Euthanasia: Can It Ever Be Morally or Ethically Justifiable - Essay Example

? Euthanasia: Can It Ever Be Morally or Ethically Justifiable? This paper reflects on the Assisted Suicide bill by Lord Joffe, which has been the subject of immense controversy when it was attempted to be introduced in the House of Lords. The bill, if enacted into law, would allow terminally ill patients to seek drugs from their doctors that would end their lives. The benefits of the act, if passed, will only be for those who have been medically diagnosed to live for six months, who are suffering from unbearable pain, and who are psychologically of sound mind and not depressed. The bill was defeated in the House of Lords but the debates concerning assisted dying persist and are unlikely to be resolved. At present, it would seem that there is a greater openmindedness surrounding euthanasia and the bill has a greater chance to be passed. This paper begins by giving an overview of the concept of assisted dying or euthanasia, as well as a brief description of some of the more famous cases and personalities involving the same. Afterwards, it will look at two sides of the debate concerning euthanasia and look at the points being raised by each side in support of their respective positions. The main question, it would seem, is: does the concept of human rights contemplate the right to die? Lastly, this paper will reflect on whether or not society has become more and more open to the idea of euthanasia and if the moral and ethical reasons beyond its continued prohibition are being dislodged by other imperatives. If there is a change in mindset, what has changed? And why? Then, it will make some conclusions and provide its own perspective on the subject matter. We begin by having a definition of what euthanasia is. Euthanasia is the act of consciously assisting someone’s death in order to relieve that person of suffering as a result of terminal illness (Pattinson, 2011). In common parlance, it is often referred to as “mercy killing”. There are two general procedural classifications of euthanasia: the first is passive euthanasia, which means that life-sustaining treatments are withheld. The second type is active euthanasia, which means that substances are introduced to cause the termination of the life of the subject (Rachels, 1995). Likewise, euthanasia can be voluntary or involuntary: voluntary euthanasia is when the patient suffering the terminal illness has given his or her consent to the procedure that will hasten his or her death. On the other hand, euthanasia can be involuntary, as in cases when the patient is unable to articulate consent and the next of kin is allowed to make that decision for the person. This is common in cases where the patient is not yet brain dead but is unable to speak or has lost control of critical faculties that enable an adequate quality of life. A question then presents itself: how about situations where the patient has given prior consent to terminate life support or even to be given death-inducing substances, and acting on such consent, the next-of-kin allows the performance of euthanasia? Perhaps where there is a written document clearly expressing the will of the patient, then it is voluntary euthanasia. But it is less clear when a next-of-kin states that in prior communications, of which there is no record, the patient has expressed desire to avail of euthanasia. Is that then voluntary or involuntary? In such a case, a big gray area presents itself. Perhaps the most famous advocate of assisted suicide is Jack Kevorkian, an American doctor known for his passionate, even flamboyant at times, defense of euthanasia. He died recently, in June of 2012, and left behind a controversial legacy of supporting patients who chose to end their lives because they faced terminal illnesses. He was thrust to the spotlight when he helped an Alzheimer’s patient in her early 50’s commit suicide by hooking her up to his homemade suicide contraption. (New York Times, 2011). He was jailed nearly a decade later for second degree murder, admitting to around 130 assisted suicides and using his trial as a platform to advocate his rather controversial cause. Whilst there were a number who were sympathetic to his cause, a great majority scored his cavalier attitude towards his patients’ actual medical condition. According to the New York Times, “he often hooked up patients without long-term knowledge of their cases or any corroborating medical judgment that they were terminally ill or suffering beyond hope of relief with aggressive palliative care. (ibid.)” Another famous American case is the case of Terri Schiavo, who was diagnosed to be in a persistent vegetative state after a sudden cardiac arrest. Her husband filed a petition to remove her feeding tube, and essentially, starve her to death by denying her nutrition. Her family opposed to petition of her husband and argued that since Terri Schiavo was a devout Catholic, she would not have gone against the Church’s teaching on the sanctity of life. In the end, the federal court favoured the husband and she died in 2005. Her case – spanning 1998 to 2005 – raised public awareness of euthanasia and spelled out the terms of the debate as far as the pro-life and pro-euthanasia camps were concerned. It also involved not just the courts, but the US Congress and then President George Bush himself, who supported Terri’s family and signed a number of resolutions designed to keep her alive. In the end, it became a question of what the patient would have wanted for herself, had she been capacitated to make judgement. Quill (2005) summarises the case in this wise: In considering such profound decisions, the central issue is not what family members would want for themselves or what they want for their incapacitated loved one, but rather what the patient would want for himself or herself. The New Jersey Supreme Court that decided the case of Karen Ann Quinlan got the question of substituted judgment right: If the patient could wake up for 15 minutes and understand his or her condition fully, and then had to return to it, what would he or she tell you to do? If the data about the patient's wishes