Active euthanasia has been a well-debated topic since the legalization of the act in Netherlands in the 1980s. However, little debate has arisen about the voluntary choice of the elderly to end their life through assistance. The normal cycle of life is “development, aging, dying, and death” (Cicirelli, 2001). Many elderly people believe that new medical technology can result in prolonged undignified death, and therefore prefer assisted suicide, which would relieve them of their sufferings. Thus, they prefer euthanasia, which literally means “good health”. Active euthanasia means the doctor’s intent to end the life of a suffering and terminally ill patient. Active euthanasia can be of two types – voluntary and involuntary. Voluntary active euthanasia refers to the consent and request of the patient to die early. The reason for providing euthanasia on terminally-ill patients may make sense as this to a great extent relieves patients of his sufferings, however, elderly people seeking active euthanasia have not been administered by doctors even in Netherlands where euthanasia is a legalized practice. Study shows that elderly patients with Alzheimer disease have made requests for euthanasia however, “physicians have cooperated in only a tiny handful of cases and for those cases usually only when the patient was stricken with another serious disease” (Battin, 2007, p. 59). Therefore, the question remains even in case of elderly patients who would not like to postpone death through artificial aid may request for assisted suicide or active euthanasia from the physician, should the act get legal validity in some countries like the US. This paper is a study of debate of active euthanasia specifically related to elderly patients and under what circumstances such an action can be allowed and why. The paper studies if elderly patients who are terminally ill should be given active euthanasia to relieve them of their sufferings.
Debate on Active Euthanasia
The question related to euthanasia does not relate to the availability of the right to physicians to end a life, rather if it is possible to end the life of a patient under clearly defined conditions. Further, if the ailing patient expresses the desire to die, should voluntary active euthanasia be permissible. The supporters of voluntary active euthanasia argue that from the point of view of virtue ethics the scope of the morality of the act broadens (Begley, 2008). In a way, the dilemma for medical practitioners arises between duty and compassion. From the point of the virtue ethics, the choice to employ active euthanasia is a context in the history of the patient, and medical practitioner relationship:
“Virtue ethics does not consider discrete episodes in life, but looks at a person at a certain point on a journey; this applies to the agent (doctor or nurse) and the patient. Any ‘end-of-life’ choice, therefore, is made within the context of patients’ history, and the way they expressed themselves in life; dying is part of that narrative, not a ‘full stop’ at the end of the story … Decisions such as when physicians should cease efforts to prolong life and when they can hasten death (if ever) have to be made in the context of the complete narrative of the individual patient’s life.” (Begley, 2008, p. 441)
Thus, the supporters of active euthanasia argue that when compassion is felt for the pain and suffering of the other, then benevolence should follow the pain. As life becomes unbearable for a patient and he will continue life as a vegetable depending on others completely, according to this line of argument, should be given the gift of death as a measure to relieve him of his pain and suffering.
Another supporting argument for active euthanasia argues that if death can be the best possible option of an ailing patient, then he or she should not be refrained from it (Doyal & Doyal, 2001). The argument arises from the best interest of the patient point of view and if it is death that can relieve the pain of the patient, then morally it should be actively practiced. Doyal and Doyal further their argument that not only voluntary but also involuntary euthanasia should be legalized from this argumentative stand.
However, critics of active euthanasia and of Begley believe that virtue without the right reason cannot be considered as virtue at all (Sellman, 2008 ). Others argue against the process of legalization of active euthanasia (Keown, 2003). From the US perspective the article shows that active euthanasia cannot be accepted from the ethical point of view of ending a life when life could be possible and state: “Regardless of their precise positions, most United States authors agree on three particular points—physicians must: (1) provide better relief of physical symptoms; (2) improve their ability to communicate with patients and their families about end-of-life care and treatment goals; and (3) help the dying patient find closure and meaning in this final phase of life.” (Keown, 2003, p. 404).
