Anker Susan. Real Essays with Readings with 2009 MLA Update
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READINGS
Chapter 51 • Argument Casebook 857
a medical care environment that is characterized by increasing pressure
on physicians to control the cost of care.”
Oregon Is a Deeply Flawed Model
6 The California bill is modeled after a nearly identical law that went
into effect in Oregon in 1997. Assisted suicide advocates laud Oregon’s
example. But Oregon shines only if you don’t look too closely. Cali-
fornians concerned with good government have reason to be highly
skeptical.
7 Each year, Oregon publishes a statistical report that leaves out more
than it states. Several of these reports have included language such as
“We cannot determine whether assisted suicide is being practiced out-
side the framework of the law.” (In fact, the statute provides no resources
or even authority to detect such violations.) All of the information in the
report comes from doctors who prescribed the drugs, not from family
members or friends who probably have additional information about the
patients. The state doesn’t even talk to doctors who refused to assist the
very same patients, though these doctors may have viewed the patients
as not meeting legal requirements. Autopsies are not required, so there’s
no way to know if the deceased was actually terminally ill, opening the
door to another Dr. Kevorkian.
4
The state’s research has never reported
on several prominent cases inconsistent with the law — these cases came
to light only via the media. Last month, an editorial in The Oregonian
complained that the law’s reporting system “seems rigged to avoid fi nd-
ing” the answers.
8 Also disturbing, end-of-life care in Oregon has been touted as
improving because of this law, but when the full situation is taken into
account, the claim lacks data, or the improvement has been explainable
by other factors. For example, assisted-suicide advocates have lauded
the increased use of hospice
5
care in Oregon — but hospice referrals
increased dramatically across the U.S. during the same period. In July
2004, a study in the Journal of Palliative Medicine showed that dying
patients in Oregon are nearly twice as likely to experience moderate
or severe pain during the last week of life as similar Oregon patients
around the time the Oregon law came into effect, suggesting a signifi -
cant decline in care.
PAUSE: What,
according to
Golden, is troubling
about Oregon’s
reporting system?
4
Dr. Kevorkian: Dr. Jack Kevorkian, a controversial fi gure in the debate over
physician-assisted suicide. He created several devices that allowed individuals to self-
administer lethal dosages of drugs. Kevorkian, a trained physician whose license was
revoked in 1991, claimed to have participated in the suicide of some 130 people and
was convicted of second-degree murder in 1999.
5
hospice: a program or facility that provides special care for people who are near
the end of life
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858 Part Eight • Readings for Writers
9 Most troubling, the California bill and Oregon’s law legalize negli-
gence by means of the “good faith” standard, which says that no practi-
tioners of assisted suicide will be subject of any legal liability if they act
in good faith, something nearly impossible to disprove, making all other
rules unenforceable. For everything else doctors do, they are liable if
they are negligent. But on assisted suicide, even if negligent, health care
practitioners cannot be found to be violating the law, as long as they
practice in good faith.
10 There are many more reasons progressives
6
should oppose the legal-
ization of assisted suicide. We must focus not on what we hope to have
available for ourselves someday but, rather, on the signifi cant dangers of
legalizing assisted suicide in this society as it operates today. This col-
umn is sure to bring howls from those already ideologically supportive
of legalization, but those who want to look deeper, beyond the simplis-
tic mantras of choice and “right to die,” are encouraged to read other
articles and testimony that can be found in these locations:
• a longer article by this author at http://dredf.org/assisted
suicide.html
• commentary by Dr. Herbert Hendin, Medical Director of the
American Foundation for Suicide Prevention, at http://
www.psychiatrictimes.com/p040201b.html
• testimony by Dr. Gregg Hamilton, Physicians for Compassionate
Care, at http://www.pccef.org/articles/art32HouseofLords
.htm
• analysis of the fi rst six years of Oregon’s assisted suicide law by
the International Task Force on Euthanasia and Assisted Suicide
at http://internationaltaskforce.org/orrpt6.htm
6
progressives: people whose political philosophy leads them to advocate for social
justice and the rights of workers and the lower classes
SUMMARIZE AND RESPOND
In your reading journal or elsewhere, summarize the main point of “Why
Progressives Should Oppose the Legalization of Assisted Suicide.” Then,
go back and check off support for this main idea. Next, write a brief sum-
mary (three to fi ve sentences) of the selection. Finally, jot down your initial
response to the reading. What do you think of the arguments that Golden
makes here? Does anything in the essay tempt you to rethink your position
on physician-assisted suicide? What might you say to Golden about her stand
on this issue?
PAUSE: Why is
Golden critical of
the “good faith”
standard?
