DP Barrett - The Philosophical Debate
About Euthanasia
The word ‘euthanasia’ derives from Greek and originally meant
‘good death.’ Today we use it to indicate a mercy killing, when life is cut
short for the sake of avoiding a painful death. Euthanasia is the purposeful
killing of a person in order to avoid chronic physical pain, and a person by be
euthanized either by themselves or by another person. This gives us a strong
link to suicide; if suicide is immoral and wrong in all cases, then it seems
that euthanasia is almost certainly wrong also.
The definition given above mentions only physical pain, and does
not mention psychological pain such as extreme stress and depression. In many
cases physical pain will be accompanied by psychological trauma, and it is this
factor which might decide whether someone can cope with their pain or not. In
some cases (e.g. total paralysis) there is no actual physical pain but a person
may consider their life not to be worth living. Many people argue that
euthanasia should not be permitted for psychological distress because a person’s
psychology can be treated, hopefully making them happier in the end. Euthanasia
is generally called for when a person is suffering from an incurable physical
illness which will kill them but make the process horrifically painful. For the
main part this article will focus on euthanasia for the sake of avoiding
physical pain.
Types of Euthanasia:
Voluntary and Involuntary
There are many kinds of euthanasia, and this makes it a
difficult issue to make general rules of thumb about euthanasia. Every example
of euthanasia will be voluntary or involuntary. Voluntary euthanasia is when a
person specifically asks for their life to be ended. Involuntary euthanasia is when a person has
not given their permission, but instead the decision is taken by another person.
Involuntary euthanasia is generally treated as murder, after all, we are talking
about ending a person’s life without asking them, or perhaps against their
expressed wishes. However, there are special cases when it is not regarded as
murder, and is actually legally allowed, such as when a person is actually
incapable of making a choice due to being in a coma or Persistent Vegetative
State (PVS). In many cases further treatment (i.e. keeping them alive) is viewed
as futile, and doctors or family make the decision to turn life preserving
machines off. This has sometimes been termed as ‘non-voluntary’
euthanasia.
Types of Euthanasia:
Active and Passive
In addition to being voluntary or involuntary, every example of
euthanasia will be either active or passive. Active euthanasia is when action is
taken to actually end a person’s life, such as shooting them, giving them a
lethal injection, smothering them with a pillow, and so on. Meanwhile, passive
euthanasia is considered more to be ‘letting die’ rather than killing, as it
involves allowing a person to die due to taking away treatments which could save
their life, e.g. switching off a life support machine, not giving them food and
water, not giving them life extending drugs, not resuscitating them, and so on.
Whilst active euthanasia is an act of commission (doing something), passive
euthanasia is an act of omission (leaving something out). Many view it as
‘letting nature take its course’ and therefore they do not see it as immoral.
Meanwhile others are keen to point out that this method is often more painful
than actively killing someone and therefore that active euthanasia is actually
more humane.
Assisted
Suicide
Assisted suicide is when another person helps you to kill
yourself because you are not capable of doing so yourself; this may include
providing a person with the means to kill themselves, such as giving them a
poison which they will then drink, but it may also take other methods. Dr. Jack Kevorkian created a device
called a thanatron, a machine designed to allow a person to kill themselves; the
machine contained canisters of drugs which were connected to the person to be
euthanised by intravenous lines by Kevorkian. The person would then press a
button to start the machine by themselves. Kevorkian claims to have helped over
130 people to die in the USA. He was sent to prison when he was discovered to
have killed one himself by lethal injection.
One point that is often missed in the debate on assisted suicide
is that according to Swiss law the person must be fully conscious and sane in
order to be assisted in death. Suppose that a woman is diagnosed with
Alzheimer’s disease and knows that she will eventually lose her memories and her
sense of herself. This may horrify her to the extent that she would rather die
than continue to live in such a way. However, since she must be sane at the time
she chooses to die this means that she cannot wait until the disease takes hold
and then die afterwards, she must instead die early whilst she is still mentally
healthy. This means that she will miss out on many final opportunities for good
and valuable life experiences before the disease takes hold. Some argue that
people should be allowed to produce ‘living wills’ stating that if they do fall
victim to such problems they should be killed or allowed to die.