Thus, the question related to medical intervention in ending the life of patients has traditionally been debated upon, and the legalization of the matter has been questioned. Some believe it is right due to acceptance of such an act from the point of view of moral virtue while others believe that ethically it wrong to end the life when medical practitioners are supposed to increase the chances of living. However, mostly the debate has concentrated on delivering active euthanasia on patients, even though terminally ill, express a desire to end their life and seek the medical practitioner’s help. In the next section, the paper sees the studies related to active euthanasia in case of elderly patients.
Active Euthanasia for Elderly Patients
The debate relate to active euthanasia and elderly patients arises due to the fear of many that if legalized, this would lead to serial killing of elderly patients by medical practitioners due to the feeling of pity on the part of the perpetrator (Oehmichen & Meissner, 2000). The desire to end their lives among the elderly i.e. the very old people is very strong as they believe that hastening their deaths will lead to a healthy death (Cicirelli, 2001). The debate began with the argument posed by Mr. Drion at Netherlands regarding legalization of a fatal pill that can assist elderly patients to end their life, based on the argument of “beneficence” (Rurup, Onwuteaka-Phiupsen, Wal, Heide, & Maas, 2005). This line of argument supporting euthanasia for elderly patients insisted on peace for those who were at the end of their life. This line of argument is based on justice to the wish of the old people and they be given the right to autonomy to choose death (Rurup, Onwuteaka-Phiupsen, Wal, Heide, & Maas, 2005). Thus, elderly patients who are terminally ill have the option of committing suicide, physician assisted suicide, or voluntary active euthanasia (Cicirelli, 2001). Therefore, it is believed as someone who wants to live should not be stopped from living, same goes for one who intends to die (Oehmichen & Meissner, 2000).
In case of voluntary active euthanasia, patients ask physicians to end their lives and the physicians act to do so. The morality regarding such an act is widely debated and in case of elderly patients the act of the physician to remove life support and allowing the patient to die is acceptable morally as the disease, and not the physician, kills the patient (Cicirelli, 2001). However, the argument posed by the morality criticism of active euthanasia leads fails to distinguish between the two acts – removing life support and administering an injection to end life – when the intention behind both the acts are same. Thus, when a physician intends to end suffering of the ailing patient then the supporters of euthanasia believe should be acceptable ethically.
Critics of active euthanasia and the argument of autonomy of the elderly people argue that providing a means to end one’s life is equally wrong as taking away a life or committing murder. In case of active euthanasia, it is the patient who requests the medical practitioner to end his or her life and the former abides by the wish. No doubt if the freedom to choice is applied then it is the viable right of the patient to be the sole decision maker in ending his life (Rurup, Onwuteaka-Phiupsen, Wal, Heide, & Maas, 2005). Nevertheless, a doctor who prescribes the pill or assists in ending the life of the patient by other means actually becomes a party to the killing or suicide and an aide in it. Thus, how can the doctor know that the patient was in the right state of mind and was capable of rational decision making while deciding to end his life? Further legalization of active euthanasia poses a risk towards public health and become a potential harm to innocent people.
Empirical findings have suggested that the acceptance of active euthanasia has grown over time. A study conducted by Kraus, et al. (1977) studied the attitude of elderly patients, above the age of 65 years, on active euthanasia. The study showed that people above the age of 65 years living independently expressed interest in active euthanasia than those living in a group. In another study which showed that request for active euthanasia among elderly showed that practitioners get request for active euthanasia from elderly patients regularly, however, the percentage differ between countries. The research showed that studies conducted in Netherlands showed the age of the patient and showed that physician assisted suicides occurred mostly within the age group of 65 to 79 years. Further, mostly of the people who died this way were sufferings from cancer. The fear of the critics of euthanasia of “slippery slope” argument and vulnerability of elderly patients of the process shows that the study findings do not indicate any significance of age on occurrence of active euthanasia. Further, this is administered least at an older age group, i.e. above 80 years. Thus, the study shows that the “slippery slope” argument that the elderly will be vulnerable to legalized active euthanasia does not hold true.
