The word euthanasia originates from the Greek, its root words meaning "good" and "death." This understanding lies at the heart of the concept, which in the modern sense is defined as a person choosing to end their own life. This is not normally taken in the same context as suicide, but rather as a physician-assisted death, so that the person chooses how and when they will die, and that they may do so in a peaceful and painless manner. The term is not usually understood to encompass things like 'do not resuscitate" orders, where a physician is ordered not to save a person, but rather is specifically applied to situations where the person is actively killed, usually through the administration of drugs.
Euthanasia has become a hot button topic of late in the medical community, in particular in the field of medical ethics. In most societies, there are taboos against killing oneself, much less against enabling such an act. In the context of the modern debate on euthanasia, the practice is understood to mean the termination of life for somebody who has a terminal illness, and is reaching the end stages of that illness. In those situations, euthanasia is merely giving the person control over their own death, which at that point is inevitable, so that they may die with dignity and minimize their suffering. The ethics of euthanasia applied to somebody who is not terminally ill, or who is but is far from the end stage, is an entirely different matter. There are conflicting issues with respect to the ethics of euthanasia, for example the matter of the basic human right of self-determination, versus general societal mores, versus the physician's Hippocratic Oath. This paper will analyze these different issues regarding euthanasia and weigh the balance of evidence. While there are credible arguments with respect to the autonomy of individuals, there are greater societal factors at play where legalization is concerned, and far too many of the critical issues are unresolved where participation in the death of another is concerned. For this reason, it is not possible to recommend the legalization of euthanasia at this time.
The central issue with respect to euthanasia from the patient perspective is that of basic human rights. There are several underlying assumptions, however, that need to be clarified. There is a clear distinction in the field of ethics between suicide and euthanasia, owing primarily to the involvement of another person. Any individual has the right to commit suicide, because nobody can genuinely control a person to the extent that suicide can be prevented. Euthanasia is distinct not just for the involvement of others, but for the means in which the person elects to die -- they are to die peacefully and painlessly, which is usually not the case in suicides. The person's medical condition does not matter in terms of their right to take their own life, but rather their right to die peacefully, painlessly and under medical supervision.
From the patient perspective, the right to euthanasia has traditionally been granted, under most philosophical traditions. There were no legal provisions against euthanasia, and from the ancient Greeks to Sir Thomas More the right to die at peace was considered to be a right that people had. That said, most early codes of human rights such as the Magna Carta did not explicitly address the question -- that is a more recent phenomenon of the 20th century (Young, 2014).
The patient-centered argument for euthanasia rests on the right to self-determination. A person of sound mind, in rational Western traditions, has the right to autonomy, and that right extends to their choice of death. Even in societies were suicide is considered taboo (most of them), euthanasia is more widely accepted when a person's life has deteriorated as the result of terminal illness. Most pre-industrial societies neither had the means to prolong such lives, nor saw the value in doing so; they were phlegmatic with respect to the value of life once a person could no longer contribute to society. The idea that we can and should prolong life at all costs is, in essence, a modern one.
In any given society,...
In the U.S. Bill of Rights, there is a right to privacy, and this surely extends to a person's right to determine his or her fate. The United Nations Universal Declaration of Human Rights, in Article 5, cites that on one "shall be subject to ... inhuman or degrading treatment," which surely being made to suffer, by law, the horrific effects of end stage terminal illness qualifies. Article 18 highlights the right to "freedom of thought, conscience and religion," which allows for one to determine one's own sense of morality, though arguably this should be within reason. The implication, however, is that laws based on religious doctrine, should not be used against people who do not hold that doctrine. If one has full autonomy, then one has the right to determine his/her death as well -- autonomy does not end prior to death, only after it (Gorsuch, 2006).
