Euthanasia: A Moral Dilemma
The word euthanasia is derived from two Greek words, “eu” which means “good” and “thanatos” which means “death,” thus, you have the translation “good death.” For many, when faced with a terminal disease or injury, it is all they truly want. That is, the ability to choose the right to die, in lieu of, a slow and painful death. The Merriam-Webster dictionary defines Euthanasia as, “The act or practice of killing hopelessly sick or injured individuals in a relatively painless way for reasons of mercy,” and also, “The act of or practice of allowing a hopelessly sick or injured patient to die by taking less than complete medical measures to prolong life – mercy killing.” In those two separate definitions, you have the words that define the difference between active and passive euthanasia. “The act or practice of killing…” is what is termed as active euthanasia, in that it involves a person physically “doing” something to bring about the death of an individual. Whereas, “the act or practice of allowing…” is considered passive euthanasia, in that it allows a person to die. Normally, this entails the withholding or withdrawal of necessary medical equipment or medicine. Historically, both methods have evoked great emotional turmoil throughout society. Why? Because, it puts into dispute moral, cultural, social, and religious values that individual’s hold regarding their right to live, aswell as their right to die. Furthermore, individuals want to be able to control, should the need arise, their right to how they die, when they die, and where they die. The fear of lacking this control comes from the thought of dying a slow and painful death from the likes of ALS, Huntingdon’s, or terminal cancer. Likewise, the fear of being trapped in a persistent vegetative state (PVS) from injuries sustained from some form of brain trauma or infection. In brief, no-one wants nor should have to go through a death like the one experienced at the hands of such debilitating diseases or injuries. However, the thought of euthanasia calls into question the very moral fiber, of “thou shalt not kill” which as the sixth commandment is recognized as one of the unbreakable vows. With that said, faced with the prospect of dying or having to watch a loved one die an undignified and painful death, many change how they perceive this vow. The central ethical argument for voluntary euthanasia is that society has a right to demand respect for its autonomic choices, and as long as these choices do not harm another being, then they should be granted! Historically, the opinion that euthanasia is morally permissible can be traced back to the writings of Socrates, Plato, and the Stoics. However, the modern day movement to legalize voluntary euthanasia was not founded until 1935 in England, when C Killick Millard founded the Voluntary Euthanasia Society. In contrast, the USA did not establish the Euthanasia Society of American until 1938. (Encyclopedia Britannica, 2011). Ultimately, euthanasia will continue to incite countless debates both morally and legally all over the world, however, if society, as a whole, were to fully understand the reality of a terminally ill patient, then they could address the true incentive of legalization, which is a person’s right to a painless, dignified death.
Passive Euthanasia is defined as, “hastening the death of a person by altering some form of support and letting nature take its course.” Examples may include turning of a respirator, halting life-sustaining medications, or discontinuing food and water. In addition, a person may have taken the initiative of writing an advanced directive with strict instructions that they do not wish to be resuscitated in the event of cardiac arrests (West Encyclopedia of American Law, 2011). Passive euthanasia can be further broken down into voluntary and involuntary passive. Voluntary passive emphasizes on the competence of the patient, with a dependence on the ability of the patient to understand his or her options for treatment, their prognosis, and ultimately the consequences of their decision to either accept or refuse the prescribed treatment. Involuntary passive would be applicable when the wishes of the patient are unknown. For example, in the landmark case of 21-year-old Karen Anne Quinlan who fell into an irreversible coma in 1974, and then declared to be in a persistent vegetative state (PVS). In 1976, her parents went to the Supreme Court to plead for their daughter’s right to die by removing her respirator. Markedly, they won their case and Karen Anne’s respirator was removed. However, she survived a further ten years before that of Terri Schiavo. Terri’s story is a tragic example of a tug of love between parents and a spouse, when no advanced directive or living will is in place. In 1990, Terri was only 26 years old when she collapsed from a suspected heart attack, and due to the length of time that her brain was starved of oxygen, she fell into a coma and then declared in a persistent vegetative state. Thereafter, a battle to allow her to die began between her husband and her parents. It was her husband’s belief that Terri would not want to carry on in this state of being, but her parents disagreed. Many brain scans were carried out over the course of the next fifteen years; many court battles, ultimately, ending in her husband’s victory to have her feeding tube removed. On March 31st 2005, Terri Schiavo died, thirteen days after having her feeding tube removed (Fuhrman, 2005). During an interview with Fr. Frank Pavone, a family friend, and one of the people with Terri in her final hour, he says, “She was a person who for thirteen days had no food or water. She was, as you would expect, very drawn in her appearance as opposed to when I had seen her before. Her eyes were open but they were moving from one side to the next, constantly darting back and forth. I watched her for hours, and the best way I can describe the look on her face was that of terrified sadness. Her mouth was open the whole time. It looked like it was frozen open. She was panting rapidly. It wasn't peaceful in any sense of the word” (Pavone, 2005). This account, from a man of the clergy, begs the question of the humanity and morality of passive euthanasia. Would it not seem far more humane to have given Terri a lethal dose of morphine to speed up her death, rather than slowly die an unimaginable death over the course of thirteen days, with her family and friends having to bear witness?
