The issue of whether or not people have a right to decide when to end their life has plagued society throughout history. The values, morals and laws concerning this subject have varied from culture to culture. This paper will explore some of the consequences of the medical advances and the prolongation of life for people in the U.S. It will also explore options for patients who are nearing the end of their lives, including nursing homes, hospice, and euthanasia. If the medical definition of living is the beating of a heart, and the heart isn’t able to beat on its own or needs medical assistance then is it still considered living? Throughout medical history many patients have died during surgery because there was no way to maintain the breathing and heart rate while the surgery was being performed. Medical advances that have been made in the last 100 years are astounding, and have created the ability to sustain and create life in new ways. A major advancement for medical history occurred over fifty years ago when the heart and lung machine was invented by John and Mary Gibbon (Edmunds 2). Doctors were able to perform surgeries with the heart and lungs being sustained by the machine instead of by the person. This machine was a great advancement for the medical world but it has also created a downfall which has led to legal issues. Is a person being sustained by such a machine actually alive or not? Society has changed in many areas over the years. In the 20 th century the life expectancy of a person was mid to late forties. Today it has risen greatly to the late seventies and early eighties. Prior to the 20 th century the numbers of terminal illnesses or infections from injuries kept people from reaching such ages as are possible today. Degenerative diseases such as cancer, heart disease, strokes, and diabetes are more common factors ending the lives of many people today. Since World War II there has been a great increase in the number of vaccines, which have allowed many people to live to a much older age, yet some are unable to care for themselves. Many of these people have to be placed in homes, hospitals or other care facilities in order to live. In the late sixties a nurse could visit a person who was ill or could not care for him-herself in their home. By the early to mid seventies there were established places with medical facilities where an ill or elderly person could live and receive medical care. This was the creation of the nursing home. Since the seventies there has been an increase in the number of nursing homes throughout the country as elderly people become more reliant on such facilities (Going the Extra Mile…. The History of Home Nursing Agency). Instances when a person may choose to seek the assistance of a nursing home are when a couple is no longer able to care for one another or, due to the loss of a spouse, one could no longer care for them self. The reliance on ones children to care for you when you age also decreases as the number of men and women in the work force increases, leaving children unable to care for ailing and elderly parents. Nursing homes have become increasingly relied upon to handle this problem. Some of the downfalls of elderly people who live in these homes are that they are no longer free to make such basic decisions like what and when to eat, when to sleep or take medication. Their personal space is minimized as these places become crowded and they have to share what little room they have with others. There are also instances where elderly people are abused and mistreated by the care persons working in these facilities. These are the types of places in which many of the people in America find themselves at the end of their lives. Not every person must end his or her days in a nursing home. During the medieval times pilgrims and travelers would stop and rest, or get care they needed in places known as hospices. In the late sixties the concept of hospice continued on in England and influenced a similar system of care in America. In 1979 hospices in North and South Carolina began the trend of in-home care (Hospice of Hoke County). Hospice provides care and medication for patients who are ill, in pain and need treatment for ailments. Physical, social and spiritual support is also provided for a person who may be dying and doesn’t want to be alone. The support is offered to the families as well as the patient. There are many hospice organizations throughout the country today. For many hospice services are wonderful because they are often covered by insurance or Medicare. Some hospice services will offer services, even to those who cannot pay. These options are available not only to the elderly but to others who suffer from terminal illness or people who have been injured from accidents and who have diseases that, for a variety of reasons, cannot yet be cured. Although the care facilities may be nice they often can do little to help sooth the suffering many patients endure towards the end of their life; should there be another way? This has been one of the debates for Euthanasia. Euthanasia has been a topic of religious debate since the beginning of time. The main argument of religion is that being created by a higher being we do not have the right to end the life given to us. Only the higher being has this right. As the majority of religions do not agree with assisted suicide it will inevitably remain a debate for many years to come. Physicians spoke of euthanasia as a way to end suffering as early as the 16th century in France, and the topic started making