Abstract
The twenty first century has witnessed impressive advances in science and medicine, resulting in increased life expectancy. Unfortunately there has also been a dramatic increase in degenerative diseases such as diabetes and cancer. These development have brought the issue of euthanasia to center stage. The following essay attempts a careful examination of the issue, looking at the arguments opponents and supporters have put forward. Among the issues examined is the right to choose how one dies in accordance with the principles of autonomy and beneficence. It is argued that the practice of euthanasia only benefits the very few individuals living in wealthy countries such as the Netherlands who are in a position to plan their own death after careful meditation and professional counseling. A distinction is made between euthanasia and withholding life-sustaining treatments. The notion that terminally ill patients are a burden to society should be reconsidered if it is accepted that every individual has been a burden to society at one time in his or her life simply by being human. The role of palliative care should be considered before resorting to euthanasia. The slippery slope argument is examined in detail as it is perhaps the single most solid argument against the legalization of euthanasia. Finally the essay traces the lack of effectiveness of safeguards and controls that have been put into place to prevent physicians from abusing euthanasia. The experience of the Netherlands demonstrates that the practice of euthanasia is widely spread to all segments of the population
The idea of legalizing euthanasia has been debated as early as 1935 in the United Kingdom (Chao DVK, Chan NY & Chan WY 2002), but with increased life expectancy throughout the world, especially in economically developed countries, the notion of ending one’s life with dignity has gained the attention of patients, families and health professionals. At the same time, the debate whether euthanasia should be legalized is being fought in court and discussed among government officials. Furthermore, with the increase of chronic degenerative illnesses such as diabetes and cancer the debate has acquired even more relevance in modern society. With advances in modern medicine and technology, physicians acquired the power to delay or hasten the time of death. Such power brought moral responsibility and public scrutiny for physicians (Terry, 1993). At the heart of the debate are the following types of euthanasia: (1) active voluntary euthanasia, (2) assisted suicide and (3) physician-assisted suicide (Ebrahimi, 2012). In general, these terms encompass the definition of euthanasia: the termination of a person’s life to prevent further suffering, resulting from an incurable or terminal disease. (Chao DVK et al. 2002).There are staunch supporters for and against the practice of euthanasia. This essay will examine the most salient arguments on both sides of the issue, for both sides offer equally persuasive arguments. The fact remains, however, that despite the benefits euthanasia brings by relieving some patients from unbearable suffering, its potential abuses far outweigh the benefits it brings to society.
One of the most forceful arguments favoring euthanasia holds that if one has the freedom to make all kinds of life choices, then one should also have the right to decide how to end one’s life. This argument is based on the principles of autonomy and beneficence. (Ebrahimi, 2012). The author defines autonomy as the patient’s right to make decision concerning his or her life as long as those decisions do not harm others. According to the principle of beneficence, physicians have the obligation to act in the patients’ best interest (Terry, 1993) Since death may be the best option for the patient, “physicians have an obligation to seek that ‘good’ when other traditional forms of therapy do not bring about a greater good as represented by the alleviation of pain and suffering” (p. 1261). At first, this argument seems reasonable provided the patient in question is mentally competent and has had ample time to plan how and when his or her life should be ended in the case of extreme pain and suffering. Furthermore, well-educated individuals can articulate their ideas about pending death with their pastors or priests. In addition they may have the support of family, friends and friendly medical professionals. Under such circumstances euthanasia may indeed seem the best course of action in the patient’s best interest, and few objections could be raised. The scenario just described roughly corresponds to conditions in countries like the Netherlands where euthanasia is openly practiced and whose citizens enjoy universal health coverage, enjoy income equality and are well educated (Emanuel, 1997). Since such favorable social conditions are not prevalent in most countries, the Dutch experience should not serve as a guide to allow widespread practice of euthanasia or physician-assisted suicide elsewhere.
Opponents of euthanasia argue that even when people have a right to make all kinds of decisions about their life, life is of great value and people do not have the right to destroy it, much less assist in the termination of the lives of others. This view is based on philosophical and Judeo-Christian principles (Terry, 1993). Opponents of euthanasia add that ending one’s own life is not entirely an act of autonomy, since at least another person—the physician must participate (Terry, 1993). Another argument advanced by opponents of euthanasia is that appropriate palliative care can relieve the pain and suffering (Ebrahimi, 2012). Critics also point out that if euthanasia were to become an accepted practice, it would undermine the rights of vulnerable patients (Ebrahimi, 2012). One only has to think of people who suffer serious accidents, who never regain consciousness and who have a poor medical prognosis. The question arises as to who should decide if they live or die. What are medical professionals to do in the case of millions of economically disadvantaged persons who suffer painful terminal illnesses but who lack the means to secure even the most basic palliative care? Some of these people may even be pressured by their relatives to request medical professionals to put an end to their lives even when they themselves may disagree with such request.
