Abstract
Making decisions on whether to end the life of terminally ill patients is shrouded in controversies and disagreements, and is seen as an unethical act. This paper attempts to make arguments in support of euthanasia as an alternative form of healthcare for terminally ill patients whose quality of life is significantly reduced due to the effects of such an illness.
The paper evaluates three perspectives in support of euthanasia: patient rights and autonomy, humanistic concern for patients’ happiness and utilitarianism view on the attainment of the highest happiness. Crucial evidence is drawn from real life and hypothetical cases to justify the arguments herein.
It is imperative to note that the paper calls for euthanasia for only deserving patients, based on the quality of life, the terminal illnesses, patient’s consent and patients happiness. Additionally, the role of healthcare professionals becomes significantly important as it enhances professionalism as well as in helping to determine patients that deserve to be euthanized.
Introduction
End of life is one of the most critical periods in a person’s life, which becomes even more critical when terminal illness mediates the end of life process. Dealing with terminal illnesses is the hallmark of controversies surrounding the end of life process.
As a result, various controversial views, such as assisting terminally ill patients in ending life, have emerged. Euthanasia, as assisted death is commonly referred to, generates debate, especially on ethical permissibility.
. It is imperative to note that for both the opponents and proponents of euthanasia, the quality of life is usually the focal point, even though there is no agreement on the criteria of defining quality with regards to life.
Nevertheless, there are situations in which euthanasia is not only justifiable but also the only ethically permissible act in alleviating pain for terminally ill patients. The paper evaluates three basic viewpoints for euthanasia and also attempts to justify the call for euthanasia through citing various forms of evidence.
Defining Euthanasia
It is primarily assumed that healthcare is not only intended to eliminate human suffering but also to prolong life. Healthcare at the end of life has always been an issue of great controversy. Various treatment regimens, such as use of traditional treatment methods, seeking spiritual healing as well as science-based disease elimination methods have been developed (Buse, 2008).
Suffice to state that the development of various treatment methods has also led to the emergence of legal, ethical and philosophical challenges (Munson, 1996). One such challenge is how to deal with terminal illnesses, with euthanasia increasingly becoming a preferred option.
Euthanasia is shrouded in mystery and controversy. But defining it helps to address such controversies. The modern perception of euthanasia borrows from two Greek terminologies “‘eu’ implying good, and “thanasia’ implying death” (Coyle, 1992).
Thus, while euthanasia refers to ‘good death’, a number of controversies emerge since euthanasia involves ending the life of an innocent person. Traditional treatment methods are not only intended to eliminate pain and suffering but also for the attainment of prolonged life.
However, there are instances where treatment is ineffective or further prolongs a patient’s suffering. Some treatment methods also expose terminally ill patients to increased risk of death. In such cases, terminal illness diminishes the quality and the dignity of life, making a living more problematic. Death seems to be the only way through which terminally ill patients comes out of the unendurable situation (Irish Council for Bioethics, n.d.).
Euthanasia can be defined within certain parameters. For instance, a terminally ill patient, despite being in an insufferable state and with minimal chances of recovery, may be unwilling to die. A physician may propose euthanasia, against the will of the patient, as the only treatment alternative.
This is referred to as involuntary euthanasia. A terminally ill patient may also degenerate into vegetative state, thus unable to give consent on euthanasia. This is referred to as non-voluntary euthanasia and has faced stiff opposition, especially from religious-based organizations.
As opposed to involuntary euthanasia, a patient may be willing to end suffering through death and may thus request for assistance to end life. This is referred to as voluntary euthanasia and is supported by humanists and human rights activists.
A physician may withhold or omit treatment due to its ineffectiveness (Zdenkowski, 1996). While Zdenkowski (1996) refers to this as passive euthanasia Irish Council for Bioethics (n.d.) asks whether omission of treatment amounts to euthanasia.
The definitions above portray euthanasia as an appropriate and necessary alternative for the elimination of human suffering for terminally ill patients. However, these definitions fail to exhaustively capture the confines within which euthanasia is said to be morally permissible.
