Active euthanasia involves painlessly putting individuals to death for merciful reasons, as when a doctor administers a lethal dose of medication to a patient. Passive euthanasia involves not doing something to prevent death, as when doctors refrain from using devices necessary to keep alive a terminally ill patient or a patient in a persistent vegetative state. In voluntary euthanasia, a person asks for death (by either active or passive euthanasia). Non-voluntary euthanasia refers to ending the life of a person who is not mentally competent, such as a comatose patient, to make an informed request for death.
In addition there is another category of involuntary euthanasia. This is said to occur when a patient is killed against his express will. It is important that euthanasia is not confused with assisted suicide. The latter involves a patients voluntarily bringing about his or her own death with the assistance of another person, typically a physician. In this case, the act is a suicide (intentional self-inflicted death), because the patient actually causes his or her own death.
Thus, while in assisted suicide the doctor makes available to the patient the means by which he can kill himself, in euthanasia the doctor himself (by act or omission) kills the patient. The issue of assisted suicide is closely related to that of euthanasia because it also involves questions of similar nature. Furthermore, some countries have preferred to legalise assisted suicide though they remain averse to permitting euthanasia.
While growing population demands make it nearly impossible to have referendums of popular choice in every particular dispute, it is true that or the law to be respected and effective, it must, in a democracy, embody what is generally regarded as right. A series of opinion polls conducted both in India and abroad revealed that a majority of the population was in favor of legalisation of euthanasia. In one such historic referendum in November 1994, Oregon (U. S. A. ) became the first state to vote in favor of physically assisted suicide. Some scholars have recently been arguing that the State has no right to force a person to live in a state of unbearable pain and bear the expense of unproductive medical treatment.
Every person must have a right to choose his own way of life and the State cannot force a person to live in a particular manner. In England, there is the famous case of Dr. Nigel Cox who was tried for attempted murder. In August 1991, Lillian Boyes had been suffering acute pain from rheumatoid arthritis, which her doctor, Nigel Cox, was unable to control with analgesics. She repeatedly begged him to kill her and, in the face of her terrible anguish and his own inability to control the pain, Dr. Cox injected Lillian Boyes with two ampoules of potassium chloride a double dose of a lethal drug that has no curative or pain killing properties.
Some days later a Roman Catholic nurse reported his action and he was charged with attempted murder. He was found guilty and was given a twenty-month suspended prison sentence. The General Medical Council reviewed his case and said that while a doctor could ease pain and suffering, it is wholly outside that duty to shorten life in order to relieve suffering. Nevertheless, the Council added that it had decided to temper justice with mercy and impose no penalty. The comparatively recent de-criminalisation of suicide in many countries offers an escape for the patient without doctors involvement.
In England, though the 1961 Suicide Act has removed the possibility of criminal prosecution for those recovering from a failed suicide attempt, it is still a criminal offence to aid, abet, counsel or procure a suicide. Therefore death must be accomplished alone and unaided, and unfortunately for many this is no longer physically possible. In some countries notably Germany, Switzerland and Sweden, aiding a suicide is not a crime and a doctor can provide appropriate drugs to an incurably ill patient though not administer them. In India, suicide per se is not a crime but attempted suicide is.
Exception 5 the Section 300, IPC protects a person who causes the death of another above the age of eighteen with his/her consent. However this section has a limited scope. It only reduces the gravity of the offence and the person charged is made liable for culpable homicide not amounting to murder. The doctors, who have taken active steps in supplying lethal drugs to patients on their requests, can claim the benefit of this exception. However this is not sufficient as euthanasia is absolutely different and is applied in cases of advanced old age and severe illness.
Euthanasia presents a paradox in the code of medical ethics, for it involves a contradiction within the Hippocratic oath, which is essentially the promise to prolong and protect life even when a patient is in the late and most painful stages of a fatal disease. The paradox lies in the fact that while an attempt to prolong life violates the promise to relieve pain, relief of pain by killing violates the promise to prolong and protect life. This argument of conflict of duties was used by the defence in a crucial case decided by the Dutch High Court in 1984, known as the Alkmaar case.
In this case, a ninety-five year old lady was unable to eat or drink and subsequently lost consciousness. On regaining consciousness, she pleaded with her doctor several times to put an end to her suffering. After discussing the matter with his assistant physicians and the son of the patient, the doctor agreed to her request for euthanasia. Later, charged with mercy killing, in his defence, the doctor argued that his legal duty to preserve and prolong life had been in conflict with his duty as a physician to relieve his patients unbearable suffering.
Though the lower court and the court of appeals rejected this argument, the High Court suggested that this matter should be considered taking into account responsible medical opinion, measured by the prevailing standards of medical ethics. This decision implied that when a patient was in an unbearable situation and there was no hope of improvement and his suffering could not be relieved in any other way; a doctor who has acted on the patients explicit, persistent and well-informed request for euthanasia, would not be held guilty of an offence.
