What is Euthanasia?
Euthanasia is the termination of a very sick person's life in order to relieve them of their suffering.
A person who undergoes euthanasia usually has an incurable condition. But there are other instances where some people want their life to be ended.
In many cases, it is carried out at the person's request but there are times when they may be too ill and the decision is made by relatives, medics or, in some instances, the courts.
The term is derived from the Greek word euthanatos which means easy death.
Euthanasia is against the law in the UK where it is illegal to help anyone kill themselves. Voluntary euthanasia or assisted suicide can lead to imprisonment of up to 14 years.
The issue has been at the centre of very heated debates for many years and is surrounded by religious, ethical and practical considerations.
The ethics of euthanasia
Euthanasia raises a number of agonising moral dilemmas:
- is it ever right to end the life of a terminally ill patient who is undergoing severe pain and suffering?
- under what circumstances can euthanasia be justifiable, if at all?
- is there a moral difference between killing someone and letting them die?
At the heart of these arguments are the different ideas that people have about the meaning and value of human existence.
Should human beings have the right to decide on issues of life and death?
There are also a number of arguments based on practical issues.
Some people think that euthanasia shouldn't be allowed, even if it was morally right, because it could be abused and used as a cover for murder.
Killing or letting die
Euthanasia can be carried out either by taking actions, including giving a lethal injection, or by not doing what is necessary to keep a person alive (such as failing to keep their feeding tube going).
'Extraordinary' medical care
It is not euthanasia if a patient dies as a result of refusing extraordinary or burdensome medical treatment.
Euthanasia and pain relief
It's not euthanasia to give a drug in order to reduce pain, even though the drug causes the patient to die sooner. This is because the doctor's intention was to relieve the pain, not to kill the patient. This argument is sometimes known as the Doctrine of Double Effect.
Very often people call euthanasia 'mercy killing', perhaps thinking of it for someone who is terminally ill and suffering prolonged, unbearable pain.
Why people want euthanasia
Most people think unbearable pain is the main reason people seek euthanasia, but some surveys in the USA and the Netherlands showed that less than a third of requests for euthanasia were because of severe pain.
Terminally ill people can have their quality of life severely damaged by physical conditions such as incontinence, nausea and vomiting, breathlessness, paralysis and difficulty in swallowing.
Psychological factors that cause people to think of euthanasia include depression, fearing loss of control or dignity, feeling a burden, or dislike of being dependent.
Against the will of God
Religious people don't argue that we can't kill ourselves, or get others to do it. They know that we can do it because God has given us free will. Their argument is that it would be wrong for us to do so.
They believe that every human being is the creation of God, and that this imposes certain limits on us. Our lives are not only our lives for us to do with as we see fit.
To kill oneself, or to get someone else to do it for us, is to deny God, and to deny God's rights over our lives and his right to choose the length of our lives and the way our lives end.
The value of suffering
Religious people sometimes argue against euthanasia because they see positive value in suffering.
The religious attitude to suffering
Most religions would say something like this:
The nature of suffering
Christianity teaches that suffering can have a place in God's plan, in that it allows the sufferer to share in Christ's agony and his redeeming sacrifice. They believe that Christ will be present to share in the suffering of the believer.
Pope John Paul II wrote that "It is suffering, more than anything else, which clears the way for the grace which transforms human souls."
However while the churches acknowledge that some Christians will want to accept some suffering for this reason, most Christians are not so heroic.
So there is nothing wrong in trying to relieve someone's suffering. In fact, Christians believe that it is a good to do so, as long as one does not intentionally cause death.
Dying is good for us
Some people think that dying is just one of the tests that God sets for human beings, and that the way we react to it shows the sort of person we are, and how deep our faith and trust in God is.
Others, while acknowledging that a loving God doesn't set his creations such a horrible test, say that the process of dying is the ultimate opportunity for human beings to develop their souls.
When people are dying they may be able, more than at any time in their life, to concentrate on the important things in life, and to set aside the present-day 'consumer culture', and their own ego and desire to control the world. Curtailing the process of dying would deny them this opportunity.
Several Eastern religions believe that we live many lives and the quality of each life is set by the way we lived our previous lives.
Those who believe this think that suffering is part of the moral force of the universe, and that by cutting it short a person interferes with their progress towards ultimate liberation.
A non-religious view
Some non-religious people also believe that suffering has value. They think it provides an opportunity to grow in wisdom, character, and compassion.
Suffering is something which draws upon all the resources of a human being and enables them to reach the highest and noblest points of what they really are.
Suffering allows a person to be a good example to others by showing how to behave when things are bad.
M Scott Peck, author of The Road Less Travelled, has written that in a few weeks at the end of life, with pain properly controlled a person might learn
The nature of suffering
It isn't easy to define suffering - most of us can decide when we are suffering but what is suffering for one person may not be suffering for another.
