On euthanasia

Definition

There are many definition for “Euthanasia” and “Assisted Suicide”. A few of those being:

• Euthanasia: A physician is allowed by law to end a person’s life by a painless means, as long as the patient and their family agree.

• Assisted suicide: A physician intentionally helping a person commit suicide by providing drugs for self-administration, at that person’s voluntary and competent request.

• Some definitions include the words “in order to relieve intractable (persistent, unstoppable) suffering.”

Classification

1. Based on patient’s level of consent, euthanasia is categorized into:

• Voluntary: When euthanasia is conducted with consent. Voluntary euthanasia is currently legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon and Washington in the U.S.

• Non - voluntary: When euthanasia is conducted on a person who is unable to consent due to their current health condition. In this scenario the decision is made by another appropriate person, on behalf of the patient, based on their quality of life and suffering.

• Involuntary: When euthanasia is performed on a person who would be able to provide informed consent, but does not, either because they do not want to die, or because they were not asked. This is called murder, as it’s often against the patients will.

1. Based on procedure, euthanasia is categorized into:

• Passive euthanasia is when life-sustaining treatments are withheld. The definitions are not precise. If a doctor prescribes increasing doses of strong pain killing medications, such as opioids, this may eventually be toxic for the patient. Some may argue that this is passive euthanasia.

• Others, however, would say this is not euthanasia, because there is no intention to take life.

• Active euthanasia is when someone uses lethal substances or forces to end a patient’s life, whether by the patient or somebody else.

• Active euthanasia is more controversial, and it is more likely to involve religious, moral, ethical, and compassionate arguments.

For the sake of this passage, all the definitions above will be referred to as Euthanasia.

The debate

Euthanasia for animals, especially pets, is popular with the purpose of ending sufferings. However, euthanasia in human remains a controversial subject.

Relief of suffering (mental and physical, patient and family - free of burden)

Physical and emotional pain of illness, especially of patients with chronic pain and terminal illness, and prolonged death impacts patients’ quality of life. Legalizing euthanasia would help alleviate suffering of terminally ill patients. It would be inhuman and unfair to make them endure the unbearable pain. In case of individuals suffering from incurable diseases or in conditions where effective treatment wouldn’t affect their quality of life; they should be given the liberty to choose induced death. Also, the motive of euthanasia is to "aid-in-dying" painlessly and thus should be considered and accepted by law.

In an attempt to provide medical and emotional care to the patient, a doctor does and should prescribe medicines that will relieve his suffering even if the medications cause gross side effects. This means that dealing with agony and distress should be the priority even if it affects life expectancy. Euthanasia follows the same theory of dealing with torment in a way to help one die peacefully out of the compromising situation.

Many who witness the slow death of others believe that assisted death should be allowed. It is more humane to allow a person with intractable suffering to be allowed to choose to end that suffering.

Mental Capability for decision-making in patients

On the other hand, proponents of euthanasia says that patients opting for euthanasia are often incapable of and unreliable for decision making.

For instance, chronic pain patients are often mentally incompetent to make critical decisions. Therefore, the patient’s will to terminate his/her life must not be accepted like that of a drunk person. Deciding to undergo euthanasia is the most critical decision of a person (not only a patient) since this decision leads to the end of making other decisions.

Suicidal attempts (in this case euthanasia) are commonly seen in patients suffering from depression, schizophrenia and substance users. It is also documented in patients suffering from obsessive compulsive disorder. Hence, it is essential to assess the mental status of the individual seeking for euthanasia. In classical teaching, attempt to suicide is a psychiatric emergency and it is considered as a desperate call for help or assistance. Several guidelines have been formulated for management of suicidal patients in psychiatry, and therefore attempted suicide is considered as a sign of mental illness.

Autonomy

One of the key arguments favored by euthanasia and assisted suicide proponents is that of autonomy, that is, that people should be able to do what they want with their lives. The right to make decisions about your own body and health care is rooted in core principles of personal liberty and autonomy, and this right includes the right to die. Although this seems to be a straightforward argument, opponents of euthanasia often refer to patients’ incompetence in decision-making (mentioned earlier) as reason to why patients’ choice to have euthanasia is actually non-autonomous. Dr Ole Hartling, a medical doctor, university professor and former chair of the Danish Council of Ethics claimed that:

“It is under these circumstances [desperation, hopelessness, a feeling of superfluous] that the right to self-determination is exercised and the decision is made. Such a situation is a fragile basis for autonomy and an even more fragile basis for decision making.”

“Autonomy is largely an illusion in the case of assisted dying. A patient overwhelmed by suffering may be more in need of compassion, care and love than of a kind offer to help end his or her life.

However, in reality, most patients that consider euthanasia experience a lengthy period of completing procedures and waiting to be approved. Before even requesting authority approval, patients have to contemplate their condition and seek family and friend’s support. Hence, it is unlikely that the decision is ill-considered.