Thus before active euthanasia is legalized for elderly people, a few grey areas must be evaluated. First, if the elderly patient who insists on active euthanasia is capable of making a rational choice. For instance, patients suffering from motor neuron disease are susceptible to depression and fear of a painful death, however, research has proven that this may not be the case. Second, people usually ask for ending their life due to the fear of future and depression. Such causes to end life cannot be acceptable. Third, in order to participate in active euthanasia a physician may undergo tremendous psychological strain and distress as they go out of the fundamental principles of medicine in order to elevate a patient out of pain. Research ahs shown that many doctors who have participated in active euthanasia or physician assisted suicide have had negative impact on their emotional and psychological experiences (Stevens, 2006 ).
Legal Sanction
In the US, active euthanasia is not legally accepted. The Oregon law of Death with Dignity Act states that, “lethal injection, mercy killing, or active euthanasia, where a physician or other person directly administers a medication to end another’s life” (Oregon.gov, 2009).
On studying the characteristics of the patients who accepted death after ingesting a lethal dose of medication in Oregon from 1998 to 2008 shows that the maximum percentage (i.e. 77%) of cases occurred in the age group of 55 to 84 years (Oregon.gov, 2009). However, for very old patients, i.e. above 85 years, the cases constitute only 9.4%. The maximum occurrences have been found in the age group of 75 to 84 years (28.7%) and between 65 to 74 years (27.3%) (Oregon.gov, 2009). Thus, the occurrences of active euthanasia in the age group considered to be old i.e. 75 years and above consist of 38% of the case (Oregon.gov, 2009).
Incidence of active euthanasia or physician-assisted suicide is high as these deaths are caused due to lethal dose of medication. Thus, in case of the US, especially the data on cases of active euthanasia or physician-assisted suicide were high in case of elderly patients. This shows that the “slippery slope” argument that if legalized, and then the cases of active euthanasia may lead to higher deaths for the elderly generation through this mode.
The reason for acceptance of end of life assistance by the patients who have died after accepting a dose of legal medication in Oregon from 1998 to 2008 suggests that mostly they are worried about loss of autonomy and dependence on others to meet daily needs, and loss of dignity (Oregon.gov, 2009). Therefore, the elderly who seek death in face terminal illness is more due to loss of autonomy and dignity and less for relief from pain.
According to National Council of Disability (NDC) the council objects to legalization of both active euthanasia and physician assisted suicide (Frieden, 2005). The argument that is posed by the council is that 5% of the cases under Oregon Act were referred for psychiatric help. The council states that if the patient is a special case due to disability or old age, he should be treated in a special way.
Thus, euthanasia is legally banned in most of the states around the world and in all states in the US. Euthanasia is considered to be a “crime of manslaughter” if a medical practitioner helps a patient commit suicide or active euthanasia. Thus, from this point of view US law has not been able to accept the criticism of euthanasia and accept it as possible measure to provide relief to terminally ailing, extremely old patients.
Conclusion
Active euthanasia is a process of ending the life of a patient usually by consent of the patient. The reason for such an act is that the patient will not be able to lead normal life and will lose autonomy and freedom and will have no dignity in life. The supporters of active euthanasia argue that terminally ill patients have the right to choose to get relief from the unbearable pain. A continual of life will lead to survival, as a vegetable depending on others completely. Embracing death would relieve him of his pain and suffering. Further, as humans have the right to live, similarly they have the right to end their life. Prolonging the patient’s life with the aid of technology helps only in increasing their sufferings. Thus, if medical practitioners are allowed to practice active euthanasia it will only aid in improving the life and death of the terminally ill and help the doctors reduce their suffering.
Critics feel that active euthanasia is a means of killing and avoiding the medical ethics of healing people. The argument for active euthanasia has not been able to override the criticism which states that in no circumstance does a medical practitioner have the right to aid in or actively participate in ending another life is beyond acceptance of many and legally amounts to manslaughter and felony in the US. The popular argument against active euthanasia is that providing a means to end one’s life is equally wrong as taking away a life or committing murder.
