Euthanasia: and Anthropological Perspective

The HIDDEN DIMENSION OF CULTURE

• Proponents of legalization focus on the issues of autonomy and relief from suffering of the individual. Opponents base their arguments on the sanctity of life, concerns about the "slippery slope" and the appropriate role of physicians (as those that save lives).
• The debate is conducted primarily by "experts" in social policy formation. 
• Together, these factors preclude a broader discussion of social norms and ideal and the manner in which legalization will affect social relations. 
• the social consequences of hidden expectations and obligations with respect to access to health care 
• allocation of resources 
• terminal and chronic illness 
• disability and difference 
• suffering
• the nature of death itself

QUESTION: How will our CULTURAL EXPECTATIONS change if we adopt physician assisted suicide?

• Durkheim's "altruistic suicide"
• these "voluntary" acts can be seen as acts of social conformity
• In most cases the abandonment or death was initiated by the old/infirm person, apparently to avoid becoming a burden to the group.  
• eskimo (aged)
• 19th century Sicily (aged)
• Japanese rural society (aged, warriors, shamed individuals)
• appear to increase under circumstances of scarcity
• decrease or increase according to socio-genie forces

"If suicide rates have been genuinely linked to socio-cultural expectations, what is to be gained by altering these expectations in such a way as to favor increased rates of suicide?" 

• Euthanasia from the perspective of the disabled
• proponents suggest that euthanasia is a an act of compassion for those that are in the final stages of a bearable life (assumptions):
• Euthanasia is a "good death" and that all want to end suffering
• that "death with dignity" -life with a profound disability is lacking in dignity
• Are these cultural ideas based in discrimination and stigmatization of the disabled?
• related to the encouragement of abortion for "disabled" fetuses (Down's syndrome, tay-Sacks, Sickle-cell, spina-bifida).
• Disabled consumers view medical professionals as controlling information given to terminally ill patients about future quality of life and prospects for pain and suffering 
• 
  suicide often means the removal of social burdens, including psychological, emotional and or financial burdens imposed by the chronically or terminally ill.
• The American cultural rhetoric, is changing from the language of caring to the language of efficiency and cost (dangerous?)
• independence and self-reliance are valued while dependence is stigmatized as undignified and shameful (problem for the old, disabled, dependent?) 

Seeking to address these concerns, disabled consumers focus on the following ethical and communication issues:

1. Providing severely disabled and terminally ill people with op- tions, including community-based, self-directed care.
2. Ensuring that consumers' decisions to discontinue life-pro- longing treatment or request euthanasia are durable.
3. Ensuring that consumers' decisions are made autonomously and reflect meaningful informed consent.
4. Providing continuity of care and access to universal health care, palliation and social service benefits.
5. Providing access to peer counseling by other disabled and/or terminally ill persons.
6. Developing quality of life criteria which reflect consumer preferences and avoid application of external standards of social worth to the lives of the disabled or terminally ill.