Ethics and Euthanasia Draft. Ethical Issues

Introduction

Ethical issues have always been debated by human beings with different reasoning and justification for a particular outcome they favor. It involves one group of people who believe in moral standards of the “absolute and eternal” variety and another group that believes that ethical issues depend on a variety of factors (Waller, 2008). Human beings from different fields in life contribute to the hotly debated topics: journalists, medical professionals, caregivers of various kinds and the geriatric population and people who are invariably opinionated about any issue available: they belong to the group which finds factors for influence on ethical issues. (Waller, 2008). Assisted suicide or euthanasia is an issue that has been on and off gaining importance especially when someone in the world has applied for such an end to their loved one and a case comes to court. This paper is exploring into the various theories of ethics and their application to the contemporary problem of euthanasia which is a widely debated topic.

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Thesis statement

What are the different views on physician-assisted suicide or euthanasia and can euthanasia be made legally feasible and morally correct using legislation?

Euthanasia

As Kant has indicated that “fundamental and unconditional ethical truths or categorical principles” are required to reason out issues so that a universal law is possible, let us look through euthanasia (Waller, 2008). The issue of euthanasia can meet a successful outcome only through a rational ethical theory.

Surprisingly many definitions have evolved out of the debates on the topic. Years ago, the words “mercy killing” were the only description. Today different descriptions have arisen. They have been taken from the website Euthanasia.com.

  • Euthanasia: the intentional killing by act or omission of a dependent human being for his or her alleged benefit. (The keyword here is “intentional”. If death is not intended, it is not an act of euthanasia)
  • Voluntary euthanasia: When the person who is killed has requested to be killed.
  • Non-voluntary: When the person who is killed made no request and gave no consent.
  • Involuntary euthanasia: When the person who is killed made an expressed wish to the contrary.
  • Assisted suicide: Someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill himself it is called “physician-assisted suicide.”
  • Euthanasia by Action: Intentionally causing a person’s death by performing an action such as by giving a lethal injection.
  • Euthanasia By Omission: Intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water

Theories in ethics

There are mainly two groups of theorists in ethics: one group who base their ideas on absolute and moral standards and another which believes that there are factors that influence ethics (Waller, 2008). The theological voluntarists belong to the first group and their belief is that all moral principles occur according to the will of God. Both groups have no advantage over the other and have difficulties in each. A rationale does exist for ethics but how much of it can be explained by reasoning is a contentious issue. The philosopher Kant says that reasoning establishes what is understood as categorical imperative. However his thoughts cannot fully explain moral conflicts and why they occur (Waller, 2008).

Other philosophers have based their ethics on feelings or emotions. The two groups of emotional thinkers and reasoning thinkers have traded conflicts that have formed history (Waller, 2008). Kant and David Hume are opponents as far as ethics are concerned. Hume claims that even the reasoning has arisen from emotions. Objective ethical truths do not impress Hume. Intuitionists also do not believe that sheer reasoning can lead to moral truths (Waller, 2008). They think that each situation has a “right action”. Others say it is the “right principle”. Whatever it is, it is a special inborn power of recognizing ethical truths. There is a question as to how disputes of intuitional ethics can be settled; whose intuitions are right?

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Bentham believed that all pleasures are equal but Mill believed in the different qualities of pleasure. The qualitative differences may be evident from the utilitarian calculations. Ethics is considered a human creation by social contract theorists. The legitimacy of ethical rules makes this theory good. Thomas Hobbes spoke about the social contract theory (Waller, 2008). Rawls elaborated it further: he said that ethics should be judged from a veil of ignorance. Gauthier’s game theory spoke about group cooperation. Care ethics is focused on maintaining relationships.

The scope of morality varies in the different theories. Moral consideration is seen more in the Regan’s theory (modified version of Kant’s) and the utilitarian theory (Waller, 2008).

Background

The Quebec College of Physicians of Canada has recommended euthanasia for terminally ill patients (Kondro, 2009). They have expressed their opinion that patients must be told about the many possible last-minute treatments that they can choose to have. The doctors are not obliged to practice euthanasia. However if the occasion demands, they have to rise to the occasion keeping well within the boundaries of the medical practice. Their actions should not be considered criminal. Doctors and the public are equally aware that it may be necessary to end quality care occasionally with euthanasia (Kondro, 2009). Patients, who are incompetent and in their terminal phase and suffering from acute pain leave them in agony and their families and doctors all feel emotional and helpless. The evolution of society has reached a point where doctors, families and others caring for patients can make consensus decisions when their loved ones are caught in difficult clinical situations. The patient would not have taken an advance decision and it would be left to the families to do so at an appropriate time. Physicians believe in shortening the period of agony (Kondro, 2009). More open discussion may be needed to determine the various options available at the end of life. The differing responsibilities of the people involved have to be identified. The decision to terminate treatment or relieve pain or apply euthanasia is one type of decision to be taken. Another would be euthanasia and assisted suicide (Kondro, 2009). If euthanasia is the decision, it has to be a medical act during the caregiving process.

