Introduction
Euthanasia, or Physician Assisted Suicide (PAS), the deliberate ending of an individual’s life, is continuously being legalized in various jurisdictions across the world. However, allowing PAS to be performed has catalyzed complex and emotionally charged debates in contemporary bioethics circles. The proponents of euthanasia argue that it is an act of mercy, and patients should have the liberty to have their lives ended either actively or passively.
The opponents of PAS point out that in countries where physician-assisted dying has been allowed, the number of requests has been increasing, and allowing it could compromise the inherent value of human life. Issues regarding palliative sedation and means to alleviate severe suffering are critical when making end-of-life decisions, and numerous studies related to the topic have been done. Due to the severity of the matter, PAS should be approached with caution, considering both the benefits of euthanasia brought by the proponents and the disadvantages brought forward by opposers while considering moral, ethical, legal, and societal implications.
Understanding Euthanasia
The idea of euthanasia is not new and dates back to ancient Greece and Rome, where killing was sometimes accepted as a good way to end suffering. In the 20th century, euthanasia started when C. Killick Millard, the founder of the Euthanasia Legalization Society, introduced a bill in 1936 for every person above 21, mentally competent and fatally ill and in severe suffering to request voluntary euthanasia (Sethi and Singh 954). In the United States, cases like the Dr. Kevorkiantrial, who was found guilty of performing second-degree murder for his involvement in physically assisted suicide, brought the topic into the limelight.
Today, euthanasia is a legalized practice in The Netherlands, which was legalized back in 2021, France, United Kingdom (Abdulaziz and Saif 5). However, the majority of jurisdictions take a more cautious approach towards euthanasia, allowing only palliative care and pain management for suffering patients. Some nations, such as Ireland, Poland, and Greece, criminalize the act of euthanasia (Abdulaziz and Saif 7). The great division in approach towards the issue reveals its contentious and controversial nature.
Euthanasia is a multifaceted approach with various distinct types, all of which are characterized by different circumstances and elucidates various types of debates. Active euthanasia entails causing death to the suffering by another individual, mainly a physician or a private request upon a request by the suffering or otherwise through some actions such as lethal injections (Sethi and Singh 954). Passive euthanasia, on the other hand, involves letting an individual die by withholding treatment and ceasing to offer life support.
Euthanasia can be voluntary, where the patient is on death bed and fully aware of their condition, thus requesting death. Non-voluntary, where they cannot make the decision; thus, a family member does it for them; or involuntary, where euthanasia is performed against the patient’s will. Moreover, EAS can be in the form of physician-assisted death where the patient on the death bed and in severe suffering requests for a medically qualified expert to make the best decision or guide them in the process. The distinctions highlight the complexity of the issue since each type of euthanasia has its own legal, ethical, and moral dilemmas.
Benefits and Disadvantages of Euthanasia
Autonomy and Personal Choice
Parties that argue for euthanasia state that individuals should have the liberty to make decisions about their own lives, especially on serious matters that involve life, death, and pain. Autonomy is the cornerstone of medical ethics and states that people have the right to make informed consents about their treatment options after being well guided on their medical conditions, treatment options, the risks they are likely to face, and the benefits the treatment should bring (Akdenizet al. 2; Zhou and Shelton 227).
Physicians generally have to respect the patient’s choices regardless of whether they go against the conventional norms or the best treatment option. Autonomy also goes further to incorporate complex mechanisms such as shared decision-making and advance directives, where the patient is given the right to have living wills and be guided in medical decisions even in situations where they cannot make decisions independently. The proponents of euthanasia often cite this principle of medical ethics, arguing that individuals must be given the freedom to choose by requesting euthanasia when facing unbearable suffering.
However, the opponents of euthanasia have laid out several limitations against autonomy as a tool that should be used to legalize euthanasia. They argue that vulnerability and cohesion, where the patients feel pressured about their medical and socioeconomic conditions, could push people towards choosing euthanasia where it is not necessary. According to this school of thought, personal choice is not always so autonomous as cohesion, financial burdens, and pressure from family members could guide the decision-making. The opponents also cite that medical errors and misdiagnosis may guide some decisions toward autonomous euthanasia.
According to Akdeniz et al., “Nonmaleficence is the principle of refraining from causing unnecessary harm” (3). They, therefore, argue that to ensure that nonmaleficence is minimized, euthanasia should be criminalized as a mistake decision made due to a lack of complete and incorrect diagnostics, which could have irreversible consequences. Euthanasia, guided by the principle of autonomy, is also opposed because it could lead to a slippery slope. The opponents say that even if euthanasia is allowed under strict guidelines, over time, the strict guidelines may erode, leading to the inclusion of individuals who do not qualify for the critical process.
A comprehensive analysis of the two sides of the argument shows that people who favor euthanasia based on autonomy have more valid concerns. Their perspectives highlight the need for personal agency and self-determination in end-of-life decision principles that have guided most aspects of life to date. Autonomy is the cornerstone of medical ethics, and issues such as cohesion, nonmaleficence, medical errors, and misdiagnosis should be addressed instead of being seen as a deterrence. However, for euthanasia to be done based on autonomy, well-set policies and guidelines should be designed to ensure that this freedom is not abused. For instance, a separate body of medical experts should be established to investigate the patients’ conditions and consent statements before the physicians can perform this act.
