asiaDeath that path for her son. When one
asiaDeath is deeply personal, generally feared, and wholly inescapable, but medical technology now can prolong our biological existence virtually indefinitely, and, with these advances, comes the question of whether we should pursue the extension of life in all cases. Most people would agree that, under certain circumstances, it would be preferable to cease our hold on life. Nearly everyone can agree that there are situations when terminally ill patients have the right to call for a halt to life-extending treatments, and that their physicians will have the moral obligation to comply. What appears to be quite difficult for us as a society to come to terms with is the thought that someone would actively intervene in the “natural” process of the death of another human being. Why is it tolerable, even desirable, to intervene (with decidedly unnatural technology) in the “natural” process of death when it results in extending life, but intolerable and morally abhorrent when we act to speed the patient to his or her unavoidable death? Certain members of society see active euthanasia as “killing,” where passive euthanasia is viewed in the more favorable light of “letting one die”.
My question is this: how are the two morally different? Examine the following case:Perry L. was a nineteen-year-old who played in a local band, loved the outdoors, and planned to become a doctor. One night in 1989 while driving a skidoo he ran headlong into a tree. Perry no longer has any cognitive abilities, he does not recognize anyone that he once knew, he cannot communicate in any way, and he has no meaningful control over his body or its functions.
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Perry will never recover any of his lost abilities and he will never leave the hospital. His family has been impacted in ways no one could have foreseen; his parents have divorced as a direct result of this accident and his only brother refuses to visit, insisting that his brother died in 1989. Perry was kept alive long enough for his critical injuries to heal, allowing him to recover the ability to breath unassisted once weaned off a respirator. This means that he will continue to live, if one can call his existence living, for years to come. Perry’s mother, who refused the suggestion of “letting him die” while her son was comatose, acknowledges that he would not have wanted to live in his present condition. She refused the suggestion of letting him die while he was comatose, by her own admission, because she could not accept the guilt she felt at the thought of his slow death from starvation (which is the commonly accepted, and legally permissible, form of passive euthanasia). Had the more humane option of active euthanasia been available, she would have chosen that path for her son.
When one sees Perry, one has to ask in whose best interest was it that he was saved? What possible good can be said to have been achieved in prolonging the existence of someone who can no longer even realize what the word “life” means? Our society needs to examine the reason why one type of euthanasia is condoned where another form, often less brutal, is refused. Certain clarifications are necessary before discussion can begin on whether there truly is a moral difference between active and passive euthanasia as the two terms are commonly used today. Barron’s Medical Guide defines the word euthanasia as “the act of deliberately causing another’s death to relieve suffering”. It is broken down into active euthanasia, which is “the use of artificial means to hasten death”, or passive euthanasia, which is the “withholding of treatment necessary for the prolongation of life”. Interestingly, both are classified as “mercy killing”. At least in this particular situation, the medical community does not distinguish between killing and allowing to die. For the purposes of this paper, I will adhere to Barron’s definition – that euthanasia is intended to relieve suffering, generally for those patients who are in the later stages of terminal illness, or those who face prolonged or significantly painful treatments for disease or injury.
Certain philosophers have argued that there is a monumental moral difference between active and passive euthanasia. They attempt to make this distinction on the grounds that active euthanasia causes the death of another person, whereas passive euthanasia simply allows a chain of events to proceed unhindered to conclusion. I fail to see how this difference in causality leads one to an ethical difference. It is well recognized that a failure to do something is in itself an action; it is simply the choice not to take action.
It would not be any more morally permissible for someone to stand by and watch another die if they could easily have saved that person than it would be for someone to actually kill another.James Rachels expresses this point in his paper entitled “Active and Passive Euthanasia”. In his example, Rachels uses the case of two men, each of whom will benefit from the death of a six-year-old cousin. In the first case, Smith intends to, and indeed does, drown the child in the bath. In the second case, Jones intends to drown the child, and sneaks into the bathroom for that purpose, but the deed is done for him when the child slips in the bathtub. Jones, in choosing not to act, allows the child to die.
In each case, these men can be said to have caused the death of the child – the first acted to bring about death, while the second allowed death to occur by refusing to act.Both men were in a position to do something that would bring about a different end. The lack of intervention in a particular situation does not excuse the person who fails to intervene from responsibility for the outcome. So, when this logic is applied to active and passive euthanasia, we see that there truly is no ethical difference. When another person – usually a doctor – fails to intervene in a life-saving or life-sustaining way, he/she is choosing not to act, thus ensuring the death of the patient. And is that not the same outcome that we would see if active euthanasia were implemented? Of course it is.
How can one condemn active euthanasia and yet support the cessation of treatment when both constitute the intentional termination of life? The only difference in the death will be in the length of time it takes to die, the amount of pain experienced, and the amount of dignity that is allowed the patient in the last moments of life. The difference between the two options leads to the most important reason why active and passive euthanasia should be considered ethical equivalents. J. Gay-Williams, in his paper entitled “The Wrongfulness of Euthanasia” says that the aim of euthanasia is “to spare the person additional and unjustifiable pain, to save him from the indignities of hopeless manipulation”. Even Gay-Williams, who believes that euthanasia is inherently wrong, believes that the purpose of the act is to bring relief to those who most desperately need it. The relief of pain and suffering is the objective of both categories of euthanasia. The currently accepted form of passive euthanasia is to sedate the patient, under the guise of pain relief, and to then withhold water and nutrition.
