For many years the topic of euthanasia has caused a mixed reaction in society and it still does. Attention to the issue of euthanasia has increased with the development of social progress, and with the development of technology to sustain seriously ill people, in particular. Relevance of this topic is difficult to overestimate, because it is associated with the most expensive thing a person has – his life. Moreover, it happens because of poor knowledge of the euthanasia problem, lack of underlining that is revealed in writings of scholars-lawyers. Doctors, psychologists, lawyers, religious figures and politicians constantly lead numerous debates upon this issue. However, euthanasia’s practice still has not found a common clear answer to the question of its justification.
The main objective of this paper is to understand what euthanasia is, including the analyses of the problem from the standpoints of humanistic ethics with consideration of the arguments for and against upon euthanasia issue. However, the author further provides the facts, own thoughts and considerations to let the reader know what exactly proves euthanasia’s existence and why the author goes with it.
The Concept and Methods of Euthanasia
Events of the past years only emphasized the urgency of euthanasia problem. In early 2005 debates around the death of American Terri Schiavo, who for 15 years was in coma that induced clinical death and subsequent irreversible changes in the brain (the effects of a severe stroke), heated the United States (Cranford, 2005). Michael, Schiavo’s husband, got the decision of the Court of the State of Florida to disconnect Terry from the artificial feeding, which meant a fortnight delayed death of the patient. Because of the reactions of people on the court’s decision, America actually split into two camps of supporters and opponents of this kind of soft euthanasia (Annas, 2006).
This example reflects the real attitude towards euthanasia in the international community, which has split into its irreconcilable supporters and opponents. Both camps state fairly strong arguments that do not allow them to reach any particular compromise. Numerous historical examples cited by opponents of euthanasia and supporting “against” arguments highlight the danger posed by the insufficient knowledge of the phenomenon.
Hence, euthanasia can be defined as the intentional acts or omissions of the medical worker, which are in line with clearly and unequivocally patient’s will and are expressed to inform the patient, medically in life-threatening condition, or his/her legal representative to end the physical and mental suffering, which should result in death. The problem of euthanasia did not come today, and is not sudden in its occurrence. Moreover, from the time of Hippocrates to the present days traditional medical ethics includes a ban: “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” (tr. North, 2002). More recently, however, doctors show increasing willingness to resort to this practice, at least in cases when the patient asks for death himself. How should society react on this trend? Should that be like liberation from outdated prohibitions or as some kind of permissiveness that is both morally wrong and practically dangerous?
It should be underlined from here that the term euthanasia has different contradictions. The approach to euthanasia changes depending on the definition. Specialists distinguish active and passive euthanasia (criterion is the position of the doctor), voluntary and involuntary (criterion is the position of the patient) (Ardelt, n.d.). Passive euthanasia (or as it is sometimes called “deferred syringe method”) is expressed by the fact that aimed at providing life-prolonging care stops and that accelerates the natural death. An active euthanasia (“filled syringe method”) means the applying any medications or other means or any other activity entailing quick and painless death (lethal injection) to a dying patient. Voluntary euthanasia is carried out on the unambiguous request of the patient or with his/her previously expressed consent (to express the will in the event of irreversible coma in advance in a legally valid form has become a widespread practice in the United States and some other Western countries). Involuntary euthanasia is performed without the direct consent of the patient. Combining these forms of euthanasia, society have four kinds (situations) of euthanasia: voluntary and active, voluntary and passive, involuntary and active, passive and involuntary.
Experts expressed their “for” and “against” about the first situation (voluntary active euthanasia) and fourth (involuntary and passive euthanasia) as well. Other opinions, most often negative, cause the discussions of a third situation (involuntary active euthanasia). Those who generally lean to a second situation, where euthanasia is voluntarily for the patient and a passive for a doctor, are “for” euthanasia.
Real understanding of the phenomenon called euthanasia includes a set of interrelated aspects, among which bio-medical, ethical, legal and religious are generally isolated. Bio-medical aspect of the problem lies primarily in establishing categories of patients, with respect to whom the possibility of euthanasia can be considered. Among these patients may be noted those whose biological death is imminent and who is dying, experiencing severe physical pain. Question about interrupting the life of a patient, whose physical suffering can be eliminated by means of appropriate medical devices should not even be considered.
Another category of patients are the patients who are in a persistent vegetative state. In this case, the medical side of the issue is the problem of determining the severity of the disease, its incurability, the stage in the treatment process, time by which all possible medical means will have been exhausted, establishing sustainable irreversible vegetative state.