Death as a ‘side
effect’
Death as a side effect is technically legal in the UK. In many
cases terminally ill patients are given strong pain killing drugs because of the
severity of the pain they are experiencing. Continued usage of these drugs at
high levels can shorten life, for example, use of morphine can cause
asphyxiation or pneumonia. Despite the known risks many doctors continue to give
their patients the drugs, with the patient’s knowledge, and this eventually
kills them. However, this is not considered to be euthanasia as there is no
actual intention to kill the person, the main intention is to take away their
pain, not to kill them. Their death is considered to be a lamentable side
effect, or ‘double effect’ of the care they require. This is not too dissimilar
to the way in which a person may die when having a risky life saving operation
like a heart transplant.
UK euthanasia
laws
As stated above, assisted suicide is illegal in the UK, whereas
causing death as a side effect of treatment such as pain relief is considered
acceptable. According to the law all acts of active euthanasia are illegal,
whether they are active or passive. Essentially it is regarded as murder. When
making judgements on these matters judges have made the following
statements:
If the acts done
are intended to kill and do kill it does not matter if a life is cut short by
weeks or months, it is just as much murder as if it were cut short by
years.
Justice
Devlin, 1957
However gravely
ill a man may be he is entitled in our law to every hour that God has granted
him. That hour may be the most precious and important of his life.
Justice Mars-Jones, 1986
The only forms of euthanasia which are ‘allowed’ are passive,
but there is a great deal of restriction depending on whether it is voluntary,
involuntary, or non-voluntary. A patient has the right to refuse treatment, and
in this way passive voluntary euthanasia is legal because a patient can opt to
refuse life-saving operations, life extending drugs, and even food or water.
This can be done with a ‘living will’ which states, for example, that if the
person’s heart stops then they are not allowed to be resuscitated, although the
legal standing of living wills is an area of debate. However, if the patient is
deemed to be mentally unstable then they can be sectioned under the mental
health act, meaning that a doctor may ignore their wishes not to be treated and
treat them anyway. In many cases the wish to die is itself seen as a sign of
mental instability, and the law states that it cannot be in a person’s best
interests to be dead.
Passive non-voluntary euthanasia is allowed because the law
recognises that in some cases treating a patient is futile, which means that it
is of no benefit to them. In these cases it is not a crime to withhold
treatment. The classic example of this is switching off the life support system
of a person in a coma or PVS, or withdrawing food and water drips and allowing
them to starve to death. This is viewed as letting nature take its course rather
than killing the patient. However, it is a crime to refuse treatment to a person
who has a good chance of benefiting from it or who has requested it, as health
workers have a duty of care to treat their patients:
For a doctor
deliberately to interrupt life-prolonging treatment in the face of a patient’s
expressed wish to be kept alive, with the intention of thereby terminating the
patient’s life, would leave the doctor with no answer to a charge of
murder.
Lord Phillips, 2005
This means that in many cases passive non-voluntary euthanasia
would be ruled out as there might be a good chance of a person waking from a
coma after some time. It also means that involuntary euthanasia is illegal in
all cases as the patient’s wishes need to be taken in to consideration and it
cannot be right to withhold food or treatment from a conscious person, this
would again be considered murder.
The Ethical Debate:
Voluntary Euthanasia
It is best to look at one kind of euthanasia at a time as
different factors may be involved in the consideration of each. For the sake of
this debate we will assume that there is no moral difference between active and
passive euthanasia as this will make our considerations easier.
Let’s start with a moral dilemma: suppose that you were a
soldier fighting in a war, and that you were captured by the evil enemy forces.
Your enemies are sadistic and delight in harming captured prisoners. They offer
you a choice: either you will be killed now relatively painlessly, or you can be
tortured every day for two months and then killed painfully. Now it may well be
that you are the kind of person who would rather be alive, no matter how bad
that life is, than die. And you may be the kind of person who would opt for the
torture in the hope of being rescued at some point. However, most people would
more than likely choose to die sooner and avoid the pain. In a very real sense
this is very much like the option faced by a person requesting euthanasia, such
as a person who has a terminal cancer and can expect to spend the last few
months of their lives in constant pain and being cared for by hospital staff.
This gives a strong argument for allowing voluntary euthanasia out of sympathy
and compassion for those who suffer, however, it is an emotive response rather
than one based on reasoning or principles of any kind.
Voluntary Euthanasia –
The Teleological Approach
Teleological moral theories consider the consequences when
choosing whether to allow euthanasia or not, the most famous version of the
theory being Utilitarianism which seeks to minimise pain and maximise happiness.
Suppose that a man is mauled by a tiger in the jungle and that he is so badly
injured that he cannot survive more than an hour, with help being at least six
hours away; he asks you to shoot him and end his pain. You have two options, to
kill or not to kill; whichever option you take part of the final result is the
same, the death of the suffering person, except that in performing euthanasia
the person will suffer much less pain, which surely makes it the better option.
This short term example of euthanasia shows us the basic jist of the
teleological position: that in many cases where a person is suffering euthanasia
will be allowed because it minimises pain before their eventual death.
Of course, this is an over simplification of the Utilitarian
position as all of the consequences need to be taken into consideration before a
judgement can be made. Utilitarians will also consider the wider implications,
such as the effect that killing a person will have on the one who performs the
euthanasia, the effects it will have on the person’s friends and family, and the
effects it will have on the judge or authority who allowed the euthanasia to
occur, and so on. The one who performs the euthanasia may feel guilty for ending
a life, but then again, some people may feel guilty for not ending a life and
leaving the person to suffer instead. Family and friends might feel abandoned
because their loved one has chosen to die, but on the other hand they may feel
relieved that their loved one is no longer suffering, and relieved that their
lives can go back to normality, since caring for a loved one who is ill can take
your entire life up and be extremely upsetting and stressful. Looking at wider
implications again, keeping people alive may be very expensive, so allowing them
to end their lives could mean that the money can be spent elsewhere to help
other patients, a clear utilitarian benefit.
Euthanasia certainly prevents a person from feeling anymore
pain, but it may also mean that they lose opportunities for final moments of
happiness. There is a strong argument that the best approach to ensure happiness
is to give palliative care in hospices where people can die naturally and in
relative comfort, share precious moments with friends and relatives, and help
everyone to achieve closure. Sisley Saunders, a Christian who founded a hospice
had this to say: “I’m against euthanasia for a positive reason. I have seen
people achieve so much in the ending of their lives – times that their families
would have missed… They perhaps would have gone in bitterness, whereas they
finally go in peace and fulfilment.” If
we take a teleological standpoint we must take all of the factors in to account,
and it may be that these wider factors indicate that euthanasia is not
appropriate in a particular case.
Voluntary Euthanasia:
The Deontological Approach
Deontology is not concerned with the consequences of an action,
nor necessarily the action itself, but instead the principles that underpin the
action. There are deontological principles that support euthanasia as well as
oppose it.
The very fact that we distinguish between voluntary and
involuntary euthanasia is telling of our moral assumption of a principle of self-determination. There are
supporters of euthanasia who believe that individuals should have a right to die
because it is their own life and that we others ought to respect their autonomy
and choices of what to do with their life. This, then, is a deontological
argument for allowing voluntary euthanasia. Interestingly, a large number of the
people who go to the Dignitas euthanasia clinic in Switzerland opt not to end
their lives; it seems that the knowledge that they could kill themselves if they
wanted to makes their suffering easier to cope with because it gives them a
sense of control and removes feelings of helplessness; they are choosing to stay
alive rather than being forced to do so. A problem is that if people have a
right to die, and a right to choose, then this seems to indicate that anyone who
wants to die, for any reason, should be allowed to kill themselves, and possibly
helped to do so. Can we really legalised assisted suicide for depressed people,
or those in similar situations? Euthanasia is meant to only be reserved for
those whose suffering is greatest, rather than for everyone, and it seems
strange to say that only those who are suffering have a right to die, since
rights are meant to be universally applicable.