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Chapter 51 • Argument Casebook 859
CHECK YOUR COMPREHENSION
1. Which of the following would be the best alternative title for this essay?
a. “Conservative Opposition to Legalizing Physician-Assisted Suicide”
b. “Physician-Assisted Suicide and Managed Care”
c. “The Oregon Model of Physician-Assisted Suicide”
d. “Liberals Should Rethink Their Position on the ‘Right to Die’”
2. The main idea of this essay is that
a. the California Assembly Judiciary Committee has begun conducting
hearings on whether the state should legalize physician-assisted suicide.
b. liberals in favor of assisted suicide should rethink their position based
on its potential misuse under managed-care programs and problems
that arise under governmental oversight.
c. the Oregon model of physician-assisted suicide is deeply fl awed
because it does nothing to detect violations, it allows the only in-
formation about patients to come from the prescribing doctors, and
it protects doctors from charges of negligence by a “good-faith”
clause.
d. although insurers could not force clients to seek assisted suicide, poor
patients whose managed-care program denies them other treatment
options are being pushed in that direction.
3. Golden makes the point that when physicians are pressured to cut costs,
a. state governments should step in to make sure that patient treatment
does not suffer.
b. they are more likely to refer their patients to hospices.
c. their practice may come under scrutiny for medical negligence.
d. their willingness to participate in assisted suicide increases.
4. If you are unfamiliar with the following words, use a dictionary to check
their meanings: coalition (para. 2); bureaucracies (3); skeptical (6); autop-
sies (7); lauded, palliative (8); negligence (9); ideologically, mantras (10).
READ CRITICALLY
1. In paragraph 2, why does Golden list the groups that have come together
to oppose an assisted-suicide bill in California? What does this suggest to
you about her intended audience?
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2. Golden ends her second paragraph with a question. Why? What is the
effect of this strategy?
3. In paragraph 4, Golden notes that the author of Oregon’s assisted-suicide
law is a former HMO executive. Why does she do so? What does this
information make you think of the Oregon law? Is this a fair conclusion?
4. Why do you suppose that Golden focuses on the Oregon assisted-suicide
law in paragraphs 6–9? How does she expect readers to respond?
5. Golden ends her argument with a list of “other articles and testimony”
that oppose assisted suicide. What is her reason for doing so? Do you feel
that you should seek out these other sources? Why or why not?
WRITE AN ESSAY
Write an essay in which you assume that your audience is made up of read-
ers who share your general political views but disagree with you regarding
the specifi c issue that you are writing about. For example, if your politics
are conservative, you still might support amnesty for illegal immigrants, mar-
riage for same-sex partners, or more money for prisoner rehabilitation. Try to
convince an audience of conservatives to consider your position even if they
don’t embrace it. If your politics are liberal, you still might oppose the previ-
ously mentioned issues or another issue that liberals tend to support. Try to
convince an audience of liberals that your differing views have merit. In either
case, try to establish some common ground with your readers.
Herbert Hendin
The Case against Physician-
Assisted Suicide: For the
Right to End-of-Life Care
Born in New York City in 1926, psychiatrist Herbert Hendin received
his bachelor’s degree from Columbia University and his medical degree
from New York University. A clinical professor of psychiatry at New York
Medical College in Valhalla, New York, he was also a founding direc-
tor of the American Foundation for Suicide Prevention in 1987, serving
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Chapter 51 • Argument Casebook 861
as its fi rst president, its executive director, and its medical director. He
currently acts as director of Suicide Prevention Projects for the foun-
dation. Hendin’s research has focused on suicide, post-traumatic stress
disorder, substance abuse, and euthanasia, and his books include Black
Suicide (1967), Wounds of War: The Psychological Aftermath of Com-
bat in Vietnam (1984), Living High: Daily Marijuana Use among Adults
(1987), Suicide in America (1996), and Seduced by Death: Doctors, Pa-
tients, and the Dutch Cure (1997).
In the following essay, originally published in Psychiatric Times,
Hendin uses his access to studies of physician-assisted suicide in the
Netherlands, where it has been practiced in some form since 1984, to
make a case against its legalization elsewhere.
GUIDING QUESTION
Why does Hendin use information obtained from the Netherlands
regarding physician-assisted suicide? What does this information
contribute to his argument?
1 Euthanasia is a word coined from Greek in the seventeenth century
to refer to an easy, painless, happy death. In modern times, however, it
has come to mean a physician’s causing a patient’s death by injection of
a lethal dose of medication. In physician-assisted suicide, the physician
prescribes the lethal dose, knowing the patient intends to end his or her
life.
2 Compassion for suffering patients and respect for patient auton-
omy
1
serve as the basis for the strongest arguments in favor of legal-
izing physician-assisted suicide. Compassion, however, is no guarantee
against doing harm. A physician who does not know how to relieve a
patient’s suffering may compassionately, but inappropriately, agree to
end the patient’s life.
