Ethical Justification for Voluntary Active Euthanasia

Justification for Voluntary Active Euthanasia

The quest to legalize euthanasia is among the most ethical debates in contemporary society, akin, during its time, the discussion over decriminalizing abortion during the 1960s (Cholbi, & Varelius, 2015; Davis, 2016; Paterson, 2012).  A number of ethical scholars and moralists have argued against euthanasia. In the US and indeed the world over, when people are terminally ill or faced with extreme old age, tend to give up on life and often desire for physician-ended deaths to relieve them of pain. Physician assisted suicide is an intentional killing of patients who are at terminal stages of chronic illnesses or have been diagnosed with illnesses and conditions that cannot be treated and are experiencing severe pain (Cholbi, & Varelius, 2015). There are two broad forms of mercy killing; active or passive euthanasia and voluntary or non-voluntary euthanasia. Active mercy killing involves causing death by fatally injecting the patient with drugs causing immediate death while the passive forms involves letting an individual die by not making an effort to save them (Shibata, 2017; Van den Block, 2009). Voluntary euthanasia involves a competent adult giving consent to a specified form of treatment for physician assisted suicide. Non-voluntary refers to the consent obtained from another individual when the patient is not competent (Shibata, 2017). Whereas some parties feel that it is within the right of individuals to select when and how they wish to die, others opine that this should not be left to choice because it goes against clinical ethics and erodes the element of trust among caregivers who take lives. The current paper seeks to explain why voluntary active euthanasia is a viable and ethically justifiable option for the terminally ill patients.

Modern medical practice is based on respecting the right of competent patients to refuse interventions depending on their judgment of the benefits and burdens of the said interventions (Shibata, 2017). Some patients may seek that the life-sustaining treatments are withdrawn after performing a cost-benefit analysis of the medical interventions. In other occasions, the patient may not be competent, but a competent surrogate or proxy will have a similar role in deciding when to terminate the treatment (Sumner, 2011). One of the consensuses in the medical field is that the healthcare providers are allowed to honor the patient requests in addition to being bound legally and ethically to respect the autonomy. While some studies have sought to differentiate euthanasia and physician assisted suicide, others have argued that the concepts are similar as they involve an intended or direct act to cause death (Quinlan, 2016). In the former, the physician performs an act that is intended to cause death while in the latter, the physicians help the patient to perform the last act.

Decisions regarding medical treatment that pose consequences for the nature and timing of an individual’s death elicit strong emotions among both the public and health professionals while raising complex ethical matters for all concerned (Van den Block, 2009). According to Gorsuch (2009), the decision is usually a source of conflict between the patient’s family and health professionals, or at times, between health professionals in a given healthcare setting. Ethical dilemmas emerge when a perceived differing duty to the patient exists, for example, that between the responsibility to preserve life and that of acting in the patient’s best interests. Decisions made at the end of life constitute some of the most debated issues in clinical ethics committees as viewed from both the establishment of trust policies and review of individual cases (Shibata, 2017; Paterson. 2012). When this occurs, policymakers and other stakeholders intervene with the intention of finding a middle ground between the conflicting interests.

As life comes to an end, the ability of care giving and provision of medicine to prolong and heal life tend to reach an inevitable conclusion (Van den Block, 2009).  The discussion regarding suicide assisted by the physicians revolves around the role of caregivers and patient’s autonomy towards the end of life when suffering is evident (Shibata 2017; Davis 2016). The situation has often contributed to suits being filed against governments around the world. For instance, in the 2002 case of Pretty v. the United Kingdom, the applicant faced imminent death because of motor neurone disease that was affecting the muscles and has no cure (ECHR Press Release 2018). The applicant desired to control when and how she ended her life, given that the disease’s final stages are undignified and distressing. The Court ruled that there was no infringement of the right to life under (Article 2) of the European Convention on Human Rights, holding that life could not be construed as deliberating the wholly opposite right, which is the right to die (ECHR Press Release, 2018). However, whereas committing suicide is not unlawful in the UK, assisting one to commit suicide is which led the Court to protect third parties who may have been compelled to help with the death.

The ethical consideration of non-maleficence can be used to justify the role of the physician in euthanasia. The principle dictates that a physician is obliged not to bring harm, or expose the patients under his care to risk of harm (Sumner, 2011). With the advancements in technology, patients can prolong their lives with the use of life support machines. However, this approach does not always serve the interest of the patients. Patients can be kept in persistent vegetative state for an indefinite amount of time using feeding tubes and respirators (Emanuel, et al., 2016). While the length of life is prolonged, its quality is significantly reduced without resulting in cure. Indeed, scholars in medicine have termed this as prolonging dying as some of the patients take medicine that affect the life of the patients (Shibata, 2017; Sumner, 2011). Some drugs, while succeeding in prolonging life, may have little effect on the levels of pain experienced by the patients. Failure to provide the patients with the option to end their life when they are clearly in excruciating pain and illness condition cause more harm to the patient that good. The physician will be causing more harm to the patient if they deny them the liberty to end the suffering individual’s life.

Another ethical principle that can be used to justify active voluntary euthanasia is beneficence which requires physicians to always act in promoting the welfare of the patients. There exists debate on the best course of actions a physician should take to fulfill the requirements of this moral obligation (Shibata, 2017). Some scholars argue that the physician is tasked with preserving the life of the patients at all costs while others contend that the doctor serves the autonomy of the patient and should be sensitive to the excruciating suffering of the patient by being willing to take action and end the pain and suffering of the patient (Van den Block, 2009). Mercifully ending the life of a terminally ill patient seems to be the most helpful course of action. For such patients, the physician allowing the disease to take its natural course only achieves nothing more than prolonging the suffering, while actively choosing to help end the pain through euthanasia helps the patient end the life less painfully and hence acting with beneficence.

