The question of euthanasia creates numerous debates because of diverse views and opinions regarding the value and meaning of human life. Some critics admit that it is simply not true that human life is so absolutely sacred that people may never under any circumstances take a person’s life or, to put it more neutrally, bring about a person’s death. Christian moral theologians have always allowed that one may justifiably take another person’s life in self-defense, or in a so-called just war, or as a punishment for certain crimes. Again, one may bring about another’s death quite deliberately when it is a secondary effect of some other act; for example, where saving the life of a mother in childbirth will inevitably involve the death of the child. Further, there may be circumstances where it is legitimate to bring about one’s own death: indeed, those who lay down their lives for their friends, or for the truth, or for their religious faith or a noble cause, are often seen as moral heroes and heroines (Allen et al 5). In these cases some moralists argue that people are not really intending to kill other people or themselves; rather they are doing something–helping friends, standing up for a cause–that indirectly involves another person in losing their life, or us in losing human lives. People can really make such a distinction, and this distinction will bear the weight some moralists want to put on it. Terminally ill patients should have a right to die in order to avoid sufferings and agony before death.
Euthanasia is permissible if it helps a patient to terminate terrible sugaring and painful death. In certain very special circumstances, bring about the death of a patient, at the free and informed request of the patient or the patient’s proxy, where it is clear the prolongation of the patient’s life would be of no real benefit to him or her. It is simply emotive scaremongering to suggest that both positions are based on the same logic. There is no ‘slippery slope’ which begins with helping a patient at his or her request to die a properly human death and which ends in something like the Nazi euthanasia program. After all, some people think that there should be a death penalty for certain crimes (Keown 32). They believe that in certain cases the taking of the criminal’s life is justified. It does not follow from this that capital punishment is the first step on a slippery slope that will lead logically and inevitably to something like the Nazi extermination program. A distinction which has also played a major part in the discussion of when life sustaining medical treatment should be given or not given is that between ‘killing’ a patient by, say, actively administering a lethal drug, or letting a patient die by removing medical treatment or drug therapy, or basic care such as providing food and liquid. This distinction is also sometimes described as ‘active’ and ‘passive’ euthanasia and it has commonly been held that while it is morally wrong actively to cause a terminal patient’s death, it can be morally permissible to refuse or withdraw treatment even though this brings about the patient’s death (Kaveny 2).
In contrast to this view, theologizes state that human life and sufferings are divine gifts so a person must endure them. Those who support this position usually talk a great deal about the ‘sanctity of human life’ as though human life were absolutely sacred and they had a positive duty to sustain human life in all circumstances. Some have even cited the Hippocratic Oath of the medical profession which forbids physicians from deliberately taking the life of a patient. The argument that if you allow physicians to bring about the death of a patient, even for the most compassionate reasons, you will inevitably end up in something like the Nazi extermination program–as though the same logic operated in both cases–is constantly brought up in discussions about mercy killing. It is therefore worthwhile saying something about it (Somerville 33).
There are other cases where removing medical technology or other forms of life-sustaining treatment is tantamount to. active killing. If it is certain that you will die if switch off the respirator to which you are attached, and if then deliberately switch off the respirator, have killed you just as surely as if had given you a lethal injection. The distinction between ‘killing’ and ‘letting die’ therefore does not of itself help us very much since the same one act may in some circumstances be described as ‘killing’ and in other circumstances as ‘letting die’. Put in another way, one may bring about the death of another person and be culpable for it either by active ‘killing’, for example by administering a lethal drug, or by the refusal or withdrawal of essential medical treatment (Mahjabeen b.d.). The crucial question is: when is the deliberate bringing about of another person’s death, either by active means or by withdrawing treatment, justifiable. People cannot say that all cases where active means are used to bring about another person’s death are immoral and that all cases where people bring about a person’s death by letting that person die are morally acceptable. The Hippocratic Oath does not mean that a physician has a duty to preserve life at all costs. As an eminent British specialist in palliative care has put it: ‘Since Hippocrates, doctors have undertaken never to destroy life deliberately. This implies that they will Endeavour to sustain life when, from a biological point of view, it is sustainable. On the other hand, a doctor has no legal, moral or ethical obligation to use drugs or apply treatments if their use can be described as prolonging the process of distress of dying. He does not have a duty to preserve life at all costs’. The same physician goes on to say: ‘Priorities change when a patient is expected to die within a few weeks or months; the primary aim is then not to preserve life but to make the life that remains as comfortable and as meaningful as possible. Thus, what may be appropriate treatment in an acutely ill patient may be inappropriate in the dying (Kaveny 5).
In contrast to this view, critics state that euthanasia can be used for immoral purposes and can lead to death of a healthy individual. In this case, critics have been considering the problems about the prolongation of life by medical technology from an external, ‘objective’, perspective, the point of view of the physician looking at the patient’s ‘quality of life’ and trying to judge whether or not life-sustaining treatment should be offered or refused, continued or withdrawn. The physician can, of course, give the patient medical advice about his or her condition and provide estimates about the future course of an illness or disease (Garrett 87). In the last resort the question whether it is worthwhile for patients to have their lives prolonged is not a medical question; it is a moral question which requires a personal conscientious choice and decision about the most momentous matter anyone has to face. Of course medical advice will be relevant to the making of that decision, but the decision is whether it is for the patient’s real good or benefit as a human being to have his or her life prolonged, and that is a decision that only the patient can make. One patient might decide that prolonging her life will involve needless suffering, loss of personal dignity et cetera. Another patient may very well choose to live out her terminal illness for religious reasons. She may, for example, see her suffering as having a redemptive meaning. Many Christians will, no doubt, see suffering in this way; but if a person is not a Christian je may see certain kinds of suffering and pain as demeaning and pointless. For the physician or external observer the suffering involved may, in objective medical terms, be very much the same, but that suffering will be seen in very different ways by different kinds of patients. Dying is, or ought to be, a very personal business (Geisler and Moreland 87).