There are objections to some of these arguments. First, modern palliative care has advanced to a point where nobody with terminal illness need die in pain. The question, therefore, is not whether someone wishes to end his/her own life prior to pain, but rather to end it prior to the point where they will be bedridden and under heavy sedation. The second objection is that of legality -- there are very few circumstances in which the killing of another person is permissible, and one would prefer that great caution is exercised when such decisions are made (Young, 1994). There is also the question of slippery slope, thought slippery slope arguments are logical fallacy and should be discounted.
Another objection is the idea that people with terminal illness may not be fully autonomous. Such diagnosis, and certainly when the effects of the illness become apparent, places an incredible amount of stress on the patient. While supporters of euthanasia present an image of a clear-headed decision made by somebody with the serenity and rationality of a Buddhist monk, in practice this vision may be idealistic. Scholars examining the subject feel that the risk of coercion, even unconscious coercion, is real, and that laws governing euthanasia must take this risk into account, so that those of fragile mind are not unduly convinced that euthanasia is the best choice for them. One study found that most laws written with respect to euthanasia offer poor protections against coercion (Nielsen, 1998) and that attempts are legalization are premature given our present understanding of this aspect of the issue. There are conceivable possibilities where perverse incentives or unethical physicians could guide a patient to euthanasia where it is not warranted, or even on the basis of misdiagnosis.
Physicians in the West are guided by the Hippocratic Oath, to which they swear. Even though the ancient Greeks accepted suicide, the oath specifically addresses euthanasia:
"I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan"
Critics of the oath point out various ways in which it is outdated, ranging from worship of Apollo to its views of women's rights, but physicians take the oath seriously, because they see their role as healing the body, not harming it. It is not unreasonable, even with the changes in ethics of the modern age, to see this principle as extending to euthanasia. The physician is currently being asked to assist with euthanasia mainly because it is the physician who has the knowledge and the access to drugs to enable it. One could make the case that if there were professionals who were not physicians tasked with the facilitation of euthanasia that the involvement of physicians would be moot, but at this point such a scenario does not exist. Further, it is the involvement of the physician that matters most, because the legal prohibitions against euthanasia involve doctors, not the deceased.
One of the key issues for physicians lies with their ability to assess the patient's psychological state. While doubtless there are people making this decision with a clear head, any legalization of euthanasia would require clear guidelines that would assist doctors. Such guidelines would need to be in place to protect both doctors and patients. Sanson et al. (1998) note that at present there is little research with respect to the psychological state of people who are diagnosed with terminal illness, at least where it references their ability to make a decision regarding their death. In a legal sense, it would be very difficult to write effective guidelines for euthanasia based on evidence, where such evidence is lacking with respect to the cognitive processes that underlie such a decision.
Given that the autonomy of human beings is a fundamental human right, the central issue for physicians is not one of…
Gorsuch, Neil M.. Future of Assisted Suicide and Euthanasia. Princeton, NJ, USA: Princeton University Press, 2006. ProQuest ebrary. Web. 15 March 2016.
Hippocratic Oath. Retrieved April 6, 2016 from https://www.nlm.nih.gov/hmd/greek/greek_oath.html
Nielsen, T. (1998). Guidelines for legalized euthanasia in Canada: A proposal. Annals of the Royal College of Physicians and Surgeons in Canada, Vol. 31 (7) 314-318.
Sanson, Ann, Elizabeth Dickens, Beatrice Melita, Mary Nixon, Justin Rowe, Anne Tudor, and Michael Tyrrell. "Psychological Perspectives on Euthanasia and the Terminally Ill: An Australian Psychological Society Discussion Paper." Australian Psychologist 33.1 (1998): 1-11. Web.
United Nations Universal Declaration of Human Rights. Retrieved April 6, 2016 from http://www.ohchr.org/EN/UDHR/Documents/UDHR_Translations/eng.pdf
Young, R. (2014). Voluntary euthanasia. Stanford Encyclopedia of Philosophy. Retrieved April 6, 2016 from http://plato.stanford.edu/entries/euthanasia-voluntary/
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