Active voluntary euthanasia is also supported by the ethical theory of utilitarianism. The theory determines the morality and ethics of an action by looking at the outcomes (Paulo, 2016). Utilizing the case of Dianne Pretty will help in explaining the theory in regard to euthanasia. The decision not to let Ms Pretty die would lead to immense suffering and pain to her husband and such agony can be measured using the hedonic calculus. The hedonic model uses such factors as the duration, intensity and how remote the pain is to determine the anguish and agony. Clarke (2015) argues that Mill used the utilitarianism theory to evaluate the quality and quantity of pleasure and pain that result from an action. Clarke (2015) argues that from Mill’s perspective, a high value ought to be placed on the freedoms of the individuals. Since Dianne Pretty could not have lived a long life to enjoy high pleasures, then utilitarianism would recommend euthanasia. Besides, the author provides that people should be provided with the sovereignty to decide especially when the decisions do not affect other persons, irrespective of the outcome for the people acting. Other Modern utilitarians such as Hare agree with Mill by suggesting that people may not always attach value to pleasure. As such Hare believes that a condition that does not allow an individual to live with dignity provides sufficient basis for permitting euthanasia. Further, Hare argues that meeting the greatest preference results in the greatest good and hence in the case of Dianne Pretty, Hare would have allowed her request not out of her suffering, but because it was her request (preference). Similarly, Singer (2003) introduces the element of the interest of the people that will be affected by a given decision. In this sense, the interests of the people affected by the decision to ask for mercy killing would be considered and other factors that may not necessarily fall into classic utilitarianism (well-being, welfare of the patient and interest) are considered.

Despite the many arguments supporting the act of euthanasia, there are a number of counterarguments to the practice. Some opponents of the practice argue that in interfering with the natural progression of the condition of the patient constitutes playing God as it results in a physician exercising certain power over life and death; a preserve of God (Duckett, 2017). However, the accusation is faulty since the healthcare providers are constantly interfering with the patient’s disease every time they administer an intervention. Indeed, when a physician is saving lives, it is not thought of as acting God, but when such a doctor seeks to end the suffering of a patient by practicing euthanasia, he/she suddenly acts God by exercising power over death (Greif, 2019).

Another argument that is presented by the opponents of euthanasia relates to the dangers of legalizing the practice (Keown, 2018). The opponents argue that for some patients, their illnesses put them into a state of depression and may make irrational and rushed decisions which may make the emotional family members and physicians to comply with the requests without sufficient caution (Sulmasy, Travaline, Mitchell, & Ely, 2016). While such an argument is valid and may compromise the very essence of ethical practice for the healthcare providers, the same argument is used by the proponents to push for appropriate laws to regulate the practice of euthanasia. An appropriate euthanasia law could provide that the practice is only done in hospital setting, in the presence and at the opinion of at least two physicians after assessing and confirming that the patient lacks any prospects of recovery (Greif, 2019). Indeed, the majority of the current cases of euthanasia are performed in secret and legalizing it would provide the patients with more freedom and would not necessarily obligate the doctors to assist patients commit suicide unless the conditions set out in the laws are met. Effective euthanasia law would protect the patients and provide them with more options than they get currently. Other opponents cite the possibility of incorrect diagnosis (Quinlan, 2016). While such a possibility should not be discounted completely, the stand point of many proponents, as argued in this paper, is that euthanasia should only be considered when it is no longer possible to offer any other intervention to alleviate the pain and cure the patient (Daskal, 2018). When such points are reached, the patient will clearly have no hope for recovery. With an effective law, all stakeholders will be consulted and their opinions provided before the actions is completed. By all means, providing the patients and their proxy the liberty to choose how to spend the life of a terminally ill patient is the right way to go.

Other opponents to euthanasia have suggested that legalizing the practice will set a ‘slippery slope’ precedent that will see a decline for respect of life (Keown, 2018). The possibility of abusing euthanasia upon being legalized cannot be dismissed. The opponents argue that families may push for a sick family member to be killed because of the financial and emotional burden. The physicians may also try to push for the practice as a way of hiding their mistakes or a solution to complicated illnesses they have failed to solve. Finally, the opponents argue, that institutions may use the law to limit the options for treatment as a cost-cutting measure (Keown, 2018). The concerns raise serious issues for the regulation against legalizing of euthanasia; however, keeping the practice illegal is not an appropriate solution (Daskal, 2018). Continued criminalizing euthanasia may avoid the potential abuses, but also will continue to deny the terminally ill patients the benefits of the practice. The best way of resolving the issues is to legalize euthanasia while setting stringent conditions to control and regulate the practice to stop potential abuse.

In conclusion, the discussion has provided a succinct discussion about the euthanasia. The advancements in technology have allowed terminally ill patients to prolong their lives to points where they can no longer derive pleasure and value. Such patients continue to live in agonizing pain while draining their family members both financially and emotionally. As the discussion has shown, for such individuals, active voluntary euthanasia can be ethically justified. The principle of autonomy dictates that for competent individuals, they deserve the right to select how and when to die. Denying these patients, the opportunity is unjust in ethical senses. The physicians have the duty of ensuring maleficence and beneficence to the patients under their care and in the case of euthanasia, allowing the terminally ill patients to end their pain is an ethical action by the doctors. Moreover, the ethical principle of utilitarianism dictates that individuals should be provided with the liberty to exercise their preference as it would result to the greatest outcome for the patient and the affected people. Despite the validity of some counterarguments to legalizing the practice, passing effective laws that will protect the potential abuse will result in realizing the benefits of euthanasia for the terminally ill patients.