Smith (2009) has expressed alarm about the changes in the “purposes and practice of medicine”. He speaks about how once upon a time the purpose of medicine was to save lives however today people are speaking about ending lives legally. The strong convictions and fears have been clearly mentioned in his article. He is upset about the terminations of pregnancies that are occurring in the United States: a million or more of them a year. Physician-assisted death is legal in Oregon. Active euthanasia is already practiced in Netherlands, Belgium and Luxembourg (Smith, 2009). He believes that at the rate things are going, doctors would be given the authority to terminate patients’ lives through active euthanasia. Smith resembles a theologist voluntarist (Waller, 2008).

The trend towards euthanasia is progressing fast. Smith (2009) suggests that the termination of life could be associated with cloning which may be facilitated through the euthanasia. A decision to describe a persistent vegetative state as death could also be imminent. In this new situation, organ transplantation and experimentation may increase. The methods and ethics are undergoing great changes among the medical professionals so that the morals and virtues which they swear by Hippocrates have become questionable (Smith, 2009). Even though euthanasia is permitted in Oregon and Washington, doctors are allowed to refrain from hastening the death of a patient. Similarly though abortions are allowed in the US, doctors are permitted to refrain if religion or personal conscience is against them. The different “voices” are moving in a direction where the moral judgments of professionals may not matter anymore. The professionals may just have to do what their patients ask for. Respect for the patient would be grounds enough to conduct euthanasia.

Bioethicist Jacob Appel suggested that the law may permit a doctor to go on providing treatment to a dying patient without bothering to know what the patient wishes (Smith, 2009). If the court did not condone the access to assisted suicide, the right to die cannot be exercised. Medical professionals are moving into a situation where the taking of a life becomes justified. A pharmacy in Washington refused to stock an abortifacient contraceptive on religious grounds. The trial judge ruled that the owners were right but the Ninth Circuit Court of Appeals ruled that the State regulation expected all pharmacies to fill all prescriptions and it was a law generally applied and therefore had to be followed. Religion was not targeted (Smith, 2009). Flimsy reasons for not dispensing medication were to be prohibited according to the ruling.

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A situation of euthanasia by the back door has been allowed by the California legislation. Terminally ill patients who had less than one year to live had the right to demand palliative sedation. The palliative technique to be assumed was redefined. If a patient is near death and no treatment could change his suffering, he is to be put into artificial coma till natural death. The patient was not to be given artificial food or hydration in the redefined bill. The bill was actually legalizing active euthanasia (Smith, 2009). It also gave the right to demand sedation and dehydration when the patient could be living for another year. The evaluation by the doctor may not necessitate the sedation and dehydration. However, he would have to comply with the provisions of the bill. Finally when the bill was passed, it did not have the unwanted provisions and palliative sedation was well-defined (Smith, 2009).

The Department of Health and Human Services passed a new rule whereby employment discrimination against a professional who refused some service on the grounds of conscience was prevented. Many people spoke against this as they thought that professionals would forget everything else if they could afford to refuse services and put religion above services (Smith, 2009). The whole nation protested. Professions were to put patients’ rights first.

Medical professionals need to remember the Hippocratic Oath with pride and sincerity. The principles of the oath need to be maintained. Conscientious clauses must be legally binding (Smith, 2009). Human life must not be taken in any procedures. No service must be provided to help the patient have a lifestyle he has selected. The rights of conscience must be limited.

The motives that have been delineated for euthanasia are severe worsening of the patient’s condition and progressive losing of autonomy (Boisvert, 2009). Boisvert has the opinion that euthanasia should be the “ultimate palliation”. His is an example of care ethics and his opinion has probably been formed from seeing so many patients who would have opted for euthanasia if they could (Waller, 2008). Unacceptable dependency on caregivers is another condition that distresses terminally ill patients. Pain is no more the main reason for euthanasia because pain management has progressed very far. Pain is ranked as the fourth or fifth reason for euthanasia requests (Heyland et al, 2006). These conditions all cause meaninglessness even after palliative care has been provided. Patients ask for their life to be ended (Collier, 2009).Studies have shown that 6% of palliative care patients wanted euthanasia immediately when asked (Wilson et al, 2007). 80% of Canadians and 75% of Quebec specialists opted for euthanasia (Boisvert, 2009). Boisvert was a retired palliative care physician when he wrote the article.