appearances as a legal issue in the 17th century in England and in 18 th century Prussia, which created one of the first laws reducing the punishment for someone assisting another in suicide. The term euthanasia has its roots from the Greek words Eu Thanatosis which means “good death”, or “gentle and easy death”. The Romans were the first to write of euthanasia which was a term used to describe the ending of a persons life because of terminal sickness or injury in which the person had little or no hope of recovering ( Erdimir, Aysegil Demirhan M.D. 26,27). Many cultures depended on an idea like euthanasia in the matter of elderly people. Many tribes sustained by hunting and gathering moved frequently to find more food and resources. They would often leave behind an elderly person who was no longer able to care for him-herself and was no longer useful to the tribe. It was part of the survival of the tribe that these people not remain. Caring for them could mean a loss of resources for the tribes that were often very scarce to begin with. For example a tribe known as the Tiwi who were hunters and gatherers living on an island off the northern coast of Australia had a custom for women who became unable to care for themselves. Part of the custom was to have total agreement by her brothers and sons without which this could not be done. The woman would be placed in a hole and buried up to her neck to be checked on after a couple of days. Being too old and feeble to raise herself from the hole she would die. This was a natural custom for this tribe and seen as essential for their survival (Henslin, James M. 361). In society today leaving an elderly person on his or her own out in the wilderness to die would not be tolerated under any circumstance. The arguments for and against euthanasia today involve more than just a peaceful ending for ailing elderly. It also includes issues of people who are injured in accidents and have sustained injuries such as severe brain damage that no longer allows them the ability to live a normal life, as well as babies born prematurely as a way of sustaining them until they can develop further. With ever advancing technology, such as the heart and lung machine and feeding tubes, people have been able to “live” in the hospital after a severe accident or illness for many years. The controversy concerning euthanasia in America began in the early 20 th century. The very first euthanasia bill was drafted and rejected in Ohio in 1906. In the late 60’s similar bills were introduced in Florida and Idaho, also resulting in failure. In 1967 an attorney in Indiana created the first living will (Humphry, Derek). A living will is a legal document that states a person’s wishes as to the care and medical treatment they wish to get if they are injured or incapacitated and unable to tell the doctors themselves. It may also state the person’s wishes as to the actions to be taken if their life depends on a support system or if death is imminent. In 1976 the Natural Death Act was passed in California giving authority to living wills. Other states followed with similar laws of their own. Doctors from Harvard proposed in 1968 to change the definition of death to include brain-dead along with heart and lung failure. Other medical doctors gradually accepted it. In 1990 the American Medical Association took the position that, with patient consent, treatment could be withheld and/or there could be a discontinuance of life support for a dying patient (Humphry, Derek). Today there are few states that have successfully passed laws allowing for euthanasia. Currently in 35 states there exists a criminal statute against assisting a person in ending their life. There are nine states that have regulations through common law. In Ohio assisted suicide is not considered a crime and in Oregon doctor assistance is allowed in ending a patients life (Assisted Suicide Laws State by State). The law in Oregon is known as the “Death With Dignity Act” and was first enacted in 1994 and was immediately challenged in the courts. It didn’t officially become law until 1997. The law states that a physician may assist a person’s death by prescribing medication to the person who has been determined to be terminally ill. The medication can then be taken by the patient to end their life. When the law was first passed many felt it would not remain long and thought the Supreme Court would stop any progress with it. There remains much controversy over this bill, however it is now widely accepted by both residents and doctors in Oregon. The law has been in effect for about seven years now and there have been more than 200 people who have used it to end their suffering (Physician Assisted Suicide Activity in Oregon). Many feared that such a law would spark a dramatic increase in the number of suicides. However there are strict provisions, stipulations, and procedures that must be followed. Before a person can receive such medication from his or her doctor the person must be an adult of eighteen years or more. They must be terminally ill usually with a time line of about six months or less in which to live. They must submit two oral requests to the physician as well as a written request. The physician must be their primary care physician or someone who is familiar with the patient, their past treatment and their illness. A patient must undergo psychiatric counseling and be determined to understand what they are requesting and be informed of other possible treatments and/or hospice care. There is also a waiting period of at least fifteen days before the patient would receive the prescribed medication . The type of medication prescribed would be a barbiturate sufficient to cause death. The law neither acknowledges nor does it allow such things as mercy killings like those of Jack Kevorkian, nor suicides induced by carbon monoxide or lethal injections(The Oregon Death With Dignity Act). The Death with Dignity Act is seen by many in Oregon and other states as the right of people who are terminally ill or dying, and as a proper way to help end their pain and suffering. A problem with this act is that it depends on the patient to ask for and receive this “end of life” treatment. However, there has been some controversy in other states concerning situations in which a person is not able to ask for, or take a measure to end their own life. What happens when a person is unable because of illness or injury to ask for or refuse treatment? In such cases there are steps that can be taken to ensure a person receives the care they wish to receive by having a living will, a “do not resuscitate” order, or giving someone a health care power of attorney in which you allow someone you trust and who knows your wishes to make the decisions for you and advise the doctors as to the kind of care you wish to receive. The problem that seems to arise more and more is that many people don’t think to set up these kinds of provisions they believe they are too young for such things, are in good health and wouldn’t need someone to make such decisions for them until they are old or ill. Many people often tell their family and loved ones what to do if something ever happens which can lead to complications later. Not having anything in writing often results in a court case. This is what happened recently with the Terri Schiavo case. Terri Schiavo was a woman who suffered from a heart attack in 1990 and had suffered severe brain damage because of this attack. In March of this year Terri died after an intense battle ensued between her husband who claimed she wished to die, and her parents who were fighting to keep her alive. Terri did not have a living will only the statement from her husband that she had told him she would wish to die. The interesting thing about this ca se was that it drew into it direct tension between the courts and politics. When Terri’s husband asked the court for and was granted a removal of her feeding tube, against her parent’s wishes, Florida Governor Jeb Bush became personally involved and filed a motion for another hearing. Even with the push of the Governor and all the press that surrounded this case the courts decisions still held firm and Terri died 13 days after the feeding tube was removed (Ertelt, Steven). Another not so recent case occurred in 1998 where a woman who lived in California had a power of attorney for her mother who lived in Pennsylvania. The mother lived in a nursing home and suffered dementia from Alzheimer’s disease. The nursing home needed authorization to hospitalize the mother because she needed treatment for an ulcer on her foot, which could lead to gangrene and other complications if not treated. The daughter, stating that she had been told by her mother not to let her continue if her quality of life had deteriorated, was contacted but refused treatment for her mother. The case went to court in Pennsylvania where the daughter explained that her mother had told her to make all decisions regarding medical treatment in the event that she was unable to, and also wanted to enact a “do not resuscitate” order. The courts ruled that there was to be a co-guardian who could make decisions concerning noninvasive treatment, such as the treatment for the ulcer on her foot. However the daughter was still responsible to carry out her mother’s wishes for any treatment that would be considered invasive(Sacks, Michael E.). As situations arise more and more in which the courts get involved and have to determine life or death situations the government is sure to further its involvement with laws that protect people from premature death and from having their wishes denied. In the future there may be many more attempts by states to enact laws similar to the ones in Oregon and this may even include changes to the Oregon law regarding instances when a person is not able to ask for the treatment themselves. Not only will there be continuation of involvement between the courts and the government, as legislation looks at these issue and attempts to enact more laws with regard to them; but the religious organizations will inevitably be involved as it is still considered wrong by many religious leaders. It is ultimately up to the courts to determine what is right or wrong in these decisions if, and when, disputed by family, friends, and/or medical personnel. Assisted Suicide Laws State by State. http://www.euthanasia.com/bystate.html Edmunds, Henry L. History of Medicine: The Heart- Lung Machine. 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Court Grants Daughter the Right to Make Life-Death Choice. Law Weekly. February 23 1998. http://web.lexisnexis.com.proxy.lib.uiowa.edu/universe/document?_m=dd46033dc7f2f2e53720281b5eae 2b51&_docnum=100&wchp=dGLbVtbzSkVA&_md5=63e941f16a755010e4d9bb45964a3a1f Physician Assisted Suicide Activity in Oregon. http://www.religioustolerance.org/euth_us1.htm The Oregon Death With Dignity Act. Oregon Revised Statutes http://egov.oregon.gov/DHS/ph/pas/docs/statute.pdf William, Glanville. 1957. The Sanctity of Life and the Criminal Law. The Trustees of Columbia University in the City of New York.