Bioethics of Euthanasia

As biological organisms, humans design patterns of how to live by way of autonomous lifestyle choices, only after being born into a subjective realm of existence with social opportunities and limitations suggested by how one is nurtured and raised. A sense of a connection to objectivity is gained depending on how closely one associates themselves with an organized institution such as religion, or other form of moral code.

The idea that knowledge learned from a moral superior at a young age can suggest, or sometimes in early adulthood, coerce decision-making is indicative of a set of parameters or expectations that one must achieve so to honor the objective family belief. Therefore, the family is also an institution which generates the same attachment to objectivity that encourages a certain set of goals. Ultimately though, it is one’s subjective experience that has it’s own social, physical, mental, and spiritual habits and attachments that cause the mind and body to perform and exist in a particular way.

The overarching illegality of euthanasia across North America is supported by religious institutions which act as the sole moral platform for questioning the professional conduct of medical practitioners. The hegemonic belief that is fostered views euthanasia as a breach of non-maleficence, though doctors have and will likely continue to comply with life-ending aid in North America, regardless of recent deliberation regarding legislation. A legalization of euthanasia could ease tensions for physicians and patients dealing with chronic fatal health conditions, but would require specific criteria for legality.

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The debilitating suffering from a terminal illness should be the first criteria, as well as an autonomous request made by the sufficiently competent patient. Those who advocate for the legalization of euthanasia are part of a particular morality that sees beyond the mystical value of medical non-maleficence and opposes overarching institutional moralities that forbid life-ending decisions. Also of concern is the slippery slope argument, whereby any level of legal euthanasia would likely incite requests for more flexible criteria, publicly bringing into question the intangible value of human life.

A central notion of biomedical ethics that stands as a major contender against the legalization of euthanasia is non-maleficence. To generally adhere to the principles of non-maleficence, physicians should not provide ineffective treatments to patients as these offer risk with no possibility of benefit and thus have a chance of harming patients. In addition, physicians must not do anything that would purposely harm patients without the action being balanced by proportional benefit (Beauchamp, 155).

This benefit is not necessarily beneficial to the terminally ill individual who has requested euthanasia. The benefit referred to in the medical field is generally an extension of life and a restoration of health, which is not a reality for the terminally ill, rather a benefit might be an end to incurable suffering. Because many medications, procedures, and interventions cause harm in addition to benefit, the principle of non-maleficence provides little concrete guidance in the care of patients, and acts as a fairly weak argument against euthanasia.

A helpful distinction when debating the validity of physician assisted suicide is that of ‘killing’ and ‘allowing to die’. If a patient is too frail to undergo restorative treatment, it can be said that the withholding of that treatment is allowing the patient to die. On the other hand, ‘killing’ entails taking action that would hasten the onset of death. There is considerable overlap between these two concepts, to the point that a clear distinction is not readily discernible (Beauchamp, 172).

The prima facie nature of allowing a patient to die, as expressed by Beauchamp is acceptable under certain conditions whereby a medical technology is considered futile, or ineffectual, or a patient and/or surrogate decision maker has validly denied a medical technology (173). In the case that a patient is suffering unnecessarily, and has denied or been denied the opportunity for treatment due to severity of illness, should euthanasia not be an acceptable option?

This action would undoubtedly fall under the category of ‘killing’, but if the nearest solution is the imminent death of a terminally ill patient, the concept of non-maleficence should not apply to a deliberate hastening of the patients’ biological shutdown. It can also be argued that fading to death in palliative care with little to no cognition is of little value, and coming from a strictly utilitarian perspective, in some cases, may be unnecessary. If an elderly patient has no immediate family, and is in the final stages of a degenerative disease, the option of the patient to deny extended care and hasten the imminence of death should ot be considered immoral.

The approval of certain cases such as the example above would definitely introduce a ‘slippery slope’ argument whereby the notions and parameters of conducting euthanasia would be challenged, inflated, and publicly scorned. The infamous example of Dr. Kevorkian is indicative of the demand for physican-assisted suicide, and the flexible moralities of perhaps many physicians who are faced with the challenge of allowing a patient to pursue a hastened death.

Michigan doctor Jack Kevorkian was convicted of second-degree murder for delivering a lethal injection to a 52-year-old man suffering from Lou Gehrig's disease. It was the first time in five trials that Kevorkian was found guilty of a crime after participating in, by his count, at least 130 assisted suicides. Likened to "a medical hit man" by the prosecution, Kevorkian compared himself to Martin Luther King and told the court he was no more culpable than an executioner.

The 70-year-old doctor had dared prosecutors to charge him and threatened a hunger strike if convicted. “Suicide”). The case of Kevorkian’s assisted suicides shows that public hegemonic belief places all burden on the physician involved, for it is technically legal to carry out or attempt suicide, but not with the aid of any other person, especially a clinician. These laws tend to make sense in every realm except the medical world, where euthanasia is an issue that arises with the terminally ill, and particular moralities strongly advocate for the right to die under certain circumstances, as illustrated by Kevorkian’s rash threats of a hunger strike if convicted.

