For centuries, animals have been euthanized to stop their suffering when they have become too old or injured. While the decision to put down a beloved pet may be emotionally devastating, there is no question of the ethics involved. In fact, many people would think to keep an animal lingering in pain and distress would be considered inhumane. Why, then, do we allow human beings to suffer in pain and distress? Does a human not have the right to a final relief granted to an animal? An animal does not have the ability to grant permission for self-euthanasia like a human might. For that reason, an agreement of the ethics of allowing a person to decide when and how they may die when the end of life is inevitable precedes future and present accepted practices in health care.
The topic of euthanasia has become widely discussed as modern medicine has developed the ability to sustain life long past quality or desirability. The economics of prolonging the life of a patient without hope of recovery may be massive and the ethics of discontinuing life support includes components of religion, philosophy, and legal liability. Euthanasia is defined as “the act or practice of killing someone who is very sick or injured in order to prevent any more suffering” (Merriam-Webster.com, 2016); it does not specify if the responsible party if the patient or someone else. The concept of self-euthanasia entails the consent of the patient and may or may not include his or her physical act. The purpose of this paper is to argue that for terminally ill adults of able mind or children through their legal consenters, self-euthanization is morally permissible as it offers dignity in death and is ethical provided the infrastructures administering the act operate in adherence of proper regulation.
The scope of euthanasia is wide. Voluntary euthanasia implies the consent of the patient in some form such as exquisite suffering in the face of impending death or a legal document such as a Do Not Resuscitate order. Involuntary euthanasia would occur in the case where responsible parties such as the family, court-appointed guardian, and/or physicians decide the act is the best for all concerned; instances where this may be appropriate would be if the patient did not leave behind formal wishes and was unable to be involved in the decision. The act of euthanasia may be active, as in giving a medication that induces death, or passive such as withholding life support, food, water, or other less active forms of causing loss of life. The results are the same. The ethics involved in any of the actions are if they are considered by the legal system to be murder, and by morality as being wrong. Physician-assisted suicide results when a doctor administers medication that ends life; however, in some part of the world, the physician is not held liable if he does not actively administer the medication that he prescribes.
In addition to the legal and ethical aspects of allowing a person to die, there is the illness of mental instability. In 1939, the Nazis began a euthanasia program that terminated the lives of more than 70,000 mentally ill patients by poisoning or use of gas chambers (Ernst, 1996). While physical end-of-life may be determined by monitoring and comparison of standard values, it is more difficult to evaluate the ability of a mentally unstable individual’s to recover to an extent that a relatively normal life is possible. These actions by the Germans stopped any promotion of legalizing euthanasia until the Netherlands reopened the discussions in the 1970s and 1980s (Emanuel, 1994). At this time, the Netherlands remains the only country in the world where physician-assisted suicide is legal and then only when in accordance with government regulations which include the agreement of at least two doctors that the act is ethically acceptable.
There is the morality of suicide inherent in the notion of euthanasia. The major religions of the world abide by the rule that killing oneself is an act of murder and therefore forbidden. In rejecting God’s gift of life, a person who hastens his own death through his actions or permission of other to act is committing a great sin. The Dharmic religions such as Hinduism and Buddhism view suicide as a supreme act of violence, albeit that it is toward oneself, and therefore unforgiveable. When an individual’s perception of self-euthanasia is that the act is suicide and he or she has devout religious beliefs, active or passive hastening of death presents a quandary. The controversy may be resolved by health care personnel “allowing” a patient to die by withholding treatments that would sustain life. Patients have been sustained on tube feedings and antibiotics for years in a comatose state until the body reaches the point where the organs no longer function adequately. Should a person wish for all actions, including food and fluids, to be withheld in the case of an inability to recover, even in the absence of pain, this may be perceived as an end-of-life decision that is natural and dignified (Kuhse 1998).
The ethics involved in the performance of euthanasia are not only those of the patient. A physician takes an oath to support life and by prescribing or administering detrimental drugs or ordering the cessation of treatments sustaining life, he or she is acting against those beliefs. By stopping the administration of food and fluids, a patient who is conscious will suffer from dehydration and experience significant discomfort prior to dying. For this reason, analgesics provided by medical staff may alleviate the effects of dying from thirst until the patient expires. Nurses and doctors with strong aversion to physician-assisted euthanasia have the option of referring the patient to another care provider who is more sympathetic to the practice. This is a personal decision each member of the medical staff must decide individually.
