Pergarnon Sm. Sri. Med. Vol. 40, No. 12, pp. 1671-1681, 1995
Copyright Q 1995 Elsevier Science Ltd Printed in Great Britain. All tights reserved
EUTHANASIA: AMERICAN ATTITUDES TOWARD THE PHYSICIANS ROLE
DAVID P. CADDELL, and RAE R. NEWTON Department of Sociology, Seattle Pacific University, Seattle, WA 98 I 19, U.S.A. and 2Department of Sociology, California State University, Fullerton, CA 92634, U.S.A.
Abstract-This is a study of American public opinion toward euthanasia and the physicians role in performing it. The authors examine how these attributes are affected by religious affiliation, religious self-perception, political self-perception and education. The data include 8384 American respondents from years 1977, 1978, 1982, 1985 and 1988 of the General Social Survey conducted by the National Opinion Research Center. The findings suggest that highly educated, politically liberal respondents with a less religious self-perception are most likely to accept active euthanasia or suicide in the case of a terminally ill patient. The data also show that Americans tend to draw a distinction between the suicide of a terminally ill patient and active euthanasia under the care of a physician, preferring to have the physician perform this role in the dying process. The tendency to see a distinction between active euthanasia and suicide was clearly affected by religious affiliation and education.
Key words--euthanasia, death and dying, professional codes of ethics
INTRODUCTION THE SOCIAL CONTEXT OF EUTHANASIA
Historically, medicine and other spheres of social life have been closely related. In preliterate cultures, the holy person and healer were often one and the same [ 11. Technology, however, has largely differentiated the task of healing into its own separate sphere. This distinction raises many questions regarding the relationship between religious beliefs, political ideol- ogy and education and modern medical issues. One such issue is the question of merciful care for terminally ill patients experiencing severe pain during their last days. This study examines the relationship between these spheres of social life and attitudes of Americans toward the role of the physician in performing euthanasia at the request of the terminally ill.
Perhaps the most familiar name in the current euthanasia debate is Dr Jack Kavorkian. He has assisted several terminally ill patients to commit suicide using an apparatus he designed to allow them to die painlessly. After one incident, murder charges were filed [lo] and subsequently dropped [ 1 l] because there were no clear legal guidelines regarding euthanasia. Kavorkians license to practice medicine in Michigan was suspended after he assisted in the deaths of two more patients, violating a court injunction against the use of his apparatus . After several more cases involving Kavorkian, the Michigan legislature passed a law making assisted suicide a felony.
Issues concerning the sanctity of life have been the subject of much recent debate in the United States, especially as it relates to abortion [2-61. With few exceptions [7, 81 euthanasia has not been included in much of the discussion within the social sciences. Despite the fact that abortion has dominated social science research concerning health and life issues, euthanasia and assisted suicide have become more pervasive in public discourse. There is no reason why the debate regarding euthanasia should be considered any less important  or social research in this area any less fruitful. Problems originating from the use of life-sustaining technology and the lack of consistent social policy regarding the treatment of the terminally ill highlight the importance of academic research which examines the relationship between medical science and other social spheres.
The United States legal system has experienced similar difficulties in deciding other cases like Kavorkians [ 131. California physicians Robert Nedjl and Neil Barber faced murder charges for disconnect- ing a ventilator and intravenous fluids. All charges were dismissed in a court of appeals. Michigan doctor Donald Caraccio pled guilty to euthanizing a terminal patient and received a sentence of five years probation. California physician Richard Schaeffer was arrested after euthanizing a patient by lethal injection. No charges were ever filed. In the context of such inconsistent legal definitions, it is clear that physicians receive little guidance from the law regarding these types of cases.
ACTIVE VERSUS PASSIVE EUTHANASIA
The legal system currently recognizes what many perceive to be an important distinction between types
1672 David P. Caddell and Rae R. Newton
of euthanasia. The most common distinction is that which differentiates between active (intentional killing) and passive (letting die) forms of euthanasia. In the case of active euthanasia, a specific action is taken to kill the patient, such as an injection of a lethal dose of morphine or some other drug. Passive euthanasia, which appears to be more acceptable to Western society, involves the withholding of treatment which would prolong the patients life.
This issue touches medicine at its very moral center; if this moral center collapses, if physicians become killers or are even merely licensed to kill, the profession-and therewith, each physician-will never again be worthy of trust and respect as healer and comforter and protector of life in all its frailty. For if medicines power over life may be used equally to heal or to kill, the doctor is no more a moral professional but rather a morally neutral technician (p. 27).
Many authors [14-191 have engaged in the debate concerning whether there is any real moral difference between active and passive euthanasia. On one side of this debate Rachels [l&18] states that there is no moral difference between the intentional killing of a patient and intentionally letting them die. According to this perspective, the decision to intentionally hasten a patients death is the crucial factor, and not the method used to do so. Therefore, these authors assert that once the decision has been made to hasten the patients death, the morally correct action is that which eases the patient from life to death in the most merciful way possible. In many cases, this would include an active form of euthanasia.
These authors suggest that even if public opinion favors legalizing euthanasia of any kind, someone else besides physicians should be charged with carrying it out. This study examines whether or not Americans maintain a moral distinction between suicide (in the case of terminal illness) without the help of a physician and active euthanasia in which a physician takes part in assisting a terminal patient to die.
Research concerning public attitudes toward the physicians role in euthanasia is important because doctors currently have very little consistent social policy from which to obtain guidance on this issue. Even the various ethical statements which guide physicians are somewhat ambiguous. In the Hippo- cratic tradition, doctors are forbidden to take part in intentionally killing a patient. As is stated in the Hippocratic Oath:
Euthanasia is likely to receive different definitions and invoke diverse mental images among different individuals. For the purposes of this research, we define active euthanasia as any treatment initiated by a physician with the intent of hastening the death of another human being who is terminally ill and in severe pain or distress with the motive of relieving that person from great suffering. This definition avoids value laden definitions which equate euthanasia with murder or tie the definition to a particular political or religious position. We define suicide as the terminal patient taking steps to end their own life independent of a physicians assistance for the purposes of shortening their suffering. Differentiating between suicide and active euthanasia in this way allows examination of attitudes toward the physicians role in euthanasia, not simply attitudes toward the act itself.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. In purity and holiness I will guard my life and my art.
In contrast, the code of professional ethics espoused by the American Medical Association does not directly forbid an act of euthanasia on moral grounds, but encourages the physician to remain within the law while treating the patient with compassion and dignity. It is not difficult to imagine the moral dilemmas dealt with by physicians when faced with the choice between vague directives in the law, pro- fessional ethics and the wishes of a suffering terminal patient and his or her family. The euthanasia debate rests on the question concerning the ability of medical technology to bar the passage to death and what the members of a society believe should be the doctors role in allowing (or assisting) the dying patient to make that passage.
ANOTHER DISTINCTION: ACTIVE EUTHANASIA VERSUS THEORETICAL ORIENTATION SUICIDE
Another distinction concerns whose role active euthanasia would become should it be legalized. This study is designed to investigate whether or not Americans accept euthanasia in the abstract, or if they draw a moral distinction based upon the presence or absence of a physician. Is the act of terminating a terminally ill patients life more acceptable if performed by a physician rather than allowing the patient to resort to suicide? Many authors  maintain that expecting physicians to participate in legalized active euthanasia would destroy the role of physician in society. As Gaylin ef al.  state: