A DESPERATELY ILL woman is brought into the emergency room. As the staff rushes to save her, they find that the woman has taken an overdose because of a terminal illness. Later, after she dies, her husband tearfully admits that he reluctantly gave his wife the overdose at her request. The staff members are moved by his obvious love for his spouse.
This was one of the storylines in a recent episode of the top-rated television drama ER.As anyone who has watched much TVin the past few years knows, euthanasia storylines are becoming commonplace. But how accurate are such stories and how do they affect public opinion?
Unlike dry news reports on Jack Kevorkian's latest victim or talk show debates about legalizing so-called “physician-assisted suicide,” prime time TV dramas combine powerful storylines with compelling continuing characters whom many viewers feel they know personally. This makes for a powerful impact on viewers' emotions, as entertainment and education blend together almost seam-lessly.
Take some other recent examples: ?Ayoung woman doctor is comatose and dying from a fast-growing brain tumor when a handsome neurosurgeon orders a newly graduated nurse to radically turn up the morphine drip to end the patient's life. When the nurse is hesitant, she is chastised by a colleague who tells her she is depriving her patient of a “death with dignity” and that euthanasia is a common practice. (Chicago Hope, 1994)
? An Alzheimer's patient is given a lethal overdose of pills by a loving stepdaughter who remembers her promise not to let him suffer. When this is discovered, the politically ambitious district attorney wants to prosecute the step-daughter for murder, but surviving family members rally around the stepdaughter. (Sisters, 1995)
? An elderly woman in failing health starves herself to death with the help of her devoted granddaughter.When the granddaughter's involvement is discovered, she is willing to go to jail rather than tell how her grandmother wanted to commit suicide by starvation because, the girl fears, her grandmother would not be allowed a Catholic burial. The Catholic prosecutor is touched by the granddaughter's explanation and allows a plea bargain. (Law and Order, 1995)
Prime time TV dramas usually frame the controversy as a conflict between a sad but courageous choice vs. inhumane laws and religious or political intolerance. While points are made on both sides of the issue, the resolution of such stories is almost always the same: The terminally ill person is grateful to “die with dignity,” the surviving family members grow closer, and the person assisting in the euthanasia or assisted suicide becomes wiser, more caring, and usually escapes legal punishment. With such a positive view of euthanasia, it is easy for nondiscerning viewers to conclude that when something as humane and compassionate as euthanasia is against the law, the law should be changed. Indeed, current polls consistently show 50-70 percent public approval for legalizing euthanasia for the terminally ill.
Stereotypes abound on TV: the agonized patient who begs for help, the conflicted but loving relative, the doctor or nurse who finds idealism clashing with the desire to help patients, and the unenlightened or rigidly religious euthanasia opponent.
While such characters make for good drama, these recurring elements don't reflect reality but merely reinforce misinformation about death and euthanasia. Central to most stories is the premise that pain is often unbearable in terminal illness. But, as pain experts testify and as euthanasia leaders have admitted, the reality is that even severe pain can be controlled in terminal patients—and usually without oversedation. Many people suffer unnecessarily because too many doctors and nurses have not been adequately trained in pain management. Efforts are being made in the medical field to educate all health care professionals in effective pain control to solve this problem, but the myth of uncontrollable pain continues to persist in the popular imagination.
Another frequent misconception on TV is that suicide is a rational and immutable choice made by the dying person. Actually, studies show that suicide rarely occurs in the absence of a major psychiatric disorder, even among the terminally ill, who, in fact, constitute only 2-4 percent of all suicides. Depression, for example, is notoriously underdiagnosed in the terminally ill. These patients too often are assumed to have a good reason to want to die, while their depression can be successfully treated as it is in physically healthy people.
A wavering between wanting to die and wanting to live is a universal characteristic found in suicidal people but rarely, if ever, acknowledged in TV dramas. Suicide hot lines are familiar with this ambivalence and their success is based on treating suicide as a cry for help rather than as a logical choice. In TV dramas, however, a terminally ill person's desire to commit suicide is easily accepted as final.
Also omitted or dismissed in these dramas are alternatives such as the hospices, that provide physical and emotional support to the dying and their families. Unfortunately, TV tends to downplay such vital and useful information.
The portrayal of opposition to euthanasia as primarily religious is a main tenet of pro-euthanasia groups, but this too is erroneous. National medical and nursing organizations, suicide prevention groups, disability rights leaders, and many legal and ethics experts also strongly oppose assisted suicide and euthanasia, citing both the protection of vulnerable people and the prevention of corruption of medical personnel among their reasons.
The opposition by such groups as the American Medical Association and the American Nurses Association is particularly instructive because it is they who will have to complete the death equation. While some polls have shown that a significant number of doctors and nurses say they could support assisted suicide in a hypothetical case, the numbers drop dramatically when they are asked if they would want to personally participate. Ironically, the greatest opposition to euthanasia is found among doctors and nurses who have the most experience with terminal illness, in specialties such as oncology and hospice.
The portrayal of relatives who participate in (or approve of) assisted suicide as always loving and supportive people is particularly problematic. The dysfunctional family, a staple of other TV dramas, apparently does not exist when the subject is euthanasia. Relatives, instead, are portrayed as stable and selfless people whose only regret is that they opposed the suicide in the beginning. These relatives invariably wind up praising the “courage” of the person who has chosen to die.
Ulterior motives, conflicted feelings about caring for a terminally ill person, or even emotional and physical exhaustion in relatives are facts of life that never seem to occur in such dramas. Also, as bereavement counselors report, the grieving process in surviving family members is much more complicated and difficult when a death is from suicide rather than natural causes. How could an assisted suicide be any less painful?
Sex, violence, and the decline of family values on television are often and loudly protested. The pro-euthanasia bias often found in TV dramas may be harder for less discerning viewers to detect, but it's no less important. With the U.S. Supreme Court now considering the legality of assisted suicide, public approval is crucial to euthanasia supporters and is one of their legal arguments. TV is a powerful medium that reaches millions of people daily, a fact not lost on euthanasia supporters who openly court the media.
The success of abortion supporters in framing that debate as the “right to choose” is also not lost on euthanasia supporters who have adopted the same slogan and similar arguments. Disturbing facts such as the tragic situation in the Netherlands, where even euthanasia without consent is openly tolerated, and the expansion of euthanasia arguments to include the elderly and disabled are seldom brought by euthanasia supporters. The “right to choose” arguments are simpler and easier.
Besides the problem of using one-sided arguments to persuade the public, another danger is that the lack of accurate information in such areas as pain control and hospice care can lead to despair in viewers who suffer similar illnesses and who may assume that suicide is the only option. Families may also falsely assume that suicidal relatives only want approval of their proposed action, rather than reassurance that they are not a burden. Help, therefore, may not be offered when it is most needed.
Although euthanasia is often presented as a personal matter of choice, its potential impact on society is incalculable. As the culture of death rapidly gains ground, insisting on accuracy and fairness in TV shows is not just good public policy—it could be life-saving.
Nancy Valko, R.N., is based in St. Louis, Mo.