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"Should individuals, especially terminally ill-people in excruciating pain, be able to end their lives? If so, may they hasten their deaths only be refusing medical treatment designed to sustain their lives, or may they take active measures to kill themselves? Can they ask others to assist them? Who can they ask: their spouses? Close friends? Their doctors? Should they expect the law to support their decision?" These are commonly asked question when debating on euthanasia. In this paper I shall try to answers these questions from different moral perspectives.
According to Vincent Barry, euthanasia is "the act of painlessly putting to death a person suffering from terminal or incurable disease or condition". To elaborate, euthanasia is deliberate act; it is painless killing and is performed to people with incurable disease or irreversible coma. In addition euthanasia is performed only to those patients who have confirmed diagnosis of untreatable disease, are at their terminal stage of life and are suffering from intense pain or other painful medical symptoms. The term euthanasia is often used interchangeably with physician assisted suicide/death as it is usually assisted or advised by a physician.
There are six categories of euthanasia. However it can be classified in two different ways. First is the way life is taken from the patient suffering from terminal disease, which is known as active or passive euthanasia. Active euthanasia is an act of killing the person by injecting lethal drugs to cause immediate and painless death. While passive euthanasia is omitting the act of saving a person's life with incurable disease, and is not benefiting from the existing medical treatment. Hence passive euthanasia is allowing the patient to die (Daniel Gorman, 1998). Moreover it could be painful or painless depending on the present condition of the sufferer. Not everyone agrees with classifying passive euthanasia under the category of euthanasia as it is not a deliberate act of killing, and is usually prolong and painful. Therefore allowing the patient to die can be morally permissible (Gay-Williams, 1979). Others argue killing and allowing dying holds same moral position in some cases and therefore should be answered separately (James Rachels, 1975). The second method of classification of euthanasia is (a) voluntary i.e. the sufferer who is competent adult is giving consent for particular form of treatment for euthanasia. (b) Non-voluntary euthanasia i.e. when the consent is given by some other person because the patient to die is not eligible to give consent (Vincent Barry, 1985, pg 195).
Different moral positions and arguments are held for different forms of euthanasia. Therefore in this paper I would discuss voluntary active euthanasia from Kantian and utilitarian's perspective. In additions I would be discussing arguments for and against voluntary active euthanasia.
Immanuel Kant focuses on actions and labels an action morally right if it is done for the sake and respect of duty. For him rational being is someone who guides his 'will' and duty with reason. In addition he talks about principal of categorical imperatives that actions are morally correct if a person can will it to be universalized. Also he says not to use human beings as mere beings. Kant would look at voluntary active euthanasia as a form of suicide. In his groundwork for metaphysics of morals he talks about it as "Act in such a way as to treat humanity, whether in your own person or in that of anyone else, always as an end and never merely as a means". So a person choosing euthanasia is using himself as mere being and is not respecting his own rationality. Hence Kant would strictly forbidden voluntary euthanasia as the person in pain inclined to take his life, is not acting according to duty and is therefore always immoral. The action is moral as Kant says "if the unfortunate one, strong in mind, indignant at his fate rather than desponding or dejected, wishes for death, and yet preserves his life without loving it --- not from inclination or fear, but from duty, then his maxim has a moral worth".
There are many schools of thoughts on utilitarianism but John Stuart Mill's theory on utilitarianism and euthanasia will be discussed. Mill's ethical theory mainly talks about pleasure and avoidance of pain. According to him, "actions are right in proportion as they tend to promote happiness, wrong as they tend to produce reverse of happiness". Hence voluntary active euthanasia can produce happiness for a number of people. Firstly the persons suffering from pain will get rid of it and having control over their lives would give pleasure. Secondly the family of the patients, who feel the pain of their close ones, and who are spending lots of money in the treatment, will ultimately be free of pain. Therefore utilitarian's would allow active voluntary euthanasia because it follows greatest happiness principle.
