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Voluntary Active Euthanasia

In: Philosophy and Psychology

Submitted By mrufo15
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Professor McDonald
PHL 154: Moral Foundations
December 10, 2012
Voluntary Active Euthanasia: Morally Impermissible
Voluntary active euthanasia can be defined as “the intentional and direct termination of a person's life when that person is terminally ill or when his or her death is imminent, and where that person is a competent adult who voluntarily, consistently and repeatedly requests the termination of his or her life. A terminally ill person is defined as one who has an incurable or irreversible condition which is highly likely to cause his or her death within a relatively short time (six months or less) with or without treatment.” In the recent election, Massachusetts voters had an opportunity to allow such a procedure as a ballot referendum. Regardless of whether it is legally permissible or not, voluntary active euthanasia (hereafter “VAE”) is morally impermissible.
A Natural Law Argument

According to the ethics of natural law, “our primary life goal should be to realize as fully as we can our potential as human beings” (Harris 91). To do this, people should use the standard of human nature to act in a way that is in accordance with human nature (92). Our human nature is determined by the common natural inclinations of humans (93). Human nature can be determined the goals humans collectively strive for (93). These ‘natural inclinations’, as referred to by Aquinas, “reflect the structure of our human nature, which natural law directs us to follow” (93). In summation, the moral standard of natural law says, “Those actions are right that promote the values specified by the natural inclinations of human beings” (93).
By using the method of observation, natural-law theorists have determined that there are biological values specified by the basic human inclinations (93). Our natural inclination “to preserve our own existence” demonstrates that a basic human value is the value of life (94). Not only do our voluntary actions promote our natural inclination for life, but our involuntary bodily actions do as well, such as when our bodies produce a scab to heal a cut or when our immune system fights to prevent diseases (Gay-Williams 162). Our bodies are designed to promote our survival. According to natural law, we have a moral obligation to promote the value of life (Harris 94).
Euthanasia, according to natural law, is immoral because it is in our human nature to promote the basic value of life. Euthanasia violates the natural inclination to survive. The negative rule of natural law theory states that “none of the basic human goods or values specified by natural inclinations may be deliberately or intentionally or directly violated” (96). Since the basic values “cannot be measure or compared,” one is not justified in trading of one for another (96). Since euthanasia violates the negative rule by violating the basic value of life, it is immoral. However, according to natural-law ethics, there are certain conditions under which such an act is justified and we must look at them in the context of euthanasia to decide whether or not it is immoral.
If the principle of double effect applies to a situation, then it can be considered a moral act. The principle of double effect states that “it is morally permissible to perform an action that has two effects, one good and the other bad” if four criteria are met (97). The first criterion states that the act is good in itself (97). The second states the bad effect must be unavoidable in order to achieve the good effect (97). The third states that the bad effect must be a side effect of the good effect and not a means to achieving the good effect (97). Lastly, the good effect and the bad effect must be proportionate in importance (97).
From this principle, it can be concluded that VAE is morally wrong. In applying the principle of double effect one might argue that when a person commits suicide through voluntary euthanasia there are two effects; the good being the end of pain and suffering and possibly other positives, and the bad being the death of that person. However, the four criteria are not met. Although the bad effect is unavoidable to achieve the good effect, the action in itself is wrong, the action is a direct means to the good effect, and the proportionality of the effects is debatable. Therefore, euthanasia must be considered a violation of natural law and hence be immoral.
The Categorical Imperative