The patient literally wastes away; they die of starvation and dehydration. This type of death can be agonizingly slow, dehumanizing, painful, and very costly, both in financial and emotional terms. How can this type of death be said to spare the patient pain or indignity? Refusal of medical treatment is not always enough to lead to a reasonably good death; when death comes too late, we need to do more than refuse to act.Some people can easily see that there are people who would be better off dead, and of course a dignified and painless death would be the ideal. But they still cannot accept active or passive euthanasia because they believe we have a duty to God not to take a life. For them, human life is a gift from God and it remains a gift no matter how much pain and suffering it may bring.
God is the only being who should determine when a life should end. It is morally abhorrent and an offense against God to take any human life. Even if we assume that such a God exists, I still do not agree with this position for two reasons. First, it involves the assumption that it is possible to take a human life before God wants it ended, but that we cannot possibly preserve it after God wants it ended. If we do not make that assumption, we face two dangers – the danger that we are prolonging human life beyond its divine purpose, as well as the danger that we are ending it too soon.
I can understand the view that everyone dies at precisely the right time, the moment God intends. If that is so, people who opt for euthanasia also die at precisely the moment God wants them to die. I can also understand the view that we can take life before God wants it ended but we can also extend life longer that God wants it prolonged. But I cannot make sense of the view that we can end a human life too soon, but not preserve it too long. Surely such a God has given us both abilities, or neither one.
I also have a second difficulty with this religious objection to euthanasia: suppose there is a correct time to die, a divinely ordained moment when God wants each life to end. Even so, we cannot assume that God will take that life at the right time, or that he will send a terminal illness that will kill at the right time. Perhaps He is testing the patient in question – God may want the patient to take his own life and the question is whether he will meet the challenge. Or God may wish to spiritually enlighten the individual in question through the trial of deciding to allow euthanasia. In short, we have no possible way of knowing what such an entity would have us do, or if in fact such an entity exists at all. How can we rationally justify a moral principal based on what could amount to a figment of our imagination?Another argument frequently used against active euthanasia is one known as a “slippery slope” which is based on the premise that once society begins to accept active voluntary euthanasia, we will spiral downward into a state of immorality that will allow for indiscriminate killing of any unwanted persons, such as was the case in Germany under Hitler.
Those that use this argument state that, if we do not draw a line, we will be unable to prevent substantial harm to others, and that the moral line should be drawn at active euthanasia. Nowhere in this argument is it explained how this would come to pass, and I certainly see no evidence that this would be the case. I find no relation at all between the Nazi “euthanasia” program and the modern use of the word. The Nazis, after all, used the word only to camouflage mass murder. The Nazi program of “euthanasia” was neither voluntary, nor based on compassion; it was motivated by the desire to remove undesirables and preserve the purity of the race, and hence was the result of a vicious and racist ideology already firmly in place, not the unwanted and unexpected upshot of an intrinsically desirable ethical reform. Where is the evidence that a moral policy allowing death on request, under specified circumstances, begun in good faith and motivated by compassion, will lead to unwanted killings? The fact that in one case a person is killed in his or her own interest because they have requested it, whereas in the other a person is killed in the interest of others without (or contrary to) his or her consent, is a fundamental moral difference.
No one thinks that making killing in self-defense an exception to criminal homicide starts society on a slippery slope which logically must end in the abolition of the crime of murder; one simply does not follow from the other. And so it is that endorsing active euthanasia will not inevitably lead us to become a society of murderers. One way to protect against abuses of this policy would be to set guidelines on who could request euthanasia, and under what conditions that option could be exercised.So in which situations would active euthanasia be ethically acceptable? First and foremost, patient request or approval would be mandatory, with families having control regarding any decision for children and incompetent adults, with physician input, recommendation, and documentation.
This stipulation alone should curtail discussion regarding any type of “slippery slope” defense. Certainly competent adults with a confirmed diagnosis of a terminal illness, or even a progressive degenerative illness, would be able to request that they not be forced to endure the final phases of the disease. A future shaped by severe deterioration (such as that which accompanies Amyotrophic Lateral Sclerosis, Acquired Immune Deficiency Syndrome, or Multiple Sclerosis) is a future that some people prefer not to live out. The same should apply to adults who, by the nature of certain diseases or injuries, are forced to undergo extended and painful treatments with little or no hope of returning to a quality of life they would find acceptable. An example of this type of situation would be a person, severely burned, who faces months of pain-intensive treatment, is very likely to survive with significant disfigurements and disabilities, who chooses euthanasia as opposed to living a life he or she finds unacceptable in the extreme. But unrelieved pain should not be the only condition under which death is allowed.
Consider cases where a loss of independence, control, mental capabilities, mobility, or disorientation and confusion are the prognosis. These types of situations need also to be considered, on an individual basis, by the patient, family and attending physicians.When people try to decide whether certain actions are morally correct, they must ask themselves whether they would be willing for everyone to follow that rule given similar circumstances. Each of us is going to die some day, although most of us do not know where or when, and we will likely have little choice in the manner of death. But suppose you were given the choice between a painless, swift death or the opportunity to suffer unimaginable pain for a period of time. Which would you choose for yourself; which would you choose for a loved one? It would be incredibly cruel to force people to suffer through a prolonged death when more humane options should be open to them.
Most of us are willing to put a dear pet out of its misery when it is suffering, but we refuse to allow our family members, and ourselves, the same consideration. Why? Euthanasia, as it is defined here, is morally justified because it ends suffering. BibliographyJ. Gay-Williams, “The Wrongfulness of Euthanasia”, Social Ethics: Moral and Social Policy, McGraw-Hill, 1982. 48-52J. Rachels, “Active and Passive Euthanasia”, Social Ethics: Moral and Social Policy, McGraw-Hill, 1982.
52-56M. Rothenberg & C. Chapman, Barron’s Medical Guide Second Edition, Barron’s Educational Series’, 1989