Legal issue is the need to develop procedures for the implementation of legal euthanasia if this act is allowed by the law. The most important question to be considered in this issue is a possible need for the law on euthanasia.
Hence, of course, euthanasia is the conscious infliction of death. Criminal law is considering euthanasia as a murder, but it sounds like too rigid definition. After all, the intention of the person doing certain actions is to help a seriously ill person to relieve his/her suffering, in addition having his/her own will to be treated this way. Euthanasia should be discussed only when people are dealing with intentional infliction of death. In one case, hopeless, terminally ill people are willing to die in order to avoid unnecessary suffering either through direct intervention (e.g., injection of barbiturates) or leaving themselves to die by stopping artificial nutrition. In another case, a newborn child is deprived of life with severe physical disabilities. So, euthanasia itself is placed on the level of intentions: (1) any statements about euthanasia are relevant to the intention to end the life of a given person or hasten his/her death, and (2) euthanasia is not a question when one tries to alleviate the suffering of a person who is in the last stage of a serious illness, assigning him/her the medicines that can only indirectly accelerate the physiological process of dying. Death is not intentionally provoked here, but is a possible consequence of pain therapy.
It is necessary to determine two issues here. Actually, moral (in particular, what one can say about the character of a person who commits such acts) and law (should such actions be prohibited by the law?). The prominent medieval theologian and philosopher Thomas Aquinas argued that in general, the human law should be based on the natural law; it should be prohibited to all people to do anything that is wrong for humanity, not adopting the laws, but using tyranny. However, he continued that morality and legality are not the same ideology. In some cases, something what is morally bad yet is inappropriate and legally prohibited. At the same time, something that is allowed by moral issues may be prohibited by the law, as for sometimes people have to give up even their rights for the common good.
Some argue that euthanasia should not be prohibited by the law although it is immoral (Lewis, 2007). Their arguments are as follows: firstly, the costs are too high to give effect to lawful sanctions in life, and secondly, the prospect of disobedience is so wide that it is already undermining general respect for the law. Other opponents argue that although euthanasia is not always wrong, it should not be permitted by the law. This argument states that practice of euthanasia is to be too easily abused. Another version says that the legalization puts many people in a quandary choice either to continue living, or to do one step out of the way and that is the situation that no one can be put in.
The literature offers many options for the moral evaluation of euthanasia. Most authors support passive euthanasia methods and reject any possibility of active one (Garel, Caeymaex, Goffinet, Cuttini, & Kaminski, 2011). However, there is the opposite view. One of the most famous exponents of it is a prominent American philosopher James Rachels, who harshly criticized the American Medical Association Resolution of 4 December 1973, who states, “… intentional termination of the life of one human being by another is compassionate murder and contrary to the very purpose of the medical profession and policies of the American Medical Association” (Rachels, n.d.). Rachels (n.d.) believed that if the patient is conscious and is aware that his/her days are limited as he/she is no longer able to endure physical suffering or may suffer more in case a doctor hastens his death, the performance of the request is simply stopping a treatment (passive euthanasia). According to philosopher, lethal medication is somewhat more appropriate in the latter situation described.
Most scientists do not agree with the philosopher mentioned above, especially because it contradicts the principles of humanism and purpose of medicine. Value of human life makes people fight for it even contrary to the objective medical laws in the most hopeless situations (by the way, medical practice is rich in healing the most hopeless cases of patients).
Strong pain is usually the cause of the patient’s requests to hasten death, because it is forced and insincere. The physician must confront it through a rich selection of painkillers, which medicine has today. Another thing is when, for example, a person for a long time is in a coma and his/her mind is already irretrievably lost, and modern medical technologies allow life-supporting treatment as long as it can be applied, as it was in the case of Terri Schiavo.
Many scientists fear that the formal permission of euthanasia can appear as a certain psychological obstacle for finding new and more effective means of diagnosis and treatment of seriously ill patients, as well as will contribute to bad faith in curing such patients (Golden, n.d.). Emergency care for such patients requires not only high material costs, but also the enormous physical and mental stress forces for serving nurses. It is also the lack of proper treatment and such care can provoke seriously ill patient to demand death acceleration and will allow the doctor to completely stop all treatment and care. This is one more reason for the legal regulation of this issue. More common was the view that euthanasia is morally permissible only in exceptional cases, in which it should be legalized. Recent legislative initiatives allow euthanasia only in exceptional cases in the countries where it is permitted (Eijnden & Martinovici, n.d.).
