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Is euthanasia morally defensible?
 

The "Yes" Case

Michael's Essay

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Voluntary euthanasia involves the killing of a terminally ill person, a rational and self conscious being and not merely a conscious being  who asks to be killed. Non-voluntary and involuntary forms of euthanasia lack these characteristics and thus are quite distinct. Non-voluntary euthanasia may involve the killing of an infant or someone in a vegetated state. Involuntary euthanasia is tantamount to murder and involves killing someone competent who has not expressed a wish to die. I shall argue that the argument for voluntary euthanasia is (more) morally defensible. In doing so I will present the arguments for voluntary euthanasia, followed by the arguments against voluntary euthanasia and show why the arguments against are less morally defensible. 

Voluntary euthanasia can be applied in two ways – in an “active” or “passive” way. While the ultimate result is the same in both instances (the death of the patient), some argue that there is a moral distinction. The Roman Catholic Church is an advocate of this distinction – through Thomas Aquinas as well as through it's Declaration on Euthanasia. In the Declaration on Euthanasia the Church defined euthanasia as “an act or omission which of itself or by intention causes death.” Some, from this, have argued that a doctor administering large (fatal) amounts of pain killing drugs is not practising euthanasia as the intention is to reduce the pain – not to kill the patient. The death of the patient is an unintended (but foreseen) consequence. Thomas Aquinas also discussed this notion – popularly called the “principle of double effect.” 
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I have addressed this issue now to assert that there is no real moral distinction between active and passive euthanasia. The fact that the death of the patient is foreseen renders passive voluntary euthanasia no more morally defensible than active voluntary euthanasia. This is also true when doctors do not administer medication knowing that their patients will die as a result. While the death of the patient is not directly caused by the doctor, the doctor's choice to withhold medication implicates him (morally) to a no lesser degree. Arguing for passive voluntary euthanasia while against active voluntary euthanasia is equivalent to saying there is a moral distinction between killing and letting die. I do not believe one can effectively argue that, for instance, that turning off life-support to someone in a coma is morally superior than administering a lethal injection (to end the suffering). In both cases the intent is to end a hopeless life through death. In the former the patient may die “naturally” but still as a result of the actions of the physician. Utilitarianism conveys this idea that one is responsible for his acts and omissions to an equal degree. Utilitarianism also argues that there is nothing intrinsically wrong with actions – only the consequence's matter. Passive euthanasia may in fact be less morally defensible that active euthanasia. By withholding medication, for instance, the patients suffering may be prolonged unnecessarily. The patient will die regardless – but with passive euthanasia in a more painful and undignified way .

 

The fact that the patient believes the pain is intolerable is important. Choices about how to live (within practical restrictions) and die are fundamental to many people. The choice of a patient to die should be respected in a liberal, democratic society. Preference utilitarianism would support this notion. If the preference of the patient is to die, his preference must be respected. Similarly, if there exists a right to life, the right to waive such a right also exists. 
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Allowing voluntary euthanasia may well be a legislative nightmare. Nevertheless, as Peter Singer points out, the legislative difficulties do not raise “objections to the underlying ethical principles”. 
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John Stuart Mill also makes an argument for self-determination and autonomy. Max Charlesworth in Bioethics in a Liberal society reveals Mill’s argument by quoting his essay On Liberty: “Over himself, over his body and mind, the individual is sovereign”. Mill, according to Charlesworth, believed that a mans actions should not be interfered with by the state to the extent that they do not infringe upon the rights of others. Paternalism by the state should be minimal at all times. 

 

The moral argument against voluntary euthanasia

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The following are the major arguments against voluntary euthanasia. 
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       1.  As a result of innovations in modern medicine, many people argue that 
            palliative care makes euthanasia unnecessary. 

This argument is flawed because of the following reasons. Firstly, the fact that palliative care is available should not remove the patients right to euthanasia. Those who argue against euthanasia because of the availability of palliative care ignore the patients right to autonomy and self determination. Secondly, palliative care is not a miracle solution. The pain of some terminally ill people can simply not be alleviated by modern medicine. Even if the physical pain could be alleviated, the psychological pain remains. The thought of being vegetated and having a life without the possibility of hope can simply not be “treated”. 

