be killed by someone else, by euthanasia. BBC News conducted a 12 minute interview which can be found on YouTube. I have transcribed important questions below.
In terms of the change in law that you are campaigning for, what is it specifically that you want?
Wife: We want mercy killing to be different from straightforward murder. There needs to be some sort of system in place that allows Tony to take his own life. It shouldn’t be easy, there are people that need protecting, but it should be possible.
Tony: People may not like my decision, but I should be allowed to make it
If there is any change in the law, then some people with disabilities could be coerced into dying when they don’t want to. What would you say about that?
Tony: It’s called voluntary for a reason
But some people say those with long-term conditions that would kill them would feel pressured into taking their own life because they don’t want to be a burden on their family.
Wife: We understand that there are those that are vulnerable, that they do need to be protected, but at the moment, they are being protected at Tony’s expense. There should be a system in place where those people that need to be protected are protected, but if this is what people really do want then that should be possible.
Tony is there anything in this life, you think worth living for?
Tony: In general, no. obviously I love my wife and children and it will be very difficult when it’s time to say goodbye but that would apply whenever I die. Sadly, they are not to stop me wanting to die. Fortunately, they understand how I feel and support me and what I’m trying to do. I appreciate the support I have from my friends but again they are not enough to make me want to prolong my miserable life. Nothing would make me happier than to see the girls get married and have children of their own but I don’t want to see it like this. I am not an advocate of life at any cost, because the quality of life is important to me and this life doesn’t have any quality. When you have had what I had it’s very difficult to except something less.
What do you say to people, who cannot understand anyone wanting to end their own life?
A very difficult question. The most obvious reason to use is that most people who ask this question are perfectly normal and haven’t experienced life from my perspective. However some people are handicapped themselves, although rarely as severely as me, have some notion of what it’s like to be me. In the end it is about personal choice and whether one is prepared to live twenty odd years like this. Actually it’s not your decision; it’s the states, because the state has decided on our behalf to make it a crime rendering help to those who need it (Tony Nicklinson BBC News Part 2).
As you can see, even though the issue surrounds Tony Nicklinson and he is the one campaigning hardest for his right to self-determination, he has very little power in the Euthanasia debate. He even tells us in the last statement “It’s not your decision; it’s the states.” The interviewer bring up some valid concerns for other disabled patients, but Tony suggests have strong safeguards while pleading for at least the euthanasia option. Despite advocating for a change in the law to allow euthanasia for his unique circumstances, the court denied his request on the basis of greater repercussions. He literally has everything at stake in the debate because the courts decisions do “affect a life.” Tony has considerable power taking the matter into his own hands, but his individual power is miniscule compared to that of the courts, organizations, and even doctors.
Despite considerable public interest, I’ve found that little is definitive when it comes to opinions of physicians on this matter. While doctors do have a strong influence on patients, their families, and politicians, they are understandably wishy-washy about choosing an actual side in the Euthanasia debate. The New England Jounral of Medicine conducted a survey among thousands of doctors from Washington. A slight majority favored the legalization of euthanasia, but only a minority of physicians expressed a willingness to participate in assisted suicide or euthanasia or believed these practices to be ethical. Since Doctors would be the ones administering euthanasia, that is a powerful point. However, “Despite the lack of consensus on these issues, a substantial number of physicians believe that currently available treatments may be inadequate to eliminate pain and suffering for terminally ill patients (nejm.org).” So far it seems like physicians are growing more towards Assisted-Suicide more than anything. However, organizations such as Physicians for Compassionate Care have a pledge on their website “to do no harm.” They believe “physicians are to use all knowledge, skills and compassion in caring for and supporting the patient. Medicine and physicians are not to intentionally cause death (pccef.org).” Justin Hall says voluntary euthanasia does not violate this code. “If the most good a doctor can do in a situation–if the most viable means of eliminating suffering–is to end the patient’s life prematurely, then they should have no qualms about granting a person’s last wish. By ending a patient’s life before protracted pain sets in, doctors are doing everyone, including the patient’s family, a favor (choate.edu).” When trying to examine these almost evenly split viewpoints, I believe that the physicians code of ethics conflict with the individual results. It can restrict the doctor from the idea completely, eliminating the discussion and ignoring the problem. Until doctors become less polarized in their views, not as much power will be at hand; but their influence and experience with the patients first-hand makes them crucial to the debate.
Another Stakeholder, with a clear opposition, can be represented by the Disability Rights Education and Defense Fund. The DREDF is a policy center that works for the advancement of laws that further civil disability rights. Many disability organizations share the same views that the legalization of euthanasia would unwittingly “restrict choice and self-determination (DREDF.org).” As an organization, they have a strong interest in protecting and informing the disabled and also have a very strong influence. For example, in 2008 the DREDF contacted Californian governor Arnold Schwarzenegger to veto AB 2747, a bill “Based on a dubiously established non-problem, would treat any Californian with a diagnosis (or misdiagnosis) of terminal illness as if they are imminently facing death, and would constrain the communications of doctors and other healthcare providers to their patients in a death-focused direction upon receipt of a terminal diagnosis (DREDF.org).” The power of the organization is one of the strongest stakeholders, as the bill never passed, however they use some pretty powerful “overcharged” words as well. Examining their complaints, the number one objection that resonates throughout is that the safeguards put in place are not enough, and that euthanasia cannot be limited to a small, targeted group once it is in public policy. Based on other countries and court guidelines, the assumption that Euthanasia will be abused is a common wrong assumption, although there are people that need to be protected, as Tony Nicklinson’s Wife admitted. The DREDF states, that if made into public policy, “The degradation of quality in end-of-life care would ensue, and will be based on fear and depression rather than treating these diagnoses” (DREDF Assisted Suicide). However, looking at cases such as the Terri Schiavo Case, removing the feeding tube and letting nature take its course is more inhumane in my opinion (Vlad, Perju). As every stakeholder has mentioned so far, I believe that if there are specific guidelines in place that make Euthanasia extremely difficult to obtain, but still have the ability to have that option, it would be a progressive step.