3 Patient autonomy is an illusion when physicians are not trained to
assess and treat patient suffering. The choice for patients then becomes
continued agony or a hastened death. Most physicians do not have such
training. We have only recently recognized the need to train general phy-
sicians in palliative
2
care, training that teaches them how to relieve the
suffering of patients with serious, life-threatening illnesses. Studies show
that the less physicians know about palliative care, the more they favor
assisted suicide or euthanasia; the more they know, the less they favor it.
4 What happens to autonomy and compassion when assisted suicide
and euthanasia are legally practiced? The Netherlands, the only country
PAUSE: Summarize
the contrast that
Hendin establishes
in this opening
paragraph.
PAUSE: Underline
the sentence in
this paragraph that
best summarizes
Hendin’s main idea.
1
autonomy: freedom to act independently and to carry out one’s own wishes
2
palliative: concerned with easing pain
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862 Part Eight • Readings for Writers
in which assisted suicide and euthanasia have had legal sanction for
two decades, provides the best laboratory to help us evaluate what they
mean in actuality. The Dutch experience served as a stimulus for an
assisted-suicide law in Oregon — the one U.S. state to sanction it.
5 I was one of a few foreign researchers who had the opportunity to
extensively study the situation in the Netherlands, discuss specifi c cases
with leading Dutch practitioners, and interview Dutch government-
sponsored euthanasia researchers about their work. We all indepen-
dently concluded that guidelines established by the Dutch for the
practice of assisted suicide and euthanasia were consistently violated
and could not be enforced. In the guidelines, a competent patient who
has unrelievable suffering makes a voluntary request to a physician. The
physician, before going forward, must consult with another physician
and must report the case to the authorities.
6 Concern over charges of abuse led the Dutch government to
undertake studies of the practice in 1990, 1995, and in 2001 in which
physicians’ anonymity
3
was protected, and they were given immunity
for anything they revealed. Violations of the guidelines then became
evident. Half of Dutch doctors feel free to suggest euthanasia to their
patients, which compromises the voluntariness of the process. Fifty per-
cent of cases were not reported, which made regulation impossible. The
most alarming concern has been the documentation of several thousand
cases a year in which patients who have not given their consent have
their lives ended by physicians. A quarter of physicians stated that they
“terminated the lives of patients without an explicit request” from the
patient. Another third of the physicians could conceive of doing so.
7 An illustration of a case presented to me as requiring euthanasia
without consent involved a Dutch nun who was dying painfully of can-
cer. Her physician felt her religion prevented her from agreeing to eu-
thanasia so he felt both justifi ed and compassionate in ending her life
without telling her he was doing so. Practicing assisted suicide and eu-
thanasia appears to encourage physicians to think they know best who
should live and who should die, an attitude that leads them to make
such decisions without consulting patients — a practice that has no legal
sanction in the Netherlands or anywhere else.
8 Compassion is not always involved. In one documented case, a
patient with disseminated
4
breast cancer who had rejected the possibil-
ity of euthanasia had her life ended because, in the physician’s words:
“It could have taken another week before she died. I just needed this
bed.”
PAUSE: Based on
this paragraph,
what do you
predict Hendin
will discuss in the
paragraphs that
follow?
PAUSE: How do
you respond to
the behavior of
the physician that
Hendin describes in
paragraph 7?
3
anonymity: a state of not being identifi ed by name
4
disseminated: spread widely
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Chapter 51 • Argument Casebook 863
9 The government-sanctioned studies suggest an erosion of medi-
cal standards in the care of terminally ill patients in the Netherlands
when 50% of Dutch cases of assisted suicide and euthanasia are not re-
ported, more than 50% of Dutch doctors feel free to suggest euthanasia
to their patients, and 25% admit to ending patients’ lives without their
consent.
10 Euthanasia, intended originally for the exceptional case, became
an accepted way of dealing with serious or terminal illness in the
Netherlands. In the process, palliative care became one of the casual-
ties, while hospice
5
care has lagged behind that of other countries. In
testimony given before the British House of Lords, Zbigniew Zylicz, one
of the few palliative care experts in the Netherlands, attributed Dutch
defi ciencies in palliative care to the easier alternative of euthanasia.
11 The World Health Organization has recommended that govern-
ments not consider assisted suicide and euthanasia until they have dem-
onstrated the availability and practice of palliative care for their citizens.
All states and all countries have a long way to go to achieve this goal.
12 People are only beginning to learn that, with well-trained doctors
and nurses and good end-of-life care, it is possible to avoid the pain of
the past experiences of many of their loved ones and to achieve a good
death. The right to such care is the right that patients should demand
and the challenge that every country needs to meet.