In the same year, the Royal Dutch Medical Association issued guidelines on euthanasia, which were later put into law by the Dutch Parliament in 1993. Under these, Dutch doctors could provide help to patients who were suffering unbearably without any hope of improvement and who also asked to be helped to die. Netherlands thus became the first country in which euthanasia is officially condoned and widely practiced. The controversy over active euthanasia remains intense, in part because of opposition from religious groups and many members of the legal and medical professions.
Opponents of euthanasia treat it as a euphemism for murder and maintain that euthanasia is not the right to die but the right to kill. They emphasise that health-care providers have professional obligations that prohibit killing and maintain that euthanasia is inconsistent with the roles of nursing, caregiving, and healing. Instead with the rapidly advancing medical science it is very much possible that those ill today may be cured tomorrow. Hence, the society has no right to kill them today and thereby deny them the chance of future recovery. Further, it is not always that the patient wants to die.
The relatives of the patient are also allowed to decide whether to let the patient live. In addition, even where the consent is that of the patient it may be one obtained by force. Use of physical force here is highly unlikely. But emotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Moreover, financial considerations, added to the concern about being a burden, could serve as a powerful force that would lead a person to choose euthanasia or assisted suicide.
Moreover, it is argued that when a healthy person is not allowed to commit suicide then why should a diseased person be allowed to do so. It is pointed out that suicide in a person who has been diagnosed with a terminal illness is no different than suicide for someone who is not considered terminally ill. Depression, family conflict, feelings of abandonment, hopelessness, etc. lead to suicide ” regardless of ones physical condition. Studies have shown that if pain and depression are adequately treated in a dying person ” as they would be in a suicidal non-dying person ” the desire to commit suicide evaporates.
Suicide among the terminally ill, like suicide among the population in general, is a tragic event that cuts short the life of the victim and leaves survivors devastated. In addition, it is also frequently pointed out that the legislation relating to euthanasia is full of vague and ambiguous terms which allow# the provisions to be easily misused. For example, the term terminally ill is not subject to a fixed definition. Even within the medical fraternity (let alone the legal community) there is dispute about who is a terminally ill patient and thus the category could cover a very wide range of patients.
Another favourite argument is that of the slippery slope. The slippery slope argument, in short, is that permitting voluntary euthanasia would over the years lead to a slide down the slippery slope and eventually we would end up permitting even non-voluntary and involuntary euthanasia. The opponents of euthanasia point out the following two examples to display the working of the slippery slope:
1. In England, the House of Lords in Airedale NHS Trust v. Bland permitted non-voluntary euthanasia in case of patients in a persistent vegetative state. Subsequently, the Supreme Court of Ireland in Re A Ward of Court expanded the persistent vegetative state to include cases where the patient possessed limited cognitive faculties. 2. In Netherlands, the Supreme Court in a 1984 ruling had held that euthanasia could be lawful only in cases of physical illness. However, a decade down the line, the Supreme Court in Chabots case held that it could even extend to cases of mental illness. Opponents also argue that permitting physicians to engage in active euthanasia creates intolerable risks of abuse and misuse of the power over life and death.
They acknowledge that particular instances of active euthanasia may sometimes be morally justified. However, they maintain that sanctioning the practice of killing would, on balance, cause more harm than benefit. The arguments against the legalisation of voluntary active euthanasia Autonomy The argument of autonomy does not justify the legalisation of voluntary active euthanasia (hereby referred to as euthanasia). Euthanasia advocates consistently confuse the notion of autonomy with satisfying preferences. They argue that a person with intractable suffering should have the autonomous right to choose to end their own suffering.
The inclusion of the right to choose death by anothers hand in this notion of autonomy is contradictory. The autonomy of an individual requires that the conditions for the exercise of autonomy are not compromised, and the killing of someone to end suffering does just this. Autonomy requires that the individual lives according to rationally conceived decisions, and the free conditions by which these decisions or plans are made are compromised by the act of euthanasia. Individuals cannot voluntarily and irreversibly surrender the conditions necessary for autonomy.
For example, in the modern world we have universally rejected the notions of voluntary slavery and duelling unto death. This is because in both of these situations the individual commits herself to removing her autonomy irreversibly. In addition, even if one accepts that autonomy includes the right to choose to end ones own life, in which case suicide or the refusal of life-sustaining treatments is not morally wrong, it certainly does not extend to having someone elses assistance. Euthanasia requires a lethal act by another individual to end the patients life, so the argument of autonomy does not justify the legalisation of euthanasia.