It's also impossible to measure suffering in any useful way, and it's particularly hard to come up with any objective idea of what constitutes unbearable suffering, since each individual will react to the same physical and mental conditions in a different way.
The slippery slope
Many people worry that if voluntary euthanasia were to become legal, it would not be long before involuntary euthanasia would start to happen.
This is called the slippery slope argument. In general form it says that if we allow something relatively harmless today, we may start a trend that results in something currently unthinkable becoming accepted.
Those who oppose this argument say that properly drafted legislation can draw a firm barrier across the slippery slope.
Various forms of the slippery slope argument
If we change the law and accept voluntary euthanasia, we will not be able to keep it under control.
- Proponents of euthanasia say: Euthanasia would never be legalised without proper regulation and control mechanisms in place
Doctors may soon start killing people without bothering with their permission.
- Proponents say: There is a huge difference between killing people who ask for death under appropriate circumstances, and killing people without their permission
- Very few people are so lacking in moral understanding that they would ignore this distinction
- Very few people are so lacking in intellect that they can't make the distinction above
- Any doctor who would ignore this distinction probably wouldn't worry about the law anyway
Health care costs will lead to doctors killing patients to save money or free up beds:
- Proponents say: The main reason some doctors support voluntary euthanasia is because they believe that they should respect their patients' right to be treated as autonomous human beings
- That is, when doctors are in favour of euthanasia it's because they want to respect the wishes of their patients
- So doctors are unlikely to kill people without their permission because that contradicts the whole motivation for allowing voluntary euthanasia
- But cost-conscious doctors are more likely to honour their patients' requests for death
- A 1998 study found that doctors who are cost-conscious and 'practice resource-conserving medicine' are significantly more likely to write a lethal prescription for terminally-ill patients [Arch. Intern. Med., 5/11/98, p. 974]
- This suggests that medical costs do influence doctors' opinions in this area of medical ethics
The Nazis engaged in massive programmes of involuntary euthanasia, so we shouldn't place our trust in the good moral sense of doctors.
- Proponents say: The Nazis are not a useful moral example, because their actions are almost universally regarded as both criminal and morally wrong
- The Nazis embarked on invountary euthanasia as a deliberate political act - they didn't slip into it from voluntary euthanasia (although at first they did pretend it was for the benefit of the patient)
- What the Nazis did wasn't euthanasia by even the widest definition, it was the use of murder to get rid of people they disapproved of
- The universal horror at Nazi euthanasia demonstrates that almost everyone can make the distinction between voluntary and involuntary euthanasia
- The example of the Nazis has made people more sensitive to the dangers of involuntary euthanasia
Allowing voluntary euthanasia makes it easier to commit murder, since the perpetrators can disguise it as active voluntary euthanasia.
- Proponents say: The law is able to deal with the possibility of self-defence or suicide being used as disguises for murder. It will thus be able to deal with this case equally well
- To dress murder up as euthanasia will involve medical co-operation. The need for a conspiracy will make it an unattractive option
Patient's best interests
A serious problem for supporters of euthanasia are the number of cases in which a patient may ask for euthanasia, or feel obliged to ask for it, when it isn't in their best interest. Some examples are listed below:
- the diagnosis is wrong and the patient is not terminally ill
- the prognosis (the doctor's prediction as to how the disease will progress) is wrong and the patient is not going to die soon
- the patient is getting bad medical care and their suffering could be relieved by other means
- the doctor is unaware of all the non-fatal options that could be offered to the patient
- the patient's request for euthanasia is actually a 'cry for help', implying that life is not worth living now but could be worth living if various symptoms or fears were managed
- the patient is depressed and so believes things are much worse than they are
- the patient is confused and unable to make sensible judgements
- the patient has an unrealistic fear of the pain and suffering that lies ahead
- the patient is feeling vulnerable
- the patient feels that they are a worthless burden on others
- the patient feels that their sickness is causing unbearable anguish to their family
- the patient is under pressure from other people to feel that they are a burden
- the patient is under pressure because of a shortage of resources to care for them
- the patient requests euthanasia because of a passing phase of their disease, but is likely to feel much better in a while
Supporters of euthanasia say these are good reasons to make sure the euthanasia process will not be rushed, and agree that a well-designed system for euthanasia will have to take all these points into account. They say that most of these problems can be identified by assessing the patient properly, and, if necessary, the system should discriminate against the opinions of people who are particularly vulnerable.
