It’s Time We Helped Patients Die

For three years, the husband of one of my elderly patients watched helplessly as she deteriorated. She'd burst an aneurysm and later had an astrocytoma removed from her brain. Early in the ordeal, realizing that she'd never recover from a vegetative state, he'd pleaded with me to pull her nasogastric tube.

Citing the policy of the convalescent hospital, I told him I could do it only if he got a court order.

Although most states have enacted living-will laws in the past decade, none has yet taken the next logical step - legalizing euthanasia. But I believe it's time they did. Ten years of practice in geriatrics have convinced me that a proper death is a humane death, either in your sleep or being put to sleep.

I see appropriate patients every day in the extended-care facilities at which I practice. About 50 of the 350 people under my care have already ended their biographical lives. They've reached the stage in life at which there's no more learning, communicating, or experiencing pleasure. They're now simply existing in what is left of their biological lives.

Most of these patients are the elderlydemented. A typical case is that of a woman in her 80s or 90s, who speaks only in gibberish and doesn't recognize her family. She has forgotten how to eat, so she has a feeding tube coming from her nose. She is incontinent, so she has an indwelling catheter. She can no longer walk, so she is tied into a wheelchair. She's easily agitated, so she gets daily doses of a major tranquilizer. Why shouldn't I, with the concurrence of her family and an independent medical panel, be allowed to quickly and painlessly end her suffering?

I think of another patient, a woman in her 50s, with end-stage multiple sclerosis, unable to move a muscle except for her eyeballs and her tongue. And younger patients: I have on my census a man in his early 40s, left an aphasic triplegic by a motorcycle accident when he was 19. For nearly a quarter of a century, while most of us were working, raising children, traveling, reading, and otherwise going about our lives, he's been vegetating. His biographical life ended with that crash. He can't articulate – only make sounds to convey that he's hungry or wet. If he were to become acutely ill, I would prefer not to try saving him. I'd want to let pneumonia end it for him.

Of my remaining 300 patients, there are perhaps 50 to 100 borderline functional people who are nearing the end of their biographical lives and – were euthanasia legal – would probably tell me: "I'm ready to go. My bags are packed. Help me."

Anyone who's had front-line responsibility for the elderly has been asked if there wasn't "something you can give me" to end life. Such requests are made by patients who clearly see the inevitability of their deterioration and dread having to suffer through it. For these people, there is no more pleasure, let alone joy – merely misery. They want out.

What is their fate? Chances are they'll be referred for psychiatric consultation on the grounds that they must be seriously depressed. The psychiatrist, usually decades younger than the patient, does indeed diagnose depression and recommends an antidepressant.

But if such patients lived in the Netherlands, odds are they'dget assistance in obtaining a release from

the slow dying process to which our modern technology condemns them. While euthanasia is not yet legal there, it's openly practiced. On a segment of the CBS show "60 Minutes" not long ago, I heard a Dutch anesthesiologist describe how doctors in his country help 5,000 terminal patients slip away peacefully each year. Isn't that a promisingindication of how well euthanasia would work in this country?

I realize that there are those who vigorously oppose the idea. And thereare moral issues to confront – how much suffering is too much,

the one-in-several-million chance that a person given no hope of improving will beat the odds. But it's time for society to seriously reconsider whether it is immoral to take the life of someone whose existence is nothing but irreversible suffering. Euthanasia ought to be treated the same way the abortion issue has been treated: People who believe it a sin to take a life even for merciful reasons would not be forced to do so. What I'm pleading for is that doctors and their patients at least have the choice.

Every day in my professional life, I encounter illogical, irrational, and inhumane regulations that prevent me, and those with whom I work, from doing what we know in our souls to be the right thing. Before high technology, much of this debate was irrelevant. There was little we could do, for example, when a patient arrested. And what we could do rarely worked.

But times have changed. Now we have decisions to make. It helps to understand that many of the elderly infirm have accepted the inevitability – and, indeed, the desirability– of death. We who are younger must not mistake this philosophical position for depression. We need to understand the natural acceptance of death when life has lost its meaning.

.