Beneficence The argument of beneficence is also often used as a justification for the legalisation of euthanasia. It is argued that even with the best palliative care, and the best pain management, that there will still be a small group of patients for whom there is no relief from their suffering, and so for whom the most humane option is to end their life. However, it is doubtlessly true that physicians and the medical care system in general are not adequately treating the pain and suffering of terminally ill patients.
The emphasis should be on the furthering of palliative care for patients who are still needlessly suffering, and not on creating legislation on the basis of a few hard cases. While euthanasia may be a compassionate act in a handful of extreme cases, this does not mean it should be legalised under the guise of promoting the wellbeing of patients in general. The ethical difference between killing and the shortening of life as a side-effect or letting die The crux of the argument that there is a difference between actively killing (E. . in euthanasia) and knowingly shortening a patients life as a side effect of treating their suffering (E. g. double effect, See glossary) is intention.
Intention is a notion widely used for judgements in law courts, E. g. in order to differentiate between manslaughter and murder, and has historically changed in meaning. Some have argued in the past that intention must include any foreseen, or foreseeable, consequences of ones actions, but this definition has long since been accepted as fallible.
If I get drunk, knowing that I may have a hangover the next morning, I do not intend to get a hangover. In the same way, if a physician prescribes analgesics or sedatives in a dose that she knows may shorten the life of the terminally ill patient, but her intention is to alleviate the suffering of the patient and this is the only way to do it, she is not morally wrong. However, if the physician prescribes a dose of analgesic or sedative with the intention of shortening a patients life, this is morally wrong.
Although it is argued that the means of active euthanasia can be justified by the end of suffering, alleviating the suffering of a patient with the intention of shortening their life is not morally justified. In the same way the withholding of life-prolonging treatment (letting die), E. g. antibiotics for an end-stage cancer patient who has developed pneumonia, does not have the intention of shortening the patients life, only abstention from unnecessarily prolonging the life and suffering of the patient.
The erosion of the doctor-patient relationship, and the adverse effects on the practice of medicine The doctor-patient relationship is built on trust, and this would be compromised with the legalisation of euthanasia. If a terminally ill patient felt that their doctor would wish them to allow euthanasia, even if it were not acknowledged between them, this would inevitably lead to a degree of distrust. With the increasing burden of allocating scant resources, doctors may come to believe that expensive palliative care costs could be saved by the more widespread practice of euthanasia.
However, this seductive point of view could lead both doctors and patients to feel under pressure to accept euthanasia as the fairest option for society. Proponents of the legalisation of euthanasia also insist that being able to end the lives of terminally ill patients may alleviate the burden of grief and stress of the doctor. This easy option would allow doctors to shirk their sometimes burdensome, but incredible important, duty of care for the patient to the best of the physicians abilities until the unassisted death of the patient.
It may also hinder the development and investment into new advances in pain relief and palliative care as a whole. If euthanasia were legalised, any reported abuse of the protocol would lead all patients to question their physicians motives and care. To guarantee that there is no abuse would require nothing short of monitoring all patient visits with a physician. This would mean the intrusion of courts, prosecutors, and the police into medical practice, and the erosion of the privacy of the doctor-patient relationship.
Indeed, the example of the Netherlands shows that even in a country where euthanasia is legal, there is severe underreporting of euthanasia cases in order to avoid scrutiny. The slippery slope If one accepts that it is morally justified to alleviate the suffering of an individual by ending their life, the argument for euthanasia cannot be accepted because of the medical character or conduct of the lethal act. So, the killing to alleviate suffering of an individual outside of the medical establishment would also be justified. This is the central core of the slippery slope argument.
The moral arguments for euthanasia require consistency, and so the acceptance of euthanasia as morally right consequentially requires that the killing of people who are living lives judged to be not worth living is also morally right. The consequences of legalising euthanasia would therefore be very widespread. Even if the moral climate at the time of legalisation was not accepting of euthanasia on the grounds of disability or burden to others, the acceptance of the central moral core of euthanasia would lay the way for much more wide-ranging tolerance in the future.
Non-Religious Arguments against Voluntary Euthanasia Although we believe that a true rational understanding of moral issues can only ultimately be grounded on fundamental principles, which ultimately derive from religious faith, we believe that there are many many rational non-religious arguments for banning voluntary euthanasia, in response to Dr Wood (Times Letters July 5th 1999) who says Statistically I have a much higher IQ and am much better educated than most of the people who will read or respond to this letter.
I know with complete certainty that there is no god and no afterlife. Why do people argue that I should be denied the choice of death rather than senility? I can only assume that their view springs from religious belief, and they are intolerant enough to force their view on nonbelievers by force of law. If any of them can produce a rational, non-religious argument in favour of banning voluntary euthanasia, I would be glad to hear it.