When it comes to the euthanasia debate two of the most important
principles are Sanctity of Life and
Quality of Life. The sanctity of
life principle states that human life is special and of extremely high value,
and therefore that life is not to be taken: people are not to be disposed of,
but preserved. Many people would argue that if a dog was in severe pain we would
be kind and put it down, and they argue that the same should be allowed with
human beings, but many others respond that human life is sacred and that it
should not be so easily cast aside. The Sanctity of Life principle is a major
deontological principle standing against euthanasia, and it is most often linked
to religious perspectives which see life as belonging to God, and as special
because we are made in God’s image (Genesis 1:26). However, there are also
secular reasons to be of similar mind, for example, Immanuel Kant placed infinite value on
all rational beings meaning you cannot abuse or mistreat them in any way, and
the UN declaration of human rights describes human beings as endowed with
reason, conscience, and dignity. From this deontological perspective life is to
be preserved regardless of its quality or lack thereof. Additionally, there are
numerous commandments in holy texts such as the Bible forbidding killing, such
as the sixth commandment “thou shalt not kill.”
Many supporters of euthanasia would argue that life is indeed
precious and special, but that there comes a point when it is undignified to
continue living, so euthanasia should be allowed to preserve dignity. Think of your life as you live
it now; perhaps you are proud of yourself because of your sporting achievements,
or how popular you are with your friends, or how well you do at your job or in
school. There are things about you which make your life valuable to you and
worth protecting and preserving. However, extreme suffering can rob a person of
all the things which, in their view, give their life its dignity and sanctity.
As an example, the author Terry Pratchett has been diagnosed with Alzheimer’s
disease. Over time he will lose his personality, and his memories, and
everything that made him the man he is; he will no longer be able to write, and
he probably will barely be able to even remember having been an author at all.
Pratchett is now a leading campaigner for the legalisation of euthanasia in the
UK. Many supporters of euthanasia argue that those who are afflicted by extreme
pain and debilitating conditions should be allowed to die while they still have
their dignity.
Opposing the principle of Sanctity of Life there is the
principle of Quality of Life; roughly speaking this concerns the degree to which
a life is fulfilling, pain free, and enjoyable. The idea of quality of life
supports euthanasia because it indicates that life is only worthwhile if it is
purposeful and enjoyable, so that it is better not to live at all rather than
live a poor quality life. As David
Hume put it: “That suicide may often be consistent with interest and with
our duty to ourselves, no one can question, who allows that age, sickness, or
misfortune, may render life a burden, and make it worse even than annihilation.
I believe that no man ever threw away life, while it was worth keeping.”
However, many may disagree with Hume’s last point and state that many people
have thrown away worthwhile lives; how precisely quality of life can be
measured, and who should be doing the measuring, is highly debatable.
Another point of principle to be taken in to account is the
Hippocratic Oath. The Hippocratic Oath
which doctors swear before being allowed to practice medicine specifically says
that the doctor should keep their patients from harm and also states “I will not
give a drug that is deadly to anyone if asked, nor will I suggest the way to
such a counsel.” Surely it is the job of doctors to preserve lives, and it is
dangerous or at least a bad practice to introduce the killing of people in to
their job? Could this not lead to abuses such as those performed by Harold
Shipman who killed at least fifteen of his patients, if not many more? Might not
a doctor pressure someone into euthanasia so that he could reap their organs for
donation, or to save the hospital trust the cost of expensive treatments? On the
other hand, it might be noted that doctors already perform abortions, which many
view as a form of murder.
The famous deontological thinker Immanuel Kant specifically argued
against suicide, and so by extension we can also say that getting someone else
to end your life for you would also be wrong in his opinion. First of all, for
Kant the lives of rational beings are of infinite value, which means throwing
them away is never an option; remember that for Kant people should be seen as
“ends in themselves” who should therefore not simply be used or simply disposed
of like mere objects. Kant can be seen as trying to defend the traditional
Christian position on suicide and euthanasia, but rather than relying on the
religious commandment of “Thou shalt not kill” he is instead trying to give the
Sanctity of Life a secular grounding in Reason.
It can be argued that neither killing nor suicide are
universalisable, since this would lead to the destruction of the human race.
However, Kant asks us to universalise the principle on which we are acting
rather than the action itself, which may mean that something like killing in
self defence is allowable, but not killing for monetary gain. This makes it
difficult to see whether euthanasia could be allowable in the right
circumstances, for which reason Kant’s theory has been accused of being quite
hollow and unhelpful in most issues. Arguably it is perfectly possible to
universalise a maxim such as “I will end my life painlessly to avoid a painful
death.”