Obviously viewing himself as a liberator, Kevorkian’s particular morality quickly earned him a reputation, and having participated in over one hundred assisted suicides, he stands not as a reputable opposition to hegemony, but rather a moral pariah. Kevorkian’s comparison of his ‘moral fallacy’ with the conduct of an executioner is an interesting philosophical idea, and also illustrates the exclusivity of moral professionalism within the medical world. This is mostly apparent in the United States where there is a domination of privatized health care, and plenty of capital punishment.

The application of morality is varied when it comes to death and dying, in a society where a 20 year old can be put to death for committing murder, and in the same society, a terminally ill, suffering patient cannot decidedly seek a peaceful death without moral intervention. In both cases, strong moral impositions are made, and guide the fate of both individuals. The convict has a chance at rehabilitation, and renewing his moral adherence and contribution to society, but is not rewarded the chance because his actions stripped him of his dignity.

On the other hand, the dying patient is not permitted to seek assistance in death because common morality forbids it, much like the same common morality denies the convict a second chance. The patient is denied euthanasia because the hegemonic function of the medical field is to avoid non-maleficence, so according to the same morality, the criminal is denied rehabilitation and put to death because the function of the law is to appropriately punish offenders.

This paradox shows how two distinct versions of the same common morality are stamped like a ‘cookie cutter’, yielding the anticipated results of the societal function: the patient can’t die because medicine is designed to keep him alive, and the criminal can’t live because capital punishment is designed to eliminate him. Therefore, it is not unreasonable to suggest that the application of euthanasia in the medical field should be acceptable in certain circumstances, and that exclusive clinical moralities should allow deliberation on the subject, and not continue to function in a ‘cookie cutter’ fashion.

In Canada and the United States, laws distinguishing ‘active’ and ‘passive’ categories of euthanasia are divided into four sections: “deliberately killing persons who wish to die or assisting them in suicide (active voluntary euthanasia and assisted suicide), deliberately killing persons whose wishes are unknown or opposed to such treatment (active involuntary euthanasia), withholding or withdrawing life-preserving means from those who do not want them used (forgoing treatment of competent individuals), and letting persons die by withholding or withdrawing life-preserving means when their wishes are unknown or when they want, or would tolerate, such means to be applied or maintained (forgoing treatment of incompetent individuals)” (Dickens, 136). According to these legal parameters, it would seem that active and passive euthanasia should only occur when indicated by the patient, living will, or a surrogate, such as active voluntary euthanasia, and the forgoing of treatment to competent individuals. These two forms provide the patient with the moral decision to adopt the institutional values of their choice and affect their course of longevity and suffering.

In the cases of active involuntary euthanasia, and the withholding of treatment from incompetent patients it can be said that, morally, the physician has no right to change the course of the patient’s treatment without clearance from a living will or surrogate. To conduct active involuntary euthanasia, or withhold treatment for no apparent reason indicated by the patient or surrogate, negligence would necessarily apply and represent the justified fault of the attending physician. Dealing with death is a subjective experience that generates fear, and causes humans to seek comfort in institutional beliefs, whether that be family, religion, other forms of spirituality, or modern medicine itself.

Death reminds humans of their biological capacities and fleeting opportunities for experience in life, and generates a desire to medicalize suicide. “We want physicians to provide the means to end life in an antiseptically acceptable fashion. Knives, guns, ropes, and bridges tend to be messy. We seek a more aesthetically pleasing way of terminating life, one that leaves the patient looking dead, but not disgusting. For this, as in so much else in the 20th-century quest for happiness, we turn to the physician” (Paris, 33). Much like we seek aesthetic modifications from plastic surgeons, and mental stability from psychologists, we turn again to professional doctors for a method of dealing with the harsh reality of death.

Though euthanasia may be an acceptable option for some people in certain sets of dire circumstances, it is the fear of death generated by the triumphs of medicine that provide the illusion that death and suffering are something a physician can cure. Medicinal miracles and the rise of technological medicine give people the impression that old losses are new triumphs, at least insofar as one can be kept alive for longer with chronic diseases. This notion sparks the fear of suffering before death, and that morbidity will be extended instead of compressed. Essentially then, it is the physician who bears all weight of the laws pertaining to euthanasia, which seems unjust when there is little more that medicine can do for a terminally ill patient than aid in their peaceful departure from life.

The argument that legalized euthanasia would initiate the slippery slope, and “hospitals would become cruel and dehumanized places” are refuted by the suggestion and observation of the exact opposite (Schafer). As Schafer suggests, “experience has shown that what happened was exactly the opposite of what was predicted by the naysayers: Doctors and hospitals have become kinder and gentler, patients' wishes are better respected than previously and society has come to accept the importance of individual autonomy at the end of life” (3). Clearly, the legalization of euthanasia would not entirely disrupt the nature of medical care in Canada, and with current debates indicating the possibility of change, society may undergo a change of ideas in the near future.

The idea that euthanasia may provide a patient with more dignity at death than what is often referred to as ‘sedation to unconsciousness’ is becoming more common, and should not be deemed unacceptable next to palliative care. With the right safeguards in place, euthanasia should be one of many life-ending options available to Canadians near the end of their life, with palliative care being a morally adjacent decision. The subjective experience of death is one’s own, and even familial institution can only do so much to comfort the process of being terminally ill. Therefore it should be a decision of the patient to seek medical help, either in the form of sedation and longevity, or immediate peace.

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