are not clear, then in the absence of public policy or family consensus, we should err on the side of continued treatment even in cases of a persistent vegetative state in which there is no hope of recovery. But if the evidence is clear, as the courts found in the case of Terri Schiavo, then enforcing life-prolonging treatment against what is agreed to be the patient's will is both unethical and illegal. Coming now to our jurisdiction, a very important British case is the case of Diane Pretty, a terminally ill woman from Luton who was in the advanced stages of motor neurone disease. Because her sickness prevented her from performing the suicide herself, she required the assistance of her husband, but they both rightly feared that if he assisted her, he would be liable for murder and be sent to jail. She brought her case all the way up to Strasbourg, the European Commission on Human Rights (ECHR) but the high court in Strasbourg dismissed Mrs. Pretty’s claim that her human rights were being violated by the British courts when they ruled against allowing her husband to assist her death. In the end, Mrs.Pretty died in a hospice facility – her manner of death (choking as a result of her motor neurone disease) was exactly what she had feared when she had first sought recourse from the courts to allow her to die in a manner she pleased. Cowley (2004: 251) sums up cogently the dilemmas that the Pretty couple had faced: In English law, any competent patient can refuse any treatment, for any reason, even when such a refusal will certainly and knowingly result in the patient’s death. Switching off a ventilator in response to such a patient’s request is legal. The only difference with the case of Diane Pretty is that she was not dependent on any such machine to survive; the only ‘treatment’ she was in a position to refuse was nutrition and hydration. The problem was that Mrs. Pretty did not want to die from starvation. She did not want to die by cutting off the machine that gave her nutrients and suffer the slow, painful death of being deprived of food and drink. Neither did she want to die from the effects of her disease, which was painful choking. She wanted to die in a manner of her choosing – painless and with dignity. However, she did not want to render her husband vulnerable to prosecution and did not want him to break the law on her behalf. Her recourse was to seek permission from the courts to end her life by inducing barbiturates with the assistance of her husband. Ultimately, the courts denied her this in a historic decision that, like the Schiavo issue, generated public consciousness and polarised the divergent opinions on euthanasia. She died only a few days after the ECHR issued its decision. Euthanasia: looking at both sides of the issue We now proceed to look at the two divergent positions on Euthanasia. The first one is the position that says assisted suicide is not ethically or morally justifiable. The most basic objection of course is predicated on sanctity of life: that life is so sacrosanct that any and all attempts to end it, through whatever method, is akin to murder and must be punished as such. This “sanctity of life” view is dominant among religious circles, believing as they do that human autonomy must necessarily be restricted by Divine supremacy. (Cameron, 1996). Strongly connected to that argument is the argument that it is fallacious to link value of life with quality of life, such that life only has value when it stays on a certain quality threshold. Opponents of Euthanasia fear that this argument opens alarming floodgates and may give rise to an increased openness in eliminating the poor, the disabled, those who are sick and incapacitated by illness. Linked to that is the argument that that legalizing ‘voluntary euthanasia’ – that is to say, euthanasia where the patients have given their explicit consent – may gradually lead to the legalization of involuntary euthanasia, or cases where the wishes of the patients are not as explicit or are more difficult to discern. Also, once the social stigma against euthanasia is lifted and assisted suicide is ‘normalised’ and even seen as beneficial, patients who are terminally ill may find themselves facing pressure to opt for euthanasia so that they stop being a burden to their respective families, or being even more consumed by hopelessness and a lack of desire to pull through. Specific objections to the Joffe Bill is that the phrase ‘terminal illness’ and ‘unbearable suffering’ are so loosely defined that they are capable of multiple interpretations. For example, given the advances in medical science today, it is rather difficult to make a prognosis of how long a person can live. A person might be able to live longer than six months with proper health and hospice care, but can be defined as ‘terminally ill’ for purposes of falling within the allowable range of assisted suicide cases. Next is ‘unbearable suffering’ – it does not necessarily mean physical suffering but can also be psychological burden, which is so fluid and can vary from person to person. Instead of finding ways to help a person who is psychologically damaged as a result of the illness, the Joffe bill, it is argued by its opponents, will allow that person to be killed rather than explore other avenues and options for his healing and comfort. To wrap up the explanation for those who oppose euthanasia, we look to the words of Saunders (2003) who said that the Joffe bill “remains a dangerous document that Christian doctors should oppose. Christian doctors should make every effort to ensure that the committee hear again the many good arguments against legalising euthanasia, along with specific critiques of the bill’s revised wording. Secondly, we look at the arguments of those who support euthanasia or voluntary assisted suicide. Those who belong to the latter group are of the disposition that the wishes of the patient and his or her autonomy must be allowed to prevail over sanctity of life invocations. They believe that the argument espousing the sanctity of life is not founded on any ethical considerations, but rather, is intuitive in nature. According to Jewell (2005: 7): An examination