Ethical Dilemma In Euthanasia

Many leading medical practitioners have over time expressed differing opinions on the issue of euthanasia. For example ten doctors from major hospitals wrote in a New England Journal of Medicine stating that “it is not immoral for a physician to assist in the rational suicide of a terminally ill person” (Wanzer, 1989, p. 844). There is also the famous case of Dr. Jack Kervorkian who used his suicide machine on a patient suffering from Alzheimer’s disease in 1990 to end her life in the back of a Volkswagen car (Risen, 1990). According to Council on Ethical and Judicial Affairs (1992) “surveys have consistently indicated that a large majority of people in the United States would like to be allowed to end their lives before incurable and painful diseases finally kill them” (p. 2229). These events and many more similar cases have made euthanasia a controversial issue that begs for a solution. It is an ethical debate that seeks to provide answers to the question whether assistance to commit suicide is right or wrong and whether family members have the right to request for the ending of the life of one of their own.

In order to understand the ethical considerations of euthanasia, it is imperative to first provide a concise definition of euthanasia. The American Medical Association defines euthanasia as “the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy. In this report, the term euthanasia will signify the medical administration of a lethal agent to a patient for the purpose of relieving the patient’s intolerable and incurable suffering” (Council on Ethical and Judicial Affairs, 1992, p. 2230).

Euthanasia has also been defined as “the act or practice of painlessly putting to death persons suffering from incurable conditions of diseases” (Wolhandler, 1984, p. 363). Euthanasia is better understood when it is subdivided and classified as voluntary or involuntary and as active or passive euthanasia. Voluntary euthanasia refers to the ending of someone’s life by another person with the consent of the one being killed. The consent can be in the form of writing such as a will or last testament. Involuntary euthanasia refers to the ending of another person’s life without his or her consent. The American Medical Association describes the issue of consent as follows:

“Voluntary euthanasia is euthanasia that is provided to a competent person on his or her informed request. Non-voluntary euthanasia is the provision of euthanasia to an incompetent person according to a surrogate’s decision. Involuntary euthanasia is euthanasia performed without a competent person’s consent” (Council on Ethical and Judicial Affairs, 1992, p. 2230).

Passive euthanasia refers to the act of letting a patient die by removing him or her from an artificial life support system such as a respirator or feeding tubes. It can also involve the discontinuance of medical treatment that is critical to the sustenance of the patient’s life. Active euthanasia on the other hand involves taking active measures to bring the life of a patient to an end by, for example, a lethal injection (Gifford, 1993).

Euthanasia is a controversial issue that can be supported or opposed from different ethical perspectives. Legalization of euthanasia has been a movement popularized since the 19th century in Britain and has gained a large following in the United States in recent times. The popularity of this movement can be attributed to emergence of groups like the Hemlock Society whose members actively agitate for the right of a terminally ill person to a dignified death (Gifford, 1993).

Euthanasia can be supported by the fact that every individual has rights guaranteed by the Constitution to choose when to die. These rights are provided from the standpoint of self-determination and right to privacy. Liberty is a basic guarantee of the constitution which involves the right to choose when to die. Therefore any individual should be allowed to seek the services of a medical practitioner for assistance to commit suicide or active euthanasia when there are valid reasons for it.

Secondly, passive techniques of euthanasia can be argued to be morally acceptable since they simply provide a way for natural death to take place unlike active methods which independently cause death. It has been argued that putting a terminally ill person on artificial life support system can be equated to the use of technology to prolong life unnaturally. Adams (1992) addresses the issue of passive techniques of euthanasia by posing the question, “Is a physician who turns off a functioning respirator actively turning off a machine or ‘omitting’ to provide air, or is a patient who refuses food and water actively starving or ‘omitting’ to eat?” (p. 2028).

Thirdly, patients in great pain are usually given large amounts of pain relief medications because the pain they undergo can be so great that it can easily lead to death. From an ethical standpoint, a physician who administers a lethal dosage of pain relief medication can not be blamed because his or her intention was to bring comfort to a suffering patient even though the ensuing death could have been foreseeable. Such cases can not be differentiated from active euthanasia which is done with the consent of the patient’s family.

Newman (1991) states that euthanasia gives a terminally ill patient control and ability to face the agony of sickness and death effectively and a “total ban on assisted deaths might have another unintended, detrimental effect…persons with diseases like Alzheimer’s are now tempted to try suicide at an early stage of their disease when they are still mentally and physically fit… if they knew euthanasia were available later, perhaps through an advance directive or health care proxy, these individuals might choose to live longer, through a later stage of the illness” (p. 183). In any case, the state does not reserve the right to control the body of an individual when it does not have any compelling interest in the person. When performed under clearly set guidelines that regulate the conduct of all persons involved, euthanasia might even elevate the level of trust patients and the general public have towards the medical profession.

On the contrary, there are several moral and ethical arguments that can be advanced in opposition to euthanasia. The major argument against euthanasia is the fact that the practice overlooks the sanctity and societal respect of life. This can be attributed to a hypothetical situation where euthanasia becomes commonplace and is used in the medical practice in the same way other healing methods are used to an extent where the society becomes desensitized about death and life is no longer sacred or valuable. This is an attitude that would degrade humanity by devaluing life thereby promoting violent crimes and murder in the society. Doerflinger (1989) states that, “euthanasia undermines the overall quality of life and leads to a deterioration of the society” (p. 16).

If euthanasia is legalized, there is a high potential for abuse by caregivers leading to unnecessary losses of lives. It might lead to psychological intoxication by medical practitioners involved in the exercise so much that they might end up performing euthanasia on other patients even without consent. Wolhandler (1984) asserts that “legalized voluntary euthanasia inevitably would lead to legalized involuntary euthanasia because it is impossible to draw a rational distinction between those who seek to die because they are a burden to themselves and those whom society seeks to kill because they are a burden to others” (p. 377).

In conclusion, the issue of euthanasia is actually a controversy of ethics. It is about a value debate between people who weigh values and the place of human beings in this world in two different ways. It is also an ethical dilemma for the physician because the imperative of the medical profession is based on the Hippocratic Oath. The oath confines doctors to the duty of preserving life by all means. It makes any effort at ending life contrary to the ethical and moral obligations of the profession. Therefore the practice, if legalized, would severely undermine ethical standards of the profession.

References

Adams, R. (1992). Physician assisted suicide and the right to die with assistance. Harvard LawReview, 105, 2021-2040.

Council on Ethical and Judicial Affairs. (1992). Euthanasia. Journal of the American MedicalAssociation, 265, 2229-2233.

Doerflinger, R. (1989). Assisted suicide: pro-choice or anti-life? Hastings Center Report,January/February, p. 16-19.

Gifford, E. (1993). Artres moriendi: Active euthanasia and the art of dying. UCLA Law Review,40, 1545-1583.

Newman, S. (1991). Euthanasia: Orchestrating “the last syllable of . . .time”. Pittsburgh LawReview, 53, 153-191.

Risen, J. (1990). Death and the doctor: Jack Kervorkian has long taken an interest in the dying,but did he go too far in assisting a suicide? Los Angeles Times, June 21, p. E1.

Wanzer, S. (1989). The physician’s responsibility toward hopelessly ill patients: A second look.New England Journal of Medicine, 320, 844-848.

Wolhandler, S. (1984). Voluntary active euthanasia for the terminally ill and the constitutionalright to privacy. Cornell Law Review, 69, 363-382.