Death with Dignity

Every individual should be able to die with dignity. People in the late stage of terminal illness often end up bedridden and reliant on nurses and relatives for everyday tasks such as eating, washing and going to the toilet, which can be degrading.

Eliminating the invalid:

Euthanasia opposers argue that if we embrace ‘the right to death with dignity’, people with incurable and debilitating illnesses will be disposed from our civilised society. The practice of palliative care counters this view, as palliative care would provide relief from distressing symptoms and pain, and support to the patient as well as the caregiver. Palliative care is an active, compassionate and creative care for the dying.

Dr Ole Hartling explains how the autonomy of someone with a terminal illness can be affected by ‘right to die’ laws: “But if a law on assisted dying gives the patient a right to die, that right may turn into a duty to die. How autonomously can the weakest people act when the world around them deems their ill, dependent and pained quality of life as beyond recovery?”

The Doctor’s role

The assumption that patients should have a right to die would impose on doctors a duty to kill, thus restricting the autonomy of the doctor. However, a death using assisted suicide pod approved for use in Switzerland require no doctor intervention. At the push of a button, the pod becomes filled with nitrogen gas, which rapidly lowers oxygen levels, causing its user to die humanely.

A Slippery Slope

Opponents argue that normalising euthanasia would be a philosophical slippery slope to legalised murder. As applied to the euthanasia debate, the slippery slope argument claims that the acceptance of certain practices, such as physician-assisted suicide or voluntary euthanasia, will invariably lead to the acceptance or practice of concepts which are currently deemed unacceptable, such as non-voluntary or involuntary euthanasia. Thus, it is argued, in order to prevent these undesirable practices from occurring, we need to resist taking the first step.

This “slippery slope is real”, said James Mildred of Care (Christian Action Research and Education), which campaigns against assisted suicide. In a 2018 article in The Economist, Mildred cited “a steady increase year on year in the number of people being killed or helped to commit suicide by their doctors” in countries that have legalised assisted suicide. It was “only a matter of time” before the criteria for euthanasia was widened, he added.

To prevent this phenomenon, strict standard guidelines should be formulated to practice euthanasia in countries where it is legalized, regulation of death tourism and other practices like mandatory reporting of all cases of euthanasia, consultation with psychiatrist, obtaining second opinion, improved hospice care have to be followed for standardization of euthanasia.

The Religious Viewpoint

Several faiths see euthanasia as a form of murder and morally unacceptable. Suicide, too, is “illegal” in some religions. Morally, there is an argument that euthanasia will weaken society’s respect for the sanctity of life.

Buddhist: According to Damien Keown, emeritus professor of Buddhist ethics at Goldsmiths College, University of London, Buddhists generally oppose assisted suicide and euthanasia. Buddhism teaches that it is morally wrong to destroy human life, including one’s own, he says, even if the intention is to end suffering. Buddhists are taught to have a great respect for life, Keown says, even if that life is not being lived in optimal physical and mental health.

However, he says, Buddhists also believe that life need not be preserved at all costs and that one does not need to go to extraordinary lengths to preserve a dying person’s life. This means, for instance, that while a terminally ill person should not be denied basic care, he or she could refuse treatment that might prove to be futile or unduly burdensome. “The bottom line is that so long as there is no intention to take life, no moral problem arises,” Keown says.

The Roman Catholic Church strongly opposes physician-assisted suicide and euthanasia. The church teaches that life should not be prematurely shortened because it is a gift from God, says John A. Di Camillo, staff ethicist at the National Catholic Bioethics Centre in Philadelphia, Pa. “We don’t have the authority to take into our hands when life will end,” he says. “That’s the Creator’s decision.”At the same time, the church recognizes that a dying person has the moral option to refuse extraordinary treatments that only minimally prolong life. “The predominant distinction or criteria for legitimate refusal of treatment is whether the treatment in question is considered proportionate or disproportionate,”

Islamic teachings oppose physician-assisted suicide and euthanasia. “Muslims believe that life is sacred and comes from God; therefore it is a sin to take life,” says David Stephen Powers, a professor of Near Eastern studies at Cornell University in Ithaca, N.Y. While Islamic thinkers oppose hastening death, they also generally believe that the terminally ill need not employ extraordinary means and technologies to delay dying. “We are basically talking about the difference between a conscious decision to end life, which is wrong, and life ending by itself,” Shabana says, adding that the line between the two is not always clearly defined.

In sum, most religions do not support, however, refusal of treatment is acceptable.

Legality

In the U.S. while active euthanasia is illegal, assisted suicide is legal in Colorado, Oregon, Hawaii, Washington, Vermont, Maine,New Jersey, California, the District of Columbia. The Netherlands decriminalized doctor-assisted suicide and loosened some restrictions in 2002. In 2002, doctor-assisted suicide was approved in Belgium. These countries followed suit: Luxembourg (2009), Colombia (2014), Canada (2016), Spain (2021), New Zealand (2021),

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by minh khue.