Terry (1993) advances the argument that health professionals who oppose euthanasia practice it themselves when they withhold treatment of very sick patients. The withholding of life –supported treatment results in the eventual death of the patient. Thus the physician has done nothing different than the physician who uses active means to end a patient’s life. Opponents of euthanasia contend that supporters “confuse the distinction between causing something to occur and the moral responsibility for its outcome” (Terry, 1993, p. 1260). Failing to provide treatment results in death only when the inherent illness would result in the patients’ death. Disease is the cause of death, not the withholding of life-sustaining treatment. These actions contrast with direct ending of a patients’ life.by lethal injection which will cause the death of person, healthy or sick (Terry, 1993).
Supporters of euthanasia argue that terminally ill patients afflicted with such diseases as Alzheimer’s, Parkinson’s and cancer can become an economical and financial burden to society and everyone is better served if such people are euthanized. In fact, it has been found that some patients who have requested euthanasia have done so under pressure from family members and health professionals. (Chao DVK et al., 2012). Reflecting on the above reasoning, Sinead Donnelly, a palliative care physician points out that “being a burden can happen at any age—infancy, childhood, teenagers includedThis is because we are human. Because we are all a trial or a burden, we create a community where there is give and take” (pp.5-6). He stresses that this is the very reason why nations should refrain from legislating in favor of euthanasia. Furthermore, Terry (1993) adds that when doctors engage in widespread euthanasia they will decrease their efforts to develop and promote more effective palliative care techniques to the detriment of all patients.
The ideas just discussed lead to one of the most powerful arguments put forth against euthanasia: the slippery slope argument. This argument contends that once the health system, supported by approved legal measures starts terminating patients’ lives, abuses will soon be committed, dangerous precedents will be set, resulting in unintended regrettable consequences for society at large (Donnelly, 2012). Reflecting on the experience of the Dutch regarding voluntary euthanasia, which had its beginnings in 1973, Emanuel (1997) asserts that “the slippery slope feared by opponents and supporters alike is the route from physician-assisted suicide or euthanasia for terminally ill but competent adults to euthanasia for patients who cannot give consent: the unconscious, the demented, the mentally ill, and children.” While countries where euthanasia is openly practiced such as the Netherlands, Belgium, Luxembourg and Switzerland, have instituted protective laws and safeguards, these have been largely ignored and breached ; often such transgressions are not prosecuted (Pereira, 2011). For example, an agreement between Dutch prosecutors and the Royal Dutch Medical Society resulted in the following guidelines which would ensure that physicians who participated in physically assisted suicide would not be prosecuted.: (1) the patient must be mentally competent at the time of requesting euthanasia and explicitly provide written request for physician- assisted suicide or euthanasia repeatedly over a period of time; (2) the patient must be undergoing unbearable suffering—physical or psychological that cannot be alleviated by any medical treatment other than euthanasia or physically assisted suicide; (3) the physician caring for the patient must seek the opinion of an independent physician to ensure that euthanasia or physician-assisted suicide is the best treatment option for the patient; and (4) the physician must report the procedure to the appropriate authorities to allow for investigation and to ensure that the guidelines were followed (Emanuel, 1997, Pereira, 2011). According to Pereira (2011), despite these safeguards, more than 500 people in the Netherlands are euthanized involuntarily every year. The fact that efforts to bring such cases to court have failed is an indication that the judicial system has become tolerant of such transgressions over time (Pereira, 2011). While reporting all cases of euthanasia is mandatory in all jurisdictions, this requirement is often ignored. In Belgium almost half of the euthanasia cases were not reported to legal authorities (Pereira, 2011). The written request in the cases that were reported was frequently absent.
Pereira (2011) provides a chronological account of how euthanasia and physician-assisted suicide have spread beyond terminally ill elderly patients. During the 1970s and 80s advocates of euthanasia and physician –assisted suicide in the Netherlands stated that these practices would only be available to a reduced number of terminally ill patients who were experiencing unbearable suffering and that it would only be a last resort. By 2006, the Royal Dutch Medical Association declared that ‘being over 70 and tired of living’ was an acceptable reason to request euthanasia. Before 2001 Dutch laws allowed euthanasia to be practiced only on adult patients, but by 2001, the law allowed children between the ages of 12 to 16 to be euthanized upon parental consent even though children are not deemed capable of making such decisions. Under Dutch laws physicians can proceed with euthanasia even if there is disagreement between the child’s parents. By 2005, Dutch laws allowed euthanasia of newborns and younger children who are not expected to have a high quality of life. The Dutch experience with euthanasia clearly shows the pitfalls of allowing such practices to be commonly accepted. Society begins to lose respect for and devalue human life.
This paper has explored the issues surrounding the practice of euthanasia. Supporters of euthanasia embrace this medical procedure on the grounds that people have a right to die with dignity and with the least possible suffering; they have the right to make decisions about their death as they did about their lives. Furthermore, they contend that no individual should be subjected to extreme suffering in the case of incurable illnesses. However, laws against the legalization of euthanasia are more beneficial to society because they protect vulnerable populations such as the disabled and those patients who do not consent to be euthanized or who are coerced by family members or health professionals. This is why according to Pereira (2011 and Ebrahimi (2012) some countries have refrained from legalizing euthanasia; they include France, England, Australia, and Scotland. Instead, these countries have chosen to improve palliative care and to educate health professionals and the public. The words of oncologist Ezequiel J. Emanuel (1997) lend force to the conclusions presented thus far: “By establishing a social policy that keeps physician-assisted suicide and euthanasia illegal but recognizes exceptions, we would adopt the correct moral view.”