Thus, its appropriateness and moral permissibility is an issue that has continued to not only elicit sharp reactions from various quarters but also generate difficult questions.
For instance, whether a terminally ill patient has an exclusive right to determine the manner and the time of death, whether euthanasia diminishes the value of human life or whether euthanasia undermines the quality of healthcare are some of the major questions not sufficiently addressed through the definitions above. Nevertheless, an attempt is made to address some of the shortcomings in the section that follows.
Major viewpoints in support of euthanasia
Terminal illnesses are mostly irreversible. They also involve insufferable pain which reduces the quality and the integrity of life. Dealing with terminal illnesses is a complicated matter due to issues beyond human ability. Nevertheless, there are some instances where assisting terminally ill patients seems to be not only appropriate but also morally permissible. This generates numerous viewpoints, as seen below.
Patient’s rights and free will
In liberal societies, it is assumed that every individual has the right to make decisions regarding life without undue influence. It is also assumed that individuals have the right to access necessary information that allows them to make informed choices for their own benefit in a way that does not affect other people (Buse, 2008).
This right also involves determining the direction of ones life, and whether an individual has the right to choose to die incase circumstances, such as terminal illness, demand so. Supporters of this viewpoint argue that a terminally ill patient has the right to choose death as a possible treatment for an insufferable and irreversible condition.
As such, it is generally perceived as an act of immorality to force terminally and chronically ill patients to live against their wish (CNBC News, 2011). Additionally, such an act is considered as denial and violation of personal rights, freedoms and liberties (Irish Council for Bioethics, n.d.; Humphry, 1991).
Proponents of these views argue that a terminally ill patient has the right to determine where, when and how to die. However, this viewpoint is strongly opposed by religious-based organizations on assumption that an individual’s right to life is determined by God.
Since terminally ill patients lack the power to determine when they are born, they also lack the right to determine how and when they die (Irish Council for Bioethics, n.d.). Opponents also argue that allowing an individual the right to choose when and how to die devalues God, life and God’s Devine will (Johnstone, 2008; Bowie and Bowie, 2004).
Nevertheless, as Gorsuch (2009) argues God is compassionate and would not subject anyone to prolonged suffering in the form of terminal illnesses. Thus, it is within the rights of a terminally ill patient to choose to die immediately rather than live an intolerably, without upsetting the Will of God.
Humanistic genuine care and concern for patients’ happiness
The thoughts illustrated above indicate that both the liberal and religious-based authorities value the dignity of human life. Similarly, humanists portray significant care and concern for human life, but from a different perspective. Humanists argue for the quality and the dignity of human life and the search for personal happiness as the absolute goal in life.
If a condition, such as terminal illness lowers the quality of human life, then patients are within their right to seek any form of treatment that alleviates pain and suffering (Kuupellomäki, 2000).
Humanistic beliefs suggest good quality life, the search for happiness and absolute fulfillment as the utmost goals in life. Most of the terminal illnesses are chronic in nature and result to extreme pain through which no medication can reverse or alleviate. Additionally, terminally ill patients gradually degenerate into a vegetative state.
Humanists argue that in such a condition, a patient is not in a humanly dignified state and that euthanasia is not only most appropriate but also an act of mercy. Mercy killing, despite opposition from religious-based organizations, becomes morally permissible.
Those inclined towards conservative views with regards to mercy killing propose palliative care as the most ethical form of healthcare for terminally ill patients. Humanists, on the other hand, argue that while palliative healthcare prolongs life amid extreme pain and suffering, it nevertheless fails lessen patients suffering (de Casterlé, Verpoort, De Bal and Gastmans, 2006).
As such, despite the best palliative care practices, terminally patients remain in a humanly indignified state (Musgrave and Soudry, 2000). While humanists argue that euthanasia remains to be the only morally permissible solution, de Casterlé et al. (2006) assert that physicians ought to approach euthanasia with “active openness” since terminally ill patients “request for euthanasia out of fear and ignorance”.
