Medical Ethics and The Issues of Euthanasia

There are many controversial topics in medical ethics that lack consensus and polarize not only the general public, but also policymakers, healthcare professionals, and the criminal justice system’s representatives. Among those subjects, arguably the most debatable one is euthanasia, also known as mercy killing, or physician-assisted suicide. In fact, there is a fundamental difference between these concepts that should be addressed. Under euthanasia, the patient’s death (most often but not necessarily voluntary) is the result of direct action or intervention of a physician or other healthcare professional; under physician-assisted suicide (PAS), the patient dies as a result of a healthcare professional’s material assistance in dying, though the former performs the procedure himself/herself (Cholbi, 2017). Hence, the proponents of euthanasia or PAS argue that a person has the right to die, that it is a physician’s obligation to help the suffering patient die, and that legalization of euthanasia is economically beneficial; the opponents, however, claim that the purpose of euthanasia is achievable through palliative care, that it contradicts the medical profession’s meaning, and that euthanasia in any form is suicide or murder, which is wrong from the Christian ethics’ perspective.

Addressing the topic of euthanasia, however, it appears reasonable to begin by discussing why this is an issue in the first place. As follows from the previous section, the key question related to this subject is whether active or passive (i.e., physician-assisted) euthanasia should be legalized. As of today, the overwhelming majority of countries answer negatively to this question, which is illustrated in the picture below. As to the United States, there are five states that currently allow legal physician-assisted suicide, and the majority of such deaths are cancer-related (“State-by-State Physician-Assisted Suicide Statistics,” 2019). What the aforementioned question entails is the discussion on the possibility, primarily ethical one, of the terminally ill patient’s voluntary death, and the responsibility, both legal and ethical, of a healthcare professional who engages in this process as an active (that is, who deliberately kills out of mercy) or passive (i.e., who allows death to happen through inaction) agent. Hence, what complicates the issue is the dichotomy between the fact that a patient experiences excruciating pains and that technically a physician still acts as a killer.

As such, the first argument of the advocates for euthanasia appears to be the most intuitively understandable, simple, and perhaps reasonable. That is, many patients in a persistent vegetative state or suffering from chronic illnesses want to have the right to “with dignity” as a part of their right to life granted by the fundamental laws (Math & Chatuvedi, 2012). The underlying reasons for this decision may be that they either do not want to be a burden on their families or continue experiencing excruciating pains from their chronic illness or both. It, therefore, does not appear surprising that the majority of patients seeking euthanasia are diagnosed with cancer, acquired immune deficiency syndrome (AIDS), and other medical conditions that lack an option of active treatment (Annadurai, Danasekaran, & Mani, 2014). In light of that, the proponents of euthanasia, not without certain grounds, argue that people are free to make their own choices throughout their lives, such as those to marry or to travel, and the right to choose to die under certain adversary circumstances should also become one of the person’s fundamental rights, and being kept alive against one’s will should be considered wrong.

The second argument of the proponents of euthanasia in any form concerns the moral obligations of a physician. In that sense, it is argued that doctors have many duties, but of primary importance and carrying the greatest weight are those owed to their patients, and in that sense, the doctor’s duty never to kill does not appear to be unconditional to those who argue in favor of euthanasia. As such, among the basic duties that healthcare professionals have to their patients are respect for autonomy, confidentiality, and avoidance of harm, but of the greatest significance is the duty to relieve physical suffering whenever possible (Seay, 2006).

In light of that, in cases where the patient desires a quicker death due to futility of further treatment and significantly lower quality of life accompanied constantly by physical/psychological suffering it might be a physician’s duty to help the patient end his/her life. In essence, objectively speaking, this is just an interpretation of medical duties within the framework of consequentialist ethics, which states that healthcare professionals should advance the patients’ welfare and serve their best interests (Cholbi, 2017). Hence, within this framework, euthanasia brings benefits and must be allowed.

Finally, those who advocate for either passive or active euthanasia have generally a more material and cynical argument. It is stated, thus, that the lack of the possibility of the patient’s euthanasia not only maintains and increases the patient’s suffering for no objective purpose but also contributes to a catastrophic economic situation in the patients’ families by means of depleting the latter’s financial resources. Indeed, economic pressures that result from the patients’ severe medical conditions were a long time ago shown to serve as an important factor in family members’ decision to stop life-sustaining treatments for their dying relatives (Emanuel, 1999).

While it is still quite difficult to locate the data on the economic motivation of those patients who seek euthanasia, a recent Indian study, though having a quite small sample size, has demonstrated that more than one-third (36.8%) of terminally ill patients request euthanasia exactly due to this reason (Subba et al., 2016). Of course, this argument may be considered to be among the most substantial and reasonable ones for those whose family member is terminally ill and continues to be administered futile treatment, thus suffering and depleting family’s financial resources.

The opponents of euthanasia or physician-assisted suicide, however, do also have a set of reasonable arguments in favor of their position, and the first among them is that the goals of euthanasia can be achieved without killing. As such, both euthanasia and palliative care based on the principles of beneficence and non-maleficence, paying attention to medical ethics (Bernheim et al., 2008). They also share many common values, such as an intention to stop human suffering, respect to human beings (Hurst & Mauron, 2006).

