Introduction Euthanasia, and all its variations including physician-assisted suicide, terminal sedation, and involuntary euthanasia, are among the most challenging issues in bioethics. The Hippocratic Oath, the classic ethical doctrine that guides medical practice, denounces euthanasia. However, the Hippocratic Oath is an anachronistic document that serves more sentimental and symbolic functions than pragmatic, ethical, or legal ones. Euthanasia and physician-assisted suicide are both defined as the “deliberate action taken with the intention of ending a life, in order to relieve persistent suffering,” (Nordqvist, 2017, p. 1). Other factors, such as the patient’s competency (whether the patient is unconscious, conscious, or conscious but mentally or psychologically impaired) need to be taken into consideration when determining individual cases. Likewise, there have been attempts to differentiate between passive and active euthanasia, the former of which refers to the withdrawal of life support systems and the latter to the active administration of some medicine or method that terminates the life. The application of ethical theories can also shed light on the different roles the patient and the physician play in determining whether euthanasia is appropriate. Euthanasia can be approached by deontological ethics, utilitarian ethics, and virtue ethics. Whereas both deontological and virtue ethics categorically decry any type of physician-assisted suicide, utilitarian ethics provide a more nuanced, flexible, reasoned, and pragmatic approach to addressing this tricky issue.

Euthanasia in Light of Ethical Theories

Deontological Ethics

Deontological ethics are ethics based on duty or moral imperative. The philosopher most credited for explicating deontological ethics is Immanuel Kant, who wrote extensively on the specific issue of the moral legitimacy of suicide. Kant concludes that preserving one’s life should always remain an ethical duty. It therefore follows that Kant would also have agreed that it would be the physician’s ethical duty to preserve the life of patients, even if it was not their wish to do so.

In Groundwork for the Metaphysic of Morals, Kant claims outright: “It is a duty to preserve one’s life, and moreover everyone directly wants to do so,” (p. 8). This statement is problematic on two levels. The first is that if one believes that it is a “duty to preserve one’s life” in any and all situations, then Kant would say that fighting for one’s country is unethical, or also that it would be unethical for a fireman to save a baby even if it meant losing her own life. The second reason why Kant’s reasoning is wrong is the assumption that “everyone directly wants to do so.” The cases involving physician-assisted suicide and euthanasia exist precisely because not everyone wants to preserve their life. Chronic suffering can cause a person’s life to become nothing but pain, or if not pain, then any number of other problems like difficulties...

For Kant, a person is acting ethically when and only when the person acts out of a genuine sense of respect for duty, respect for moral law. If the person begrudgingly acts, then their motives signal a kind of moral depravity that negates the ethical validity of the action. Following from this, Kant states “he preserves his life without loving it, not led by any want or fear, but acting from duty,” (p. 8). It is important for the patient to want to preserve life, not because the patient has been told that is what they are supposed to do. ”For an action to have genuine moral worth it must be done from duty,” (p. 9). If patients were prohibited from taking advantage of physician-assisted suicide, they would be preserving their own life only because they had no other option, not because they were acting ethically. Also, if a patient were enduring suffering because of their religious laws, their reasons or motives for acting would not be ethically sound according to Kant’s rigid ethical reasoning.
Furthermore, Kant claims “to have a duty is to be required to act in a certain way out of respect for law,” (p. 10). Euthanasia laws do vary from state to state, as well as from country to country. The deontological perspective proclaims to be universal, which makes it impossible to actually apply given the great variation in legal frameworks. Kant also attempts to show that the physician would be used as a tool, and deontological ethics expressly prohibit a person from being used as a means to an end: “If he escapes from his burdensome situation by destroying himself, he is using a person merely as a means to keeping himself in a tolerable condition up to the end of his life. But a man is not a thing,” (Kant, 2017, p. 29)

Finally, Kant does address the issue of whether it is morally permissible for a person to commit suicide when chronically ill or suffering. Kant believes that doing so would be an affront to moral duty and therefore wrong: “For love of myself, I make it my principle to cut my life short when prolonging it threatens to bring more troubles than satisfactions... couldn’t be a law of nature, and therefore would be utterly in conflict with the supreme principle of duty,” (p. 24). The problem with Kant’s deontological ethics is that it cannot take into account the wide range of people and circumstances that might come into play when judging cases involving physician-assisted suicide.

Utilitarian Ethics

Utilitarian ethics are based on the “greatest happiness principle,” (Mill, 2017, p. 2). Utilitarianism is also a type of ethical consequentialism, in which the results of an action are more important than the motives prompting it. Also integral to utilitarianism is the emphasis on happiness. Happiness is difficult to definitively define but John Stuart Mill does a fairly good job saying, happiness…