        2.  It is also argued that voluntary euthanasia can lead via a “slippery slope” to 
             involuntary euthanasia or even genocide. The events in Nazi Germany (that is, 
             the genocide of Jewish people, the killing of the disabled, elderly, and infants) 
             are often cited as empirical proof that voluntary euthanasia will lead inevitably 
             to undesirable social practices. 
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This argument is also flawed. Here we return for the criteria for voluntary euthanasia. That is, that we have “consenting, terminally ill people who make a rational choice to die”. In addition, that death is brought about because of  “mercy” and “concern for the patient”. It is clear that the practises in Nazi Germany were not modelled on consent or concern. Furthermore, events in the present Netherlands suggest that there is no reason why people who accept voluntary euthanasia on the premises put forward, would embrace the rise of involuntary euthanasia and/or genocide. Singer and Kuhse agree on this : 
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                 [Singer] “In fact the Nazis did not have a euthanasia program, in the proper 
                 sense of the word. Their so-called euthanasia program was not motivated 
                 by concern for the suffering of those killed ... Nazi euthanasia was never 
                 voluntary.” 
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                 [Kuhse] “There are no logical grounds why the reasons that justify 
                 euthanasia - mercy and respect for autonomy - should logically also justify 
                 killings that are neither merciful nor show respect for autonomy.” 
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        3.  Perhaps the most potent objection put forward to voluntary euthanasia is that 
             human beings do not in fact have the right to end their own life. There is said to 
             be a “sanctity” of human life. Such an argument is not only religious. While 
             Christianity argues that voluntary euthanasia, the killing of a human being, is “to 
             usurp the right of God to give and take life”, there are also secular philosophers,   
             such as Immanuel Kant, who believed that “man cannot have the power to  
             dispose of his own life.” 

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Such an argument relies on the personal beliefs of the individual. Thomas More – a Catholic Saint – wrote a book Utopia outlining the “perfect” world. In such a world, voluntary euthanasia is practised. Such differences of opinion emphasise that while such beliefs are valid, it would be wrong to force competent and rational adults to adhere to a particular doctrine. One cannot really prove or disprove the existence of a “sanctity” of human life. While many may believe that life is indeed precious, the issue of voluntary euthanasia confronts the dilemma of whether there comes a time when life is no longer worth living. 

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I believe such a time can exist. In the absence of any concrete evidence suggesting why voluntary euthanasia is not morally defensible and because I believe that principles such as autonomy are important, I am of the opinion that voluntary euthanasia is morally defensible. 

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END 

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FOR ENDNOTES PLEASE EMAIL ME. I USED THE FOLLOWING TEXTS: 

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• Charlesworth, M Bioethics in a Liberal society, 1993, Cambridge University Press : UK.

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• Glover, J  Causing Death and Saving Lives, 1982, Penguin: Middlesex.

 

• Kuhse, H “Euthanasia”, A Companion to Ethics, ed. Peter Singer, 1995, Blackwell : Massachusetts. 

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• Singer, P Practical Ethics. 1993. Cambridge University Press: USA. 

 

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The "No" Case

My Essay

Euthanasia is the intentional killing of a person, for compassionate motives, whether the killing is by a direct action, such as a lethal injection, or by failing to perform an action necessary to maintain life. For euthanasia to occur, there must be an intention to kill the patient under consideration. 

The most common suggestion by those who support euthanasia is for voluntary or active euthanasia, where the person asks to be killed. Although those who call for euthanasia do not like the use of the word 'kill', it is the only accurate, clinical word to describe the reality. Assisted suicide is also now being proposed, where a person would be provided with the means of committing suicide, and would then perform the act. Finally we have involuntary euthanasia. This involves the killing of persons who cannot express their wishes, because of age (such as a new born infant : abortion also falls into this category), mental retardation, coma and so on. Here it is decided by "loved ones" that the person is better of dead. Current law in Australia states that all forms of euthanasia are murder and assisting suicide is also a criminal offence. 

Now that I've defined the various types of euthanasia I want to move to a term known as passive euthanasia. This term causes a great amount of confusion because it refers to actions which are not any kind of euthanasia. Passive euthanasia consists of : 

a)  The ceasing of medical treatment which is unwanted, or is imposing excessive 
     burdens on the patient, or is incapable of providing any benefit 

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b) The use of drugs in necessarily large doses to relieve very severe pain, though 
    such doses may endanger life. 

Medical actions intended to relieve suffering are ethical and lawful, as are the withdrawal of treatments which are only unnecessarily prolonging dying. Although the patient may later die of his terminal illness and though such death was foreseen, death was neither intended nor caused by what was done. All attempts were made to prolong life : when these attempts fail then the patient was allowed to die. To describe these practices as euthanasia is misguided and mischievous, especially when it is used to confuse active killing with good medical practice.