The second argument against VAE is based on Immanuel Kant’s ‘Categorical Imperative’. One version of Kant’s categorical imperative says you ought to act only on that maxim which you can will without inconsistency to become universal or to become a universal law of nature (Kant). The other states that you should “act only in such a way that you treat humanity, whether in your own person of in the person of another, always…as an end and never simply or merely as a means [to an end]” (Kant). Therefore a person contemplating VAE must ask whether the action is consistent to become a universal law and whether they are treating his or herself as an end. To will VAE to be a universal law however would be thinking with inconsistency, because it is irrational to end your life in order to try and make it better. Also, by choosing VAE you are treating yourself as a means to an end and not as an end in itself by taking away your right to life. Therefore, VAE is immoral.
Slippery Slope Argument Furthermore, accepting VAE as morally permissible would lead to several possible negative outcomes. Permitting VAE would lead its performance on many patients in cases in which it would be morally wrong (Brock 224). Vulnerable patients would be pressured into giving their consent for VAE when they don’t actually want it or worse, they would be killed without their consent (Singer 2). Several reasons for this could lead to these situations such as when the patient’s life becomes bothersome to his or her family or when the patient’s health-care provider want to save money (Singer 2). To prevent the wrongful cases of euthanasia, we should not permit even morally justified performance of it in any case.
The Autonomy or Self-Determination Argument Dan Brock objects to these arguments based on the value of self-determination or autonomy. Brock defines self-determination in regards to euthanasia as “people’s interest in making important decisions about their lives for themselves according to their own values or conceptions of a good life, and in being left free to act on those decisions” (Brock, 205). Self-determination allows people to have control over their lives. They are able to make decisions that effect and direct their lives. They are responsible for all aspects of their lives including who they are (206). To Brock, this value is so important because “it permits people to form and live in accordance with their own conception of a good life” (205-206). People are often concerned with autonomy during the last stages of their lives (206). While some people find meaning and value at the end of their lives, others find problems that cause them to no longer want to live (206). Based on the value of autonomy, they wish to stay in control of themselves and still retain their dignity (206). So, some opt for voluntary active euthanasia. They view their life as a burden and no longer as a benefit (207). Based on the value of self-determination, they should be able to “control the manner, circumstances, and timing of their dying and death” (206). Brock maintains that this principle of autonomy is one of the same ones used to support the argument for allowing patients to refrain from life-sustaining treatment (202). This is an argument that a general consensus has been agreed on that competent patients should be able to make decisions regarding their treatment. They should be able to look at all the alternatives of treatment and decide if they want to undergo or forgo treatment (202). Based on their desire for control over their own lives, patients are able to opt for no treatment knowing very well it will result in their death. Brock argues patients should also be able to choose suicide or euthanasia based on this same principle of autonomy. Each person has the right to determine the course of his or her life, even if it means ending it. This argument, however, does not hold up in supporting the moral permissibility of VAE. The decision to participate in VAE is one that is made solely on the rational self-interest of the patient. The patient wants to be remembered how he or she was in good times and not when he or she is sick (Brock 217). The patient acts selfishly because he or she fails to take others into consideration. The patient denies their family the opportunity to provide care in their final stage of life. An opposing view to this is care and responsibility ethics. This moral philosophy takes into consideration the need for others to provide care and the benefits they receive from providing that care. In many cases, the family and friends of the terminally ill patient would have liked for them to live longer so they could care for them. Although taking care of a terminally ill patient would be inconvenient to say the least, the care-takers would benefit greatly from the experience. The experience is very valuable and allows for new intimacy and growth (Battin, Mercy, 29).
Mercy Argument
Another advocate for VAE, Margaret Pabst Battin argues based on the principle of medical mercy. This principle states that “where possible, one ought to relieve the pain or suffering of another person, when it does not contravene that person’s wishes, where one can do so without undue costs to oneself, where one will not violate other moral obligations, where the pain or suffering itself is not necessary for the sufferer’s attainment of some overriding good, and where the pain or suffering can be relieved without precluding the sufferer’s attainment of some overriding good” (Battin, Autonomy, 182-183). This principle argues that we have a duty to end the pain and suffering of others when possible (183). Therefore, VAE is morally permissible because it relieves the patient from pain and suffering.
This argument however, does not hold up for all instances. Due to the many advanced in modern medicine and technology, pain can be controlled and reduced dramatically in terminally ill patients (Battin, Mercy, 31). Physical pain in most cases can be taken care of by proper pain relief techniques (Brock 216). Even in cases where pain is intolerable, VAE is not the only option. Terminal sedation is a last resort for many cases, however, it is morally permissible unlike VAE because it lets the patient die instead of killing the patient (Battin, Mercy, 32). Voluntary active euthanasia is immoral for many reasons. All of nature leads us toward the pursuit of life; therefore it is irrational and immoral to act deliberately against this basic value. Participating in VAE not only treats the patient as a means to an end, but also irrationally attempts to better life by ending it. Allowing such a procedure would cause a slippery slope effect and VAE would be performed in many instances where it would be immoral. The autonomy argument against VAE fails to consider the feelings of others, and the mercy argument is no longer valid with the progress made in the medical field. Many voters in Maryland were able to understand these arguments as the ballot was voted down 51% to 49%.

Angell, Marcia. “Letter to the Editor.” The New York Times. 04 November 2012. 06 November 2012. < >.
Barcalow, Emmett. “Problems for Natural Law Theory.” Bluebook (2012): 159-160.
Ballot*Pedia. “Massachusetts ‘Death with Dignity’ Initiative, Question 2 (2012).” 07 November 2012. 08 December 2012. < with_Dignity%22_Initiative, _Question_2_%282012%29 .> Battin, Margaret Pabst. "The Case for Euthanasia: Mercy,” In her Ending Life: Ethics and the Way We Die. New York: Oxford University Press, 2005: 29-32.
________. "The Case for Euthanasia: Mercy and Autonomy.” In Contemporary Moral Problems in a Diverse Society. Ed. J. McDonald. Belmont, CA: Wadsworth Publishing, 1998: 182-187.
Brock, Dan. “Voluntary Active Euthanasia.” In his Life and Death: Philosophical Essays in biomedical ethics. Cambridge: Cambridge University Press, 1993: 202-232.
Compassion and Choices. 05 December 2012. <http://www.compassion >.
Death with Dignity National Center. “In Oregon: History and Overview.” 05 December 2012. <http://www. >.
Emanuel, Ezekiel. “Four Myths about Doctor-Assisted Suicide.” The New York Times. 27 October 2012. 28 October 2012. < >.
Gay-Williams, J. “The Wrongfulness of Euthanasia.” Bluebook (2012): 161-162.
Harris, C. E. “The Ethics of Natural Law.” Bluebook (2012): 146-153.
Kant, Immanuel. Grounding for the Metaphysics of Morals. 3rd ed. Trans. J. Ellington. Indianapolis, IN: Hackett Publishing, 1993.
Mattlin, Ben. “Suicide by Choice? Not So Fast.” The New York Times 01 November 2012. Web 31 October 2012. 02 November 2012. < >.
Mill, John Stuart. Utilitarianism. 2nd ed. Ed. George Sher. Indianapolis, IN: Hackett Publishing, 2001.
National Right to Life Organization. “Policy statements on euthanasia and assisted suicide.” 05 December 2012. < >.
Oregon Public Health Division. “Oregon’s ‘Death with Dignity Act.’’ 01 December 2012. ’”
Rawls, John. “A Social Contract Perspective.” Bluebook (2012):
Singer, Peter. “Decisions about Death.” Free Inquiry (August/September, 2005) 05 September 2005 < >.
Solomon, David. “Double Effect.” Bluebook (2012): 154-155.
State of Massachusetts. “QUESTION 2: Law Proposed by Initiative Petition Prescribing Medication to End Life.” 2012 Information For Massachusetts Voters Fall 2012. 06. November 2012. < >.
Stern, Susan. The Self-Made Man. Bernal Beach Films, LLC: 2004.

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