Chochinov and colleagues found that fleeting or occasional thoughts of a desire for death were common in a study of people who were terminally ill, but few patients expressed a genuine desire for death. (Chochinov HM, Tataryn D, Clinch JJ, Dudgeon D. Will to live in the terminally ill. Lancet 1999; 354: 816-819)
They also found that the will to live fluctuates substantially in dying patients, particularly in relation to depression, anxiety, shortness of breath, and their sense of wellbeing.
Other people have rights too
Euthanasia is usually viewed from the viewpoint of the person who wants to die, but it affects other people too, and their rights should be considered.
- family and friends
- medical and other carers
- other people in a similar situation who may feel pressured by the decision of this patient
- society in general
Proper palliative care
Palliative care is physical, emotional and spiritual care for a dying person when cure is not possible. It includes compassion and support for family and friends.
Competent palliative care may well be enough to prevent a person feeling any need to contemplate euthanasia.
The key to successful palliative care is to treat the patient as a person, not as a set of symptoms, or medical problems.
The World Health Organisation states that palliative care affirms life and regards dying as a normal process; it neither hastens nor postpones death; it provides relief from pain and suffering; it integrates the psychological and spiritual aspects of the patient.
Making things better for patient, family and friends
The patient's family and friends will need care too. Palliative care aims to enhance the quality of life for the family as well as the patient.
Effective palliative care gives the patient and their loved ones a chance to spend quality time together, with as much distress removed as possible. They can (if they want to) use this time to bring any unfinished business in their lives to a proper closure and to say their last goodbyes.
Palliative care should aim to make it easier and more attractive for family and friends to visit the dying person. A survey (USA 2001) showed that terminally ill patients actually spent the vast majority of their time on their own, with few visits from medical personnel or family members.
Spiritual care may be important even for non-religious people. Spiritual care should be interpreted in a very wide sense, since patients and families facing death often want to search for the meaning of their lives in their own way.
Palliative care and euthanasia
Good palliative care is the alternative to euthanasia. If it was available to every patient, it would certainly reduce the desire for death to be brought about sooner.
But providing palliative care can be very hard work, both physically and psychologically. Ending a patient's life by injection is quicker and easier and cheaper. This may tempt people away from palliative care.
Legalising euthanasia may reduce the availability of palliative care
Some fear that the introduction of euthanasia will reduce the availability of palliative care in the community, because health systems will want to choose the most cost effective ways of dealing with dying patients.
Medical decision-makers already face difficult moral dilemmas in choosing between competing demands for their limited funds. So making euthanasia easier could exacerbate the slippery slope, pushing people towards euthanasia who may not otherwise choose it.
When palliative care is not enough
Palliative care will not always be an adequate solution:
- Pain: Some doctors estimate that about 5% of patients don't have their pain properly relieved during the terminal phase of their illness, despite good palliative and hospice care
- Dependency: Some patients may prefer death to dependency, because they hate relying on other people for all their bodily functions, and the consequent loss of privacy and dignity
- Lack of home care: Other patients will not wish to have palliative care if that means that they have to die in a hospital and not at home
- Loss of alertness: Some people would prefer to die while they are fully alert and and able to say goodbye to their family; they fear that palliative care would involve a level of pain-killing drugs that would leave them semi-anaesthetised
- Not in the final stages: Other people are grateful for palliative care to a certain point in their disease, but after that would prefer to die rather than live in a state of helplessness and distress, regardless of what is available in terms of pain-killing and comfort.
Pressure on the vulnerable
This is another of those arguments that says that euthanasia should not be allowed because it will be abused.
The fear is that if euthanasia is allowed, vulnerable people will be put under pressure to end their lives. It would be difficult, and possibly impossible, to stop people using persuasion or coercion to get people to request euthanasia when they don't really want it.
The pressure of feeling a burden
People who are ill and dependent can often feel worthless and an undue burden on those who love and care for them. They may actually be a burden, but those who love them may be happy to bear that burden.
Nonetheless, if euthanasia is available, the sick person may pressure themselves into asking for euthanasia.
Pressure from family and others
Family or others involved with the sick person may regard them as a burden that they don't wish to carry, and may put pressure (which may be very subtle) on the sick person to ask for euthanasia.
Increasing numbers of examples of the abuse or neglect of elderly people by their families makes this an important issue to consider.
The last few months of a patient's life are often the most expensive in terms of medical and other care. Shortening this period through euthanasia could be seen as a way of relieving pressure on scarce medical resources, or family finances.
It's worth noting that cost of the lethal medication required for euthanasia is less than £50, which is much cheaper than continuing treatment for many medical conditions.
Some people argue that refusing patients drugs because they are too expensive is a form of euthanasia, and that while this produces public anger at present, legal euthanasia provides a less obvious solution to drug costs.
If there was 'ageism' in health services, and certain types of care were denied to those over a certain age, euthanasia could be seen as a logical extension of this practice.