References
Donnelly, Sinead. (2012) Debates on Euthanasia. The New Zealand Medical Journal.125 (1358), 5-9
DVK, Chao, NY Chan & WY Chan. (2002). Euthanasia Revisited. Family Practice. 19, 128- 134. Retrieved from http://m.fampra.oxfordjournals.org/content/19/2/128.long
Ebrahimi, Nargus. (2012). The Ethics of Euthanasia. Australian Medical Student Journal. 3 (1). Retrieved from http://www.amsj.org/archives/2066
Emanuel, Ezequiel J. (March 1997). Whose Right To Die? The Atlantic Journal. Retrieved from
http://www.theatlantic.com/magazine/archive/1997/03/whose-right-to-die/304641/
Pereira, J. (2011). Legalizing Euthanasia or Assisted Suicide: the Illusion of Safeguards and Controls. Current Oncology.18 (2) Retrieved from
http://www.current-oncology.com/index.php/oncology/article/view/883/645
Terry, Peter B. Euthanasia and Assisted Suicide Ethics and Politics. Chest. 103 (4), 1259-1263
Annotated Bibliography
Donnelly, Sinead. (2012) Debates on Euthanasia. The New Zealand Medical Journal.125 (1358),
In this article the author discusses the importance of palliative care for terminally ill patients, especially children instead of euthanasia. He presents the plight of the elderly patients who are sometimes coerced into requesting euthanasia in order to relieve their families from the burden of caring for them and from the financial costs incurred. The author points out that each one of us is a burden at a given time; it is a give and take situation for the community. The author points out the abuses of euthanasia, especially in the Netherlands.
DVK, Chao, NY Chan & WY Chan. (2002). Euthanasia Revisited. Family Practice. 19, 128- 134. Retrieved from http://m.fampra.oxfordjournals.org/content/19/2/128.long
This is an excellent article for the reader who is trying to understand all the aspects at play in the euthanasia debate. The authors explain in great detail all the associated terms with euthanasia: voluntary euthanasia, involuntary euthanasia, active euthanasia, passive euthanasia, physically assisted suicide. The article also gives a historical perspective of when euthanasia began to gain public attention. It also goes over the arguments for and against euthanasia. In discussing the slippery slope argument the authors state that euthanasia has been used for political reasons as when the Nazis euthanized millions of Jews during World War II.
Ebrahimi, Nargus. (2012). The Ethics of Euthanasia. Australian Medical Student Journal. 3 (1). Retrieved from http://www.amsj.org/archives/2066
Like the previous article, this article also discusses the arguments for and against euthanasia and provides some definition of terms, although with less depth than the previous article. The helpful feature of this article is that it provides the legal status of euthanasia in countries like Australia, the Netherlands, the United States and Belgium at the time the article was written. In general most countries provide specific conditions under which euthanasia would not be considered a prosecutable crime. Euthanasia in Australia is illegal.
Emanuel, Ezequiel J. (March 1997). Whose Right To Die? The Atlantic Journal. Retrieved from
http://www.theatlantic.com/magazine/archive/1997/03/whose-right-to-die/304641/
The purpose of this article is to point out primarily for circuit court judges four basic myths about euthanasia: (1) It is primarily advances in medical technology that have sparked public interest in euthanasia; (2) the legalization of euthanasia and physician-assisted suicide are widely approved; (3) terminally ill patients are most interested in euthanasia and physician-assisted suicide; and (4) the experience with euthanasia and physician-assisted suicide will provide guidelines to install safeguards and protective measures to prevent abuses by doctors. The author emphasizes that judges should make an accurate interpretation of history if they are to make sound legal decisions. The author also advices judges to examine the Netherlands experience with caution, taking into consideration important cultural and economic differences.
Pereira, J. (2011). Legalizing Euthanasia or Assisted Suicide: the Illusion of Safeguards and Controls. Current Oncology.18 (2) Retrieved from http://www.current-oncology.com/index.php/oncology/article/view/883/645
In this article the author demonstrates that the legal safeguards and controls established by countries where euthanized is openly practiced failed to do their job. Some of these controls and safeguards include voluntary written consent, mandatory reporting, limiting the practice of euthanasia to physicians, and second opinion consultation. Taking the case of the Netherlands as an example, the author describe how the slippery slope argument has resulted in the widespread application of euthanasia and physician-assisted suicide to citizens of all ages, including babies.
Terry, Peter B. Euthanasia and Assisted Suicide Ethics and Politics. Chest. 103 (4), 1259-1263
This article also discusses the pros and cons of euthanasia, but takes a philosophical perspective. The author frames his discussion within two philosophical theories that determine right and wrong: the deontological and the consequential theories. Taking these philosophical theories into account the author divides the arguments for and against euthanasia into societal arguments and medical ethical arguments. The author outlines possible outcomes of the euthanasia debate. One possible solution he contemplates is that appropriate palliative care and addressing the needs of the patient at the emotional level may lessen the need for euthanasia.