While “active openness” is likely to offer the terminally ill patients some level of emotional relief and reassurance, it is only applicable to self-conscious patients and not those in vegetative state. Nevertheless, whether vegetative or self-conscious, euthanasia seems to be the only morally permissible act, if terminal illness significantly reduces the quality of life (Verpoort, Gastmans and de Casterlé, 2004).
Utilitarianism view on the attainment of the highness happiness
The assertions made above show genuine concern for the quality of human life. Nevertheless, the ideal definition of quality with reference to terminally ill patients differs significantly depending on underlying perspective.
Similarly, utilitarian thinkers argue that euthanasia is a morally permissible and merciful act aimed at not only easing a patient’s suffering but also for the attainment of the highest possible happiness. The utilitarian view of quality is perceived from the intrinsic considerations to end human suffering instead of prolonging suffering (Kasule, n.d.).
Utilitarianism assumes that there is no pain and suffering in death and as such, terminally ill patients ought to be helped to attain such a painless state, if living becomes unbearable and irreversible. Additionally, death ought to be achieved in highest possible happiness. Therefore, delivering euthanasia ought to be as painless as possible (Edwards and Graber, 1988).
Utilitarian views presuppose that there is a minimum standard under which life is said to be worth living. Should terminal illness lower the quality of life below the minimum standard, personal happiness is jeopardized and therefore judgment ought to be made on whether living is necessary or not.
Utilitarian thinkers argue that the judgment process is mostly subjective. As such, it is possible to euthanize undeserving patients or deny euthanasia to deserving ones. Nevertheless, utilitarian euthanasia seems appropriate where pain and suffering significantly deteriorates, is irreversible, and lowers the quality of life making living unbearable.
Putting terminally ill patients under palliative care only leads to a slow, painful and indignified death. Since every person deserves to die in dignity and happiness, euthanasia is the only morally permissible act through which this is attained (Singer, 1993).
Approaches and evidences for euthanasia
To support the assertions made above, it is imperative to cite crucial evidence that validates the views made therein. Consequently, it is also imperative to enumerate a number of approaches made by the authors. Three major approaches seem to be overarching.
Personal liberty and autonomy in making end of life decision, the role of healthcare professionals as well as the attainment of positive balance between suffering and personal happiness are the three overarching approaches adopted by the authors herein. Crucial evidence is derived from survey reports, real-life as well as hypothetical cases.
Healthcare, personal liberty and autonomy at the end of life
End of life is one of the most important periods in a person’s life. Matters involving end of life are critical and therefore, involvement of each individual in making decision regarding healthcare at the end of life is crucial (Buse, 2008).
Most terminal illnesses involve insufferable pain that significantly lowers the quality of life. In humanistic view, such patients live and die in conditions not humanly dignified (Musgrave and Soudry, 2000). As such, request for euthanasia by patients in such conditions ought to be respected and granted (Kuupellomäki, 2000; Bowie and Bowie, 2004).
Such conclusions have been arrived at based on varied evidence gathered form existing cases. For instance, the right and autonomy of terminally ill patients are highlighted through Sue Rodriguez, a Canadian woman suffering from Lou Gehrig’s disease, an extremely painful and irreversible condition.
The doctors had agreed to her request for euthanasia, but The Canadian Justice System refused Miss Rodriguez the right to die and effectively prolonged her suffering, leading to a slow, painful death (CNBC News, 2011). In light of Miss Rodriguez’s case, questions linger on the applicability of personal liberty and autonomy for terminally ill patients lacking self-consciousness, such as Louis Repouille’s son.
Described as ‘incurably imbecile’, Repouille’s son was said to be as good as dead. Singer (1993) asserts that such patients have the right to die in dignity and that doctors have an obligation to deliver euthanasia for such patients. While unconsciousness waives the right to life, assisting terminally ill patients in ending life does not amount to violation of personal liberty and autonomy (Singer, 1993).