Glossary

Aneurysm – a sac formed by the swelling of a vein or artery

Astrocytoma – a tumor made up of nerve cells

Nasogastric – relating to a tube inserted through the nose and into the stomach

Demented- having lost normal brain function

Anesthesiologist – a medical specialist who administers anesthesia, or painkillers to people to

Undergo operations

Aphasic triplegic – a person who has lost the ability to express or comprehend language, and

Who has paralysis of three limbs

Arrested - died

Questions

a)i) Identifythe author’s central idea/thesis/major claim; and[4 marks]
ii) state twological claims that he makes to support his thesis. [6 marks]

b)The author of the passage appeals to pathos, ethos and logos. Identify one example
of each from the passage, and say whether the appeal to pathos distracts the audience from the logical issue. [8 marks]

c)Analyse Dr. Caplan’s argument in paragraph 5:
i) What type of argument is it?
ii) What is his claim?
iii) What is his support?
iv) What is his warrant?
v) Comment on the soundness of the argument[14 marks]

d)Comment on the author’s use of statistics in this essay (did he use them appropriately, or were there statistical fallacies in his argument?). Justify your answer with evidence from the passage. [6 marks]

e)How does the author attempt to establish common ground? [6 marks]

f)Comment on the overall effectiveness of the essay. [6 marks]

ANSWERS

Question 1

a)i) The author’s thesis is that it is time for euthanasia to be legalized because death
should be humane (c.f. para. 3). [4 marks]
OR
It is inhumane for a person with irreversible suffering to be kept alive against
his will.[2 marks]
ii) Some logical claims that he makes to support this thesis (any 2): [3 marks each]
1. Some patients have reached a stage at which they no longer experience
pleasure, have ceased to learn or communicate, and are simply existing (c.f.
para. 4).
2. For some patients, there is no more pleasure, let alone joy - merely
misery (c.f. para. 8).
3. Elderly patients who have nothing but irreversible suffering and who want
out, are referred to psychiatrists and treated for depression (c.f. para. 9).

b) Pathos: Para. 5 & 6
Ethos: Why shouldn’t I…be allowed to quickly and painlessly end her
suffering? (para. 5). … what we know in our souls to be the right thing
(penultimate paragraph)
Logos: Even though euthanasia is illegal in the Netherlands, there are 5000
cases each year. “Isn’t that a promising indication of how well
euthanasia would work in this country?”
[2 marks each]
The appeal to pathos does not distract the audience from the logical issue because the language was not highly emotive. It is merely a graphic description of the state of the patients to enable the audience to visualize the suffering of these patients. This helps to strengthen the writer’s logical argument that it is inhumane for these persons to be kept in their suffering. [2 marks]

c)i)Type: Deductive enthymeme [2 marks] {Deductive syllogism [1 ½ marks]}
ii) Claim: I should be able to quickly and painlessly end this patient’s suffering (with the concurrence of her family and an independent medical panel). [2 marks]
iii) Support: She is demented, can’t recognize her family, speaks in gibberish, is incontinent and easily agitated, can’t walk, and has forgotten how to eat. [2 marks].
iv) Warrant: Anyone in such a state should be put out of her misery. [2 marks].
v) This is a valid argument. A relationship can be clearly established between C (the demented woman) and B (a candidate for mercy killing) if all persons in her condition (A) are candidates for mercy killing (B)
All As are Bs
C is an A
Therefore C is a B

d)There are no statistical fallacies.The author gives us totals as well as proportions (for example, para. 4: 50 of the 350; para. 7: 50 to 100 of the remaining 300). [6 marks]

e)The writer establishes common ground by acknowledging the right of relatives and doctors to view mercy killing as sinful and to refrain from taking part in it. [6 marks]

f)Accept any reasonable answer. Students may comment on the author’s profession and the role that this played in convincing the audience of his claims. Some may comment on the language – the semantic appeal in the penultimate paragraph. “…illogical, irrational, and inhumane regulations that prevent me… from doing what we know in our souls to be the right thing”

[6 marks]

aneurysm

a sac formed by the swelling of a vein or artery

astrocytoma a tumor made up of nerve cells

nasogastric

relating to a tube inserted through the nose and into the stomach