Alleviating Suffering
Proponents of euthanasia suggest that it is of critical importance for other humans to have compassion for those who are suffering and take all the necessary measures to alleviate their suffering. Many nations around the world, including The Netherlands, have legalized euthanasia based on this ground alone, showing the critical nature of preventing suffering in human life (Sethi and Singh 954). This guide is closely related to the principle of autonomy, where patients have a say in whether they need to have euthanasia performed on them to end their suffering.
Additionally, the proponents of euthanasia say patients should have a say in the quality of life they are living. If they objectively find out that the rate of their suffering exceeds the quality-of-life experience they are having, they should then request to have euthanasia performed on them. The proponents state that euthanasia could offer patients alternatives to pain relief when palliative care treatments are unable to achieve the same.
Conversely, opponents to euthanasia state that ethical, moral, and practical values do not allow euthanasia to be performed based on these metrics and that the advancement of science has resulted in there being other effective methods to prevent this procedure. They argue that because of the sanctity of life, death cannot be used as a means to end suffering regardless of its degree. For instance, in Jewish tradition, the value of life is considered paramount, overshadowing most rights and commandments, and is reflected in various Jewish traditions (Offer-Stark 6).
The opponents also state that it may be hard for medical experts to measure the physical pain particular patients are in, and some may fall prey to cohesion, thus requesting euthanasia for some non-existent pain. The medical diagnostics may also be erroneous and show that the patient is in unbearable and unmanageable pain while alternatives exist. Allowing euthanasia due to physical pain, as those opposed to euthanasia say, could also lead to pharmacists and medical researchers becoming reluctant to look for new medical alternatives to relieve their pain or heal some particular diseases.
Pain can sometimes be so severe that modern medication can do little to alleviate it, thus leaving euthanasia as the only feasible solution. Therefore, the argument for euthanasia as a method to end pain and suffering carries more weight as it revolves around principles of compassion, autonomy, and the quality of life for people. The argument that proponents pose is logical, as physicians and other members of society must show empathy to suffering individuals and let them have a choice to end their lives to end the distress. The legalization of euthanasia in The Netherlands, as well as partial allowance based on strict restrictions in the rest of the world, reveals that suffering should be, at times, a reason enough to perform EAS.
Sanctity of Life
Sanctity of life is an old philosophical concept that postulates human life as inherently valuable, fragile, and inviolable and should be protected and preserved at whatever cause. It has its roots in religious contexts where life is often viewed as sacred (Abdulaziz and Saif 8). Opponents of euthanasia, many of whom are religious, often cite these texts to demonstrate how the act is a sin. Religions state that God has opposed euthanasia as the scriptures state that people must not kill, that human life is sacred, and should be protected and preserved in whatever course. For instance, the Episcopal Church passed a resolution that physician-assisted dying is not allowable since it is immoral for anyone to take another’s life. However, proponents of euthanasia oppose this point based on religion, stating that the church also allows passive euthanasia by directing physicians to stop treatments if it could benefit the patient.
The Islamic religion supports those who oppose the idea of euthanasia, as Muslims believe that life comes from God. Therefore, humans are not allowed to take it under any conditions. Most Arab legislations agree that euthanasia should be prohibited but disagree on the nature of punishment for the offenders (Abdulaziz and Saif 8). The Jews, like the Arabs, prohibit both active and passive euthanasia. This religion states that humans should never take any actions that seem to hasten human life.
Instead, humans should take deliberate actions to ensure they prolong human life as long as possible. The discussions above reveal that religious scholars want doctors to do what they can to keep the patients alive regardless of the pain they are in or the chances of their survival. Based on the principle of sanctity of life supported by various religious teachings, it is clear that the opponent’s point of view has more weight. However, the proponents of euthanasia state that medical decisions can not be made based on religious teaching alone and should be based on science and other principles, such as patients’ autonomy. For instance, not all patients subscribe to religious views, and subjecting them to suffering based on religious grounds can be deemed unethical.
Beneficence
Beneficence is a central principle in the discussions regarding euthanasia, shaping the opinions and views of both those who support euthanasia and those who are against the killing. Beneficence refers to the principle of taking actions in a manner that seeks to benefit others, emphasizing the importance of doing good in all actions taken. Beneficence, for the proponents of euthanasia, is used to show that PAS should be done as it aligns with the principle of reliving profound suffering within the community.
This group of scholars states that euthanasia is an act of mercy promoting the well-being of an individual by granting them a choice to end their suffering. Euthanasia also benefits patients by granting them the dignity to live their last days on earth with some respect. Those against euthanasia disagree with the benefits that it brings, stating that preserving the value of life, preventing potential biases on the right and value of suffering in contributing to personal growth, resilience could make suffering a good sometimes.
