Euthanasia and its ethical complexities in medical practice

Medical Ethics: Euthanasia

Euthanasia is probably one of the most ethically challenging issues in medicine today. Proponents hold that "dying with dignity" is a right of which every human being should be assured. Opponents on the other hand believe that life in whatever capacity is a human right, and as such no person has the right to take it away from another, regardless of the reasons. The ethical dilemma lies in the fact that each side has good arguments. This is further complicated by the various aspects involved in the euthanasia issue. The practice takes a variety of forms. When it comes to life, death and terminal illness or permanent disability, the line between negligence and mercy becomes very thin indeed. Other medical and legal issues such as the Hippocratic oath and informed consent further make it difficult to distinguish between what society should allow and what should be avoided altogether.

Garn Le Baron Jr. divines euthanasia as "Bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy." This definition suggests that the fundamental reason for ending life is for ending suffering that cannot be alleviated or ended by anything other than the end of life. The Hippocratic principle of "first do no harm" appears to be at the heart of such an action, as prolonged life would mean prolonged suffering, and by association prolonged harm. This is however a greatly simplified definition, as Le Baron admits. There are many subtleties within the definition that form the basis of the controversy and the contention.

The author notes that euthanasia can be classified into a variety of types, including voluntary or involuntary, and active or passive. Voluntary euthanasia is performed with the consent of the person who suffers and wishes to die. Normally this consent occurs in the form of a living will or advance directive. Such consent is given by a person who is fully informed of the consequences of such a decision. If such a person then becomes incapacitated, the written consent forms can be used to make the final decision without distressing the family with such a burden. Involuntary euthanasia is performed when the incapacitated person has no ability to make the decision for him- or herself. In such a case, a surrogate, which is usually a family member or attorney, will make the decision for the person concerned.

According to Le Baron, active and passive euthanasia incorporate much greater subtleties in terms of defining the different issues involved. Passive euthanasia is when life saving treatment is withdrawn on request of the patient. This, it is often argued, is acceptable because the patient has requested to no longer receive treatment, while the physician has done everything possible to help the person. Further help is now offered by not imposing treatment that is unwanted. The decision is with the patient. Withdrawing nutrition, a possibility explored by Anthony Ozimic and John Fleming, on the other hand, is a particularly cruel form of passive euthanasia, and violates in all ways the Hippocratic directive of doing no harm.

Active euthanasia on the other hand is the administration of a substance to hasten the death of the patient for the purpose of ending suffering for either the person involved or family members in the case of for example a coma that is unlikely to end. Associations such as the AMA are in favor of passive euthanasia, while being opposed to active euthanasia. On the other hand, those who are opposed to euthanasia in all its forms would refer to one distinction as murder and the other as aiding suicide.

While some states and countries have legalized some forms of euthanasia, it is still an issue that is wide open to debate, as well as one that encourages many doctors to take matters into their own hands. For this reason, proponents such as Len Doyal (BBC News) call for the legalization of all forms of euthanasia, so that doctor-assisted deaths can be regulated in a more effective way.

Meta-ethical Solutions

As former member of the British Medical Association ethics committee, Len Doyal basis his solution on what he believes to be fact: doctor assisted suicides occur and can be better regulated by legalizing all forms of euthanasia (BBC News). In this, Doyal follows the absolutist view, in that his moral judgment is based upon a problem that is a known fact.

In the same way, a moral judgment regarding withholding nutrition, as in the case discussed by Ozimic and Fleming, is based upon the fact that dehydrating and malnourishing any living person results in more harm than good, even if the final end is the relief of suffering. The authors hold that this form of euthanasia does not fit the definition of euthanasia at all, as it is neither merciful nor quick. Indeed, it prolongs unnecessary suffering.

In relativistic terms, a possible solution is to create legislation that allows doctors, families and legal advisers to view the issues on a case by case basis, rather than attempting to find a single solution to apply to all the different cases. Such a solution accepts that there is no single right or wrong answer that can be applied to all cases. Legislation can for example recognize the right of families to make their own informed decisions, but required that legal advisers be present and documents be created that stipulates all the conditions for euthanasia. This rule can also apply to involuntary euthanasia, where the person in suffering has not given prior consent, and has lost the capacity to make such decisions regarding his or her own life.

The relativistic metasolution therefore does not disregard all sense of ethical and moral judgment in favor of a global type of legislation such as absolutism; instead it recognizes that human beings are as diverse as they are numerous, and that therefore each individual case should be judged according to individual circumstances.

Conclusion

According to Ozimic and Fleming, four principles of ethics are prominent in the medical profession, and these can also be used in considering issues such as euthanasia. The first is non-maleficence; which refers to the principle of not doing any harm; the second is benificence - to do good; the third is autonomy - the right of the patient to act freely, and the fourth is justice - fairness to the patient.

I believe that the path of least harm and greatest good should always be followed in medical practice. This should be substantiated by the law. Only by recognizing the right of individuals to receive the best possible medical care, can the law ensure that society will live together in optimal harmony. I would therefore agree with the view that each individual case should be judged upon its own basis, rather than imposing restrictive legislation upon all cases universally.

When creating a living will, for example, a person should be allowed to choose the type of euthanasia should this be necessary. The family should be allowed to help the person make an informed decision. If a person is incapacitated, the family should be allowed to make whatever decision they feel will cause the least harm. All such decisions should be underlined with full consultation with legal and medical professionals.

I believe the best solution is therefore to firstly adhere to the four principles mentioned above. These principles should be underlined by legislation, and include ethically challenging issues such as euthanasia. To prevent indiscretionary approaches to the issue, professionals, family members, and friends of the persons involved should be included in the decision making process. I believe this will curb the problem of practices such as unconsented assisted suicide because one doctor feels that it is the best solution.

Sources

BBC News. 'Legalise euthanasia' says expert. 8 June 2006. http://news.bbc.co.uk/2/hi/health/5056326.stm

Boseley, Sarah. Call for No-Consent Euthanasia. The Guardian, 8 June 2006. http://www.guardian.co.uk/frontpage/story/0,1792711,00.html

Le Baron, Garn Jr. The Ethics of Euthanasia. 1993-2008. http://www.quantonics.com/The_Ethics_of_Euthanasia_By_Garn_LeBaron.html

Markkula Center for Applied Ethics. Legalizing Euthanasia: Medical Perspectives on Death and Dying. 2007. http://www.scu.edu/ethics/publications/iie/v4n2/euthanasia.html

Ozimic, Anthony & Fleming, John. What is Euthanasia by neglect and why is it wrong? SPUC, 2008. http://www.spuc.org.uk/ethics/euthanasia/mib/ethical-reflection