5
hospice: a program or facility that provides special care for people who are near
the end of life
SUMMARIZE AND RESPOND
In your reading journal or elsewhere, summarize the main point of “The Case
against Physician-Assisted Suicide: For the Right to End-of-Life Care.” Then,
go back and check off support for this main idea. Next, write a brief summary
(three to fi ve sentences) of the essay. Finally, jot down your initial response to
the selection. Were you surprised by the information given on assisted-suicide
practices in the Netherlands? Do you agree with Hendin that these studies
make a strong case against legalizing assisted suicide? Why or why not?
CHECK YOUR COMPREHENSION
1. Which of the following would be the best alternative title for this essay?
a. “Physician-Assisted Suicide: A Lack of Compassion”
b. “Guidelines to Be Followed in Cases of Physician-Assisted Suicide:
An Overview”
PAUSE: Summarize
Hendin’s point
about palliative
care in this
paragraph.
PAUSE: What
would you say
a “good death”
(para. 12) means to
Hendin?
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864 Part Eight • Readings for Writers
c. “Physician-Assisted Suicide for Exceptional Cases Only”
d. “The Potential for Abuse in Physician-Assisted Suicide and the Need
for Greater Palliative Care”
2. The main idea of this essay is that
a. physician-assisted suicide is acceptable only when a patient’s suf-
fering cannot be eased and the patient requests the prescription
voluntarily.
b. rather than legalizing assisted suicide, the United States should work
toward better end-of-life care for all patients.
c. most physicians lack compassion for their patients when it comes to
assisted suicide.
d. the Dutch government’s concern over potential abuses of that country’s
assisted-suicide laws led it to commission studies that allowed physi-
cians to respond anonymously and without threat of punishment.
3. The Dutch government studied physician abuse of assisted-suicide laws
and did not fi nd that
a. many physicians performed assisted suicide only when they could
remain anonymous.
b. physicians suggested assisted suicide to patients who had not brought
the subject up themselves.
c. a large number of physicians did not report cases of assisted suicide
to authorities.
d. some physicians felt that they could decide when patients should end
their lives, whether out of compassion or because it was convenient.
4. If you are unfamiliar with the following words, use a dictionary to check
their meanings: sanction (para. 4); immunity (6); erosion (9); casualties,
defi ciencies (10).
READ CRITICALLY
1. In his opening paragraph, why does Hendin contrast the original def-
inition of euthanasia with how the word is currently used? How does this
original defi nition tie into the larger point Hendin is making?
2. What is Hendin’s strategy in paragraph 3? Do you fi nd it is effective in
terms of his overall argument?
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Chapter 51 • Argument Casebook 865
3. How does Hendin establish his authority to make his particular case
against physician-assisted suicide? Do you fi nd his authority believable?
4. In paragraph 8, Hendin refers to a case in which a physician performed
assisted suicide without a patient’s consent and primarily for the doctor’s
convenience, not to relieve the patient’s suffering. Do you fi nd this example
suffi cient for the point Hendin is trying to make? Why or why not?
5. In his next-to-last paragraph, Hendin summarizes recommendations that
were made by the World Health Organization. Why does he do so? Do
you think that this passage serves its intended purpose?
WRITE AN ESSAY
Write an essay that argues for a position on one side of a debatable issue to
which you can bring personal expertise and authority. Like Hendin, you should
have knowledge of the topic that most of your audience will not have, either
because you have learned things through research that others are not familiar
with or because you have had life experiences that relatively few other people
have shared. In your essay, be sure to establish your authority on the subject.
Write an Essay against Legalized
Physician-Assisted Suicide
Read the essays by Golden and Hendin that argue against legalized physi-
cian-assisted suicide. Drawing from both essays, write your own argument
against physician-assisted suicide. You may use your own experiences in
your argument as well as outside sources. When you use material from
the essays here or from another source, be sure to cite the source. (For
information on citing sources, see Chapter 21.)
Your introduction should include a statement of your position on the
issue. In the body of your essay, develop reasons for your opinion, using
the essays and other sources. In your conclusion, summarize your reasons,
and restate your opinion based on the evidence you have presented.
Write an Essay: What Do You Think?
Using material from at least four of the fi ve essays in this chapter, write an
essay either for or against legalized physician-assisted suicide.
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866 Part Eight • Readings for Writers
In your introduction, state your position on the issue. In the body
of your essay, acknowledge the opposite side of the issue — either pro
(Huttmann, Siegel, and Fensterman) or con (Golden and Hendin). Use
the appropriate selections to support your position, along with any relevant
experiences you have had and outside sources you use. Cite all sources.
(For information on citing sources, see Chapter 21.) In your conclusion,
restate your position, review the reasons you have given, and make a last
pitch for your side of the argument. As you write your argument, imagine
that someone you love will be directly affected by the issue.
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