However, Kant does provide his own argument against suicide: the reason why we are averse to pain is because pain is a risk to continued survival, therefore, we avoid pain to save our lives. Therefore, suicide to avoid pain or suffering is killing yourself for the sake of saving your life, which is absurd, it is destroying yourself for the sake of self-preservation. This he believes is irrational and contradictory. For Kant this means that suicide and euthanasia must be immoral since they cannot be universalised without contradiction. However, arguably Kant is presuming too much here by assuming that we avoid pain purely for the sake of survival, so his argument actually turns out not to be based on Reason at all, but actually traditional Christian notions of Natural Law (the idea that there is a God given purpose to our nature).
Involuntary
Euthanasia
Involuntary euthanasia can be when someone is killed without
being asked if they want to live or not, alternatively, it could go directly
against their wishes, ending their life when they have specifically said that
they want to live. In the UK involuntary euthanasia is automatically considered
to be murder, and it is easy to understand why as it denies autonomy,
self-ownership, and the right to life enshrined within the UN declaration of
human rights.
The first and most obvious argument against involuntary
euthanasia is that the right to choose is extremely important. Some use the
principles of autonomy and personal choice to argue that voluntary euthanasia
should be legalised, but even if you reject legalisation it still seems to be
true that ending the life of someone who has not asked for it, or who has even
declared a wish to live, is utterly wrong. This is a deontological perspective,
however, whether a person actually wants to die or not might not be the biggest
factor in a teleological ethicist’s calculations. From a teleological point of
view principles don’t matter, what matters is the consequences, so whether the
person actually wants to die or not may not be wholly relevant. Imagine an old
man suffering from a terminal cancer; let’s imagine that despite the pain of his
life he is determined to persevere until the end; let’s further imagine that
this is causing his family a great deal of upset and pain, and also that his
treatment is very expensive and due to limited hospital funds it is preventing
other patients from having life saving operations. An Act Utilitarian would have
to say that regardless of whether he wants to live or not, the consequences will
be better if he is killed, if he is killed then this will alleviate the burden
on his friends and family and allow us to save other lives instead, so in the
big scheme of things his own wishes are outweighed by the needs of others.
Involuntary euthanasia has often been practiced in times of war, when it was
decided by army chiefs or doctors that it would be better to kill wounded men
than allow them to be taken alive by their enemies.
However, from a Rule Utilitarian perspective it makes sense to
forbid involuntary euthanasia. JS
Mill believed that it was the goal of morality to create happiness, but that
this was best done by having strict rules which protected people, in other
words, rights. It is clear to see that people will be happier if they feel
protected from having their lives terminated without being asked. Mill believed
that people would be most happy if they were free to pursue their own ends and
not interfered with, so he declared that there was a ‘private sphere’ into which
outsiders (e.g. the government) could not pry. Essentially people can do what
they want so long as they do not harm others, which is indeed how most of our
law works. For Mill bodies like the government could not interfere with people’s
lives, even if they were suffering from alcoholism, or gambling addiction.
Involuntary euthanasia would severely violate Mill’s idea of the private sphere,
as it means controlling people’s lives at a fundamental level.
There are, however, times when involuntary euthanasia may seem
reasonable. After an earthquake in America three men were trapped on the roof of
a burning building and there was no chance of them being saved; though they were
calling out to be saved they were instead shot to save them from the pain of
burning to death. Does this seem
reasonable in this exceptional circumstance?
One of the great worries about involuntary euthanasia is that a
slippery slope might be created allowing more and more involuntary killings to
be performed, and there is often the worry that we could end up with a regime of
eugenics like that practiced in Nazi Germany whereby the state made decisions
about whose lives were worth living and whose were not. Nazi doctors murdered
somewhere in the region of 700,000 German citizens whom they deemed to be
unworthy of life, such as disabled children and the mentally ill.
Non-Voluntary
Euthanasia
This generally applies to the ending of the life of someone in a
coma, who therefore cannot possibly make any decisions about continuing their
life or dying. It is most usually done passively, e.g. through withdrawing food
and water from the coma victim, or removing their life support. However, there
are three further issues to think about which muddy the waters.
Firstly, it is thought that coma victims may be able to
experience pain, particularly if they are left to starve to death through
withdrawal of food and water. Because of this it can be argued that it would be
more humane to give such people a lethal injection (active euthanasia) which
kills instantly, thus causing less pain.
