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Background and Introduction
The problem of euthanasia and other life-terminating procedures is one of the most contradictive points in the frame of the bioethics debates. Social attitudes toward the problem have changed significantly throughout the past decades. Whereas the question is rather complicated from the legal perspective, its ethical implications seem to be even more ambiguous. In the meantime, recent research reveals that with the legalization of end-of-life practices in some European countries, such as Belgium and Netherlands, more and more people tolerate the idea of euthanasia, and physicians gradually get used to the fact that they might need to meet one’s request to terminate their life (Chambaere, Stichele, Mortier, Deliens, & Cohen, 2015).
In the meantime, a large percentage of healthcare specialists are still taken aback by the prospects of terminating someone’s life, particularly in those cases when a patient is in a coma so that there is no possibility of receiving his or her consent. As such, healthcare specialists face a critical challenge when asked to perform this procedure for a patient whose chances for recovery are close to naught. To make this crucial decision, it is necessary to evaluate all the arguments both for and against the forced life termination.
On the one hand, every person has a right to choose whether to terminate their life or to continue living. In the case where a client is in a comma, the responsibility for making this decision is naturally transmitted to the family. The main role of a doctor is to provide them with all the information essential for a grounded decision. Therefore, if the client’s relatives decide that euthanasia or any other procedure is the best alternative, a doctor does not bear any ethical or moral responsibility for this decision. From this standpoint, the agreement to carry out this procedure is a mere fulfillment of the assigned responsibilities that involve meeting the client’s demands.
Moreover, the major part of the negative response to euthanasia and other end-of-life procedures is determined by the fact that these interventions are considered to be equal to killing the person in a coma while there is still some chance for his or her survival. In the meantime, it is likewise important to analyze the question from a qualitative perspective. Otherwise stated, the non-voluntary termination of life is unethical.
However, the state of a coma should not be equaled to the state of normal life since the quality of the former state is significantly poorer. Besides, research reveals that the recovery process, even if it begins, does not normally signify a complete recovery; instead, it commonly involves severe mental impairment and other functional disorders (Honeybul & Ho, 2011). As such, it might be concluded that the termination of the condition that is characterized as life but is only perfunctory can be characterized as ethical.
Furthermore, the scope of a doctor’s responsibilities involves providing the medical care essential for improving a client’s health or condition. Otherwise stated, healthcare specialists are expected to cure their clients. The diagnosis of irreversible coma is commonly interpreted as the lack of prospects for further improvement (Keown, 2002). In other words, the state of a prolonged coma can be regarded as a state of a prolonged death. From this perspective, a doctor that continues to provide the client with the essential procedures is involuntarily prolonging the process of a client’s death. In this frame, the decision to terminate this process appears to be ethical since the client no longer needs the doctor’s services.
On the other hand, a healthcare specialist does not have a moral right to make decisions for the patient if the latter is unable to express his or her will. The state of a coma does not change the client’s status. As such, Keown (2002) notes that the primary responsibility of a healthcare specialist is to provide the essential set of care services. The termination of life, especially its non-voluntary form, cannot be included in this set.
From a professional perspective, a healthcare specialist is supposed to fulfill the assigned responsibilities and attend to the client’s needs as long as this is required. Additionally, it is essential to note that the right to life is an inherent right that every person, notwithstanding their social or health status, is entitled to enjoy. Since the patient is in a coma state and cannot protect this right, a doctor is responsible for advocating for the client’s right to live. In this frame, it is unethical to agree to perform an end-of-life procedure since it is beyond the scope of a doctor’s responsibilities.
Second, it is unethical to agree to perform euthanasia from a religious standpoint. Thus, a healthcare specialist might be unable to meet the relatives’ request for a patient’s euthanasia due to religious beliefs and spirituality. Thus, from a social perspective, euthanasia and other end-of-life procedures might be interpreted as a medical intervention. In the meantime, from a religious standpoint, such procedures are considered equivalent to murder. The latter, in turn, is regarded as a capital sin. Research reveals that a large percentage of doctors admit that their negative attitude toward life-terminating interventions is determined by their religious commitment (McCormack, Clifford, & Conroy, 2011).
Finally, the relatives’ decision to perform euthanasia or other end-of-life procedures is commonly determined by their reliance on the professional competence of the doctors that have arrived at diagnosis such as irreversible coma. As such, a doctor that agrees to meet the relatives’ demand and carry out the procedure needs to provide a valid guarantee that the diagnosis is correct, which is almost impossible in the real-time environment. Practice shows that doctors’ assessments are not always accurate, and clients frequently recover from a coma state despite the pessimism of the medical community (Furness, 2012). From this perspective, it is unethical to decide in favor of an end-of-life procedure on the condition that there are at least minimal chances for a patient’s survival.
In conclusion, it is necessary to note that the list of arguments both against and in favor of end-of-life procedures can be further extended. Each alternative has its rationale supported by strong and persuasive evidence. Therefore, while deciding to terminate one’s life, it is, first and foremost, important to realize the scope of responsibility that is associated with this decision. As such, there seems to be no “right” alternative that a healthcare specialist can use to remain on the “ethical” side. The selected option depends largely on the individual peculiarities of a doctor, his or her religious beliefs, and the ideological paradigm. From a professional perspective, it is primarily important that this decision is not driven by any unethical motives such as vested interest or financial incentives.
Chambaere, K., Stichele, R. V., Mortier, F., Deliens, L., & Cohen, J. (2008). Recent trends in euthanasia and other end-of-life practices in Belgium. The New England Journal of Medicine, 372(1), 1179-1181.
Furness, H. (2012). ‘Miracle recovery’ of teen declared brain dead by four doctors. The Telegraph. Web.
Honeybul, S., & Ho, K. M. (2011). Long-term complications of decompressive craniectomy for head injury. Journal of Neurotrauma, 28(6), 929-935.
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Keown, J. (2002). Euthanasia, ethics and public policy: an argument against legalisation. New York, NY: Cambridge University Press.
McCormack, R., Clifford, M., & Conroy, M. (2012). Attitudes of UK doctors towards euthanasia and physician-assisted suicide: A systematic literature review. American Journal of Hospice & Palliative Medicine, 26(1), 23-33.