Good Death and Euthanasia

Euthanasia comes from the Greek phrase meaning "good death," ("Euthanasia" 112). The various practices that fall under the general rubric of providing a person with the means for a "good death" include physician-assisted death, also referred to as physician-assisted suicide. Until recently, all forms of euthanasia were illegal in the United States and in most other developed countries but within the past generation, these laws have been liberalized so that citizens in democratic societies increasingly have access to a "good death." Physician-assisted suicide occurs under the guidance of an experienced and qualified physician, who is not legally obliged to agree to the practice. Therefore, no coercion takes place. The doctor is not permitted legally or ethically to coerce a patient into dying prematurely and the patient is likewise not ethically or legally allowed to persuade their doctor to intervene on their behalf. What physician-assisted death laws do allow is for the patient and doctor to agree that a "good death" is preferable to a "bad death" that involves prolonged suffering. Physician-assisted suicide is, practically by definition, a practice reserved for extreme cases in which a person has been diagnosed clinically with a terminal illness. In this essay, I will argue that euthanasia is ethically permissible because (a) it empowers the patient with basic human liberties and promotes the value of autonomy; (b) quality of life is more important than how long a person lives.

Legal Framework

For legal purposes, it is important to distinguish between the types of practices that collectively comprise euthanasia. There are six practices that can be considered euthanasia: passive euthanasia, active euthanasia, voluntary euthanasia, involuntary euthanasia, non-voluntary euthanasia, and physician-assisted suicide. Each of these practices also has ethical as well as legal distinctions. Passive euthanasia is actually "common practice and is not prohibited by law" in the United States as well as most other developed countries ("Euthanasia" 117). The Patient Self-Determination Act has affirmed the rights of patients to refuse treatment in cases like this, where the withholding of life support services does lead to the patient's death. Therefore, passive euthanasia often falls under the rubric of voluntary euthanasia. However, there are cases where passive euthanasia is actually non-voluntary. The Terry Schiavo case in the United States is the most famous example of when passive euthanasia is non-voluntary. In this case, the patient was in a persistent vegetative state and had not expressly offered her consent to in advance whether or not to withdraw life support. Because she was in a persistent vegetative state, the patient could not give consent. The patient's family members were entrusted with the decision, but in the Schiavo case, there was a conflict between the husband and the parents. The husband advocated on behalf of his wife's right to a "good death," urging the withdrawal of life support because Schiavo had been declared brain dead. However, Schiavo's parents were religious people who believed that even passive euthanasia was against their morals. Because the husband was the legal custodian of the patient's rights, he was able to decide. This case bears witness to the importance of expressly outlining one's values regarding how a person wishes to die, and whether a person would want to remain on life support indefinitely and at whatever financial cost to their family or the healthcare system.

Non-voluntary euthanasia should not be confused with involuntary euthanasia. The definition of involuntary euthanasia is a killing against the patient's will; the patient's rights are clearly violated, which is why there is no legal or ethical support for involuntary euthanasia. Involuntary euthanasia can even be considered "murder," ("Euthanasia," 117). Active euthanasia is when a person -- physician or not -- causes the death directly. Active euthanasia is ethically and legally problematic. It should ideally be carried out with the patient's knowledge, but it is possible that active euthanasia can be undertaken without the patient's full consent. For example, if a patient were temporarily unable to offer consent but was demonstrating clear signs of suffering, a doctor might decide that it would be merciful to inject the patient with a legal dose of drugs. Legally the patient has already provided their consent. The problem with active euthanasia from a legal perspective is that it places too much responsibility in the hands of the medical system in cases where the patient may have provided prior consent, but not consent at the time the lethal injection is administered. Active euthanasia is legal in the Netherlands but is not legal in the United States ("Euthanasia," 118).

Physician-assisted suicide empowers the patient to make the choice. With physician-assisted death, the presiding medical team gives the patient the means by which to die, and the patient must administer the medication -- not the doctor. Thus, by definition, the patient must be fully aware and able to give consent to the "good death." In the United States, physician-assisted suicide is legal on a state-by-state basis but was illegal for most of the nation's history. The movement towards legalized physician-assisted suicide started in earnest with Jack Kevorkian ("Euthanasia," 120). Kevorkian practiced mainly physician-assisted suicide but was eventually incarcerated after being convicted of active euthanasia practiced on one patient ("Euthanasia," 120). Physician-assisted suicide is legal in six states: California, Colorado, Oregon, Washington, Vermont, and Montana ("State-by-State Guide to Physician-Assisted Suicide," 1). When physician-assisted suicide is legal, there are clear provisions embedded in the law to prevent miscarriages of justice. For example, there is generally a waiting period between the time the patient requests euthanasia and the time the physician provides the patient with the means; and the patient must provide clear consent and be competent to make the decision without the undue influence of family members ("Euthanasia"). The Death with Dignity organization currently promotes the rights of Americans to a "good death" via physician-assisted suicide.

Theories: Utilitarianism and Deontological Ethics

Kant believed that there are four primary illustrations of deontological ethics, or ethical duties. One of those four is the ethical duty to not harm or kill oneself, suggesting that Kant would have categorically denied the right of a person to a "good death," (Lee). Kant believed that it was against natural law to harm oneself, and that the ethical inunction against self-harm was also a universal law and therefore applicable to all situations. From a deontological framework, therefore, euthanasia in any of its forms is impermissible. Catholicism embraces the deontological perspective on euthanasia.

Utilitarianism, on the other hand, takes a more libertarian approach and is more appropriate for promoting a "good death." Central to utilitarianism is the principle of the "greatest good/greatest happiness for the greatest number of people." Promoting civil liberties for all people does not restrict the rights of anyone. On the contrary, promoting the universal right to "good death" promotes the greatest good for the greatest number. Anyone who wishes to not receive a "good death" can opt out of euthanasia practices, and their physicians can do the same. Yet anyone who does want their death to be dignified, and an expression of their will does not have his or her rights impeded by the state or any religious organization that wishes to influence the state.

Warren's Five Criteria