The difference, however, is that the former implies that the patient is given treatment or medication with the purpose of his/her dying, while the latter involves the same act but with the intention to relieve the suffering of the patient through making him/her comfortable (Cholbi, 2017). In addition, of course, both euthanasia and palliative care recognize that the death of a terminally ill patient is ‘not the worst’ outcome, but palliative care aims to prove that death can be peaceful and dignified without resort to a lethal prescription. Hence, it is essentially argued that the ethical controversies entailed by euthanasia in any form can be circumvented through the application of palliative care that also reliefs suffering.

The second point made by the opponents of euthanasia or physician-assisted suicide is parallel to that of their counterparts and also concerns the nature of the medical profession and moral obligations. Specifically, one of the main arguments made within this dimension is that the Hippocratic Oath obliges a healthcare professional to heal the patient and not administer poisonous/deadly drugs, however, the contemporary versions of this oath are vaguer regarding this specific question (Merino, Aruanno, Gelpi, & Rancich, 2017). Thus, it is central to the purpose of medicine, according to this point of view, that physicians should abstain from the intentional harm or killing of their patients during care (Seay, 2006).

In all the other aspects, the followers of this approach base their argument on the same premise as do their opponents, that is, it is stated that physicians should primarily be guided by the moral obligations to their patients and acting in their best interests, which, in this case, implies that they should do whatever it takes to heal, and not kill, the latter. It can be, similarly, said that the proponents of this point tend to interpret medical duties within the deontological, or Kantian, approach to ethics.

However, the famous categorical imperative is not the only guiding principle of the people who oppose the legalization of passive or active euthanasia. Religious ethics, in general, tends to condemn a person’s suicide in any form, be it Buddhist, Islamic, or Christian ethics, all of which view one’s life as sacred and thus stating that a person should endure it in all aspects, including suffering (Cholbi, 2017).

In Christianity, in particular, there may exist several stances regarding assisted suicide due to the religion’s heterogeneity, but in general, it surely opposes this phenomenon as a whole, arguing that God, as the highest authority in this model, wants all people to experience all that life offers because He allegedly has a reason for everything, including allowing people to suffer (Villiers, 2002). At the same time, Christian ethics views modern medical intervention that eliminates or diminishes pain in terminal situations as a possible option as long as it does not shorten or lengthen the days of a dying individual (Cholbi, 2017). Hence, Christian ethics tends to support physicians that refuse to participate in active/passive killing while encouraging them to provide spiritual and medical support to terminally ill patients.

It might, therefore, be concluded that the topic of the legalization of euthanasia and/or physician-assisted suicide, though being highly debatable for several decades already, remains extremely controversial in its legal and ethical aspects. Both sides, as was shown, has a set of compelling and persuasive arguments in favor of their position, often based on the absolutely identical premises, principles, and concepts. It, nonetheless, appears that the patients still should have an opportunity and right to voluntarily end their life under certain circumstances. There are, however, several crucial points that should be made in this regard.

The patients who make such a decision should be fully informed about the prospects of the latter and should be in the terminal condition that implies an imminent death. Moreover, there is a need for a psychological evaluation to ensure that the decision is not prompted by depression, for example. Of course, the actual means of euthanasia should be painless and swift to act. Also, the physician who participates either actively or passively should do this voluntarily and be exempted from legal responsibility for this act. Finally, to avoid abuse of this practice, each case of euthanasia application must be reported publicly, regularly, and timely.

References

1. Annadurai, K., Danasekaran, R., & Mani, G. (2014). Euthanasia: right to die with dignity. Journal of Family Medicine and Primary Care, 3(4), 477-478.
2. Bernheim, J. L., Deschepper, R., Distelmans, W., Mullie, A., Bilsen, J., & Deliens, L. (2008). Development of palliative care and legalisation of euthanasia: antagonism or synergy?. Bmj, 336(7649), 864-867.
3. Cholbi, M. (2017). Euthanasia and assisted suicide: Global views on choosing to end life. Santa Barbara, CA: ABC-CLIO.
4. De Villiers, E. (2002). Euthanasia and assisted suicide: A Christian ethical perspective. Acta Theologica, 2002(3), 35-47.
5. Emanuel, E. J. (1999). What Is the Great Benefit of Legalizing Euthanasia or Physican-Assisted Suicide?. Ethics, 109(3), 629-642.
6. Hurst, S. A., & Mauron, A. (2006). The ethics of palliative care and euthanasia: exploring common values. Palliative Medicine, 20(2), 107-112.
7. Math, S. B., & Chaturvedi, S. K. (2012). Euthanasia: right to life vs right to die. The Indian Journal of Medical Research, 136(6), 899-902.
8. Merino, S., Aruanno, M. E., Gelpi, R. J., & Rancich, A. M. (2017). “The prohibition of euthanasia” and medical oaths of Hippocratic Stemma. Acta bioethica, 23(1), 171-178.
9. Roy, D. (2018, March 9). Passive euthanasia: What is ‘living will’ and ‘right to die’? Here’s a look. News18. Retrieved from https://www.news18.com/news/india/as-sc-recognizes-right-to-die-heres-a-look-at-living-will-and-right-to-die-1683977.html.
10. Seay, G. (2005). Euthanasia and physicians’ moral duties. Journal of Medicine and Philosophy, 30(5), 517-533.
11. State-by-state physician-assisted suicide statistics. (2019). ProCon.org. Retrieved from https://euthanasia.procon.org/state-by-state-physician-assisted-suicide-statistics.
12. Subba, S. H., Khullar, V., Latafat, Y., Chawla, K., Nirmal, A., & Chaudhary, T. (2016). Doctors’ attitude towards euthanasia: a cross-sectional study. Journal of The Association of Physicians of India, 64, 44-47.

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