Euthanasia as a problem exists only for those who recognize the humanistic principle of unconditional value of the individual and his/her life in relationships between individuals, who, by the nature of personal relationships and social positions, wish only to benefit from each other. Euthanasia may not be out of the question if people’s attitudes are full of enmity and mistrust, while in these situations it will turn as just one more opportunity to commit evil. Internal stress of euthanasia situation (euthanasia situation here is the situation of moral choice when one needs to make a decision about euthanasia) and, particularly, the problem of this situation lies in the fact that it is considered a continuation and a concrete expression of a humane, moral and respectful attitude to one to whom a help like death is applied. It is perceived as an exceptional case, when the principle of humanism fails to approve its positive value through the visible deviation from it.
Judging formally, intentional killing of the innocent is always a moral evil. Thus, euthanasia is a moral evil. Proponents of euthanasia can appeal to the fact that the above reasoning implies a distinction between justified and unjustified killings. Then if certain types of killing are justified, why one cannot justify voluntary euthanasia at least in some circumstances? As it is known, two types of murder are accepted even by many of the most ardent opponents of euthanasia and these are self-defense and punishment. None of them is unfair; essentially none of them is evil. Can people consider voluntary euthanasia as a third kind of justified killing? Below are the arguments in favor of euthanasia, which state it is beyond unjust murder, presented by the author:
1. Life is good only when the whole fun prevails over suffering, and positive emotions prevail over negative. According to this argument, the state of some people is that they would rather die than continue living. A striking example of such situation is those patients who suffer from severe pain or are doomed to have a life of abject dependence on others. Opponents of euthanasia provide two objections. The first means incorrect comparison of the quantity of suffering and goodness, because there is a confrontation between life in the form of suffering and lack of life in any form here. Life is good even when it becomes suffering. Second, permissibility of euthanasia argues that it is the will of the patient; if he/she is able to dispose of own life, he/she will stop it, i.e. here one actually recognizes the right to suicide. However, not everyone who recognizes the right to euthanasia recognizes the moral right to commit suicide.
2. Proponents of euthanasia postulate that life can be considered as a boon as long as it has a decent form, exists in the field of culture, moral relations (Pereira, 2011). Degraded to a purely vital, pre-human level, it is deprived of ethical sanctions and may be regarded as an object, a thing, and, therefore, the question of life’s termination is no more than the question of whether to cut down the tree, which is withered. This argument primarily affects by its emotional emptiness. Internal aspects of life exist in addition to the external aspects of it. It is appropriate to recall the dead man’s relation to the remains of his fellow here: gravesites are the subject of respect, they are considered as the ratio of those people, a reminder of who they are. If the moral attitude toward man covers his remains, it should be extended to the living body even being warped by disease.
3. Helping someone to improve his/her position is always morally permissible. Thus, killing cannot be considered as causing harm if killing improves someone’s position and the person himself wants to be deprived of life. Then what is voluntary euthanasia? This argument has serious flaws. Is it true that the killing of “hopeless” patients is the only alternative to a standstill? And what does that mean to improve? As it is known, self-defense and punishment are accepted as two types of murder by many of the most ardent opponents of euthanasia. None of them is unfair; essentially none of them is evil.
4. There is a fourth argument, which, however, does not withstand ethical criticism and is rather of mercenary character. Maintaining life on stages of dying or in a vegetative state, carried out with the help of advanced technology, is too expensive (Graham, n.d.). Namely, money that is spent on maintenance of life in hopeless situations would be enough to treat dozens, hundreds of other people, who are suffering from treatable diseases. Advocates of euthanasia often wonder whether euthanasia is the case when one has to choose between two evils. What is wrong with choosing the lesser evil if one thing is worse than the other? If the death of an innocent man and his constant suffering is evil, then the choice of euthanasia as the lesser of two evils can hardly be justified. People are making a mistake choosing death (i.e., killing) as opposed to simple reconciliation with the futility of further prolongation of life and death permission to come naturally. Here any act of euthanasia, as the choice of death, falls under the ban.
There are two ways by which one can lead a person to voluntary and perhaps even involuntary euthanasia. The first way is rooted in the question why authorities should limit such quick and merciful death to those who are able to ask for it? Why can it be solved to one (who was cautious and asked for it in advance or who is able to ask for it now), but others (who was not so prudent and who are unable to do it now) should refuse it? Will the denial of such an important act of mercy come as unfair punishment for those who have been short-sighted and do not care about the future? That is the way of voluntary euthanasia to involuntary one. Obviously, this trend exists in the Netherlands, where, according to official government report, 1,000 cases of involuntary euthanasia have been applied at 2700 cases of voluntary (Ardelt, n.d.).