At the top of the spectrum of power are the courts and policy-makers. While many stakeholders can have a strong influence, the politicians and courts ultimately hold the most power in their ability to actually change the law. As you can tell, euthanasia is still not legalized, but there is a steady increase in interest as more cases come up. As Stephen Orlando says, “Under the 14th Amendment, States are prohibited from creating or enforcing laws that deprive individuals of life, liberty or property without due process of law (digitalcommons.org).” It’s true that the state’s interest in protecting and preserving life could hinder the possibility of legalization at first glance. Looking at U.S. case history it’s found that no case has disputed the conclusion of Gregg v. Georgia: that the death penalty is not unconstitutional. Orlando notes that it is indeed peculiar that death is permitted for the sake of punishment, but not for the sake of mercy. Again, the main concern of almost all stakeholders is the possible misuse of euthanasia. If the Government “death penalty has been in effect for hundreds of years, and still follows such intensely monitored guidelines, it would seem that fears of a slippery slope argument about legalizing active euthanasia are unfounded.”
In a topic this controversial, addressing the stakeholders is the best way to address ethics. Even though certain stakeholders such as the advocates and even Doctors have the least power in this analysis, they are the most important ones. They can influence the policy-makers who have the most power, and in turn the courts influence the public with their decisions. Hopefully organizations such as the DREDF and religious institutions will re-label euthanasia as a humane way of relieving pain and suffering, instead of labeling doctors as “from healer to executioner”. Everything is at stake for the potential users. Just imagine “If your grandmother had stage-four cancer and was going to die in the next month, would you want her to suffer for her remaining time on Earth? Would you like to see her organs fail, one by one, until she cannot hold on any longer (choate.edu)?” The ethics behind letting grandma go early, or letting her be tortured can be justified. Doctor abuse of power and mass-killing is not. All the stakeholders would be willing to compromise if strong safeguards were put in place and I agree with the New England journal of medicine’s proposal. Safeguards could include “the restriction of such suicides to mentally competent, terminally ill patients with a poor quality of life; the required exhaustion of all other reasonable treatment options; and the requirement that there be an established relationship between physician and patient (nejm.org).” As Dr. Barrazo said, “A mature society should aim at respecting the decisions of its members about when and how to die.”
Cohen, Johnathan S. “The New England Journal of Medicine.” Attitudes toward Assisted Suicide and Euthanasia among Physicians in Washington State â NEJM. New England Journal of Medicine, 24 July 1994. Web. 20 Nov. 2012. <http://www.nejm.org/doi/full/10.1056/NEJM199407143310206>.
One of the most helpful sources, helped clarify the position and polls surrounding physician thoughts on Euthanasia. Provided an analysis of solutions including stronger safeguards which I used in the conclusion.
Hall, Justin. Choosing Death: The Legalization of Voluntary Euthanasia. The News, 20 May 2011. Web. 18 Nov. 2012. <http://thenews.choate.edu/index.php?option=com_content>.
Justin provided some good personal opinions backed up with fact. He helped summarize the history of legalization of Euthanasia, and compared the death penalty v. euthanasia.
“DREDF Assisted Suicide.” DREDF | Assisted Suicide. N.p., 3 Sept. 2012. Web. 20 Oct. 2012. <http://dredf.org/assisted_suicide/>.
The DREDF is a stakeholder with power and interest, but in opposition to the legalization of Euthanasia. They bring up some valid concerns that many individuals could have, and I use those points to analyze and listen for a common ground.
Orlando, Stephen, “An Argument for the Legalization of Active Euthanasia” (2010). Annual Celebration of Student Scholarship and Creativity. Paper 1.
This very detailed paper went hand-in-hand with Justin Hall’s summary description of policy-makers toward euthanasia. This source explored the 14th amendment and examined both many cases for and against the legalization.
Stanley, Joyce. “Stakeholder Analysis.” Influenzatraining.org. CDC, n.d. Web. 12 Nov. 2012. <http://influenzatraining.org/documents/s18763en/s18763en.pdf>.
This source was not a stakeholder, but used in helping to define and organize my stakeholders. Used in the introduction and also used as guidance for the creation of the Visual Stakeholder Relationship map.
Tony Nicklinson (Locked-in Syndrome)BBC News Part2. Prod. Laurennicklinson. YouTube. YouTube, 14 Feb. 2011. Web. 16 Nov. 2012. <https://www.youtube.com/watch?v=sx7vZvukhxw>.
For my field research, I transcribed this interview of a stakeholder by the BBC. It is about Tony Nicklinson, an advocate for euthanasia for himself and others. The video also gives a glimpse into his life like no other, illustrating the complexity of communicating one letter at a time, using eye motions.
Vlad, Perju, and Daflon B. Paulo. “End of Life Issues.” (n.d.): n. pag. End-of-Life Issues: Terri Schiavo Deserved to Die with More Dignity. San Francisco Chronicle, Apr. 2005. Web. 20 Oct. 2012. <http://www.wcfia.harvard.edu/node/3134>.
Two doctors quoted throughout, advocating for euthanasia based off unfortunate events surround Terri Schiavo Case.
“Welcome to Our Site!” Physicians for Compassionate Care Education Foundation. N.p., n.d. Web. 18 Nov. 2012. <http://www.pccef.org/>.
Another organization focused on physician care and taking the pledge to do no harm. Followed sanctity of life principles and provided insight into the code that doctors subliminally refer to when asked about end-of-life issues.