It is vital to understand the difference between 'letting die' and 'killing'. One acknowledges the sanctity of human life, which Michael believes to be "unproven" concepts while the other implies that human life is expendable. However, this is a difficult concept which may cause confusion. When life sustaining treatment is withdrawn for the reasons listed above, where the intention is to relieve suffering, the natural course of the underlying illness, which had been temporarily stayed, is thus allowed to run. If the diagnosis is correct, death will result from the illness which was always going to be the eventual unavoidable cause, and this is recorded on the death certificate. Until death occurs, every means of providing comfort must be maintained. Euthanasia is different in its nature and its intention. Death is now the sole intended and the sole possible outcome, and is not due to any natural cause, even in those with terminal illness. It is chemically induced so that a new and otherwise impossible cause of death has been substituted for the one which was to be expected. From both the ethical and legal viewpoints, making a person die is different from letting a person die when it is medically proper to do so. Even the nature of the persons request is different; one risks death, and the other seeks it. Prescribing for death would be unlike any other medical action. 

Euthanasia has usually been proposed only for those with terminal illness with severe suffering, but more recently the concept has been extended to include persons who wish to die for some relatively trivial social reason, such as being tired of life. If euthanasia for the terminally ill is deemed morally defensible, then does Michael think that euthanasia for someone who is simply tired of life is also morally defensible ? You cant take one and not the other : you have to take both. The challenge of euthanasia is moral : "Can it ever be right to kill an innocent person?". "Can it be right to kill such persons unnecessarily" ? For Michael who believes that the sanctity of human life is "unproven" because Singer told him so, then he probably would say yes. 

Is there a real need for euthanasia? Well those who care for the dying rarely encounter a request to be killed, and when they do, it is almost always associated with depression or an intractable social problem : it is seldom a "rational choice to die" as Michael puts it. In many cases it is a choice made under extreme duress : the duress comes from the conflict and depression raging within them. Infact I would argue that voluntary euthanasia, which Michael states occurs when  "consenting, terminally ill people who make a rational choice to die” rarely occurs : who in that state of their life is rational? With so many concurrent turbulent emotions the patient would be anything but rational. Michael would you be rational if plunged into the same predicament ? The advocates of euthanasia give the impression that there is a great need for it, but they seldom provide evidence to support this view. The reasonable conclusion is that when dying persons are well cared for, they have no need to ask to be killed. In that case, to introduce euthanasia would be a double tragedy : it would be both inhumane and unnecessary. 

For what reason is euthanasia proposed ? Well I think it is because it is not widely known that modern care of the dying (palliative care) can now effectively relieve almost all severe pain and significantly relieve emotional distress (Pollard, 1995). Michael in his essay made the statement  : 

          "Secondly, palliative care is not a miracle solution. The pain of some 
           terminally ill people can simply not be alleviated by modern medicine. Even 
           if the physical pain could be alleviated, the psychological pain remains. The 
           thought of being vegetated and having a life without the possibility of hope 
           can simply not be treated ". 

I have two comments about this. Firstly Michael is in no position to make sweeping statements about areas such as this. He is doing a law degree and has absolutely no medical background whatsoever. He gains this knowledge from looking at fairy stories given to him by none other than those who support euthanasia: good to see he continues to use objective sources. I do have a medical background and can say that palliative care can in most cases relieve pain adequately. The second comment I want to make is that Michael refers to the terminally ill here as having "psychological pain". Firstly, "psychological pain" can almost always be effectively treated with medication, patient counselling as well as spiritual and emotional support. All of these form part of a complete palliative care treatment program. Are palliative care treatment programs being optimally implemented across the country? If not, should we address this issue before looking at the need for euthanasia? Secondly, I find it difficult to see how someone with severe psychological pain could make a rational decision about whether they want to die or not (this was Michael's requirement for someone to be eligible for voluntary euthanasia). I would argue that someone with deep psychological pain would be incapable of making a clear and rational decision. Another pertinent point should be introduced at this time. How many people will choose euthanasia as an option when they feel that they are an emotional burden on the their loved ones ? I caution Michael to take care when he interprets patient requests to die : especially when they are made on national television in the presence of doctors who support euthanasia. The patient may say that the pain is intolerable and that the only humane thing would be to let them "die in dignity". However does this patient really want to die or are they sacrificing themselves for their families ? Does the Doctor with them have a social agenda (or personal belief) that is worth sacrificing one, two or three human lives for ? If you were terminally ill and a Doctor kept telling you that you were a burden on your family and that you were in so much pain that you had a right to take your own life in the end you would probably believe it : even if it wasn't true. Are those doctors advocating euthanasia doing so to ease the burden on themselves i.e. to save themselves being exposed to the challenges that patients with terminal diseases provide, rather than advocating it for the best interests of their patients? Doctors should walk hand in hand with their terminal patients, caressing them through their journey and learning from them. They should form bonds with their terminal patients, drawing from the experiences of their patients thereby allowing themselves to become better doctors. After all, isn't that what practicing medicine is all about?