Another consideration in the ethics of euthanasia is the suffering of family, friends, and caregivers as the patient lingers in pain or debilitation. If the patient is at home, someone must take the time and make the effort to provide for his or her needs. This person may be paid or be a member of the household who would otherwise be employed; either instance is an economic drain on the family. If the patient is in a medical facility, the cost to the family is even higher. In addition, they must either endure the lingering period toward death or be forced to make the decision to end supportive measures. The negative psychological and financial consequences may be severe to loved ones who are left behind after the death of the patient.
The debate concerning euthanasia involves the argument that the practice will become a “slippery slope” that leads to the killing of people who do not consent to the practice or do not warrant it. According to Kushe and Singer (2006), the defining line is the idea of consent based on the patient’s freedom of self-determination or the decision of those who have respect for what he or she may have wished. An individual’s autonomy to decide for himself if he wants life-prolonging measures is not a priviledge; it is a right. For instance, consider the situation where two men have a truck accident on a deserted stretch of road. One of the men escapes, but the other is trapped in the burning vehicle and begins to be enveloped in flames. He begs the other man to use a rifle from the back of the truck to end his suffering. The other man uses the firearm to kill him. This could be considered an act of murder or of euthanasia. The shooter acted in a compassionate manner, but due to a lack of witnesses or formal consent on the part of the victim, the legal repercussions may be severe. The only other alternative appears to be to have allowed the victim to burn alive. However, the victim’s autonomy determined his desire to end his life on his own terms and not as a helpless victim in agonizing pain for a period of time prior to death.
The “slippery slope” argument proposes that the practice of euthanasia by the consent of the patient has graduated from terminally ill patients to those that are chronically ill, as with people in a vegetative state or those in intractable pain. Opponents to using euthanasia believe that acceptance will extend to mentally ill individuals not in a state of mind to responsibly make the decision or people who are not productive due to mental retardation or disabilities (Math & Chaturvedi, 2012). In the hands of irresponsible governments, euthanasia may return to the Nazi elimination program of destroying specific races or other undesirables and relatives standing to gain by inheritance may act inappropriately.
The solution to this unacceptable progression would be careful guidelines for practice within the boundaries of consent and law. In the state of Oregon in the U.S., the law allows for assistance in dying since 1997 with the following requirements: 1) The patient must have a terminal illness confirmed by two physicians, 2) the patient must have a prognosis of death within six months, 3) the patient cannot have any significant mental health issues, and 4) the decision must have two witnesses to the documentation (Khazan, 2014). The request for the drugs must be in writing followed 15 days later by an oral request. In 19 years, only 752 patients have qualified for self-euthanasia by receiving prescriptions. Medical guidelines should include the physician attempting a discussion with the patient and family to educate them on all aspects of the decision, evaluate the physical and mental state of the patient, consult with the legal department of the medical facility, encourage consultation with the patient’s preferred religious representative, and explore other options such as alternate therapies. Although the discussion may be very uncomfortable for a doctor, a frank discussion with the patient and his family concerning the prognosis and end-of-life decisions may provide options such as not using cardiopulmonary resuscitation (CPR) in the event of a heart attack, no aggressive life-support measures, or no assistance at all such as feeding tubes or intravenous treatment. Documented wishes of the patient have the ability to relieve the family and medical staff of difficult and possibly conflicting decisions later should the patient become unresponsive.
The right to die with dignity is gaining acceptance globally. The legal debates and attempts to provide adequate definitions for euthanasia by patient consent are ongoing. The arguments within the fields of medicine, law, and society have to date failed to come to an agreement. India’s Law Commission Report-196 set a precedent in 2006 when it urged for legislation to protect the rights of patients with terminal illnesses and the doctors who care for them (Law Commission of India, 2006). As the cost of medical treatment continues to escalate and resources dwindle, the morality of denying care for the healthy may begin to be weighed against providing prolonged care for the dying. The right to health care promotes recovery and should include the right to die with dignity by people with no hope of living. In conclusion, the ethics of self-euthanasia rests in the personal beliefs of the dying individual. While those he leaves behind must adjust to his decision as to prevent life-prolonging actions or to continue to suffer until all efforts are exhausted, the patient must consider his religious convictions, desire to release his family from financial and emotional hardship, and his own ability to tolerate the process of dying. It is the responsibility of health care professionals, legal professionals, and society at large to respect the wishes of a terminal patient by putting options into place for him in his final days.
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