In case of elderly patients, the desire to end their life comes from their desire not to lead an undignified life. Thus, elderly people want to hasten death rather than live through it. However, a doctor assisting in ending the life is unacceptable. Research on active euthanasia and old age is fraught with the “slippery slope” argument. Many believe that legalized policy of active euthanasia will leave the elderly at the danger of being murdered under the pretext of active euthanasia. However, with time the acceptance of active euthanasia has grown. Research has also shown an increase in the requests for active euthanasia from elderly patients to their physicians suggesting a higher degree to hasten their death (Kraus, Spasoff, Holden, Lawson, Rodenburg, & Woodcock, 1977).
In conclusion, it can be stated that life and death decision of a patient cannot be left in the hand of a medical practitioner. He is responsible to ease the patient’s pain and help him to recover, but he cannot help him to die even if it means freeing him of his sufferings. Legally in the US, active euthanasia is not permitted and faces various objections from different groups. In case of elderly patients, data shows the incidence of such kind of death in Oregon has been high among elderly, which may make them susceptible to the law if active euthanasia is legalized and make the “slippery slope” argument true.
Annotated Bibiliography
Battin, M. P. (2007). Right Question, But Not Quite the Right Answer: Whether There Is a Third Alternative in Choices about Euthanasia in Alzheimer’s Disease. The American Journal of Bioethics Vol. 7 No. 4 , 58-60.
The article argues if patients with Alzheimer disease can be given active euthanasia. The article shows that advanced age brings about untold risks for patients of the disease face and the fear that have of being invaded by illness and the process do dying. The article supports active euthanasia for elderly patients with Alzheimer as fail to live the life they once lived.
Begley, A. M. (2008). Guilty But Good: Defending Voluntary Active Euthanasia From A Virtue Perspective. Nursing Ethics Vol. 15 No. 4 , 434-445.
The article is a defense for voluntary active euthanasia from virtue ethics perspective. Begley argues that practitioners face a dilemma of choosing between virtue and duty. This article presents an argument why active euthanasia should be legalized and allowed.
Cicirelli, V. G. (2001). Healthy Elders’ Early Decision for End-of-Life Living and Dying. In M. P. Lawton, Annual Review of Gerontology and Geriatrics, Volume 20, 2000 (pp. 163-192). New York: Springer Publishing Company.
This article presents the point of view of elders towards active euthanasia and shows how their choice and preference has changed over time. The acceptance of elderly people for active euthanasia has increased over time and more of the elderly people want a dignified death than suffering in old age.
Doyal, L., & Doyal, L. (2001). Why active euthanasia and physician assisted suicide should be legalised. British Medical Journal , 1079-1080.
The article provides reasons for legalizing active euthanasia from the moral point of view. The article presents interesting insights for the arguments posed by the supporters of euthanasia.
Frieden, L. (2005). Cover Memorandum Upon The Reissuance Of The NCD Statement Opposing Legalization Of Assisted Suicide. Web.
The report shows the objection of NCD and the grounds of the objection as they believe that the disadvantaged people like disabled or the elderly will be susceptible to such a law.
Keown, J. (2003). Euthanasia, Ethics And Public Policy: An Argument Against Legislation. The Journal of Legal Medicine Vol. 24 , 395–405.
Keon presents arguments to reject the legalization of euthanasia. This article presents point of view of the other side of the debate.
Kraus, A. S., Spasoff, E. J., Holden, D. E., Lawson, J. S., Rodenburg, M., & Woodcock, G. M. (1977). Potential Interest of the Elderly In Active Euthanasia. Can. Fam. Physician Vol. 23 No. 355 , 123-125.
Concern over elderly people’s interest in active euthanasia, this article shows why people want or do not want to accept the process. This article presents a direct understating of active euthanasia from the point of view of elderly patients.
Oehmichen, M., & Meissner, C. (2000). Life Shortening and Physician Assistance in Dying: Euthanasia from the Viewpoint of German Legal Medicine. Gerontology Vol. 46 , 212–218.
This article presents the viewpoint objecting active euthanasia from the point of German regulation and point of view of the process. This article presents arguments for the rejection of active euthanasia.