Dr. Kailash Chand has given his opinion on euthanasia. He joins Dr. Ann McPherson indicating that many patients fight a losing battle with incurable and debilitating illnesses only to give up after some time (Chand, 2009). These patients are the ones who want immediate euthanasia or assisted suicide. By denying euthanasia for them, we are helping to prolong the suffering of very ill patients and their families. However Dr.Chand agrees that safeguards must be built into any legislation that is passed so that the individuals involved are all protected. Legislation must decriminalize acts of euthanasia and physician-assisted suicide. Human rights must be protected and cruelty prevented. Allowing a person to decide to end his life will be “a humane, rational and compassionate choice” (Chand, 2009). Quality of life is essential. Patients are traveling overseas to nations that allow the euthanasia. It is better if provisions can be made within our country for the euthanasia. Conflict in the laws must be done away with. The person exercising the right to die should be an adult, must be terminally ill, mentally competent, and in severe pain (Chand, 2009). The issue must be fully debated for appropriate legislation so that terminal patients die in dignity. I have concluded that there are two schools of thought where euthanasia is concerned. Many people condone the issue hoping to reduce the distress of terminal patients. However equally large groups do not want euthanasia to become legislation. They would prefer to think that it is God’s will. This brings me back to my thesis statement.

What are the different views on physician-assisted suicide or euthanasia; and can euthanasia be made legally feasible and morally correct using legislation?

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Conclusion

Ethical issues have always been debated by human beings with different reasoning and justification for a particular outcome they favor. Human beings from different fields in life contribute to the hotly debated topics: journalists, medical professionals, theologists, caregivers of various kinds and the geriatric population and people who are invariably opinionated about any issue available (Waller, 2008). Assisted suicide or euthanasia is an issue that has been on and off gaining importance especially when someone in the world has applied for such an end to their loved one and a case comes to court and is the basis of study here. The issue of euthanasia can meet a successful outcome only through a rational ethical theory. When it is a doctor who helps another person to kill himself it is called physician-assisted suicide. When a patient is allowed to die of his own intention, it is euthanasia. Two groups of theorists mainly exist; one group who base their ideas on absolute and moral standards and another which believe that there are factors that influence ethics (Waller, 2008). Representations are being made by the Quebec Royal College of Physicians and the Royal Society of Canada in favor of euthanasia hoping to initiate legislation. Physician-assisted death is legal in Oregon. Active euthanasia is already practiced in Netherlands, Belgium and Luxembourg (Smith, 2009). Smith belongs to one group of people who are worried that allowing euthanasia through legislation may cause further problems in the life of man: widespread organ transplantation and cloning. He believed that the California legislation allowing active euthanasia in California was actually a backdoor; thankfully, the unwanted provisions were left out. Boisvert (2009), a retired palliative physician who has witnessed plenty of suffering, has the opinion that euthanasia should be the “ultimate palliation”. Studies have shown that 6% of palliative care patients wanted euthanasia immediately when asked (Wilson et al, 2007). 80% of Canadians and 75% of Quebec specialists opted for euthanasia (Boisvert, 2009). Dr.Chand agrees that safeguards must be built into any legislation that is passed so that the individuals involved are all protected.

References

Boisvert, M. (2009). Euthanasia debate re-ignited, CMAJ, Vol. 181, No. 11, p. 825 (Letters) Canadian Medical Association

Chand, K. (2009). Uncertainty on unregulated euthanasia must end. (letters) Pulse Views.

Collier, R. (2009). Euthanasia debate re-ignited, CMAJ, Vol. 181. P. 463-464. Canadian Medical Association

Heyland, D.K., Dodek, P., Rocker, G. et al. (2006) What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ, 2006,Vol. 174, p. 627-633

Kondro, W. (2009). Quebec College of Physicians issues qualified endorsement euthanasia in exceptional circumstances. CMAJ Vol. 181, No. 12. Canadian Medical Association.

Smith, W.J. (2009).Pullimg the plug on the conscience clause. First Things. 

Institute of Religion and Public Life.

Waller, B. N. (2008). Consider Ethics: Theory, Readings, and Contemporary Issues. (2nd ed.) New York: Pearson Longman

Wilson, K.G., Chochinov, H.M., McPherson, C.J. et al, Desire for euthanasia or physician –assisted suicide in palliative cancer care. Health Psychology, Vol. 26, p. 314-323

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