Challenges and ethical dilemmas the foremost among them being Euthanasia
Euthanasia! Mercy or Murder! The debate goes on. Globalization, technology, diversity and inventions along with improving our quality of life have confronted us with innumerable challenges and ethical dilemmas the foremost among them being Euthanasia. Philosophers, doctors, patients, nurses and close relatives are struggling to address this contemporary dilemma of euthanasia. Is Euthanasia ethical? Who has the right to take the decision about Euthanasia? Can an individual decide about his own death. These and many related questions keep lingering on in our minds.
The goal of this position paper is to make an attempt to highlight the various types of euthanasia and the moral concerns regarding the same. Moreover it shall throw light on euthanasia from the perspective of different philosophers and schools of thought. Finally it shall share my position on this challenging dilemma of euthanasia.
WHAT IS EUTHANASIA?
Various definitions and clarifications have been put forward to increase the understanding & clarity of euthanasia.
According to Wikipedia the word euthanasia was first used in the medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body."1 Moreover euthanasia has been defined by Dave Robinson and Chris Garratt as “bringing about a gentle and easy death, especially in the case of an incurable and painful disease".2
Francis Bacon: “The major works" By Francis Bacon, Brian Vickers pp 630 (http://en.wikipedia.org/wiki/Euthanasia) (accessed Jan 31,2011)
Dave Robinson & Chris Garratt: Introducing Ethics, Mc Pherson’s Printing Group, Victoria, 1996.
However in order to understand euthanasia and take a position about it I feel that we need to understand this subject more in detail with regards to whether euthanasia is carried out actively or passively and is voluntary or involuntary. Keeping this in view euthanasia can be categorised under four broad heads:
Types of Euthanasia:
1) Voluntary Euthanasia: Vincent Barry states that “voluntary decisions about death refer to cases in which a competent adult patient requests or gives informed consent to a particular course of medical
treatment or nontreatment."3
It is important that the person / patient requesting euthanasia is in good mental health and chooses death of his own free will i.e. voluntarily. E.g. is a 70 year old cancer patient instructing his family and physicians not to put him on the ventilator if he goes into coma. Herein it is crucial and important that the patient requesting euthanasia must give explicit consent.
2) Non-Voluntary Euthanasia: Moreover Vincent Barry emphasizes that “A non-voluntary decision about death refers to cases in which the decision is not made by the person who is to die."4
Vincent Barry, “Applying Ethics: A text with Readings". 2nd ed. Wadsworth Publishing Company Belmont, California, 1985. Pg 195
Barry, Applying Ethics,195
There is basically no request or consent of the patient being subjected to death. Such acts of euthanasia are usually applicable to cases when the patient is in coma, severe mental derangement and patients with irreversible brain damage. Herein the decision is taken by family members or close relatives or the physician.
3) Active Euthanasia: According to Vincent Barry “Active (sometimes termed positive) euthanasia refers to the act of painlessly putting to death persons suffering from incurable conditions or diseases."5 Injecting a lethal dosage of medication into a terminally ill patient would constitute active euthanasia.
4) Passive Euthanasia: Vincent Barry says “Passive euthanasia, in contrast refers to any act of allowing a patient to die."6 Not providing a terminally ill patient the needed antibiotics to survive pneumonia would be an example of passive euthanasia.
Combining the above four categories we can talk about the following four combinations:
a) Voluntary active euthanasia
b) Non-voluntary active euthanasia
c) Voluntary passive euthanasia
d) Non-voluntary passive euthanasia
Philosophers view of Euthanasia:
1) Kant: According to Dave Robinson & Chris Garratt Kant places a high value and emphasis on autonomy. For him suicide was wrong so permitting euthanasia universally would be wrong as it would destroy our understanding of intrinsic value of human life.