The role of healthcare professionals in the delivery of euthanasia
Miss Rodriguez’s case exposes critical issues, such as the role of healthcare professionals in the delivery of euthanasia. A study conducted by de Casterlé et al. (2006) in Belgium indicates that euthanasia is only ethical if healthcare professionals are actively involved in its delivery.
de Casterlé et al. (2006) study focuses on 12 healthcare givers and reveals that the role of healthcare professionals is not to limited to technical elements of euthanasia; it also involves offering professional and emotional support to patients and families.
Additionally, healthcare professionals have an obligation to help terminally ill patients understand euthanasia and the underlying implications. This helps terminally ill patients and their relatives to obtain relief and assurance at the end of life (Verpoort, Gastmans and de Casterlé, 2004).
Singer’s (1993) text further alludes to the active role that healthcare professionals ought to undertake in ensuring that euthanasia is delivered within professional and ethical boundaries. Singer (1993) cites George Zygmaniak example; Zygmaniak was completely paralyzed by a motor accident and as a result, his life became unbearably painful.
Zygmaniak’s brother, upon request by Zygmaniak, smuggled a gun in the hospital and killed Zygmaniak. While this constitutes voluntary euthanasia, it was nevertheless conducted unethically since no professional healthcare provider was actively involved in euthanizing Zygmaniak.
The principle of positive balance between suffering and personal happiness
Humanist and utilitarian thinkers portray genuine concern for the welfare of the terminally ill. They acknowledge that the pursuit of personal happiness is the absolute goal in life. Since extreme pain significantly lowers the quality of life, the balance “between misery and suffering” seems relevance (Singer, 1993; Kasule, n.d.).
The call for euthanasia is thus necessitated by condition in which suffering supersedes happiness (Edwards and Graber, 1988). In arriving at such conclusions, Singer (1993) cites several hypothetical situations, such a child suffering from spina bifida, a condition that affects the spinal cord, subsequently lowering nerve activity.
In moderate cases, a child requires more than 40 surgeries to sustain life, while in extreme cases no medical intervention improves the quality of life. A moderate case of spina bifida may not necessarily require euthanasia since the child may experience a high balance of happiness as compared to the level of suffering.
On the other hand, extreme cases experience a higher level of suffering as compared to happiness and as such is deserving of euthanasia. The balance of happiness and suffering is also alluded to in Miss Rodriguez case; her condition involved extreme and irreversible pain that significantly reduced the level of personal happiness.
Making end of life decisions, especially with regards to end of life healthcare is a personal prerogative. As such, in staking a claim for euthanasia defending the autonomy of a terminally ill patient in determining when, where and how to die is crucial.
But it is also important to consider the balance between suffering and happiness and only allow euthanasia for those patients in insufferable and irreversibly painful states. To ensure that euthanasia is delivered within professional and ethical parameters, it is also important to enlist the help of healthcare professionals.
This ensures that euthanasia is not only conducted ethically and professionally but delivered only to those patients for whom euthanasia is the only way to alleviate pain and suffering.
Conclusion
Euthanasia involves ending the life of innocent persons. Nevertheless, this does not necessarily make it unethical. Terminal illnesses involve extreme pain and suffering, which significantly lowers the quality of life. A terminally ill patient is thus justified to request for euthanasia, if living is cumbersome and insufferable.
However, in granting the request for euthanasia, there is need to enlist the help of healthcare professionals, whose role extends beyond providing crucial information to offering professional as well as emotional support. Additionally, healthcare professionals ought to be involved in the delivery of euthanasia to ensure that the dignity of life is respected in the process.
Furthermore, the involvement of healthcare professionals is vital in determining which patients deserve to be euthanized. This does not necessarily imply that all terminally ill patients deserve to be euthanatized.
While patients consent is crucial, is imperative to consider several other factors such as the happiness of the patient, the quality of life, the chances of recovery and the method through which euthanasia is to be delivered.
All these issues ought to be considered in determining the balance between happiness and suffering. Only in those cases where the scale of suffering significantly outweighs the scale of happiness qualify for euthanasia. Therefore, euthanasia is moral.
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