Secondly, who should make the decision to end the person’s
treatment or end their life? There are
often times when a hospital trust will say that there is no point and purpose in
keeping the patient alive, whilst the family wish the treatment to continue. Who
should make the choice here? Should the views of the family be given priority,
or should they be viewed as being biased or irrational in their wishes? It might
be said that a family which refuses to allow the life support to be switched off
are failing to accept that their loved one is already gone, and that the choice
should be left to the impartial medical experts. On the other hand, it might be
said that hospital staff are simply thinking about saving money, and so are also
biased.
Thirdly, there is the possibility that a person could wake up from their coma. Some people have been in comas for years and suddenly woken up, and it might be argued that we should always keep coma victims alive in case they recover. On the other hand, keeping them alive in a coma is expensive and puts the family under a lot of stress for years, so teleological thinkers argue that it may be kinder to switch their life support machines off and make a clean break for the family and friends. Note that those in PVS are brain dead, their bodies are simply kept going by machinery and there is no hope of recovery.
Passive Euthanasia Vs
Active Euthanasia
In the UK active euthanasia is automatically considered to be
murder, but passive euthanasia is not, there are some circumstances when it is
allowed or ‘tolerated’ for example, in switching life support machines off. It
is illegal to refuse treatment to someone who has asked for it and can still
possibly benefit from it, but if treatment is of no avail, or if a person
refuses treatment (and is of sound mind) then passive euthanasia can be allowed.
As previously explained, passive euthanasia is considered to be a case of
letting nature take its course, whereas active euthanasia is actively killing
someone, and so is viewed as murder.
However, according to philosophers such as James Rachels we should consider active
and passive euthanasia as morally the same, and perhaps even consider active
euthanasia to be better. In Rachels’ view acts of commission and omission are
morally equal. Suppose someone who is paralysed wishes to die believing that
their life now has no meaning or enjoyment; how could it be acceptable to allow
the person to die slowly over several weeks due to starvation and dehydration
(which is extremely painful) when it is not acceptable to simply kill them
painlessly in mere moments?
Rachels uses the following thought experiment: suppose that
Smith wants his 6 year old nephew to die so that he can inherit his parent’s
money. Consider the difference between the following two events: (i) Smith plots
to drown his nephew in the bath and does so; (ii) Smith plots to drown his
nephew, and arrives at the door just in time to see his nephew slip in the bath
and start to drown by himself; Smith then takes the passive course of omitting
to act and stands idly by with a smile on his face watching him drown. Can we
really say that Smiths actions in (i) are worse than in (ii)? Surely if the
initial intentions are the same, and if the outcome is the same, then the method
is practically irrelevant? Smith’s actions in (ii) are no better than those in
(i). Thus according to Rachels active euthanasia is no worse than passive as
both have the same intentions and the same results: an intended death. However,
if active euthanasia is less painful (as is often the case) then Rachels would
argue that it is the more moral course to choose.
There is a large problem though, because treating acts of
omission as equal with acts of commission has huge implications for ethics.
There are people starving in various parts of the world, and we in rich nations
have done little or nothing to help them; at the least we could have done much
more than we have done. We have neither provided them all with food nor the
resources to grow their own, despite having the ability to do so. We have
omitted to help them and left them to their own devices to die. If actions of
omission and commission are morally equal then we are no better than genocidal
mass murderers. Can this be correct?
Summary and
conclusion
There are a huge amount of issues to consider when it comes to
deciding on your moral view of euthanasia, and this is partly because there are
so many different forms that euthanasia can take. Perhaps we should say that all
euthanasia is wrong and that it should be illegal in all cases, an absolutist
approach? Perhaps we should say that sometimes euthanasia is acceptable whilst
other times it is not, a relativist approach? The main issues to consider are
the following: - Whether people have a right to die in order to avoid pain, or whether all life is sacred and to be preserved;
- Whether it is possible to legalise voluntary euthanasia and yet at the same time ensure that it is not abused and that no one is forced to die when they do not want to, or when they still have a life worth living;
- Whether euthanasia should be performed, actively or only passively;
- Who should decide whether it is allowed or not, doctors or the family;
- Whether people should be allowed to make living wills which state that they ought to be euthanised should certain illnesses befall them.
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