However modern philosophers argue that this could be acceptable on Kantian grounds by stating that allowing few terminally ill patients in excruciating pain to choose euthanasia would not destroy the concept of life in everyone’s mind as Kant claims. Thus it wouldn’t be irrational or immoral to allow it in a few rare instances.7
2) Utilitarians: Emphasize on allowing individuals in choosing what to do with their lives, provided no one else suffers. You should be free to do what you like as long as the consequences of what you do don’t harm anyone else. The concept talks of man’s motivation in life being pleasure above anything. Morality is not of consequence. Thus they would advocate for euthanasia. However they would think very carefully about the consequences of euthanasia for the patient, his relatives and friends, medical professional and its reputation in the general public. Several questions arise as how to measure the future happiness or freedom from pain. Herein may be a good doctor can predict how much a total happiness or pain terminal cancer patient experiences.8
3) Plato & Aristotle (Virtue Ethics): They would suggest that we should do what a good person must do or take the teleological approach as to what would be the purpose of the terminally ill patient? This approach would be situationist and relative and would be judged on its merits. Thus for them euthanasia would be acceptable in some cases and not in others depending on patient, doctor and
other all exercising their judgement within clear guidelines.8, 9
Dave Robinson & Chris Garratt: Introducing Ethics, McPherson’s Printing Group, Victoria,1996
Euthanasia- justified according to utilitarianism (http://deadpanthoughts.com/2009/01/euthanasia-justified-according-to-utilitarianism/ )
Ethel M. Albert, Theodore C. Denise and Sheldon P. Peterfreund: Great Traditions in Ethics, D. Van Nostrand Company, 1980.
I think each case wherein euthanasia is considered is a unique case and needs to be dealt with after deliberation , discussion and debate. Moreover euthanasia could be practiced in some cases and may not be feasible in others, we need to consider the patients consent if present, the nature and the irreversibility of the illness, the consequences it would have for the relatives, for the family, for the physician and for the medical profession. The pros and cons need to be evaluated keeping in mind religious ethics and western ethics.
In my view life is an invaluable gift from god, which needs to be protected in all circumstances and we as health professionals need to respect life.
Taking into account active euthanasia I would behave like a stringent Kantian and not advocate for it whether it is voluntary or involuntary. I would equate voluntary active euthanasia to suicide and if we facilitate this we are partners to it. This could be justified by the argument that since we cannot create life we have no right to end it. Creation of life and ending of life are in the divine power and should be left to the sovereign. However I would consider passive euthanasia in challenging cases
Let’s take the example of a patient who is suffering from a terminal illness with excruciating pain and the medical professionals are sure there is no reversal of the same .Herein also I will not advocate for active euthanasia i.e. injection of a lethal dose of medicine to kill the patient .However i would consider passive euthanasia i.e. refraining from putting him / her on ventilator or artificial means of respiration just to prolong his / her life unnecessarily also impinging on the economic burden. Moreover in cases where patient in terminal illness has given consent for euthanasia and the doctors confirm that the condition is irreversible herein too I could consider passive euthanasia by not providing treatment or withdrawing treatment for e.g. not giving anti-biotic to a last degree cancer patient as this would unnecessarily prolong his painful life. Herein my justification would be that even if we consider that the sovereign / supreme is the giver and taker of life we would still be justified because then we are just allowing him to die a natural death without unnecessary and supportive measures. After all these interventions were not available previously and if God wanted people to be given the supportive treatment in all cases, the methods would have been available from the very birth of humanity. The modern methods of treatment need to be evaluated and applied after careful reasoning keeping the pros and cons in view and the consultation of all concerned.
To conclude I would say that active euthanasia should be avoided to the greatest extent and as far as possible. It could be carried out in a few rare cases where the physician ,nurses ,relatives, bioethicist all evaluate and justify the case.
However passive euthanasia could be considered in those cases which according to the doctor are irreversible for sure and there is consent of the patient (if conscious) and family members along with justification by all parties.
In the end I would reinforce the idea that every case is a new case and should be handled after carefully and diligently keeping in view the ethical concerns.