Moral and Ethical Considerations in PAS
The goal for PAS is usually simple: to prevent and reduce suffering as much as possible by taking whatever means. The principles of autonomy, beneficence, nonmaleficence, and justice should guide the decisions. Open communication between physicians and patients or their patients is required during these times. The decisions must also be guided by the correct diagnosis: the patient is unlikely to discover a cure for a particular illness during their remaining life expectancy (Young 7). Patient autonomy is the right of the patient to have their treatments in a particular manner. In case the patient is incautious, they can be helped with advance directives, which are written instructions on how the patient expects to be handled once they become incautious. Therefore, decisions regarding euthanasia must be guided by these ethical considerations to reduce the limitations of its practice
Public Opinion and Stakeholder Perspectives
Despite there being various schools of thought for or against euthanasia, many surveys indicate that public opinion is shifting towards PAS, indicating that its benefits may outweigh the disadvantages. The level of support for euthanasia is higher among the younger populations and people who have witnessed a loved one suffer from intolerable pain in their end-of-life days (Walker et al. 390).
However, there are concerns that nations can put up robust measures to ensure that the loopholes put forward by the opponents of euthanasia can be addressed. Many people express that despite them favoring euthanasia, they believe that robust measures should be put in place to ensure that the right is not abused. However, the demographic for the religious people reveals that they are vehemently opposed to euthanasia.
The complexity and the need to further explore critically the disadvantages and advantages of euthanasia is revealed by accessing the perspectives of healthcare professionals. While this expert group is expected to have common arguments, doctors, nurses, and other healthcare professionals are also split into two segments regarding the issue of PAS, revealing its complexity.
Some physicians strongly support euthanasia, viewing it as a possible way of ending the suffering of people. Others are, however, opposed to the practice, with some facing high anxiety and stress when asked to stop treatment or induce some drugs to hasten death (Zhou and Sheldon 232). Moreover, some physicians opposed to the practice of euthanasia may emit it from the discussion with a terminally ill patient, resulting in serious ethical issues. This is because some patients can easily choose euthanasia if it is presented as an alternative to end their suffering.
Recommendations
Based on the comprehensive analysis of the advantages and disadvantages of euthanasia and various forms of PAS, there is a compelling argument for its legalization. Euthanasia, when performed under well-set regulations, can ensure the right to autonomy of people is respected, the suffering has the pain alleviated, and the hospitals can reduce their expenses. However, cost should not be an issue.
The concerns raised by the opponents of euthanasia can be addressed by setting robust legal safeguards, ensuring that diagnostics are accurate through various assessments, and ensuring that the decisions made by the patients are well-informed. Governments and medical institutions should set up comprehensive oversight systems to minimize abuse and ensure transparency in the processes. By critically identifying all the possible disadvantages and setting up mitigation measures, hospitals could ensure optimized care for patients during end-of-life times.
Conclusion
The benefits of euthanasia, as put forward by its proponents, include giving the patient autonomy of the care they wish, alleviating their suffering, ensuring beneficence, and reducing financial burdens on healthcare systems. However, there are numerous disadvantages to the practice. The opponents of euthanasia argue that this right could be abused, people could be killed based on wrong diagnostics, that pain could make people grow, and that religions are opposed to the practice.
Despite there being many counterarguments on this topic, it is clear that the benefits of euthanasia far outweigh the disadvantages. Before its legalization, robust legal standards such as formulating legislation on euthanasia and establishing a governing body, doing several tests to ensure correct diagnostics, and talking with the patient to ensure their personal choices should be made. The ultimate goal should be to ensure that dignity in human life is maintained and that people do not suffer in useless pain when palliative care procedures fail.
Works Cited
Akdeniz, Melahat, et al. “Ethical Considerations at the End-of-Life Care.” SAGE Open Medicine, vol. 9, 2021, pp.1–9. Web.
Abdulaziz, Ramadan Ali and Saif, Faris, Nouri. “Euthanasia Between National Legislation and International Human Rights Law.” Alrafidain of Law, vol. 25, no. 82, 2023, pp. 1-29. Web.
Offer-Stark, I. “Designing Medical Law in a Multicultural Society: The Case of Israeli End-of-Life Laws.” Ethics, Medicine and Public Health, vol. 28, 2023, pp. 1–16. Web.
Sethi, Shubham, and Angad Singh. “Euthanasia: The New Phase of Right to Die.” International Journal of Law Management & Humanities, vol. 4, 2021, pp. 953-963. Web.
Young, Robert. “Voluntary Euthanasia.” Stanford Encyclopedia of Philosophy, edited by Edward N. Zalta,The Metaphysics Research Lab, Department of Philosophy, Stanford University, Stanford, CA 94305, 2022, pp. 1–33. Web.
Walker, Simon, et al. “A Citizens’ Jury on Euthanasia/Assisted Dying: Does Informed Deliberation Change People’s Views?” Health Expectations, vol. 23, no. 2. 2019, pp.388–395. Web.
Zhou, Yan Ming Jane, and Wayne Shelton. “Physicians’ End of Life Discussions with Patients: Is There an Ethical Obligation to Discuss Aid in Dying?” HEC Forum, vol. 32, no. 3, 2020, pp. 227–238. Web.