Euthanasia Ethics: Patient Rights vs. Legal Barriers

Introduction: Defining Euthanasia and the Central Debate

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 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 hotly debated topic in the medical community, particularly in the field of medical ethics. In most societies, there are taboos against taking one's own life, and even stronger taboos 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 someone who has a terminal illness and is reaching its end stages. 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 analyzes these different issues and weighs 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 critical issues remain unresolved where participation in the death of another person is concerned. For this reason, it is not possible to recommend the legalization of euthanasia at this time.

Patient Perspective: Autonomy and the Right to Die

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 by 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 determine their right to take their own life so much as 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 in peace was considered a right that people held. 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 twentieth 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 where suicide is considered taboo — which is 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 pragmatic 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, the right to autonomous decision-making for rational adults is something that is usually protected. 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, states that no one "shall be subject to inhuman or degrading treatment" — a standard that being legally compelled to endure the horrific effects of end-stage terminal illness would seem to violate. Article 18 highlights the right to "freedom of thought, conscience and religion," which allows 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 one's own death as well — autonomy does not end prior to death, only after it (Gorsuch, 2006).

Conclusion: Weighing the Balance of Evidence

Euthanasia is a controversial topic largely because of the moralizing that surrounds it. But policy — in particular legal policy — should be free from the imposition of one group's morality on the whole, in situations where no clear harm is being done. This is the essence of respect for personal autonomy. What makes the euthanasia debate so difficult to resolve is that there is genuine doubt about the meaning of harm in this context. Surely a person dying constitutes harm, but when that person is terminally ill and destined to live only a short while longer with a very low quality of life, how do we weigh the balance of harm? It can be difficult to determine, even for the best physicians, and each patient will have his or her own interpretation of what constitutes the greater suffering. From the patient perspective, the right to choose is a given in any reasonable moral code that values human autonomy.

What is more challenging is the role of the physician and the role of the law. Many challenges to legalizing euthanasia remain unresolved, including our incomplete understanding of the cognitive processes faced by people with a terminal diagnosis, the physician's Hippocratic Oath, and the reality that not all patients or physicians are capable of reaching a truly rational decision with respect to the ending of life. Most physicians lack experience in this regard, because it works against everything they have been taught about preserving life. Most patients, when given such a diagnosis, are also facing something new and may not be capable of making the most clear-headed decision. If the moral issue is complex, the legal issue is even more so. Until these issues are resolved, it is recommended that euthanasia remain illegal — the risks are simply too great to allow people to participate in the deaths of others.

References

Gorsuch, Neil M. The Future of Assisted Suicide and Euthanasia. Princeton, NJ: Princeton University Press, 2006.

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 of Canada, 31(7), 314–318.

Sanson, A., Dickens, E., Melita, B., Nixon, M., Rowe, J., Tudor, A., & Tyrrell, M. (1998). Psychological perspectives on euthanasia and the terminally ill: An Australian Psychological Society discussion paper. Australian Psychologist, 33(1), 1–11.

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/