Other Issues in Thanatology

Thanatologists are interested not only in such traditional subjects as grief and Kubler‐Ross theories, but also in contemporary topics involving complicated moral and ethical issues. Debate over two of these issues—suicide and euthanasia—has stepped up as a result of changing state laws concerning physician‐assisted suicide and technological advances, such as life‐sustaining devices that patients are dependent upon.

Suicide

The majority of Americans view suicide, the deliberate termination of one's own life, as highly unfortunate, if not immoral. One conservative estimate is that 300,000 people attempt to kill themselves in the United States each year. Exact figures are hard to determine, and many presumed accidents may actually be disguised suicides or attempted suicides. Women outnumber men 3 to 1 in the number of attempted suicides, but men outnumber women 4 to 1 in the number of actual suicides. Men tend to use more lethal methods than women use when attempting suicide (for instance, guns instead of sleeping pills). The highest suicide rates are among older adult males.

While mostly an adult phenomenon, suicide occurs among children and adolescents, too. Although young children rarely succeed in committing suicide, some do. Each year, about 12,000 children ages 5 to 14 enter psychiatric hospitals for suicidal behavior. Suicide has increased among adolescents (especially males) by nearly 200 percent in recent years, yet the national average is still below that of middle‐aged adults.

People attempt suicide for a number of reasons, including extreme negativity and pessimism about life, feelings of utter failure and hopelessness, and the desire to spare the world of their presence by no longer being in the way. Others attempt suicide to escape the agony and pain of a chronic or terminal illness. In contrast to nonsuicidal people who see a variety of acceptable options when faced with difficult situations, suicidal people see few or no options other than self‐destruction.

Euthanasia

A very controversial issue, euthanasia (literally meaning, easy death or mercy killing) involves actively or passively assisting the death of a suffering person. Active euthanasia is the deliberate termination of life to eliminate pain. Passive euthanasia is the deliberate withdrawal or withholding of life‐sustaining treatment (often termed, extraordinary measures) that may otherwise prolong the life of the dying person. Those individuals who want to avoid having extraordinary measures taken to keep them alive may draw up a living will that outlines their wishes in the case of terminal illness.

The issues of euthanasia in the United States have a long but especially complicated history due to modern advances in medicine. In 1828, New York enacted the first laws explicitly prohibiting assisted suicide; many states followed New York's precedent shortly thereafter. While deeply rooted in the law, states' rules against assisted suicide have, in recent decades, been reexamined and typically reaffirmed. Because so many North Americans today are likely to die from chronic illnesses in hospitals, nursing facilities, and other long‐term care institutions, the public has been particularly concerned with how best to protect independence and dignity at the end of life.

A great deal of debate surrounds the subject of euthanasia, and some states have introduced substantial changes in their laws as a result of the considerations. For instance, many states now allow living wills as well as the refusal or withdrawal of life‐sustaining medical interventions. In 2000, Oregon's legalization of euthanasia took effect, and California appears close to enacting similar legislation. Yet legislators and voters generally continue to support laws that prohibit assisted suicide, expressing concerns that voluntary euthanasia will become involuntary euthanasia to control rising health‐care costs in the elderly. Objectors also express concern that assisted suicide will become a primary treatment strategy that ignores first exploring other options. Because some individuals see euthanasia as murder and others see it as a humane means of helping the terminally ill to die with dignity, the topic is likely to remain controversial for quite some time.