The second way that leads to involuntary or unwished euthanasia is somewhat different. Philosopher Margaret Battin, a leading advocate of euthanasia, protects suicide in definite case, saying, “It leaves one less number of examples of human degradation in this world” (Kemp, 2001). If suicide as an example of recently widowed woman’s suffering from glaucoma and cancer “leaves one less number of examples of human degradation in the world”, how the failure of woman to commit suicide would be perceived? The logical answer is obvious: the world would have another example of human degradation. Thus, people who are less humane than euthanasia’s inventors may use it.
One must use all possible methods to support the patient’s life if there is the slightest chance of a way out of a comatose state. This is especially important when the patient is unable to express own consent. However, it is not necessary to use painful and costly methods of both material and personal if coma is irreversible. Artificial maintenance of human life in the absence of brain activity, reflexes spontaneous respiration and heartbeat would outrage the dying and severe injury to his/her relatives.
Attempts to legalize euthanasia in the United States (since 1997 in Oregon euthanasia is allowed) have recently attracted attention. It was a reaction on the book by Derek Humphry, Last Exit, which was sold in over 300 thousand copies (ERGO, 2010). This book extols the virtue of euthanasia and assisted suicide, vividly describing the methods of its implementation. Despite all odds, passive euthanasia is gradually legalized by public opinion, and in some countries it is done by the law. For example, passive euthanasia by stopping futile life support is not considered illegal in Sweden and Finland (Vincent, 2004). However, the basis for making the decision to terminate a physician treatment is free and it is an informed wiliness of patient. Similar requests from the next of kin of the patient in an unconscious state are legally invalid.
Conflicting views on euthanasia from the medical and moral-ethical point of view have generated conflicting legal assessment of this phenomenon, which is reflected in the laws of some countries. However, in many countries, euthanasia is freely used even against the existing provisions of the law in one way or another. For example, in the Netherlands after a lengthy debate in the legislation formally introduced passive euthanasia resolution with certain reservations. There is so-called lifetime will by which the patient officially confirms the will to ensure that he/she will not have prolonged life artificially operates under certain circumstances in accordance with the laws of the State of Indiana (USA). In England, by contrast, after long discussions, medical practice is under the law on any unconditional prohibition of euthanasia. However, in many countries, euthanasia, in one way or another, is freely used even against the existing law.
In 1977 in California, after years of discussions on the referendum the world’s first law “On the Human Right to Death” was adopted. It was the law in which terminally ill people can get a document expressing the desire to turn off the resuscitation equipment. However, no one has rejected the official use of this law until now, since one of the conditions for the implementation of euthanasia should be about the psychiatric patient’s sanity, and American Psychiatric Association forbids its members to participate in such procedures. Another prerequisite is that a doctor should carry out euthanasia, which is also impossible, since the American Medical Association adopted a decision to prohibit its members to practice in euthanasia (ANA, 2013). Many scientists believe that the phrase right to die generally fails, because having the right people to death and will have the right to insist on carrying out their desires by third parties, which is obviously unacceptable. It is proposed to use the expression the human right to die with dignity.
It should be noted that the countries where euthanasia is legally permitted must practice only passive euthanasia. It is also important to point out that legislation permitting passive euthanasia contains three fundamental principles:
- Euthanasia must be voluntary;
- Only a doctor can assist in or perform euthanasia;
- The patient must be medically unsatisfactory.
Euthanasia problem still remains unsolved. Until today, euthanasia has been treated differently. Public opinion is split on rigidly polar points of view. In case of full legalization of euthanasia, many will continue to believe that euthanasia (killing innocent as) is absolute evil. Also there is a great danger of abuse. In conditions of poverty in country, medical euthanasia could become a means of killing lonely elderly, children with disabilities, persons suffering from cancer and AIDS. Recognition of euthanasia by the law may also deprive the state incentive of the fund research aimed at finding effective treatments. On the other hand, it is impossible not to see that euthanasia actually exists in medical practice. Obviously, this problem demands urgent legal solutions and can no longer require turning a blind eye on it.
With the development of recent years such as the practice of organ transplants, there are new problems that are directly related to the resolution of euthanasia. Body of man, who, according to medical opinion, will die within a short period could save another person, giving him/her a real chance to live. However, many die not waiting for a donor. It turns out that people are out of dogmatic principles of euthanasia as two lives are immediately lost. This suggests that euthanasia should not be judged categorically. Not all situations of life are measured by the theoretical beliefs, and people facing the reality of problem, start treating it differently. The author’s own opinion has changed significantly in the course of writing this paper. Nevertheless, despite the complexity of the problem, humanity must continue to look for a decent way to solve it, making compromises and avoiding extremes.