Active euthanasia, involves an “act” by an individual, which ultimately causes the death of another. It is commonly associated with the administration of a drug or some other means that will quickly end in death. Often a physician at the request of the terminally ill patient will use means to provide the patient with a quick and painless death (West's Encyclopedia of American Law, 2011). Many illnesses have very bleak outlooks; a diagnosis of terminal cancer, ALS, or perhaps Huntington’s disease leaves a person facing unimaginable pain and suffering in the later stages of either one of these illnesses. Active euthanasia can be split into sub-types of voluntary active, involuntary active, and non-voluntary active. Voluntary active euthanasia is any medical act intended to end a patient’s life at his or her persistent, yet carefully considered, and voluntary request in order to relieve them of unbearable suffering. Whereas, involuntary active is euthanasia carried out against the will of the patient, and finally non-voluntary active, where euthanasia is carried out when the consent of the patient is unobtainable, perhaps because he or she is unconscious, and has not left an advanced directive explaining his or her wishes. The subject of active euthanasia is all very hypothetical, given that there are only a few countries that have legalized it. However, it has and will continue to be carried out against the law, resulting in criminal consequences when discovered. In the story entitled, “It’s over Debbie,” a 20 year old woman, in the final stages of ovarian cancer, and is in the throes of pain and anguish, asks her gynecologist (who was a resident at the time) to “get this over with.” The resident doctor proceeded to administer Debbie with a lethal does of morphine sulphate, and she died at peace. There was a public outcry at the story, and the publication of the story, which was as stated, published without the authors name at the request of the author! The public felt that the doctor went against the very core of the Hippocratic Oath that states, “I will give no deadly medicine to any one if asked, nor suggest any such counsel.” However, depending on how the situation is viewed morally, it can and is considered by many as a mercy killing (Baird, 23). Truly, how can one not see that the doctor, even while breaking his or her Hippocratic Oath, acted out of simple compassion at the torment of this very young woman? The controversy surrounding this story only proceeded to intensify in 1990, when Jack Kevorkian helped Alzheimer’s sufferer, Janet Adkins, end her life. Kevorkian gained notoriety through his crusade to legalize euthanasia, but also through his assisted suicides of over 100 terminally ill patients (Encyclopedia Britannica, 2011). In 1993, Kevorkian served two separate jail sentences for violating the State of Michigan’s law regarding assisted suicides. In defiance, against his sentencing, he went on hunger strike, and at 65 years old, he was left weak and frail. Therefore, lawmakers released him after he assured them he would not aid in the deaths of anymore terminally ill patients. However, in 1998, Kevorkian filmed himself administering a lethal injection to a patient suffering from ALS; the film was broadcast on the program 60 minutes. Three days after the program aired, Kevorkian was arrested on charges of first-degree murder. Consequently, Kevorkian was convicted of the lesser charge of second-degree murder, but was still jailed for a term of 10-25 years. Kevorkian was released in 2007, after serving half his sentence, for good behavior (Encyclopedia Britannica, 2011). Moving into the 20th century, efforts to change the legal views on euthanasia have been met with limited success. For euthanasia continues to be regarded, by many, to be nothing less than murder and/or suicide. Currently, in the USA, only the states of Oregon, Washington, and Montana have legalized, not euthanasia per se, but physicians assisted suicide. As of today, active euthanasia remains illegal all over the USA. To be clear, physicians assisted suicide is when a physician provides a person with the means to commit suicide, whereas, active euthanasia is when the physician applies the lethal dose to cause death. Ultimately, the end in both cases is the same, a quick and painless death. Some countries chosen to legalize active euthanasia, those are: Albania in 1999, Netherlands and Belgium in 2002, and latterly Luxembourg in 2008 (USA Today, 15A). Another country, which holds views of physician assisted suicide, is Switzerland. In fact, it is to Switzerland that many terminally ill people flee to end their lives because they allow non-residents to apply to the non-profit organization called Dignitas. Dignitas was founded in 1998 by a Swiss lawyer by the name of Ludwig A. Minelli. Swiss laws on assisted suicide clearly state that people who assist in an assisted suicide can only be prosecuted if they are motivated by self-interest or personal gain. Since 1998, Dignitas has assisted in over 700 suicides, with people from over 25 different countries. While euthanasia is considered illegal in most countries, not everything that is illegal is considered immoral. When considering the ethics of euthanasia, there are many different theories that offer many varied viewpoints. Concerning passive euthanasia, many consider it a moral act because death is a consequence of the disease or injury. On the other hand, you have some who feel that there is no moral difference in doing nothing to save a life, or doing something intentional to end a life (Fletcher, 1960). Why? Because the consequences of both are the same, it is only the means that differ. From a consequential standpoint, for example utilitarianism, death is humane, dignified, and a relief from extreme suffering. The means of death are justified by relieving the patient of any kind of suffering, be it intentional in administering a lethal does of morphine, or by simply turning of a respirator, or removing a feeding tube. On the other side of the moral viewpoint of euthanasia are the non-consequentialists, for example Immanuel Kant. Kant believed that rational human beings should be treated as an end in themselves and not as a means to something else (Beauchamp, 1994).