Human life if valued only if brings happiness and joy to a person, so the terminally ill patient should have a right to choose between life and death. They may, at the patient’s request, express or implied, withdraw life-sustaining treatment and let the patient die; they may refuse treatment which is medically ‘extraordinary’ or pointless; they may alleviate the patient’s suffering by using means which they know will hasten the patient’s death; and finally they may, at the request of the patient, take direct action to end the patient’s life. At present there is a fair degree of consensus that the first three ways of bringing about the end of a person’s life are ethically acceptable, but there is still widespread unease about any form of direct action to assist a patient to end his or her life (Geisler and Moreland 82). Very much the same point is made by no less an authority than Pope Paul VI: ‘The duty of the physician consists more in striving to relieve pain than in prolonging as long as possible with every available means a life that is no longer fully human and that is naturally coming to its conclusion’. Pope Paul VI speaks of ‘a life that is no longer fully human’, he is making the same distinction people made before between ‘biological’ life and properly human, or ‘biographical’, life. Again, a French moral theologian has argued that “we cannot ‘purely and simply equate respect for life with the prolongation of life at any cost” (Geisler and Moreland 43). Following Public opinion polls:
“Americans have consistently favored the freedom to end one’s life when the perceived quality of life has significantly diminished, either by one’s own hand or with the assistance of a physician. Existing policy regarding euthanasia and physician-assisted suicide conflicts with the American public’s attitudes regarding the matter, as well as examines implications for social workers who serve clients facing end-of-life decisions” (Allen et al 6).
This survey shows that euthanasia is a complex moral problem which is difficult to solve using ethical or moral reasoning only.
The argument against euthanasia can be explained in terms of legal precedent: if we permit euthanasia we will permit death of innocent people in many other cases. The Final Report of the Netherlands State Commission on Euthanasia, issued in 1985, recommended that a physician who intentionally ended the life of a patient at the request of the patient should be punishable at law. The report also recommended that an exception should be made for physicians who do this for a patient in an extreme and irreversible situation, provided they act according to correct medical practice. Some people have in fact spoken of the ‘right to die’ or the ‘right to die with dignity’, meaning by this that individuals have a right to control when and how people end their lives, and it is worthwhile seeing what this means. At the most basic level, people have, as human beings, the right to control or determine the course of their own lives and to decide how poeple shall live (subject, of course, to their not infringing the rights of others to do the same). It follows from the fact that every individual is a human person that medical professionals must freely decide for myself and be responsible for all aspects of life within control (Friedlander 87). Others, of course, may deplore the choices that make and the personal morality and style of life adopt, but they must admit a right to make decisions and, so to speak, go to hell in a unique way. Even traditional Christian theologians admitted the right of a person to follow his or her conscience even if, objectively speaking, that conscience was morally awry or misguided. The right to moral autonomy or self-determination is in fact the basis of all other rights in that it would make no sense to speak of ‘rights’ at all unless people were able to decide freely for themselves and be responsible for their human lives (Dowbiggin 82). This right to moral autonomy carries with it the subsidiary right to control the duration of one’s life either by deliberately exposing oneself to certain death or by ‘sacrificing’ one’s life, or by accepting or refusing treatment which would prolong one’s life, or by directly terminating one’s life. With regard to the latter, there may well be religious reasons, or socio-cultural reasons, which make one reject the possibility of directly taking one’s life (in the mainstream Judea-Christian tradition suicide has always been considered to be morally reprehensible), but from a purely moral point of view, it is difficult to deny that one does have a right to end one’s life when there are serious reasons for such a course of action (Geisler and Moreland 63).
In sum, the medical evidence irresistibly and ‘objectively’ points to the patient enjoying such a low degree of ‘quality of life’ or human value that her life is not worth prolonging, that the proxy makes the decision to allow the patient’s life to be ended. Rather, it is because one reasonably supposes that the patient, had she the power to make a decision about prolonging her life, would in the circumstances see the prolongation of her life as morally pointless. Here the proxy must take account not just of the medical evidence but also of the patient’s moral (and religious) views about the value of human life and the process of dying. For example, one could envisage someone holding, on religious grounds, that a person is still a full person even though in a ‘vegetable’ state and that it is the will of God that a person should continue to live in such a state in the expectation of some kind of future life after bodily death.
Works Cited
Allen, J. et al. Americans’ Attitudes toward Euthanasia and Physician-Assisted Suicide, 1936-2002. Journal of Sociology & Social Welfare, 33 (2006), 6-9. Print.
Dowbiggin,. A Merciful End: The Euthanasia Movement in Modern America. Oxford University Press, 2003. Print.
Friedlander, H. The Origins of Nazi Genocide: From Euthanasia to the Final Solution University of North Carolina Press, 1995. Print.
Garrett, T.M., Baillie, H.W., Garrett, R.M. Heath Care Ethics. Prentice Hall. 2000.
Geisler, N.L., Moreland, J.P. The Life and Death Debate: Moral Issues of Our Time. Praeger, 1990. Print.
Mahjabeen, Hassan. Euthanasia: Should humans be given the right to play God? 2002. Web.
Kaveny, C. Assisted Suicide, Euthanasia and the Law. Theological Studies, 58 (1997), 2-6. Print.
Keown, J. Euthanasia, Ethics, and Public Policy: An Argument against Legalisation. Cambridge University Press, 2002. Print.
Somerville, M. “The Case Against: Euthanasia and Physician-Assisted Suicide”. Free Inquiry, 23 (2003), 33. Print.