of various arguments that sanctity of life should trump the welfare and wishes of the patient has shown that the arguments do not stand up well to logical scrutiny. If the arguments do not hold rationally, another explanation for their pervasiveness is called for. One possible explanation is that the sanctity of life principle is an intuition, which in turn is an expression of a psychological drive or instinct. As such, the sanctity of life does not merit overwhelming ethical status, either in professional ethics or democratic law. Moreover, the proponents also push for the notion that assisted suicide is an ethical imperative and that those who forward a contradictory position violate ethical norms. The argument is summarised very well by Jewells again: In summary, the sanctity of life principle refers to human life. A characteristic of humans is that they are capable of autonomy. An essential feature of ethical decision making is that it is the result of autonomous reflection and choice. If we were to assert that there are ethical axioms, then respect for autonomy would be a self-evident ethical axiom. Axioms cannot, by definition, contradict each other. The sanctity of life cannot be a self-evident axiom if it is contradicted by another self-evident axiom of respect for autonomy. In essence, the debate comes down to the inherent value of life, in whatever form or quality level, versus the autonomy of an individual to make decisions about his or her life (including the decision to end it) and bind the rest of the world. The present conjuncture Given that it is a choice between the inherent value of life and the right of choice, it is quite easy to see how it becomes possible for the Joffe bill to be passed. The sanctity-of-life argument, which is founded mostly on religious considerations and not only logical or ethical firmament, may find itself to be of less and less value in a world that is becoming increasingly secular. Europe is at the forefront of such secularisation. As early as 2004, France had already banned headscarves from state primary and secondary schools by passing a law that prohibited conspicuous religious symbols. The French National Assembly voted overwhelmingly in favour of the bill (494 to 36) and the Senate voting 276 to 20, passed the bill into law. There were many of those who protested against the law, feeling that Muslim women who wear veils are particularly targeted even though the law also coverse Jewish caps and big Christian crosses. The law was an amendment1 to the existing law, the Law on Secularity (la loi sur la laicite). In explaining the French mindset, Kemeni (2008)2 states: French law gives preference to a greater measure of collective equality – and subsequently religious neutrality – over what is oft considered a most basic of individual rights: freedom of religious expression. The French ideal of laicite, or secularity, flies in the face of the American conception of freedom of religion. Standing in stark contrast to American beliefs about the separation of Church and State valuing government nonintervention in religious matters, French law is more concerned rather with the prevention of religious intrusion in the dealings of the state. This concern is legitimized by France’s past, which is rife with outbursts of religiously motivated violence, most notably the sixteenth century’s bloody Wars of Religion.  This puts an interesting angle to the issue at hand and brings in a historical perspective to the legal and political discourse. We se ehow law evolves as outcomes of values that particular societies deem to be important, and the value upheld here by the French state is the value of secularism – distilled from a painful and bloody history of religious oppression. The Netherlands has also passed a law allowing voluntary euthanasia, so did Belgium, its next door neighbours. The point is that a wave of secularisation is sweeping over Europe and the United Kingdom will not be far behind. Alongside secularisation of course comes the primacy given to the individual and his or her right to make choices by adopting some options and discarding some. The human right to make choices will expand to include and subsume the right to die. In the end, the main conclusion is that people’s mindsets are changing and what was abominable before is acceptable now. Assisted suicide has consequences – and obviously, its main consequence is irreversible – but it will only be a matter of time before it gains acceptance in the legal sphere and becomes legal and regulate. Be that as it may, the debates will persist, and persist it should. It is only through continued conversations that the moral and ethical issues are surfaced and responded to. References Cameron, N. (1996). “Autonomy and the Right to Die” in Dignity and Dying: A Christian Appraisal. Grand Rapids, MI: Eerdmans Publishing. Cowley, C. (2004). “The Diane Pretty case and the Occasional Impotence of Justification in Ethics.” Ethical Perspectives Vol. 11:4. 250-258. Jewell, P. (2005). “Rationality, euthanasia and the sanctity of life.” Australian Association for Professional and Applied Ethics. Available at http://w3.unisa.edu.au/hawkeinstitute/gig/aapae05/documents/jewell.pdf Kemeni, Kris. “The Unveiling: France’s Headscarf Affair.” October 2008. University of Southern California. Available at http://angelingo.usc.edu/index.php/politics/the-unveiling-frances-headscarf-affair/ “Jack Kevorkian Dies at 83”. New York Times. June 3 2011. Available at http://topics.nytimes.com/topics/reference/timestopics/people/k/jack_kevorkian/index.html Parker, M, 'Medicine, psychiatry and euthanasia: an argument against mandatory psychiatric review', Australian and New Zealand Journal of Psychiatry, 2000, 34, pp 318–324. Pattinson, S. (2011). Medical Law and Ethics. London: Sweet and Maxwell. Quill, T. (2005). “Terri Schiavo: a Tragedy Compounded.” New England Journal of Medicine, 352: 1630-1633. Rachels, J, 'Active and passive euthanasia', New England Journal of Medicine, 1975, 292(2). Saunders, P. (2003). “The Joffe Bill returns: still a Trojan horse for euthanasia.” Available at http://admin.cmf.org.uk/pdf/helix/spr04/27editorials.pdf. Read More