Oregon.gov. (2009). Death With Dignity Act. Web.
This is the brief of the Death of Dignity Act from the Oregon state government website and presents an overview of the law, and an annual report with the demographic data of the patients died through injection of a lethal mediation from 1998 to 2008.
Rurup, M. L., Onwuteaka-Phiupsen, B. D., Wal, G. V., Heide, A. V., & Maas, P. J. (2005). A “Suicide Pill” For Older People: Attitudes Of Physicians, The General Population, And Relatives Of Patients Who Died After Euthanasia Or Physicianassisted Suicide In The Netherlands. Death Studies 29 , 519-534.
This article presents the argument that has existed in the Netherlands regarding physician assisted suicide and active euthanasia of elderly people. This article presents the study conducted in the country to ascertain the perception of physicians, general public, and family members of patients who died after euthanasia regarding the line of argument to provide autonomy to the elderly people to embrace dignified death. This article presents the general perception regarding active euthanasia.
Sellman, D. (2008 ). Comment by Derek Sellman on: ‘Guilty but good: defending voluntary active euthanasia from a virtue perspective’. Nursing Ethics Vol.15 No.4 , 446-449.
This is an article that refutes the arguments presented by Begley and why active euthanasia cannot be acceptable. This article presetns the viewpoint fo the opposers of active euthanasia.
Stevens, K. J. (2006). Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians. Issues Law Medicine 21(3), 187-200.
This article is the study of the psychological emotional effect active euthanasia has on participating doctors. The study shows that negative impact is evident among doctors participating in active euthanasia.
References
Battin, M. P. (2007). Right Question, But Not Quite the Right Answer: Whether There Is a Third Alternative in Choices about Euthanasia in Alzheimer’s Disease. The American Journal of Bioethics Vol. 7 No. 4 , 58-60.
Begley, A. M. (2008). Guilty But Good: Defending Voluntary Active Euthanasia From A Virtue Perspective. Nursing Ethics Vol. 15 No. 4 , 434-445.
Cicirelli, V. G. (2001). HEalthy Elders’ Early Decision for End-of-Life Living and Dying. In M. P. Lawton, Annual Review of Gerontology and Geriatrics, Volume 20, 2000 (pp. 163-192). New York: Springer Publishing Company.
Doyal, L., & Doyal, L. (2001). Why active euthanasia and physician assisted suicide should be legalised. British Medical Journal , 1079-1080.
Frieden, L. (2005). Cover Memorandum Upon The Reissuance Of The NCD Statement Opposing Legalization Of Assisted Suicide. Web.
Keown, J. (2003). Euthanasia, Ethics And Public Policy: An Argument Against Legislation. The Journal of Legal Medicine Vol. 24 , 395–405.
Kraus, A. S., Spasoff, E. J., Holden, D. E., Lawson, J. S., Rodenburg, M., & Woodcock, G. M. (1977). Potential Interest of the Elderly In Active Euthanasia. Can. Fam. Physician Vol. 23 No. 355 , 123-125.
Oehmichen, M., & Meissner, C. (2000). Life Shortening and Physician Assistance in Dying: Euthanasia from the Viewpoint of German Legal Medicine. Gerontology Vol. 46 , 212–218.
Oregon.gov. (2009). Death With Dignity Act. Web.
Rurup, M. L., Onwuteaka-Phiupsen, B. D., Wal, G. V., Heide, A. V., & Maas, P. J. (2005). A “Suicide Pill” For Older People: Attitudes Of Physicians, The General Population, And Relatives Of Patients Who Died After Euthanasia Or Physicianassisted Suicide In The Netherlands. Death Studies 29 , 519-534.
Sellman, D. (2008 ). Comment by Derek Sellman on: ‘Guilty but good: defending voluntary active euthanasia from a virtue perspective’. Nursing Ethics Vol.15 No.4 , 446-449.
Stevens, K. J. (2006 ). Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians. Issues Law Medicine 21(3) , 187-200.