Euthanasia remains one of the most disputable subjects in bioethics because it raises numerous philosophical, legal, and ethical issues. Does a person have a right to manage his or her life and death freely, where is the boundary between life and death, is life an absolute value, is the preservation of life always good? The answers to these and many other related questions affect the fundamental social values, and it explains the acute manner of the debate on them.
Being a bioethical issue, euthanasia implies that individuals involved in challenging medical situations are compelled to take responsibility for setting the limits of life (Dennis, 2009). Although modern technologies can maintain organism functions of a terminally ill or unconscious patient for a long time, it may lead to continual suffering, increase treatment costs, and require the investment of resources that could be distributed among other patient populations.
The opponents of euthanasia claim that it contradicts the socially accepted norms of morality and threatens social welfare (Saunders, 1994). However, according to Aristotelian perspective, external goods, such as health, are essential to the individual ability to live in accordance with virtue and attainment of happiness which the philosopher regards as an ultimate objective in life (Aristotle, 1931). In this way, the paper argues that, in some cases, voluntary euthanasia may be morally acceptable because a terminally ill patient whose life functions are disrupted cannot live life to its full extent and pursue happiness.
It is possible to say that the idea of deliberate painless death is associated with advantages for patients, their families, and health care organizations but, at the same time, it entails huge risks of the procedure’s misuse and violates the traditionally accepted codes of medical ethics (Saunders, 1994).
Through the application of the ethical principles of utilitarianism and Aristotelian virtue ethics, the paper aims to evaluate such important euthanasia-related issues as individual autonomy and the impacts of euthanasia on the society and explain the controversies associated with them. Although the mentioned problems are still theoretically unresolved, some countries, e.g. Belgium and the Netherlands, have already legalized euthanasia (Singer, 2003). It means that the relevance of the subject is defined by the need for critical analysis of the mentioned problems and practical implementation of the ethical assessment results.
Explanation and Demonstration of Moral Reasoning
According to Aristotle (1931), through moral activity and ethical behavior, individuals always seek the highest virtue which leads to happiness. Happiness may be regarded as the primary objective in life, but it is impossible to achieve it without virtue. However, although the physical goods, such as health, body constitution, material wealth, are considered to be inferior to internal or spiritual goods, they are still the essential elements of happiness (Aristotle, 1931). In this way, Aristotle (1931) does not exclude the idea of physical wellness and pleasure from the conception of happiness. Since good physical qualities are important for an individual’s ability to lead a virtuous life, a patient who is confined to a bed or suffers severe pain is deprived of the opportunity to become happy by doing well and living well.
Justice is determined by Aristotle as universal ethical responsibility, a “complete virtue” (Aristotle, 1931, VIII). Any moral activity originates from reason and inevitably leads to the recognition of human capacity to choose between the right and the wrong primarily in relation to other people. Thus, the philosopher regards collective goods as the highest virtue. This thesis can be applied to ethical decision making which focuses on euthanasia. For example, when the financial resources are allocated to the maintenance of terminally ill patient’s life who has no chance of recovery and who wills to be euthanized instead of investing these funds into the improvement of health care practices and conditions of other patients, the idea of justice is not performed.
According to Mill’s utilitarian ethics, the principle of collective benefit or happiness is the major component of ethical behavior as well (Mill, 2005). At the same time, Mill (2005) separates the idea of benefit from sensual pleasures or personal advantages but connects it to the lack of suffering. From his perspective, such a benefit is the ultimate goal of individual behavior (Mill, 2005). Moreover, the moral quality of an action is defined by the value of its consequences.
An action thus serves as a means for the achievement of a positive effect, i.e. collective benefit. Based on this, compliance with the ethical principle of universal happiness allows the freedom from suffering and the maximal fullness of pleasure to all people. This utilitarian principle of beneficence can be implemented in medical decision making regarding individual cases of voluntary euthanasia. By weighing all potentially positive and negative consequences of the procedure conduction, it will be possible to reduce the suffering of individual patients and, minimize the risks which may interfere with the development of collective well-being.
Objection and Response
The opponents of euthanasia draw various arguments against it. Euthanasia is associated with negative connotations and is often called as assisted suicide or murder. Like all other immoral activities, the medical procedure is perceived as a large threat to society. Moreover, although it is considered that euthanasia may suit a patient’s interests, it still may violate the rights of other members of society.
