The Ethics of Dying with Dignity: Euthanasia Perspectives

Introduction

Is it ethically justified to euthanize someone if they are terminally ill and suffering, or have lost brain wave function? Based on the principle of autonomy, it has been argued that physician-assisted suicide is morally justifiable (Sjöstrand et al., 2013). The larger question, however, is whether a physician can morally assist in the suicide of a patient on the basis of that principle. If it is the will of the patient to terminate his life, must the physician respect that will? Or does the physician have a higher duty, according to the Hippocratic Oath, to do all he can to preserve and protect life? Where does duty to the Oath end and the patient's right to choose death begin?

Today, euthanasia is to some extent an accepted practice under certain conditions—for example, when hospice is called to tend to an end-of-life patient. But in these cases it is usually the patient's family that calls hospice, not the patient himself. Does the patient have a right to request euthanasia before he reaches the point where he can no longer make decisions for himself? Can he request to die with dignity, as an ancient Roman might have? This paper answers that question through historical, legal, medical, biological, social, psychological, economic, political, religious, and ethical perspectives, and shows that there is no single simple solution to a question touched by so many different viewpoints.

Reasons Why One Should Be Allowed to Die with Dignity

From an ethical perspective, it can be argued that one should be allowed to die with dignity by choosing the date and manner of one's death. A mother may choose the date and manner of the birth of a child, so it stands to reason that one should also be able to select the manner and date of one's departure from this world. Ethical Egoism, which holds that the most moral course of action is that which benefits oneself, supports the principle of autonomy (Holmes, 2007).

From a libertarian perspective, a person should have the right to die with dignity, as it is his choice and no one else's decision should bear on it. From a utilitarian perspective, however, one might argue that society should consider where the greatest common good lies: if permitting euthanasia is in the best interest of the community, then it should be viewed as morally acceptable. The utilitarian might point to economic reasons first: caring for a seriously ill patient over a long period can impose a steep financial toll on a family, as well as social, emotional, and psychological costs on family members, friends, and caregivers. Therefore, the utilitarian might argue that allowing euthanasia is justified in order to avoid those various burdens.

The Kantian, however, might argue that one has a duty to oppose physician-assisted suicide because the physician has taken an oath forbidding self-slaughter. The physician is meant to heal the mind and body—not deprive it of life—which is what occurs when he helps a patient take his own life. Kantian ethics therefore forbids euthanasia "where suicide is committed in order to obtain benefits or escape harm" (Sjöstrand et al., 2013, p. 229).

From the standpoint of biological implications, it has been argued that "the bioethical heart of the matter is the moral rightness of killing or letting die for the good of the patient" (Vaughn, 2012, p. 625). According to Vaughn (2012), most physicians oppose physician-assisted suicide, yet they accept as moral what is called terminal sedation. When a patient relies on life support and it is withdrawn, most physicians do not consider this immoral. The moral issue is whether a patient can request to die before reaching the point where life support becomes necessary. Vaughn (2012) suggests that most doctors would say no—the patient cannot morally make that request of a physician.

However, as Sulmasy and Mueller (2017) explain, patients view the matter differently: for them, it is a question of staving off a fate they consider worse than death—intense suffering or a deteriorating quality of life. They see no value in pain or suffering, either because they do not subscribe to virtue ethics or to a religious belief in which suffering may be redemptive—as in the Roman Catholic tenet of uniting one's suffering to that of Christ. For those who do not believe in the redemptive power of suffering, or who simply do not wish to suffer, the question arises: should they not have the right to request a safe means of ending their lives, just as women in many jurisdictions may legally terminate a pregnancy? Should it not ultimately be a matter of individual will, as Lachman (2015) asks? The matter is not so simple, because not everyone shares the same ethical, moral, or religious perspective, or the same understanding of duty.

Historical Perspective

The historical perspective on euthanasia is a mixed one. The ancient pagan societies of the West—the Greeks and Romans of the fifth to first centuries BC—tended to view it as morally acceptable. Even though the Hippocratic Oath stems from that same period and culture, many physicians of the time did not follow it strictly when it came to providing patients with the means of dying upon request (ProCon, 2022). The Christian era reinforced the Hippocratic Oath, and Christian culture generally upheld the view that life is sacred and therefore may not be ended before God so ordains. With the Age of Enlightenment, the Christian moral perspective was challenged, yet a common law opposing euthanasia was still promoted. By the eighteenth century, however, both common law and Church law were being questioned by new philosophies such as Ethical Egoism. The American medical establishment continued to oppose euthanasia nonetheless, and it is only in recent decades that some states have begun to accept the possibility that euthanasia can be morally permissible.

Conclusion

It can be inferred from the research that there is no easy answer to the matter of euthanasia. It is a divisive issue because modern culture is divided between those who hold to ancient belief systems and those who adhere to more modern, subjective philosophical and ethical viewpoints, such as Ethical Egoism. The research reveals historical and ethical reasons both for opposing euthanasia and for accepting it, along with economic costs and many other considerations worth weighing.

Euthanasia is likely to be viewed through the lens of one's religious convictions or professional identity as a physician. If state voters wish to change the law to make euthanasia permissible, they are free to do so in a democratic society. The law is a reflection of the moral views of the majority of voters—but it is nothing more than that. Society may remain deeply divided on the matter, which is not surprising given the similar division that persists on the question of abortion. Ultimately, the debate over dying with dignity is inseparable from the broader question of who holds authority over human life—the individual, the medical profession, the state, or a higher moral or divine order.