Euthanasia is said to be an expression of such things as death with dignity, the right to die, autonomy and so on. For the most part, these are used as slogans, without understanding their true meanings. Dying persons are treated with true dignity when their genuine needs are met by providing effective loving care, which values the worth of every fellow human, in distress or not. Although a right to die is claimed by supporters of euthanasia, what is really meant is a right to be killed. There has never been a right to be killed in any code of ethics. It is a spurious concept, and no argument can be made to support it. The right to respect for one's autonomy (self-determination) is different, in that it is a genuine human right, but one which is often misunderstood. In the context of euthanasia, it is implied that a person's wish to die must be so respected as to give it power to bind others to act. That is both simplistic and flawed, since no body may have anything in life just because he/she asks for it, no matter how sincerely. Since there is no right to be killed, others are not required to kill, nor should they do so. 

Current law recognises the right of every mentally competent person to refuse unwanted medical treatment, but not the right to take one's own life. In fact, everyone is legally empowered to prevent attempted suicide. Thus the lives of all innocent persons are protected. Confusion may arise from the fact that attempting suicide is not a criminal act, but assisting suicide is. One possible reason for this is that the law recognises that attempting suicide is very often the outcome of mental illness, and that when an attempt fails, the person needs care rather than a form of punishment. "Although it is sometimes implied that a change in the law to legalise euthanasia would be a minor one, in fact it would entail a massive shift in our legal concepts of intent, responsibility and causation" (Pollard, 1995) . 

"It would single out a particular group of vulnerable individuals, the sick, for discriminatory action. No law to legalise euthanasia should be made in any country because no proposal that can be devised would be free of the likely, not just the possible, risk of abuse. The supporters of euthanasia offer no suggestions to overcome this problem. A safe law would simply not be possible" (Pollard, 1995). 

A very pertinent question to ask is who would do the killing if euthanasia was legalised ? It is usually assumed that doctors would, despite having not been asked, and that every medical association in the world forbids euthanasia as being unethical. It would be disastrous for the medical profession to be involved in any way with legalised euthanasia. There is no argument to support their participation as part of their work, and the doctor/patient relationship would be severely damaged. Doctors prescribe medicine, NOT poison. They heal and cure, but they DO NOT intentionally kill. If euthanasia were available, motivation for difficult patient care AND FOR ADVANCES IN MEDICAL SCIENCE IN THE AREAS OF FINDING CURES FOR TERMINAL ILLNESSES WOULD BE  LESSENED.  If doctors are not chosen to kill terminally ill patients then who will do it ? Finding an answer to this question would involve the community in a great deal of soul searching, as it would make us focus on the true dire realities of the proposal. At present, supporters of euthanasia can hide from the unpleasant facts, content in the knowledge that the murdering will be done clinically and cleanly by someone far away in a white lab coat. Michael, would YOU like to do it ? 

I would like to conclude with a case example of a nation which already practices euthanasia : the country under consideration is Holland (Pollard, 1995).  Euthanasia is widely practiced in Holland, despite the fact that it is a criminal offence. It is cited as an example of social progress, which we in Australia should consider. We are told that it is subject to safe, established guidelines, and that it has an agreed moral basis. Indeed, we should consider it, but only because it is a disaster we must not copy. Only in September 1991 did the official picture come to hand, supplied by Dutch government sources. We now know that intentional death is brought about by Dutch doctors in about one fifth of the deaths in the country; in over two thirds of cases, the death certificate is falsified to make it seem that the death was due to natural causes. The doctor suffers no penalty for this, and it is not known whether or not any guidelines were followed at all; where information is available about guidelines, they are known to be widely disregarded:  just over one quarter of the doctors admitted they had killed patients without any request at all, though the Dutch Medical Society correctly defines this as murder; in some of those, not even the family was told what was happening; the authorities admit they have no control over euthanasia, and finally, there is no consensus within Holland about the moral, medical, legal or social bases for euthanasia though it has been commonly performed for almost 20 years. THERE IS NO PALLIATIVE CARE IN HOLLAND. Michael, are you saying this could never happen in Australia ? If you say no your probably right but is it worth the risk ? How would you feel if one of your loved ones was taken from you without either there's or your consent ? Do you see the fundamental danger that we face if we say that euthanasia is morally defensible? Societal values and human worth will be downgraded forever. 
 

 REFERENCES 
 

• Euthanasia - Should we kill the dying ?  By Dr Brian Pollard, M.B., D.A., F.F.A., R.A.C.S.

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                                                     THE  END 
 

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