According to Saunders (1994), “autonomy is important but never absolute” (par. 7). It means that although people live in a free society, their individual independence of choice is limited because a complete autonomy may violate the freedoms of others. Saunders (1994) claims that a decision about ending own life cannot be made in isolation. Every case of euthanasia requires the involvement of many people including patients’ family, friends, and healthcare staff. It is important to consider the consequences which euthanasia may entail for all the involved individuals and the effects on their psycho-emotional state. Thus, autonomous decisions affect not only those who make them but also impact other people causing the change in the public conscience (Saunders, 1994).
The underlying controversy regarding euthanasia has its roots in the opposition between individual benefits and well-being to social welfare. According to Aristotle (1931), happiness is the final and self-sufficient goal of a person’s life, but it is also regarded as a common virtue for parents, children, friends, and fellow citizens. However, every person achieves happiness by different means, different actions, or “workings of the soul” which are founded in the individual natural propensities (VII).
Pursuing happiness, people perform the activities of the soul in a noble way – seeking excellence and goods for him/herself and others. But when patients’ physical functions are impaired and severe pain prevents their achievement of happiness in accordance with virtue and “in the way of Excellence” (Aristotle, 1931, VII), it seems unreasonable to deprive them of the right for the voluntary ending of life only because it is comfortable for their relatives and social institutions.
From Saunder’s (1994) point of view, euthanasia is regarded as a wrong deed while maintenance of patients’ lives is the right action because it confirms the traditional view of ethics in medicine. However, it is possible to say that the notions of the good and the bad are not that definite. When evaluating euthanasia in such a context, it is important to consider the place and development of the concepts of the right and the wrong depend on belief systems accepted in a particular community, macro and micro social conditions, and interests of people (Nortje, 2013). The understanding of moral or immoral action may significantly vary from one context to another.
Therefore, the evaluation of any activity should aim to determine the amount of actual positive and adverse effects it may provoke in each particular situation (Singer, 2003). In this way, it is possible to assess the actions which do not necessarily suit the requirements for the moral development of the society as a whole, but which are needed in a particular present-day context and which, thus, should be regarded as morally acceptable. It means that if through the examination of multiple factors, specialists come to the conclusion that euthanasia is the most acceptable option of behavior in one situation and if it does not provoke substantial harm to society or some of its members, it can be performed.
Thus, although according to the modern tendencies of ethical development, euthanasia does not suit the ideal of moral behavior, it is still can become the most decent option in some circumstances. This conclusion is consistent with Aristotle’s view on reason as a core component of ethical decision making because, when euthanasia is approached in this way, it allows to meet the interests of both patients and society. By being able to evaluate a specific social context, specialists may obtain an opportunity to gain a collective good which was regarded by both Mill (2005) and Aristotle (1931) as the biggest virtue and the highest form of morality, and, at the same time, reduce the suffering of individual patients.
In the paper, voluntary euthanasia is regarded as a morally acceptable action. Considering the complexity of the circumstances related to it, it is impossible not to recognize that, in some cases, it may be more ethical than other decisions. The complete rejection of euthanasia means the negation of individual autonomy and the right to control over own life. Moreover, according to Aristotle’s perspective on virtue and ethics, a person who cannot live well and do well due to illness or severe impairment is stripped of the opportunity to fulfill his life goal, achieve happiness and goods for him/herself and other people as well.
From this point of view, the life full of physical suffering and lack of activity seems to be meaningless. And in case an ill person decides to pass away through voluntary euthanasia, it appears to be a reasonable choice. Sometimes the refusal of euthanasia may lead to even more difficult consequences. However, even if euthanasia will be legalized worldwide, it is essential to take into account that this practice may be virtuous only in a limited number of circumstances. It requires strict regulation and the involvement of independent experts.
The application of virtue-based and utilitarian ethical principles and the literature review revealed that perceiving euthanasia as a form of morally acceptable behavior goes out of the frame of commonly accepted moral norms and ethical traditions in medicine. This view rather becomes an exception from the moral value of collective welfare. Nevertheless, it is suggested that euthanasia may still be a norm in some situations. And sometimes the deviation from the traditional moral values allows the resolving of multiple moral conflicts.
Aristotle. (1931). Nicomachean ethics. (W.D. Ross, Trans.). Oxford, GBR: Clarendon Press.
Dennis, D. (2009). Living, dying, grieving. Sudbury, MA: Jones and Bartlett.
Mill, J. S. (2005). Utilitarianism. (J. Bennett, Ed. ). [EarlyModernTexts version]. Web.
Nortje, N. (2013). A cultural perspective on euthanasia. Research in Psychology and Behavioral Sciences, 1(5), 77-80.
Saunders, P. (1994). Twelve reasons… Why euthanasia should not be legalised. Web.
Singer, P. (2003). Voluntary euthanasia: A utilitarian perspective. Bioethics, 17(5/6), 526. Web.