In my point of view, voluntary active euthanasia can be morally permissible. Keeping utilitarianism in mind, active voluntary euthanasia holds many advantages. It terminates the suffering and pain of the terminally ill persons and their families. In addition the material resources and paramedical staff needed to keep alive patients, whose death is certain, can be used for those patients who have curable diseases. Moreover families of such patients suffer from economic burden of medical expenses, hence it is also relieved. Lastly and most importantly, euthanasia gives a sense of autonomy and control to people, to decide how and when their lives should end, when death with incurable disease is certain.
Now I shall converse the arguments for and against the act of voluntary active euthanasia. The first argument made by most of the opponents is that act of euthanasia is against the divine will of God and it interferes in the natural processes that God has formulated for human beings. As argued by Gay-Williams (1979), "man as trustee of his body act against God, its rightful possessor, when he takes his own life". Hence killing human life is violation of God's commandments. However Vincent Barry in his writings answers this argument in the light of modern medicine. He argues that contemporary advances in medicine have also interfered with the divine plan of God as it has prolonged people's life who would have died long before. Hence if active euthanasia is said to be immoral, then prolonging people's life against the will of God can also said to be immoral.
Opponents of euthanasia argue that diagnosis made by physicians may at times be wrong. Therefore a patient diagnosed as having incurable disease might be an error. That is a mistaken diagnosis is made, and patient is forced to go for euthanasia. In addition they claim that physicians as human beings are inclined to make errors therefore euthanasia leads to an immoral and unacceptable act (Hooker, 2002, pg 28). In answer to this argument, proponents respond that there are very few cases in which such error is made. This doesn't imply that euthanasia shouldn't be legalized. If euthanasia is to be legalized and practiced, only medical experts would be eligible to make a diagnosis. Further to reduce the error of misdiagnosis, three medical experts shall discuss the diagnosis and come to the conclusion of whether euthanasia is applicable or not.
The third argument made by the opponents is regarding new treatment options. They argue that what if new treatment modalities are available after acting on euthanasia? The outcomes would be terrible. Moreover people and physicians would become hopeless as soon as they encounter fatal disease and would not look for new treatment options. Brad Hooker (2002) talks about two standards that need to be followed for euthanasia. First he says that as euthanasia is always implied at the end stages of a fatal disease, where there is no possibility of the diseased being benefited from new medical treatments, hence in such cases active voluntary euthanasia can be entertained. Secondly on the other hand, if there is a possibility that a patient might benefit from any innovative medical treatment, euthanasia should always be restricted.
Slippery slope argument on the legalization of voluntary active euthanasia is also made by most of the opponents. They argue that once we have allowed voluntary euthanasia, in no time, non voluntary euthanasia will also be allowed and legalized. Hence doctors and sufferer's family will start killing them without their consent. These people will be killed for wealth they posses, doctors will kill them so they can save hospital's resources and so on. Thus it will lead to a chain of reaction leading to devastating results. The Stanford encyclopedia of philosophy cites a study done in Netherlands in 1995 to explore the reality of slippery slope argument. The researchers found the slippery slope argument groundless. That is to say, there a clear distinction between voluntary and non voluntary euthanasia, therefore there is no point in saying that legalization of active euthanasia will lead to abuses of non voluntary euthanasia. Moreover if active voluntary euthanasia would be legalized, "it would need to be carefully drafted. And the law would have to be rigorously policed, to prevent abuse" (Hooker, 2002, pg 30).
In the conclusion, as euthanasia has six classifications, each type should be evaluated for moral worth. Some opponents might argue that good palliative care and pain relief measures are adequate and hence euthanasia is not required. However regardless of our maximum effort to provide best palliative care, euthanasia will always be picture. Moreover the price for not allowing active euthanasia will be paid by sufferer whose suffering and pain will increase (Gorman, 1999, p.860), thus active voluntary euthanasia should be legalized. However in order to ensure that people do not misuse it, law should be strictly implemented. In this way, the victim would feel autonomous and will die with dignity.