When should life end – euthanasia?

“The word euthanasia is derived from two classical Greek words, eu meaning “good” and thanatos, meaning “death”; thus, the term literally means “good death.” The word refers to the process by which people’s deaths are intentionally brought about by themselves or others, sometimes for generally commendable ends such as the relief of pain and suffering. In other words, while some people use the term euthanasia only when one person is killed by another (i.e., “mercy killing”), the term is broad enough to also encompass suicide and assisted suicide as well as the withholding of life-sustaining care with the intention of ending a person’s life.” (Basic Questions on Suicide and Euthanasia – are they ever right? Gary p. Stewart, William R.Cutrer et al, Kregel, Grand Rapids 1998)

ACTIVE and PASSIVE euthanasia
ACTIVE EUTHANASIA – an active effort of the person or another person to end their own life. So in the end the person dies not of a disease or an injury but by a process they have introduced e.g. administering a lethal drug.
PASSIVE EUTHANASIA – withdrawing or withholding or refusing treatment which would prolong life e.g. switching off a respirator or deciding not to resuscitate. This is allowing a death which could be avoidable with that treatment, but not introducing a new cause of death.
In either case EUTHANASIA always involves an INTENTION to bring death, whether by the person themselves or another person or both.

In DIRECT EUTHANASIA the person themselves carries out their wish to die. In INDIRECT EUTHANASIA another person performs the specific act which ends the patient’s life.

VOLUNTARY EUTHANASIA is when the patient themselves chooses that their life should end.
INVOLUNTARY EUTHANASIA is when the patient’s life is brought to an end against their expressed wishes.
NON-VOLUNTARY EUTHANASIA is when the patient is not in a position to express a wish to live or die. They may be in a coma or in a state of senility so that they cannot express their wishes. Equally another person may choose not to try to establish the patient’s wishes – that would still be described as non-voluntary euthanasia.
Whether euthanasia is voluntary, involuntary or non-voluntary depends on the WISHES of the patient.

Society and the law usually call EUTHANASIA which is active, direct and voluntary by the label SUICIDE. Attempted suicide is no longer against criminal law. Different philosophies and religions take differing views on whether suicide is immoral or sinful, or not.

Society and the law usually call EUTHANASIA which is active and non-voluntary by the label MURDER. Leaving aside situations such as soldiers in combat and questions of the death penalty, it is universally agreed that intentionally causing somebody to die against their wishes is wrong.

Difficult questions around euthanasia include the following.
1. Is there a moral difference between allowing death by withholding treatment and causing death by a specific act?
2. If a terminally ill patient is given pain-killing medication at such a high dose that it actually ends their life, some would justify that action by “the doctrine of double effect”. The acceptable intention was to remove pain, the (foreseeable and inevitable) side effect was to end life. Do we think that this “doctrine of double effect” is acceptable?
3. Is it acceptable for a doctor, who has sworn an oath to “do no harm” to ever do anything which actively causes a patient to die e.g. physician-assisted suicide (advocated in USA by among others Jack Kevorkian)?
4. Does any individual, including one suffering from continual pain or extreme disability, have a “right to die”?
5. If after a long and fulfilled life a person is facing massively reduced quality of life or continuous extreme pain, and they indicate an unambiguous wish to end their life, should that be supported?
6. If UK society were to make it legal (as it is in Netherlands or Switzerland) for a person to be given help to “death with dignity”, who should make the decision about when that time has come (e.g. doctors, courts?)
7. Would any change in the law to allow a person “the right to die” not be the thin edge of the wedge to causing death on grounds such as the “the treatment is too expensive” or “to spare the suffering of the relatives”? How could we then protect the rights of aging or incapable individuals when others (society or family) judge that their on-going care is becoming too expensive? In other words, how can we ensure that a “right to die” never becomes “an obligation to die”?

Key issues in the debate:

Personhood – is somebody in a terminal coma still a “person”?
The right to choose – note the overlap with debates on abortion
Quality of life” – a life worth living;
Utilitarian concerns – bringing about the greatest good
“You shall not commit murder” (Exodus 20:13) and the sanctity of life
“Where there’s life there’s hope!”

I have a further paper “Outlines of a Discussion” which I am happy to send by email.

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