Kant’s theory, which was based upon deontology ethics, expressed that morality was about doing your duty, with an obligation to follow the rules or do the right actions. His many writings on categorical imperatives support the theory that there are moral absolutes, which society should follow. Furthermore, he states that society should act in such a way that the maxims become universal laws of nature. He asks the question, is it always okay to kill someone who is suffering from a terminal illness? Does it go against the will of the patient? Do all sufferers want to die! Kant felt that having universal rules was important, and that it was one’s duty to do the right thing, and respect moral law. In summary, Kant felt that consequences, even if it was the relief of extreme pain, were irrelevant because duty was in sustaining life not from what makes one happy in life (Mackinnon, 2009). Another moral consideration is that of the Doctrine of Double Effect. The double effect’s moral viewpoint is that of the intention of the act, not the consequence (Stanford Encyclopedia of Philosophy, 2011). Most ethical theories judge morality in terms of duty, action, or consequence, however, in reality when do we ever consider the intention of our actions, in the medicine field in particular? The doctrine of double effect says that if while doing something morally good, it creates a morally bad side effect, ethically, it is okay to do it, providing that the bad side effect was not actually intended. The principle is often applied to justify a doctor’s actions when he or she administers high doses of pain killing drugs to relieve a patient’s suffering, while at the same time he or she are aware that the dosage may shorten the patient’s life.
Unfortunately, from an ethical standpoint, many feel that legalizing voluntary euthanasia would open the door to involuntary euthanasia. In modern day ethics, this is considered the “slippery slope argument.” What this means is, if we were to legalize active voluntary euthanasia today, then tomorrow it could open the door to the legalization of involuntary active euthanasia, something that is considered far more controversial and open to abuse. The history of euthanasia in America and the rest of the world is complex and controversial, and despite years of debate among religious leaders, physicians, philosophers, and human rights campaigners, questions remain unanswered and no cease-fire ruling is in sight. Nothing arouses passion amongst society more so than their freedom of choice! Euthanasia is no different from equality, liberty, and justice. Surely, it is within a person’s right to choose, when faced with a terminal illness, when they want to die. It is inhumane to allow a person to suffer extreme pain, or to lose their mind to Alzheimer’s, or their ability to walk, talk, and even breathe from ALS. Personally, having watched my beloved grandfather die a slow, painful, and degrading death from motor neuron disease, I believe that active euthanasia is far more humane than passive euthanasia. In his final days, he was barely seven stone, unable to talk, unable to breathe without a respirator, and three times a day for seven days his lungs had to be drained of the fluid that was slowly drowning him. Instead of letting him die, doctors continued to feed him, drain his lungs, and help him breathe until his heart gave up. For seven days, all we could do was hold his hand, and watch the fear in his eyes. Sadly, the end was anything but peaceful, for my grandfather fought for every breathe and the horror of watching him die is something that will haunt me for the rest of my life. That is to say, the end of life for an ALS sufferer is painful, it is degrading, and it is something that no human should be allowed to go through. Why is it that much of society finds watching this tragic death far more acceptable, than ending a persons suffering with the administration of a lethal dose of morphine. Consequently, it is the question of morality versus legality that has to be decided before any clear decisions can be made on the subject of legalizing euthanasia. Should the legal system recognize a person’s “right to die?” Is there an ethical difference between discontinuing medical treatment and giving someone a lethal does of painkilling medication, when the ultimate goal of both is to provide that person with a quicker, less painful death? Is it not more humane to end the suffering through means of administering a lethal drug, than to let a person die of starvation and dehydration once removed from a respirator? Finally, though a few countries are opening their minds to euthanasia, it seems that the debate will continue, and decisions will continue to be challenged. However, thought should be given to those who are facing terminal diagnoses every day, faced with a future of unimaginable suffering many are choosing to take matters into their own hands with far more consequences to the ones that they leave behind. If euthanasia were to be decrimininalized, might it enable more governmental control, and ethically would it not create a drop in suicide rates. In taking the time to fully address and document carefully thought out regulations, would society not be safeguarding a persons freedom to choose how they die, when they die, and where they die, should the need arise. At the end of the day, Francis Bellamy wrote about liberty and justice for all, is the right to die not upholding that liberty? Realistically, no one chooses to die, no one wants to receive a terminal diagnosis. However, when faced with the reality of dying horribly or dying peacefully, every person should have the right, by law, to choose life or death.

Works Cited
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